Designing Inclusive Healthcare Environments: Upcoming Regulatory Changes to Support Patients with Disabilities 

Key Takeaways

• Upcoming regulatory changes suggest far-reaching implications for healthcare organizations, such as retrofitting existing facilities to satisfy the new, realigned requirements.
  
• Four in ten adults with disabilities experience unfair treatment in healthcare settings, at work, or when applying for public benefits (source).
  
• More than 50% of those with disabilities reported a delay in receiving care because of discrimination—findings that are inextricably linked to poorer health outcomes for disabled Americans (source).
  
• The Department of Health and Human Services (DHHS) will issue a final rule soon, aligning the Rehabilitation Act of 1973 with the Americans with Disabilities Act (ADA) and Section 1557 of the Affordable Care Act of 2010.

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Background

In 2023, the Urban Institute (Institute) (www.urban.org) published research concluding that four in ten adults with disabilities experience unfair treatment in healthcare settings, at work, or when applying for public benefits (source). The Institute also reported more than 50% of those with disabilities reported a delay in receiving care because of discrimination. These findings are inextricably linked to poorer health outcomes for disabled Americans.

Only through thoughtful and intentional design can we create spaces that provide vital services— fostering dignity, accessibility, and equality for all.

Recently, the Department of Health and Human Services (DHHS) signaled a shift towards greater inclusivity by issuing a proposed rule (source) that seeks to align the Rehabilitation Act of 1973 with the Americans with Disabilities Act (ADA) of 1990 and Section 1557 of the Affordable Care Act of 2010. The ADA, enacted in 1990 and updated in 2010, remains a landmark legislation that mandates accessibility standards in public accommodations, including healthcare facilities. 

With a final rule anticipated in the coming weeks, healthcare facility owners and DHHS affiliate organizations and programs should be aware that retrofitting existing facilities (including medical equipment and technology platforms) may be required to meet patients’ physical and sensory needs.

Nuance and flexibility are inherent

The proposed rule states a “program accessibility” requirement that mandates each program or activity be readily accessible to disabled individuals.

However, it also states that program access does not necessarily require a recipient to make existing facilities accessible to and usable by individuals with disabilities. Additionally, recipients are not required to make structural changes to existing facilities where other methods effectively achieve equitable program access.

The proposed rule also recognizes the potential burden of retrofitting existing facilities, and the ‘phasing in’ of compliance over time is permitted. For example, providers may be able to shift patients to alternate accessible locations within a program, but not without consideration of placing an undue burden on patients to receive care.

There is also a Safe Harbor provision to be aware of, and in certain instances, facilities may be entitled to a safe harbor for building elements constructed in compliance with the specifications of UFAS (Uniform Federal Accessibility Standards) or under ANSI until those building elements are altered.

Designing inclusive healthcare environments is our moral imperative.

There is also a Safe Harbor provision to be aware of— in certain instances, facilities may be entitled to a safe harbor for building elements constructed in compliance with the specifications of UFAS (Uniform Federal Accessibility Standards) or under ANSI until those building elements are altered.

Implications for healthcare organizations and design professionals

As stewards of the built environment, facility owners, planners, and design teams carefully translate accessibility requirements into tangible solutions. Most commonly, ADA-compliant design features include wheelchair ramps, wider doorways, accessible parking spaces, and tactile signage. Beyond that, however, lies a design opportunity to elevate spaces that prioritize the comfort and autonomy of all patients.

Healthcare organizations and design professionals hold a profound responsibility to shape the built environment to serve the needs of all individuals. The importance of healthcare facilities meeting the new requirements to serve every patient, regardless of socioeconomic status, disabilities, or background, cannot be overstated.

As designers, we must be inclusive in our approach, drawing upon the Americans with Disabilities Act (ADA) principles and recognizing the broad spectrum of neurodiversity within patient populations. Only through thoughtful and intentional design can we create spaces that provide vital services in turn fostering dignity, accessibility, and equality for all.

Designing for ‘invisible’ disabilities

As designers, we must remember that not all disabilities are physically visible.

One aspect of disabilities that is often overlooked is the spectrum of neurodiversity. Individuals with autism, ADHD, or sensory processing disorders may experience heightened sensitivities to stimuli, requiring specialized accommodations to navigate healthcare settings comfortably. Other non-visible disabilities may include hearing impairment, chronic conditions, or mental health conditions such as depression.

We have the power to shape a more equitable healthcare landscape where every patient receives the care they deserve.

When incorporated, calming color schemes, quiet zones, transitional spaces, tailored wayfinding elements, and sensory-friendly waiting areas greatly alleviate stress and facilitate a positive healthcare experience for patients and their caregivers.

By embracing universal design principles, we ensure that our healthcare spaces cater to the broadest possible range of users, fostering inclusivity and equity.

It’s more than a rule— it’s our moral imperative.

Designing inclusive healthcare environments is a moral imperative. Only by adhering to the principles of inclusivity and embracing concepts to support neurodiversity can we create spaces that empower individuals to access healthcare with dignity and respect.

As stewards of the built environment, we are privileged to shape a more equitable healthcare landscape where every patient receives the care they deserve, regardless of who they are or where they come from.