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Surviving with the ADA: environmental modification.

As most nursing home managers know, perhaps, all too well, the Americans with Disabilities Act (ADA) prohibits discrimination against disabled individuals in either employment, availability of goods and services, transportation, communications, or in access to any place of public accommodation (emphasis supplied for purposes of this article). The ADA applies to existing facilities, as well as new construction. Exceptions and exemptions do exist, but if a facility is found guilty of discrimination under this Act, severe financial penalties are levied.

The ADA, in short, means business. Fines for the first violation can run as high as $50,000. For each subsequent violatons fines can be as high as $100,000. Individuals who feel that they are being denied accessibility in public-access facilities can file civil suits - and some early settlements have been for over $250,000.

This article addresses the implications of this Act as it generally applies to Skilled Nursing Facilities. It is not a complete advisory on all aspects of the Act nor will it describe all the Titles under the law. All owners and managers are urged to consult their own attorneys, architects or other professionals to evaluate their specific circumstances.

New Facilities

Under Title III of the Act, places of employment, public accommodation and commercial facilities with first occupancy after January 26, 1993,must be constructed to make them "readily accessible" to and usable by persons with disabilities. A facility is considered to be designed and constructed for first occupancy after January 26, 1993, if the last application for a building permit is certified to be complete by a governmental entity after January 26, 1992, and the first certificate of occupancy is issued after January 26, 1993.

Alterations or Renovations

Any existing facility that undergoes major alteration or renovation after January 26,1992 must be "readily accessible" and comply with the ADA Accessibility Guidelines unless the cost of compliance is disproportionate to the overall cost of the alterations. Title III of the ADA specifically requires the removal of structural or architectural barriers unless doing so creates an "undue hardship." Thus, any planned alterations or renovation must be checked against the ADA Accessibility Guidelines.

Existing Facilities

For existing long term care facilities the ADA states that discrimination will exist, "if the building owner fails to remove, architectural barrier and communication barriers that are structural in nature where such removal is readily achievable (easily accomplishable and able to be carried out with out much difficulty or expense)." This is the key phrase for all existing facilities.

In long term care facilities and nursing homes at least 50% of patient bedrooms and toilets, and all public use and common use areas, are required to be designed and constructed to be accessible.

Alterations to Patient Bedrooms

When patient bedrooms are being added or altered as part of a planned renovation of an entire wing, a department, or other discrete area of an existing medical facility, 50% of the patient bedrooms that are being added or altered shall comply with the ADA. For example, if, within one wing of a Skilled Nursing Facility, 20 patient bedrooms are being altered in a unit, 10 of the altered rooms must be made accessible. Where toilet/bathrooms are part of patient bedrooms which are added or altered and required to be accessible, each such patient toilet/bathroom shall comply with the ADA accessibility requirements, as well.

When patient bedrooms are being added or altered individually, and not as part of an alteration of the entire area, the altered patient bedrooms shall be made ADA accessible unless the "50% criteria" (above) has already been met.


At least one accessible entrance shall be protected from the weather by canopy or roof overhang. Such entrances shall incorporate a passenger loading zone that complies with the ADA.

Patient Bedrooms

"Accessible" patient bedrooms will be defined as follows:

Each bedroom shall have a door that complies with the ADA.

Each bedroom shall have adequate space to provide maneuvering room. In rooms with 2 beds, it is preferable that this space be located between beds.

Each bedroom shall have adequate space to provide a minimum clear floor space of 36 in. along each side of the bed to provide an accessible route to each side of the bed.


Where toilet/bathrooms are provided as a part of a patient bedroom, each patient bedroom that is required to be accessible shall have an accessible toilet/bathroom, and shall be on an accessible route.


If you own or manage a Skilled Nursing Facility or building with public access, you will need the counsel of a design professional who thoroughly understands the provisions of the new law, and who can advise you as to the steps you must take to bring your building into conformance. Both the landlord who owns the building and the tenant who owns or operates the facility as public accommodations are subject to the requirements of ADA. Allocation of responsibility for compliance may be determined by lease or other contract.

A display of "good faith" may provide important defense in the event of a lawsuit. Certainly, the cost of a compliance study is a small price to pay compared to potential consequences of neglect or delay.

Peter Rauma, is an Associate of Ehrlich-Rominger, a multi-discipline architectural firm with offices throughout California. An architect and skilled nursing facility planner since 1978, Mr. Rauma is a registered architect in two states and a frequent contributor to NURSING HOMES.
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Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Americans with Disabilities Act
Author:Rauma, Peter
Publication:Nursing Homes
Date:Aug 1, 1992
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