Serving People with Disabilities Short Orientation PRIMARY AND SPECIALTY CARE PRACTITIONERS Front Office Staff Serving People with Disabilities And Seniors Prepared by The Harris Family Center for Disability and Health Policy Western University of Health Sciences Pomona, California April 2011 NOTES FOR TRAINERS: This PowerPoint presentation is intended to be used with primary and specialty care provider front office staff in a 15 to 30 min. orientation to providing care for people with disabilities and seniors. LEARNING GOALS FOR FRONT OFFICE STAFF 1. Understand the functional land activity limitations that patients with disabilities and seniors who will be enrolling in their practice are likely to experience, and 2. Set the stage for the discussion of accommodations that some patients with disabilities and seniors may require and how the provider’s office and Health Plan can work together to make these accommodations available.

TOPICS FOR PRIMARY AND SPECIALTY CARE PRACTITIONERS Front Office Staff Profile of seniors and people with disabilities What are accommodations? Accommodations Check sheet Providing accommodations: How the Plan can help Coordinating accommodations with the medical staff

Profile of Medi-Cal Beneficiaries with Disabilities in California 70% who have disabilities live w/ two or more chronic conditions and 16% of these have diabetes (compared with 7% in gen. pop.) About 25% have four or more chronic conditions 30% of beneficiaries with disabilities receive treatment for mental health conditions annually NOTES FOR TRAINERS: Source: “State of California’s Concept for a Comprehensive Section 1115 Waiver to Replace the Current Medi-Cal Hospital/Uninsured Care Demonstration Project,” draft concept paper, California Department of Health Care Services, December 16, 2009. <http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/Agenda%20Item%204%20FinalWaiverConceptPaper12-16-09.pdf>

Profile of Medi-Cal Beneficiaries Who Are Seniors Seniors represent about 14% of Medi-Cal beneficiaries who have no other insurance who will experience mandatory enrollment into managed care during 2011-2012 NOTES FOR TRAINERS: Source: “State of California’s Concept for a Comprehensive Section 1115 Waiver to Replace the Current Medi-Cal Hospital/Uninsured Care Demonstration Project,” draft concept paper, California Department of Health Care Services, December 16, 2009. <http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/Agenda%20Item%204%20FinalWaiverConceptPaper12-16-09.pdf>

Chronic conditions, diseases and disabilities Definition of Disability Interaction of Impairment with Environmental Factors Chronic conditions, diseases and disabilities NOTES FOR TRAINERS: Understanding disability means understanding how chronic conditions, diseases and diagnosis may relate to functional limitation that call for specific accommodations in the health care setting. For example, seniors diagnosed with chronic conditions (e.g., diabetes, dementia, heart disease, arthritis) may experience activity limitations such as difficulty walking, seeing, understanding, or communicating, which in turn, create the need for accommodations such as accessibility and steps to ensure effective communication. People with a chronic condition such as diabetes may have activity limitations related to vision. But, regardless of the cause of the vision condition, effective health care requires accommodation of functional vision limitations such as providing care instructions in large print or audio formats. People with a chronic condition such as intellectual or developmental disability may experience an activity limitation that affects understanding and/or communication. Identifying methods for effective communication ensure effective health care. Functional Limitations Accommodations

Accommodations––What Patients May Need Physical accessibility Effective communication Sign Language interpreters, assistive listening devices, print materials in accessible formats Policy modification (for example, to allow more time for an office visit) Accessible medical equipment

Physical Accessibility Priorities for Accessibility Access into the facility (for example, level entrance with no stairs) Access to areas where services are provided Access to restrooms Tax incentives available for modification of existing facilities NOTES FOR TRAINERS: Modifications in existing facilities can be as simple as lowering a section of the reception counter to facilitate communication with wheelchair users and people of short stature; removing carpeting from pathways of travel to ensure smooth travel for mobility devices; installing grab bars in the restroom; or installing an electric door opener at the facility entrance. Priorities for accessibility: Access into the facility Access to areas where services are provided, and Access to restrooms. Readily achievable, a standard under the Americans with Disabilities Act for accessibility in existing buildings, means without much difficulty or expense. If a program can be made accessible by some method other than providing architectural access, providing architectural access is not required. Methods for achieving program access include: Redesign of equipment Reassignment to accessible buildings Use of aides Home visits Delivery of services at alternative accessible sites Alteration of existing facilities For more information about the ADA, see the US Department of Justice website at: http://www.ada.gov/

Effective Communication Auxiliary aids and services Measures to ensure communication accessibility Qualified readers Audio recordings Braille Large print Qualified ASL interpreters Relay service Assistive listening device Text message Email Captioning NOTES FOR TRAINERS: Ensuring effective communication with people who have hearing, speech or vision impairments can be seen as a specific type of access. It may also involve the modification of policies, practices or procedures, and accommodations in the form of auxiliary aids and services. There is a critical link between what needs to be communicated and whether communication is effective. For example, someone who is hard of hearing may be able to get by in a routine physical exam using handwritten notes. On the other hand, handwritten notes will rarely or never be adequate to convey the complex information needed to obtain informed consent from someone who is linguistically Deaf and therefore American sign language would likely be necessary for effective communication. Wireless text communication are among the basic and commonly used communication methods in the deaf community. Through cell phones, wireless pagers or handheld communication devices, deaf and hard of hearing people are exchanging e-mail and instant messages. Ask the patient if they prefer to be contacted via email or text messaging. Alternative formats makes printed information usable for individuals unable to use standard print materials because they cannot read, manipulate, or process print due to a visual, physical or learning disability. Federal Tax Credits available to small businesses to pay for auxiliary aids (and removal of architectural and transportation barriers).

Accessible Equipment Height adjustable exam tables Wheelchair accessible weight scales Adjustable mammography equipment Moveable optometry chairs NOTES FOR TRAINERS: When you are meeting with the front office staff, ask if the practice has a height adjustable examination table and a wheelchair accessible weight scale available. If this equipment is not available, suggest that the practice consider purchasing such equipment. Mention that tax credits are available for such purchases. Be sure to suggest that the practice consider methods for assisting patients with disabilities onto and off of examination tables such as purchasing a portable lift. NOTE: If your plan is considering assisting primary care providers to acquire accessible equipment using group purchases, mention this to the office staff. Be sure to indicate any other support your plan can provide to assist practitioners identify where accessible equipment such as wheelchair accessible weight scales are located that patients can use.

Modification of Policies Flexible appointment time Longer appointment time Providing assistance filling out forms Providing lifting assistance Providing print materials in alternative, accessible formats Allowing service animals NOTES FOR TRAINERS: Briefly discuss the need for written policies and procedures to ensure that the practice has established a mechanism, for example, for providing flexible appointment times, longer appointment times, lifting assistance and so on. NOTE––sample disability accommodation policies and procedures that spell out methods primary and specialty care practices can adopt to provide appropriate accommodations are available on the website at the end of this module in HANDOUTS.

Accommodations Check Sheets Capture information about accommodations patients require Should be readily visible in patient’s paper record Information should be added to the electronic patient record NOTES TO TRAINER: Two model check sheets are available on the website at the end of this module in HANDOUTS. They can be printed out and distributed to primary and specialty care front office staff.

How the Health Plan Can Help Assistance with arranging for Sign Language interpreters Methods for providing print materials in alternative formats Sources for equipment such as assistive listening devices, accessible weight scales, conversion of print material to Braille NOTES FOR TRAINERS: Trainers must be sure to identify the types of support and assistance their Plan can provide for primary and specialty care provider practices. For example, trainers must be aware if their Plan pays for Sign Language interpreters or requires that the provider negotiate payment as part of their capitated rates for service to Medi-Cal beneficiaries. If the Plan pays for interpreters directly, trainers should provide information about who to contact at the plan to arrange for interpreter services. Trainers should provide examples of interpreter referral services if the provider hires interpreters directly. Similarly, trainers must either provide information about who the provider should contact at the Plan to arrange for materials in alternative formats or to community organizations that provide this service. If the Plan has a designated disability services coordinator, that person’s name should be provided to the office staff as the point of contact within the Plan when they need assistance providing services to people with disabilities and seniors.

Coordinating with Medical Staff Communicate accommodation needs with medical staff Arrange accommodations IN ADVANCE Sign Language interpreters Print materials in accessible formats (for example, consent forms, insurance documents, brochures, diabetes education material) NOTES FOR TRAINERS: It is important for front office staff to communicate effectively with medical provider staff when patients with disabilities require accommodations that must be arranged in advance of the patient’s visit. For example a wheelchair user may require an exam room that has a height adjustable examination table or a person with a developmental disability may require a longer appointed time to ensure effective communication with provider staff. These requirements must be communicated and coordinated with medical staff in advance of the patient’s visit. Provider front office staff should be aware of the office’s policies and procedures regarding providing accommodations for patients with disabilities and communication with medical staff regarding patients’ accommodation needs.

Handouts/Resources Accommodation Check Sheets for Patients with Disabilities Accommodating Patients with Disabilities: Model Policies and Procedures Tax Incentives for Providers NOTES FOR TRAINERS: In addition to the handouts and resources listed in this slide, trainer should also provide: The name of the person at the Plan who can answer questions and provide information on acquiring accessible equipment, providing accommodations, and who can clarify the Plan’s role in assisting providers to meet the needs of patients with disabilities Information about the Plan’s policies concerning acquisition of and payment for specific accommodations such as Language Interpreters; community resources that can provide print materials in alternative formats such as Braille