Patient Perspective

ADA Compliance in Transitional Care Facilities

Missing in action

BY Joan Willshire

Physicians need to become involved with the selection of rehabilitation TCU’s.

System shortcomings

Every six years Minnesota reviews its entire building code and updates it as needed. In 2020 the amount of accessible residential nursing home rooms was increased from 10% to 50%. Nursing homes need to comply with Minnesota code.  It was fantastic to finally get this accomplished and create a more fair system. One shortcoming involved a lack of retroactive compliance. Building code never requires retroactive updates, and not many new long-term care facilities are being built these days. We still have to figure out how to deal with these older nursing homes and long-term care facilities. 

A solution I see is that the state of Minnesota needs to continue to use its budget surplus dollars toward helping nursing homes and long-term care facilities with these many issues. A certain percentage of their residence rooms have to be physically accessible. This past legislature approved $173 million to go toward nursing homes to help with their low-staffing situation after losing staff during the pandemic. A similar dollar amount needs to go toward creating greater accessibility in these facilities. Rehabilitation protocols such as going to a TCU or other type of rehabilitation center after one’s hospital stay are broken and do not support favorable outcomes. If you do not have family to support you at home, standard procedure will send you to a rehabilitation facility. There just aren’t enough accessible rehabilitation facilities available. Plus staffing issue at these places is at the lowest point we have seen in many years. Patients are at physical risk and staff is at risk. 

People with disabilities generally fear going to a rehabilitation facility after surgery or an illness.  They fear this because when a person doesn’t walk or stand he or she becomes very vulnerable. Being somewhere with so many factors beyond one’s control is a major concern, and there are so many nightmare experiences patients have heard from others. The fear of being dropped is very real and much of this fear comes from hearing in the news about the staffing shortage. Another real fear is neglect and isolation. There won’t be enough staff to come assist them to the toilet, to eat or dress get to bed and so on. This is a real every day life situation. Where can people with disabilities go when they are referred to a transitional care facility?

There just aren’t enough accessible rehabilitation facilities available.

Many just play the game of chance when choosing a TCU for rehab. They go with what they are assigned and hope that that’s going to be good enough. People are often not aware of their rights and think they have to accept what’s been given to them. The metropolitan area is slowly developing an understanding of how to better serve those needing ADA compliance. There is an appeal process if you are assigned to a facility that cannot meet your needs. The rural communities are living with very limited choices. They are greatly affected by their not having enough skilled nursing facilities. It’s not unusual for patients to drive great distances to get to the appropriate medical care. 

These issues make it difficult to be able to achieve good outcomes for anyone and can be disastrous for some. Unfortunately many nursing homes and long-term care facilities have not been ADA compliant for so long they don’t even realize it is a problem. They don’t seem to understand why it’s important to be fully accessible. They also do not realize that when the environment itself is fully physically accessible, it will reduce workers’ compensation issues. The patient and staff will both be happier and safer. 

Treating all patients fairly

Did disability play a part in my extended stay in the hospital? Absolutely it did. But here’s where I argue there should be no difference between a senior who has age-related disabilities and a younger person with a disability. Your physical function should determine what your needs are. The inability of medical professionals to see the need to be located in an accessible physical ADA-compliant environment is just amazing.

The social worker in the hospital is generally the point of contact when you are looking to move from an inpatient setting to a TCU for further rehabilitation. The patients give the social worker a geographic location, roughly where they would like to find a TCU. Then they wait to see if they’ve been accepted or not by a nearby facility. The patients do have a choice of where they want to go. There are generally a variety of reasons why one may or may not be accepted into a particular rehabilitation facility. My experience has been that the physician is generally not a part of this conversation other than referring patients to the facility that has accepted them based on what their medical treatment plan states. Physicians’ orders need to specify that the patients must be in an environment that is physically accessible so they are able to maneuver using their rehab devices such as a wheelchair scooter, cane, or walker and so on. A major problem is that medical professionals are unaware of what most patients with disabilities need to have in order to move around in their surroundings successfully. I encourage all physicians to have their patients give them a list of all the rehabilitation devices they use in their ADLs. The patients also should describe their home environment to their physicians. 

Demanding compliance

Despite Minnesota building code’s being updated to include institutions of assisted living, TCUs and long-term care facilities, there is still a significant lack of understanding of the rehabilitation environment needed for a person who has a disability. Compounding noncompliance problems, there is a huge staffing shortage in these facilities. The family should not be the only ones demanding the facilities be physically accessible for their loved ones. The medical professionals need to step up and be more committed.   

The Mayo Clinic in Rochester is addressing some of these issues involved with moving patients out of the hospital quickly. Social workers are given a geographic area with a 25-mile radius to find transitional care.  Patients are sent to whichever facility comes back first stating that they can be admitted based on physician orders. Many problems remain with this process but it is helping to get patients out of the hospital more quickly. It is impossible to stress enough the many reasons why physicians need to become involved with the selection of rehabilitation TCU’s. We all need to be concerned about facilitating this change, especially physicians because it could impact their patient’s rehabilitation success. It has become more dangerous than ever to be sent to a rehabilitation facility. Health care is truly at the crossroads right now, being unhelpful and just plain scary!

Joan Willshire is a consultant and advocate for the advancement of disability services. She is the former director of the Minnesota Council on Disability.