36 CFR Parts 1190 and 1191 ADA and ABA Accessibility Guidelines - Preamble (Discussion of Comments and Changes)

223 Medical Care and Long-Term Care Facilities

This section indicates the number of patient or resident sleeping rooms required to be accessible in medical care and long-term care facilities. The general scoping provision at 223.1 indicates that the facilities covered by this section include medical care facilities and licensed long-term care facilities where the period of stay exceeds 24 hours. Section 223.2 covers hospitals, rehabilitation facilities, psychiatric facilities, and detoxification facilities. In general, those facilities are held to a 10% scoping requirement, but those that specialize in the treatment of conditions affecting mobility are subject to a 100% scoping requirement. In long-term care facilities, 50% of the rooms must be accessible.

Changes made in the final rule include:

• modifying the description of the facilities covered by this section (223.1)

• adding a new exception for toilet rooms in critical care and intensive care patient sleeping rooms (223.1)

• clarifying the application of scoping requirements to rehabilitation facilities (223.2)

• revising the scoping requirement for long-term care facilities to apply to "each type" of resident sleeping room (223.3)

Comment. Comments considered it unnecessary to qualify covered medical care facilities as those that are licensed, since all are typically licensed.

Response. The general charging statement (223.1) has been changed to refer to "medical care facilities and licensed long-term care facilities." In addition, the Board has removed as unnecessary language describing these facilities as places "where people receive physical or medical treatment or care."

Comment. There are certain types of patient rooms, such as those provided in critical or intensive care units where patients who are critically ill are immobile or confined to beds and thus generally not expected to use adjoining toilet rooms. Typically, such patients are relocated to other types of rooms when no longer confined to beds. Comments recommended that toilet rooms serving these types of rooms should not have to be accessible.

Response. An exception has been added that permits toilet rooms in critical care and intensive care patient sleeping rooms to be inaccessible (223.1, Exception).

Section 223.2 addresses scoping for hospitals, rehabilitation facilities, psychiatric facilities, and detoxification facilities. The Board has clarified the distinction made in scoping between facilities that specialize in the treatment of conditions affecting mobility (100%) and those that do not (10%), including rehabilitation facilities.

Comment. The Board sought comment on how dispersion of accessible sleeping rooms can be effectively achieved and maintained in medical care facilities such as hospitals and long-term care facilities (Question 13). Commenters with disabilities supported a requirement for dispersion of accessible sleeping rooms among all types of medical specialty areas, such as obstetrics, orthopedics, pediatrics, and cardiac care. Conversely, commenters representing the health care industry pointed out that treatment areas in health care facilities can be very fluid due to fluctuation in the population and other demographic and medical funding trends. Comments indicated that in long-term care facilities, access is provided at rooms that are less desirable than others available in the facility. Commenters recommended that the final rule should include a requirement that ensures that accessibility is fairly dispersed among different types of rooms in long-term care facilities.

Response. The Board has not added a requirement for dispersion in medical care facilities because compliance over the life-time of the facility could prove difficult given the need for flexibility of spaces within such facilities. However, an advisory note has been added to encourage dispersion of accessible rooms within the facility so that accessible rooms are more likely to be proximate to appropriate qualified staff and resources. Since these considerations are not as relevant to long-term care facilities, the Board has added a requirement that the 50% scoping requirement for long-term care facilities be applied to "each type" of resident sleeping room provided to ensure dispersion among all types (223.3).