Knowledge of the Americans with Disabilities Act is an essential part of most practices.

Introduction

Working with patients with permanent physical impairments and disabilities is part of clinical practice. As a treating physical therapist, assistant or ergonomics consultant, it is very important to be versed in the rights of individuals with physical impairments and disabilities. In some cases, injury or illness cause lifestyle and employment changes ranging from minor adaptations to significant changes. To provide the patient or client with the best information on the available adaptations and necessary actions, knowledge of the Americans with Disabilities Act and patient’s rights is essential.

ADA

The Americans with Disabilities Act, established on July 26, 1990, reinforces criteria previously instituted by the Equal Employment Opportunity Commission (EEOC). It is written law, and it has been declared as the Emancipation Proclamation for people with disabilities, in that it gives such persons civil rights protection similar to those regarding race, sex, national origin, and religion. The ADA guarantees accommodation, employment, transportation, state and local government services, and telecommunications, and prohibits discrimination against qualified individuals with disabilities. The Act is divided into four categories, called titles. These titles are based on functional accommodations.

Title I: Employment is applicable to employers of 15 or more persons. For the purpose of this article, only Title I will be discussed.

Intent

The ADA’s intent is simple: To ensure that qualified individuals with a disability are given an equal and fair chance for employment as a qualified person without a disability. According to the ADA, the disabled applicant must first be qualified for the position in question, as the individual without a disability must also first be qualified for the position. The act does not entitle individuals with a disability who are not qualified for a position to special preferences and privileges.

Reasonable Accommodations

The ADA enforces the provision of Reasonable Accommodation to patients or workers who have sustained permanent physical impairments or disabilities. Reasonable Accommodation is defined as: "Providing reasonable accommodations for the purpose of enabling a qualified individual with a disability to perform the essential functions of the job, and/or to enable a qualified individual to be considered as an applicant for a position, and/or to enable a qualified individual with a disability to enjoy equal benefits and privileges of employment as are enjoyed by other similarly employed persons without disabilities."

Reasonable Accommodation may include making the existing facilities readily accessible; restructuring jobs; modifying work schedules; reassigning individuals to vacant positions; acquiring or modifying equipment or devices; adjusting or modifying examinations, training materials or policies; providing readers or interpreters; and/or other similar accommodations.

When determining the appropriate Reasonable Accommodation, the process may involve an informal interactive plan between the employer and the qualified individual. This process should identify the limitations resulting from the disability and the potential accommodation that can overcome the limitation. In most cases, it is up to the person with a disability to request an accommodation. If job reassignment is the accommodation, then with the exception of state law workers’ compensation, the pay rate does not need to be the same. In addition, accommodations are not required under the ADA if the employer can demonstrate "Undue Hardship." Undue hardship is defined as: "Significant difficulty or expense that must be incurred by the employer when considering the reasonable accommodation." The Undue Hardship includes both other employees and the operation’s ability to conduct business. Specific reasonable accommodations are described in the chart on the preceding page.

Employment Testing

Legal issues relating to injured workers and individuals with disabilities with respect to employment are long established. The ADA’s evolution has helped to increase awareness, guarantee fair hiring practices, and provide a safe and healthful working environment for all workers. To ensure equal and fair hiring practices, an individual’s physical capacities should match the job requirements in all aspects and in all placement procedures—not only when ADA issues are present. Employers must make hiring decisions based on the individual’s ability to perform the job’s essential functions. The individual’s ability must be measured objectively with respect to the actual physical and mental requirements of the position in question. As a result, employment testing has evolved in an attempt to select the best worker for the position.  Employment testing may range from informal questionnaires to state-of-the-art preemployment screens.

Employment testing focuses on finding a good match between the applicant’s abilities and the job’s mental and physical requirements. A good match will help ensure maximum productivity from the worker and the maximum utilization of the worker’s skills and experience, as well as reduce the potential for job-related injuries and accidents.

Compliance with the ADA’s rules and regulations can be ensured through the use of objective measurements obtained from carefully chosen testing procedures and good documentation.  

Who is responsible for ADA Compliance?

Several parties are responsible for enforcing the ADA. First, the employer is responsible for understanding the ADA and its application to the operation. The Union, or the operation’s bargaining unit, is also responsible for ADA compliance. However, ultimately it will be the Equal Employment Opportunity Commission’s (EEOC) obligation to enforce and further define and interpret the ADA. Individual state and local laws may also affect ADA governance. Hence, it is also important to check with state and local laws for their rules and regulations regarding employment and safe work practices for employees with and without disabilities.

Conclusion

Physical therapists and assistants treat patients with physical impairments and disabilities on a daily basis. To provide the patient or client with the best information about accommodations and necessary actions, the physical therapist should be well-versed in the rights of the injured patient and the laws that govern those rights. For additional information regarding the ADA, please refer to the EEOC; it can be reached at (800) 669-EEOC.

Nicole Matoushek, MPH, PT, has more than 11 years’ experience in physical therapy and ergonomic consulting. She practices at Ergorehab in St Petersburg, Fla, and can be reached at nicole@ergorehabinc.com