An Overview of Americans with Disabilities Act

Employee Responsibilities •Advise the _______________ of the disability; •Make her ___________ known to the best of her ability, so that the employer can accommodate the worker; •Answer questions or provide information regarding __________________, including information from health care professionals, where appropriate; •Participate in _______________ regarding possible accommodation solutions; •Cooperate with any _____________ whose assistance is necessary; •Meet agreed-upon ____________________once accommodation is provided; and •Work with the employer on an _______________

Employer Needs Relevant restrictions or limitations Discussions Experts Performance and job standards On-going basis

Dental office design *ADA helps guarantee access to _____________________for persons with disabilities. A dental practice is considered a _______________________

Place of public accomodation

Attitudinal barriers - Stereotyping Stereotype those with disabilities, assuming their quality of life is ___________ or that they are ____________ because of their impairments.

Poor Unhealthy

Under the ADAAA, "major life activities" is expanded to include __________________. The statute contains a non-exhaustive list of "major life activities" that adds additional activities to those listed in the original ADA and Section 503 regulations, and a non-exhaustive list of "major bodily functions."

"Major bodily functions"

The Department of Justice issued a final rule increasing civil penalties for violations of the Americans with Disabilities Act, which covers ____________________ . This rule is effective April 27, 2014, according to the March 28 Federal Register notice. However, the DoJ announcement said, "The new maximums apply only to violations occurring on or after April 28, 2014."

"professional offices of health care providers" including dental offices

*The final rule "adjusts for inflation" civil monetary penalties assessed or enforced by the Justice Department's Civil Rights Division. "For the Americans with Disabilities Act, this adjustment increases the maximum civil penalty for a first violation under Title III from _____________________; for a subsequent violation the new maximum is ___________" the DoJ said

$55,000-$75,000 $150,000

Some national and local organizations may certify therapy animals; however, even with certification, a therapy animal does not qualify for the access protection given to service animals under the ____________

ADA

Michigan Persons with Disabilities Civil Rights Act (PDCRA) Prohibits employers from failing or refusing to hire an individual because of disability or genetic information that is unrelated to the individual's _________________ of a particular job or position.

Ability to perform the duties

Transportation barriers - Examples Lack of ____________ for persons who are not able to drive because of vision or cognitive impairments, and _____________ may be unavailable or at inconvenient distances or locations.

Access to accessible or convenient transportation Public transportation

Dental office design Practice must apply with the....

Act, state, and local accessibility laws

Transportation barriers Due to a lack of __________ that interferes with a person's ability to be independent and to function in society.

Adequate transportation

Websites Considerations include: •The website should provide _________________ of graphical elements •The website should properly format ___________ that require user input so fields can be identified by screen readers •Tables that contain data should include ________________ •The website should embed __________________ or another means to ensure deaf or hearing-impaired users can understand a website's audio content •The website should have _______________- between background and text

Alternate descriptions Forms Column and row headers Closed captioning High-contrast

Dental office design The standards that apply depend on whether the office is... *No exemptions

An existing facility, being renovated or new construction.

Other individuals who are protected in certain circumstances include 1) those, such as parents, who have an ___________ with an individual known to have a disability, and 2) those who are coerced or subjected to retaliation for __________ persons with disabilities in asserting their rights under the ADA.

Association Assisting

Common barriers

Attitudinal Communication Physical Policy Social Programmatic Transportation

Policy barriers Frequently related to a lack of __________________ that require programs and activities be accessible to people with disabilities

Awareness or enforcement of existing laws and regulations

Title III requires that all new construction and modifications must be accessible to individuals with disabilities. For existing facilities, _____________ must be removed if readily achievable.

Barriers to services

Service animal Examples of such work or tasks include guiding persons who are...

Blind, alerting persons who are deaf, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed medications, calming a person with Post Traumatic Stress Disorder (PTSD) during an anxiety attack, or performing other duties

Patient care issues *Per HIPAA covered dental practice may need to have a compliant ______________________ with an interpreter.

Business associate agreement

The ADA's protection applies primarily, but not exclusively, to individuals who meet the ADA's definition of disability. And individual with a disability is a person who:

•Has a physical or mental impairment that substantially limits one or more of his/her major life activities •Has a record of such an impairment; or •Is regarded as having such an impairment.

Accomodations - Policy enhancements *Modifying a policy to allow a _________________ in a business setting *Adjusting work schedules so employees with chronic medical conditions can go to ____________________ and complete their work at alternate times or locations.

Service anima Medical appointments

Accomodations - Accessible communications *Providing _________________ interpreters or _______________ at meetings and events *Making materials available in _____________-

Sign language Closed captioning Braille or large print

Social barriers Related to the conditions in which a person is born, grow, live, learn, work and age - or ____________________ - that can contribute to decreased functioning among persons with disabilities

Social determinants of health

*The percentage of people living with disabilities is highest in the ___________

South

Physical barriers - Examples:

Steps and curbs that block a person with mobility impairment from entering a building or using a sidewalk

Attitudinal barriers include:

Stereotyping Stigma, prejudice, and discrimination

Physical barriers _______________ obstacles in natural or manmade environments that prevent or block ___________ (moving around in the environment) or _____________

Structural Mobility Access

Patient Care issues - Drug seeking patients Cannot discriminate based on illegal use of drugs against an individual who is not engaging in current illegal use of drugs and who: •Completed _______________ program or has been rehabilitated •Participating in a _______________ program •______________ regarded as engaging in such use.

Supervised drug rehabilitation Rehabilitation Erroneously

Websites The US Department of Justice has interpreted _____________ of the ADA to require businesses to make their websites accessible to individuals with disabilities. The area of the law is still developing.

TITLE II

______________________ companies offering telephone service to the general public must have telephone relay service to individuals who use telecommunication devices for the deaf (TTYs) or similar devices.

Telecommunications (Title IV)

Emotional support dogs - Is the assistance animal legitimate... Can i ask?

There is no law against asking Only airline employees, landlords, and educational facility administrators have a legal right to ask for medical documentation from the handler

Patient care issues - Factors to consider for OPDMD * _____________________of device *Facility's volume of _________________ *Facility's design and _________________ *Legitimate ______________concerns *Whether use of OPDMD creates a _______________

Type, size, dimensions and speed Pedestrian traffic Operational characteristic Safety Substantial risk or serious harm

Therapy dogs - Is the assistance animal legitimate... Can i ask?

Yes Although pet owners do not have a legal right to bring these animals into public places that aren't pet friendly, certain institutions such as hospitals and libraries may provide acess by prior agreement

Miscellaneous (Title V) includes a a provision prohibiting either:

(a) coercing or threatening or (b) retaliating against individuals with disabilities or those attempting to aid persons with disabilities in asserting their rights under the ADA.

Examples of ADA violations would include:

*A dentist who categorically refused to treat all persons with HIV or AIDS.

Prevalence of disabilities for ages 18+

1. Ambulatory 2. Independent living 3. Cognitive 4. Hearing 5. Self-care 6. Vision

Employment ADA prohibits discrimination by all private employers with ______ or more employees.

15

_________________ (one in 4) of adults in the United States have some type of disability. Graphic of the United States.

26%

Michigan Persons with Disabilities Civil Rights Act (PDCRA) _____________ statue of limitations

3-year

Social barriers - Examples People with disabilities are far less likely to be employed. In 2017, _________ of people with disabilities, ages 18 to 64 years, were employed, while __________ of people without disabilities were employed, about __________ that of people with disabilities. Adults age 18 years and older with disabilities are less likely to have completed _____________ compared to their peers without disabilities (_________ compared to ________). People with disabilities are more likely to have income of less than _________ compared to people without disabilities (________ compare to ________). Children with disabilities are almost four times more likely to experience ___________ than children without disabilities.

35.5%, 76.5%, double High school, 22.3%, 10.1% $15,000. 22.3%, 7.3% Violence

*Approximately ______________ adults Americans live with disabilities.

61 million

Major life activities include:

Caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

Applicants - Employers cannot fire or _______________ because they fear the worker will become too ill to work in the future. The hiring decision must be based on how well the individual can perform at the present time.

Choose not to hire a qualified person

Accomodations - Accessible and assistive technologies *Ensuring _______________ is accessible *Providing _______________ software *Using videophones to facilitate communications with colleagues who are _______________

Computer software Screen reader Deaf

Request from an employee for accomodations An employee generally has the initial burden of putting the employer on notice that ________________________, proposing an accommodation, and showing that that accommodation is objectively reasonable.

Deficiencies in his or her performance are related to an ADA disability

Programmatic barriers Limit the effective ____________ of a public health or healthcare program for people with different types of impairments

Delivery

Americans with Disabilities Act The _________ is the primary agency that enforces the ADA

Department of Justice (DOJ)

Places of public accomodation include a wide range of entities, such as restaurants, hotels, theaters, __________________, hospitals, retail stores, health clubs, museums, libraries, private schools, and day care centers.

Doctor's offices, dentist's offices

Canadian Colleagues Employers cannot terminate employees on the basis of the employee taking time off due to illness. This is because under the Ontario Human Rights Code, the employer has a ___________________ the employee in respect of any disability.

Duty to accomodate

Request from an employee for accomodations But this general rule has exceptions:

Employers have been required to initiate the interactive process even if the employee does not request accommodation where the employee's disability and its adverse impact on job performance are obvious.

_______________ requires covered employers to provide reasonable accommodations for applicants and employees with disabilities and prohibits discrimination on the basis of disability in all aspects of employment

Employment (Title I)

Relates to an ______________of device type, NOT how a person with a disability may operate the device

Entire class

Discrimination is the failure to give a person with a disability the _______________- to use or enjoy the public accommodation's goods, services, or facilities.

Equal opportunity

Patient care issues - Hearing impaired *Dentist must pay for services if needed to achieve ________________-

Equally effective communication

Examples of reasonable accomodations include: Making ____________________ readily accessible to and usable by employees with disabilities Restructuring a ___________ Modifying _____________ Acquiring or modifying _______ Reassigning a current employee to a ____________ for which the individual is ________________

Existing facilities Job Work schedules Equipment Vacant position, qualified

Title III imposes a number of requirements on public accommodations, such as taking certain steps to make their _______________, making ______________ in policies, practices and procedures that would deny equal access to individuals with disabilities, and furnishing ___________________ when necessary to ensure effective communication.

Facilities accessible Resonable modifications Auxillary aids

Reasonable accommodation: modification or adjustment is 'reasonable' if it 'seems reasonable on its face, i.e., ordinarily or in the run of cases;' this means it is 'reasonable' if it appears to be ___________________.' An accommodation also must be effective in __________________

Feasible or plausible Meeting the needs of the individual

Policy barriers - Examples Denying qualified individuals with disabilities the opportunity to participate in or benefit from ______________, services, or other benefits Denying individuals with disabilities _________ to programs, services, benefits, or opportunities to _________ as a result of physical barriers; and Denying reasonable ___________ to qualified individuals with disabilities, so they can perform the ______________ of the job for which they have applied or have been hired to perform.

Federally funded programs Access, participate Accomodations Essential functions

While the employment provisions of the ADA apply to employers of _______________ or more, its public accommodations provisions apply to all sizes of business, regardless of number of employees. State and local governments are covered regardless of size.

Fifteen employees

Major bodily functions include:

Functions of the immune system, normal cell growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

Employers responsibilities •Accept the request for accommodation in ________________; •Obtain _____________________ where needed; •Take an _________________ in ensuring that alternative approaches and possible accommodation solutions are investigated, and canvass various forms of possible accommodation; •Maintain _________________ •Limit ________________ for information to those reasonably related to the nature of the limitation or restriction so as to be able to respond to the accommodation request; and •Grant accommodation requests in a _________________.

Good faith Expert opinion or advice Active role Confientiality Requests Timely manner

Applicants - An application cannot seek information ___________ or ask ____________

Health status Disability-related questions

Communication barriers Experienced by those that have disabilities that affect....

Hearing, speaking, reading, writing, and or understanding, and who use different ways to communicate

Employmet - Examples

Hiring and termination Application procedures Job assignment Training and promotion. All employment related activities

Attitudinal barriers - Stigma, prejudice, and discrimination Within society, these attitudes may come from a person's __________ related to disability—An individual may see disability as a personal tragedy, as something that needs to be cured or prevented, as a punishment for wrongdoing, or as an indication of the lack of ability to behave as expected in society.

Ideas

Does the Americans with Disability Act Allow for an Employee's Use of Medical Marijuana?

If an employee is using drugs illegally, the employee is not protected by ADA. Federal law, Marijuana is an illegal schedule 1 drug, under state law, an employee may not be using drugs illegally.

Current use of ____________ is exempt from coverage; however a person who no longer engages in the illegal use of drugs could meet the ADA definition of disability.

Illegal drugs

According to the U.S. Department of Justice, "service animals are defined as dogs that are _____________ to do work or perform tasks for persons with disabilities

Individually trained

Do I have to have sign language interpreters for hearing impaired patients? *May or may not be required. The ADA requires you make services of an ______________ available if one is needed to achieve equally effective communication. The need for auxiliary aids and services may vary from individual to individual. *May be influenced by the __________________ *May be necessary for ______________ of a patient. *Inn 2012 US Department of Justice announced __________________ supporting effective communication strategies.

Interpreter Individual Parents or caregivers Barrier Free Health Care Intitiative

The duties of a therapy dog are not limited to working with persons with disabilities and are not ____________________. A therapy dog is allowed into locations, such as hospitals and nursing facilities, by _________________, perhaps as part of a treatment plan.

Legally defined Invitation only

Patient care issues - According to the US Deparment of Justice - OPDMD *Must allow individuals who use OPDMD, other power driven mobility devices, including Segway's to enter unless it cannot be accommodated due to a _______________

Legitimate safety concern

The ADA's definition of disability was broadened by the ADAAA effective in January 2009. •To satisfy the "regarded as" standard an individual need only show that they have been subjected to an action prohibited under the statute (e.g., termination; failure to hire) because of an actual or perceived impairment. It is no longer necessary that the impairment be perceived by the employer to...

Limit or "substantially limit" a major life activity

Accomodations

Physical changes Accessible and assisstive technologies Accessible communications Policy enhancements

Disability definition broadened •Expanded _____________ •Redefined who is __________ as having a disability •Modifying the regulatory definition of _______________ •Specifying that "disability" includes any impairment that is _______________ if it would substantially limit a major live activity when active; •Prohibiting consideration of the ameliorative effect of ______________ when assessing whether an impairment limits activities.

Major Life Activities "Regarded" "Substantial limit" Episodic or in remission "Mitigating measures"

Employment (Title I) Also regulates:

Medical examinations and inquiries

A "reasonable accommodation" is any _________________ to a job, the job application process, or the work environment that will enable a qualified applicant or employee with a disability to participate in the application process, perform the essential functions of the job, or enjoy the benefits and privileges of employment.

Modification or adjustment

Request from an employee for accomodations - Undue hardship •The ________________ of the accommodation needed; •The overall _________________ of the facility or facilities involved in the provision of the reasonable accommodation; the _______________ employed at such facility; the effect on ________________, or the impact otherwise of such accommodation upon the operation of the facility; •The overall financial resources of the ___________; the overall ___________ of the business of a covered entity with respect to the number of its employees; the number, type, and location of its facilities; and •The type of operation or operations of the covered entity, including the _________________- of the workforce of such entity; the geographic separateness, administrative, or fiscal relationship of the facility or facilities in question to the covered entity. 42 U.S.C. § 12111(10).

Nature and cost Financial resources Number of persons employed Expenses and resources Covered entity Size Composition, structure, and functions

Service dogs - Is the assistance animal legitimate... Can i ask?

No- it's against the law The handler can only be asked 2 questions: 1. Does your dog provide a service? 2. What is your dog trained to do?

A professional office of a health care provider is a location where a state-regulated professional provides

Physical or mental health services to the public, according to the DoJ Title III technical assistance manual.

A public accommodation is a private entity that...

Owns, operates, leases, or leases to a place of public accommodation

Americans with Disabilities Act Impacts...

Patient care, employer/employee interactions and dental office design.

Patient care issues - Service animals *Within ADA, must allow service animal where... *Staff can ask if the animal is a service animal/...

Patients are allowed to go How will it assist you

____________________ include facilities such as restaurants, hotels, grocery stores, retail stores, etc. as well as privatelty owned transportation systems.

Public Accomodations and Services operated by Private Entities (Title III)

___________________, public services (which include ________________) cannot deny services to persons with disabilities or deny participation in programs or activities that are available to persons without disabilities

Public Servies (Title II) State and local government agencies, the National Railroad Passenger Corporation, and other commuter authorities

Americans with Disabilities Act The Civil Rights Act prohibits discrimination against individuals with disabilities in all areas of...

Public life, including jobs, schools, transportation, and all public and private spaces open to the general public.

Public Services (Title II) In addition, __________________, such as public transit buses, must be accessible to individuals with disabilities

Public transportation systems

Request from an employee for accomodations - Informal interative process •Analyzing the particular job involved and determine its ______________________; •Consulting with the employee with a disability to determine the precise ________________ imposed by the employee's disability and how those limitations could be overcome with a reasonable accommodation; •Identifying ____________________ each would have in enabling the employee to perform the essential functions of the position; and •Considering the _________________ of the employee to be accommodated and selecting and implement the accommodation that is most appropriate for both the employee and the employer.

Purpose and essential funcitons Job-related limitations Potential accomodations Preference of the employee

The ADA prohibits employment discrimination against ________________ with disabilities

Qualified individuals

Patient care issues - Obese patients *May not _______________ *However, a _____________ whose weight substantially limits one or more major life activities may qualify for protection *Michigan's ______________

Qualify Morbidly obese person Elliot Larsen Civil Rights Act

Accomodations - Physical changes *Installing a ____________ or modifying a rest room *Modifying the __________ of a workspace

Ramp Layout

Michigan Persons with Disabilities Civil Rights Act (PDCRA) Requires employers to make _______________ for disabled persons, unless the accommodation would impose an undue hardship on the employer.

Resonable accomodations

Employment (Title I) Reasonable accomodation includes:

Restructuring jobs, making work-sites and workstations accessible, modifying schedules, providing services such as interpreters, and modifying equipment and policies

Michigan Persons with Disabilities Civil Rights Act (PDCRA) Unlawful for an employer to _________ against an individual because that individual has opposed a violation of or has filed a complaint under the PDCRA.

Retaliate

Programmatic barriers - Examples •Inconvenient _____________ •Lack of ______________ (such as mammography screening equipment); • ______________ set aside for medical examination and procedures; •Little or no _______________ with patients or participants; and •Provider's _____________ of people with disabilities.

Scheduling Accessible equipment Insufficient time Little or no communication Attidudes, knowledge, and understanding

Qualified individuals means an individual who, with or without reasonable accommodation, can perform...

The essential functions of the employment position that such individual holds or desires.

Attitudinal barriers

The most basic and contribute to other barriers

Essential functions

Those duties that are so fundamental to the position that the individual holds or desires that s/he cannot do the job without performing them Those core duties that are the reason the job position exists

Patient Care issues - Drug seeking patients Under __________ of ADA, the term disability does not include ___________________ use disorders resulting from current or illegal use of drugs.

Title II Psychoactive substance

________________ of the ADA covers 12 types of public accommodations, a category that includes as covered service establishments "professional offices of health care providers" and "hospitals."

Title III

Canadian colleagues - Typical accomodations Allowing and employee....

To work with modified duties and hours Time to attend medical appointments Breaks to sit and rest A leave of absence

Communication barriers - Written health promotion mesages with with barriers that prevent persons with vision impairments from receiving the message Include:

Use of small print or no large-print versions of material, and No Braille or versions for individuals who use screen readers.

Communication barriers - Auditory health messages may be inaccessible to an individual with hearing impairments Include:

Videos that do not include captioning, and Oral communications without accompanying manual interpretation (such as, American Sign Language).

Communication barriers - Examples Written health promotion mesages with with barriers that prevent persons with _________________ from receiving the message Auditory health messages may be inaccessible to an individual with ________________________ The use of technical language, long sentences, and words with many syllables may be significant barriers to understanding for persons with __________________

Vision impairments Hearing impairments Cognitive impairments

Patient care issues - Motorized vehicles Requires facilities to allow persons to use ________________ including manual, power, and electric scooters and _________________ mobility aids such as a walker, crutches, canes, or braces.

Wheel chairs Manually powered

Service animals are ______________, not ___________-

Working animals Pets