Slide 1: Agenda
•	Covered Facilities
•	Patient Sleeping Rooms
•	Parking & Passenger Loading Zones
•	Accessible Routes
•	Employee Work Areas
•	Service Counters
•	Public and Common Use Areas
•	Medical Diagnostic Equipment
Slide 2: Medical Care and Long-Term Care Facilities
•	§223 & §805
Slide 3: Covered Facilities
•	Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities
•	Long-term Care Facilities
•	Image: Sign with large letter symbolizing hospital with word hospital written below letter.
•	Image: Photo of a nurse with several elderly patients.
Slide 4: Covered Facilities cont’d
•	Medical units in detention and correctional facilities
•	Professional Offices of Healthcare Providers
•	Image: Inmate in bed at correctional facility.
•	Image: Doctor speaking with woman in the hospital waiting room. Also in waiting area several other people.
Slide 5: Patient Sleeping Rooms
Slide 6: Patient Sleeping Rooms
•	§223.2 - Hospitals, Rehabilitation Facilities, Psychiatric Facilities and Detoxification Facilities:
•	Conditions Affecting Mobility
•	Specializing 100%
•	Not specializing 10%
•	§223.3 Long-term care:	50%
Slide 7: Patient Sleeping Room Dispersion
•	Medical Care Facilities Covered by 2010 ADA Standards:
•	Must disperse accessible patient bedrooms in a manner that is “proportionate” by type of medical specialty
•	Regulatory sections 35.151(h) and 36.406(g) incorporated by DOJ
Slide 8: Patient Sleeping Rooms Alterations and Additions
•	Based on the number altered or added until overall number reached
•	Maintains dispersion
Slide 9: Long Term Care Facilities
•	§223 Medical Care and Long-Term Care Facilities
•	“In licensed long-term care facilities, at least 50 percent, but no fewer than one, of each type of resident sleeping room shall provide mobility features complying with 805.”
•	Image: medical facility icon
•	Image: Photo of an appealing patient bedroom.
Slide 10: Doors – Latch Side Clearance
•	§404.2.4 Maneuvering Clearances must not be obstructed 
•	ADA regulations to maintain accessible features
•	Image: Photograph of an entry door into an examination room showing adjacent built-in desk and exam table.  Clearance from the latch side of the door to the corner of the room is clearly visible.
•	Image: Close in photograph of a diagram on the table top of a rolling cart showing that it must not be located in the pull side clearance of a room entry door.
Slide 11: Doors – §404.2.4 Exception
•	 Entry doors to hospital patient rooms not required to provide the clearance beyond the latch side of the door.
•	Image: Plan figure from Standards showing maneuvering clearances in front of and to the latch side of the door.
Slide 12: Turning Space (§805.2)
•	Turning space complying with §304 must be provided within the room
•	Image: 60" diameter turing circule and  T shaped space is 36 inches wide at the top and stem within a 60 inch by 60 inch.
Slide 13: Clear or Ground Floor Space (§805.3)
•	Must provide a clear floor space complying with section §305 on both sides of the bed
•	Image: A plan diagram from the Standards showing a dimensioned 30-inch by 48-inch minimum clear floor space parallel to a wall.
•	Image: Photo of an appealing sleeping room with stylish furniture and full-story window alcove.
Slide 14: Patient Sleeping Rooms Toilet and Bathing
•	Those serving patient rooms required to be accessible
•	Exception for toilets in critical care or intensive care patient rooms
•	Image: Plan diagram of accessible toilet and bathing room.  Clear floor spaces are shown at fixtures.  A person is shown transferring to the toilet and another maneuvering in the roll-in shower.
Slide 15: Toilet & Bathing Facilities (§213)
•	In new construction, all toilet and bathing facilities must be accessible, except:
•	Portable units (5% min) 
•	Clustered single user toilet rooms (50% min)
•	Image: Graphic of restroom doors
Slide 16: ANSI A117 Working Groups
•	Working Group on Assisted Toileting and Bathing
•	Establishing technical requirements for toileting and bathing facilities designed for assisted use. 
•	Based on study by Rothchild’s Foundation
•	Assisted living, nursing homes and rehabilitation Facilities (resident bathrooms)
•	Alternative to units required to provide independent access
•	Specifications for toilets and roll-in showers
•	IBC 2021 to include scoping 
•	Image: Bathroom with roll-in shower designed for assisted use
Slide 17: Communication Features
Slide 18: TTY’s
•	§217.4.6 - Public pay telephones
•	Where provided at hospital emergency room, recovery room, or waiting room – at least one TTY
•	Image: Illustration of person using TTY in emergency waiting room.
Slide 19: Fire Alarms Systems §702.1 General - NFPA 72
•	NFPA 72 National Fire Alarm Code (1999 or 2002) – referenced standard
•	National Fire Protection Association (www.nfpa.org)
•	Cover of National Fire Alarm Code (NFPA 72)
Slide 20: Fire Alarms Systems §702.1 - Medical Facilities
•	EXCEPTION: Fire alarm systems in medical care facilities permitted to be provided in accordance with industry practice
•	Image: Caduceus symbol of medicine.
Slide 21: Parking and Passenger Loading Zones
Slide 22: New Construction - Access Required
•	Parking is not required to be provided
•	 Where parking is provided, it must include accessible parking spaces
•	Excludes commercial vehicle storage, law enforcement vehicles, or vehicle impound parking
Slide 23: Accessible Parking Scoping
•	Where visitor, patron, or employee parking is provided
•	Calculated on a facility by facility basis
•	A facility can be a single space, a parking lot, a parking floor within a building, or a stand-alone parking structure
Slide 24: Accessible Parking Scoping
•	Table: Accessible Parking chart showing the total number of parking spaces provided in the parking facility and the minimum number of required accessible parking spaces
Slide 25: Accessible Parking
•	§208.2.1 Hospital Outpatient Facilities: 10 % of spaces
•	§208.2.2 Rehabilitation and Outpatient Physical Therapy Facilities: 20 %
Slide 26: Accessible Parking Scoping
•	Doctor’s Offices: use table
•	Medical Equipment Retail Facilities: use table
•	Image: Parking spaces scoping Table 208.2 from the ADA standards
Slide 27: Accessible Parking
•	Image: Aerial perspective drawing showing satellite parking lot in relation to closer lots with accessible parking.
•	§208.3 Location – Exception 2
Slide 28: Loading Zone Access Aisle
•	Image: An access aisle at a passenger loading zone is shown to be the full length of the vehicle pull-up space and 60 inches (1525 mm) wide minimum.  The aisle area is to be marked.
Slide 29: Passenger Loading at Entrance (§209.3)
•	Required where period of stay exceeds 24 hours
•	Canopy not required as was in 1991 ADA Standard
•	Image: Photo of a building entrance with canopy over passenger loading zone.
Slide 30: Loading Zone Vertical Clearance
•	Image: Passenger loading zone with vertical dimension arrow showing 114 inches of clearance.
Slide 31: Parking Space Signs
•	International Symbol of Access required to designate and reserve accessible spaces
•	60 inches minimum to bottom of sign
•	“Van Accessible” added for van spaces
•	Exception: sign not required where 4 or fewer spaces are provided
•	Image: International symbol of accessibility (ISA)
•	Image: Sign with "Van Accessible"
Slide 32: Parking Meters and Pay Stations
•	Forward or Side Approach
•	Image: Person in wheelchair in front of a parking payment station using machine interface. 
•	Operable Parts
•	Image: Parking payment machine with a yellow highlight showing area for operable parts between 15" and 48" from the floor.
Slide 33: Electric Vehicle Charging Stations
•	The Standards do not include specific provisions for electric vehicle (EV) charging stations. 
•	Advisable to address access to EV charging stations so that they are usable by people with disabilities.  
•	If provided, accessible spaces at EV charging stations cannot count toward the minimum number of accessible car and van parking spaces required in a parking facility.
•	Image: Person using a wheelchair that is trying to reach a electric vehicle charging station
•	Image: Electric vehicle charging icon
•	Image: Electric vehicle charging device
Slide 34: Accessible Routes
Slide 35: Accessible Routes (§206)
•	At least one accessible route to building entrances from site arrival points provided
•	Image: Site arrival points:  parking, passenger loading zone, public sidewalk, and transit stop connected to accessible entrance by an accessible route.
Slide 36: Accessible Routes
•	At least one AR must connect to:
•	Image: lobby/ corridor with labels noting accessible route:
•	Must connect to: 
•	each accessible room and space  
•	each story (unless an exception applies)
•	each level on a floor required to be accessible
•	each accessible element
Slide 37: Handrails along Routes (403.6)
•	Handrails - where provided along walking surfaces other than ramps or stairs also must comply (excluding elevator cars)
•	Image: hospital corridor with railings/ integrated crash rails
Slide 38: Route Location (§206.3)
•	Must coincide or be in same area as general circulation paths
•	If circulation path is interior, AR must be interior
•	Image: Photo of a glass enclosed sky bridges between buildings
Slide 39: Vertical Access
•	Required for Professional Offices of a Healthcare Provider
•	Where a State-regulated professional provides physical or mental health services to the public
•	Title II entities and Federal facilities
•	Image: Photo of a typical office building elevator.
Slide 40: Multi-Story Facilities (§206.2.3)
•	Photo of a typical office building elevator.
•	Image: elevator bank (3 cars)
Slide 41: Exceptions (§206.2.3)
•	Accessible Route between floors (“elevator exception”)
•	Private sector facilities only:
•	Less than 3 stories
•	Image: a graphic of a 2 story building
•	Less than 3,000 sf/flr
•	Image: a graphic of a narrow 5 story building
Slide 42: Exceptions
•	Accessible route required to upper story:
•	containing a health care facility
•	containing a sales/rental establishment (if facility contains at least 5 total)
•	Image: building with health care facility on second floor and second building with 5 retail establishments, some of which are located on second level

Slide 43: Protruding Objects
•	Applies to all circulation paths (F204)
•	Image: Figure showing projection from wall 4 inches (100 mm) max with leading edge greater than 27 inches (685 mm) and person with cain walking adjacent to the wall.  On top of the person is a projection which is shown as greater than or equal to 80 inches (2030 mm) in height.
•	Image: Drawing of a blind pedestrian striking their head against an overhead obstruction.
Slide 44: Signs (§216)
•	Tactile/ visual  – labels for permanent rooms & spaces, exit doors
•	Visual only – directional or informational signs 
•	Exempt: temporary signs, building menus, directories, addresses, company names and logos
•	Image: Room number sign with raised characters and braille
Slide 45: Tactile Signs
•	Scoping (interior & exterior):
•	Restroom labels (at entry)
•	Room numbers/ names (not likely to change)
•	Floor levels
•	Exit access/discharge
•	Areas of Rescue Assistance
 Slide 46: Signs (216)
•	Required Signs
•	Means of egress
•	Parking
•	Entrances
•	Elevators
•	Toilet and bathing rooms
•	TTYs
•	Assistive listening systems
•	Check-out aisles
•	Image: ISA graphic
•	Other Info Pictograms
•	Directional Signs
Slide 47: Employee Work Areas
Slide 48: Employee Work Area (§106.5)
•	“All or any portion of a space used only by employees and used only for work.
•	Corridors, toilet rooms, kitchenettes and break rooms are not employee work areas.”
•	Americans with Disabilities Act (ADA)
•	Limited access required
•	“approach, enter, and exit”.
•	Architectural Barriers Act (ABA)
•	Must be accessible.
Slide 49: Employee Work Areas
•	Requirements for hand wash sinks in exam rooms
•	Image: Perspective drawing of a exam room sink for medical staff use only, sink has a bas cabinet beneath lavatory and is not accessible for a forward approach.
Slide 50: Service Counters
Slide 51: Minimum Number & Dispersion (§227.3)
•	At least 1 of each type of counter
•	Each type of function at a counter
•	Dispersion where counters dispersed
•	Image: hotel check-in counter
Slide 52: Check-In Counter
•	Accessible portion must be as deep as the counter depth for customer use.
•	Image: Low section of hotel check-in counter shown to be as deep as higher sections.
Slide 53: Service Counters
•	Side or Forward Approach Required
•	Image: Photo of a service counter with an accessible portion using a forward approach with knee and toe space underneath.
•	Drawing of the required knee and toe space under an element.
Slide 54: Public and Common Use Areas
Slide 55: Example: Medical Care Suite
•	Image: Medical suite plan with multiple dressing rooms highlighted (at least 5% of each type required to be accessible); also shown are other public or common use areas, including exam rooms, doctors' offices, waiting room, break room, and toilet rooms.  
•	 Labels: 
•	Public & Common Use Areas: Full Access
•	Dressing Rooms:  access to at least 5% of each type   
•	Common Use (Non-Work) Areas:  Full access 
•	Exams Rooms: 100% scoping (public access) 
•	Clustered toilet rooms  (50% min. scoping)
Slide 56: Common Use Spaces – Living
•	Image: Photo of an attractive common living room area with fireplace and built-in bookshelves in a residential care facility.
Slide 57: Dining & Work Surfaces (§226)
•	Access to at least 5% of surfaces 
•	Applies to both standing and seating spaces Dispersion within space/ facility required
•	Image: Dining Table
•	Image: Work Surface (desk)
Slide 58: Tray Slides
•	Tray slides are not required but must comply where provided
•	tray slide 28" - 34" high
Slide 59: Recreation/Rehabilitation Facilities
•	Play areas
•	Exercise or workout rooms
•	Exercise equipment
•	Locker rooms
•	Swimming pools
•	Spas or Saunas
Slide 60: Children’s Toilets
•	Advisory information provides guidance according to age group
•	Table: Different toilet dimensions and the height guidance for different age groups
Slide 61: Medical Diagnostic Equipment (MDE)
Slide 62: Rehabilitation Act §510
•	Mandates the Access Board to issue minimum technical criteria for accessible medical diagnostic equipment in consultation with FDA
•	Affordable Care Act amends the Rehabilitation Act to address access to MDE (March 23, 2010)
•	Image: Photo of Obama signing the affordable care act
Slide 63: Rehabilitation Act §510
•	Specifically addresses equipment in:
•	Physicians offices, clinics, emergency rooms, hospitals, other medical settings. Includes optometrists and dentists
•	Scoping to be determined in appropriate regulatory or administrative context
•	Final Standards are voluntary until adopted by an enforcing Agency e.g., DOJ for the Americans with Disabilities Act
•	Can be voluntarily adopted through policy
•	Image: Cover page0 of ANSI/AAMI, and ADA accessibility guidelines
Slide 64: MDE - Examples
•	Examination tables and chairs
•	Weight scales, x-ray machines
•	Radiological 
•	and mammography equipment
•	Image: Picture of Access Board Director and two Board members looking at a MRI (Magnetic Resonance Imaging).
•	Image: photo of a platform weight scale that accommodates both people who can stand and those using wheelchairs
•	Image: Photo of a woman using a wheelchair pulled up underneath eye examination equipment, adequate knee and toe space is provided.
•	Image: Photo of Board member about to transfer onto examination chair.
Slide 65: Patient Positions the Equipment Supports
•	in a supine, prone, or side-lying position
•	Image: Doctor standing beside dexa scan with patient lying on scan table
•	in a seated position
•	Image: Illustration of person using a wheelchair executing a parallel transfer onto a an exam chair.
•	Seated in a wheelchair
•	Image: A photograph of a woman using a manual wheelchair positioned on a platform weight scale.  Her shoe tip and rear wheel of the chair overhang the front and rea entry to the platform.
•	In a standing position
•	Image: Illustration of a man standing on a platform scale holding onto horizontal supports to each side of the equipment to maintain balance.
Slide 66: DOJ Guidance is Available
•	Image: Cover of DOJ's Access to Medical Care for Individuals with Mobility Disabilities document.
•	Image: Example page from the Access to Medical Care for Individuals with Mobility Disabilities document.
•	ww.ada.gov
•	800-514-0301
Slide 67: Standards for Accessible Medical Diagnostic Equipment
•	www.access-board.gov/guidelines-and-standards/health-care/about-this-rulemaking/final-standards
Slide 68: Technical Guides to the Standards
•	Available on the Access Board Website
•	Image: graphic of the first page of the drinking fountain, bathing  rooms, and toilet rooms
Slide 69: Questions ?
Slide 70: U.S. Access Board 
•	(800) 872-2253 (voice) 
•	(800) 993-2822 (TTY)
•	E-mail: ta@access-board.gov 
•	www.access-board.gov