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It's been two decades since Congress passed the Americans With Disabilities Act (ADA). Signed into law on July 26, 1990, the landmark legislation prohibited discrimination on the basis of disability, with provisions for employment, building access, transportation and communications. It was an historic feat for disability advocates, but would be followed by years of fights, lawsuits and demonstrations against local governments and businesses that failed to comply.
Today, disability rights have improved, but ADA proponents still log complaints with the U.S. Department of Justice on a regular basis. As professionals who already serve individuals with disabilities, physical therapists can be their best advocates. Not sure where to start? In honor of the ADA's 20th anniversary, here are a few ways physical therapists can ADVANCE the cause:
1. Help patients secure funding for a mobility device.
Payer rules vary within and across states, which complicates the reimbursement process for standers and mobility aids. Physical therapists can improve the odds of payment by being an active part of the ordering process, according to Nancy Perlich, COTA, ATP, a funding specialist with EasyStand, Morton, MN. "In many cases, [therapists] are the first contact the client runs into, so [patients] look to them for that kind of support," she said.
To be effective, patients, therapists and suppliers should coordinate in planning and applying for funding--and PTs may need to lead the charge. "Sometimes a consumer will already understand the process.and know who their suppliers and clinicians are, so they take the lead and will pull everybody together," Perlich said. "But there may be a scenario where the therapist has to take the lead and explain options to the consumer."
PTs play a crucial role in determining the appropriate device, and then proving medical necessity. Documentation should be comprehensive, but also comprehensible to those on the payer end, who may lack the same medical expertise. Include basics like height and weight, and explain not just why a specific device was chosen, but also the alternatives that were considered and rejected, Perlich said.
If funding is rejected, follow up with the patient. State and federally funded attorneys called Protection Advocates for Assistive Technology can coordinate an appeal, Perlich noted, and physical therapists can provide valuable testimony, whether it's in-person, by phone or written. "If [PTs] feel a program or device is appropriate for their client as part of their therapy, ethically, I think they're bound to follow through," Perlich said.
2. Advocate for integrated or community settings.
Title II of the ADA prohibits the segregation of individuals with disabilities, including cases of unnecessary institutionalization. The provision was upheld in the Olmstead Act, a Supreme Court decision in 1999 that ordered states to place individuals in community settings whenever possible.
Still, states continue to come under fire for unnecessary institutionalization and failure to provide integrated settings. Individuals with physical and mental impairments have been housed in nursing homes, with limited options for more independent living.
A number of advocacy groups exist that rally for community settings, including ADAPT, a vocal grassroots group that campaigns for disability rights.
Physical therapists can get involved on the national level or contribute locally by supporting those who seek housing beyond institutions. PTs understand the functional skills needed to live in a community-based setting, so a thumbs-up could help patients make their case. PTs can also join the call for integrated housing options, so individuals have an alternative to institutions.
3. Apply for grants related to disability research and programs. If you're a scholar, help the physical therapy field find new methods for diagnosis and intervention, which can lead to a higher quality of life for individuals with disabilities. Search for funding opportunities through ScanGrants, a public service that lists grants by topic, including physical therapy, physical rehabilitation and disabilities research.
School-based physical therapists should also monitor grants, including those made available through the American Recovery and Reinvestment Act. Know what's in your school system's capital budget, Perlich said, and investigate areas that may benefit from additional funding, such as a playground for children with special needs.
4. Evaluate your facility's accessibility to those with disabilities.
The physical therapy or rehabilitation departments may be wheelchair accessible, but what about the rest of the hospital? The gym may be designed for easy mobility, but are the consult rooms and waiting area that accommodating? Put your practice to the test with the ADA Access to Medical Care for Individuals with Mobility Disabilities, a publication from the Department of Justice Civil Right Division. The guidance outlines protocols like door clearance and turning space in exam rooms and explains the need for features like exam tables with adjustable heights. If there's room for improvement, raise the issue at your next staff meeting or schedule a time with your supervisor to discuss what needs to be changed.
Physical therapists may have more experience with accessible equipment and patient lifts than other clinicians, so offer assistance when possible. If the department allows, accompany a patient to an appointment to ensure safe transfer, or demonstrate the best technique for operating an adjustable table.
If the facility's interior--and staff skills--are up to snuff, consider outdoor features, like sidewalks and curbs. Are there enough ramps to permit easy access, and are there any cracks in the pavement? Depending on the problem, you may need to get maintenance or the local government involved.
5. Launch a job training program at your facility.
"We're all in this field because we believe people do get better with rehab and make those substantial gains. So it only seems logical that the next step is to get them back into the work force," said Rosadele Plumari, director of hospital support services at Bryn Mawr Rehab Hospital, Malvern, PA. The hospital, along with sister facilities under the Main Line Health System, is the latest to host Project SEARCH, a growing campaign to help individuals with disabilities gain employment through on-the-job training and career counseling.
The program began at Cincinnati Children's Hospital in 1997, but has since spread across the nation and to other countries. Bryn Mawr Rehab decided to get involved after Plumari attended a session about Project SEARCH.
While the original program was designed for disabled high school students, Main Line Health is welcoming older individuals to apply. Interns will have the opportunity to work in the dietary/nutrition department, materials management, transport, data entry and environmental services/housekeeping, plus gain resume writing and interview tips during the classroom segment. The program includes three 10-week rotations, but Plumari hopes it leads to permanent placement. "If there are positions open in their rotation that [the interns] want to apply for, we're encouraging and hopeful they will be able to get those," she said.
Physical therapists will be involved in the program on several levels, working with interns on the ground in the transport department, and also determining the interns' own assistive needs as part of the selection committee. "If there are adaptations or some type of equipment needed to make [the interns] able to do their job, I want input from therapy," Plumari said.
Main Line Health hopes to expand Project SEARCH into the community, so interns can get job training at grocery stores, banks and other businesses. But, Plumari believes, it's no surprise that it's starting in health care. "We see people with disabilities every single day, so we know these are folks who can get back out there," she said.
Cheryl McEvoy is former assistant editor/web editor for ADVANCE.
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