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Chapter 3: Providing Accommodations

This page is one chapter of a broader Implementation Guide on providing accessible healthcare for people with disabilities. The chapter will guide you through providing accommodations at your clinic or organization. The information in this chapter is a synthesis of existing research and learnings from health systems across the country. It is intended to provide guidelines adaptable to your local context.

Download this Chapter as a PDF↗

This chapter includes: 1) an introduction to the topic, 2) six steps for implementation, and 3) a variety of appendices. Under each step, the Actions and Tasks section outlines best practices and questions to consider while creating and implementing the provision of accommodations at your organization. The Materials and Resources section lists the relevant appendices, which include worksheets, templates, examples, and other resources to assist you in completing the Actions and Tasks of each implementation step.

Appendices can also be used independently. For example, you could use Appendix 3.4: Accommodations Frequently Asked Questions if you are only interested in sample responses to questions related to providing accommodations.

A note about terminology: Throughout this chapter, we refer to accommodations as any modification or adjustment made to standard processes in an organization to facilitate the full engagement of patients with disabilities in their healthcare. Healthcare organizations are legally required to make reasonable modifications of policies, practices, and procedures, ensure effective communication, and maintain accessible facilities for people with disabilities.1-3 Healthcare organizations are also required to provide reasonable accommodations to their caregivers with disabilities.4 In this guide, we refer to all such modifications as “accommodations”.

Accommodations can be requested by a patient to facilitate their participation in their care and should be documented in a patient’s chart (see Chapter 2: Documenting Disability Status and Accommodation Needs). In contrast, accessibility features such as accessible bathrooms and ramps should be available to all patients and do not need to be requested. Appendix 0.7: Accessibility Screening Tool Template in the General Resources chapter can help identify potential points of care and locations where accommodations or accessibility features should be available.

People with the same disabilities can benefit from a range of different accommodations. Patients should always be at the center of the conversation in determining which accommodations enable access to their care. It is also important to note that accommodations may be needed across a patient’s healthcare journey beyond the clinical encounter – from registration to after visit summaries. Accommodation needs might differ by setting and clinical encounter (e.g., a patient might need a different modification during an oncology appointment than at a blood draw appointment.)

Why is it important to provide accommodations?

A growing body of literature finds that people with disabilities experience disparities in health and healthcare outcomes.5-7 For example, compared to non-disabled people, people with disabilities are more likely to have a greater number of chronic conditions and have higher rates of asthma, hypertension, emphysema, cardiovascular disease, diabetes, and arthritis.5 People with disabilities are also more likely to rate the quality of their health as fair or poor.8,9 Research has identified that a key factor in poor outcomes is the lack of provision of accommodations.10-12

What are the requirements for providing accommodations?

The Americans with Disabilities Act is a federal civil rights law that requires healthcare organizations to provide full and equal access to healthcare for people with disabilities.1 It requires healthcare organizations to provide effective communication, establish accessibility standards, and make reasonable modifications to provide patients with disabilities access to the organizations’ health programs and activities.

Additionally, healthcare organizations are required by Section 504 of the Rehabilitation Act and Section 1557 of the Patient Protection and Affordable Care Act to provide disabled patients with accommodations, including auxiliary aids and services, to ensure access to care.13 Healthcare organizations are also required to provide accommodations to disabled caregivers of patients.

Steps FOR Providing Accommodations

When implementing any new accessibility initiative at your organization, earning buy-in from leadership is essential. Support from leadership will ensure you have the resources necessary to procure and successfully provide accommodations requested by patients with disabilities.

Actions and Tasks

  1. Identify what types of leadership support and buy-in you will need.
  2. Identify potential champions across your organization.
  3. Identify how providing accommodations will fit within your organization’s existing priorities and initiatives (e.g., health equity, quality and safety, patient experience goals, etc.).
  4. Determine if your organization is involved in any regulatory initiatives that require providing accommodations (e.g., Joint Commission Excellent Health Outcomes for All Certifications, U.S. Centers for Medicare and Medicaid Services (CMS) requirements, state-level requirements, etc.)

Materials and Resources

*Appendices 0.3 and 0.10 can be accessed in the General Resources chapter↗.

The implementation team will be responsible for designing, leading, and monitoring the provision of accommodations across your organization.

Actions and Tasks

  1. Identify the implementation team for providing accommodations.
    • Consider including people across different departments and units within your organization.
    • Include leadership and others who have the authority to make changes.
    • Include staff who will be doing the work; they know their clinic workflows and will be helpful in implementing and piloting the project. This will also help with buy-in for the staff—who will more eagerly participate—and sustainability will be more attainable.
      • It could be helpful to start with a pilot team to work through challenges before expanding to the entire clinic or healthcare system.
  2. Determine the implementation team meeting structure.
    • How often will the team meet?
    • Is this a project that will be part of a quality improvement team or embedded within another team?
  3. Identify champion(s) for the project
    • Who is this person(s) going to be?
    • Are they able to implement changes?
    • Will they be a clinical champion or a non-clinical champion? Are both clinical and non-clinical needed?
    • Is there someone at the system level with whom you can partner? For example, a Disability Coordinator or your organization’s Section 1557 Coordinator might already be engaged in the delivery of accommodations.
  4. Establish common goals for team.
    • Ensure that it fits within organizational goals.
    • Use SMART Goals (Specific, Measurable, Attainable, Realistic and Time-bound)

Materials and Resources

*Appendix 0.5 can be accessed in the General Resources chapter↗.

Identify the current state of documenting disability status and accommodation needs at your organization using Appendix 3.2: Accommodations Needs Assessment.

Actions and Tasks

  1. Engage with other healthcare organizations to understand how they provide accommodations, including what is and isn’t working for them. Consider joining the Disability Equity Collaborative’s Leaders workgroup to create a peer network.
  2. Determine how you will include patient perspectives.
    • Will you include people with disabilities on your implementation team?
    • Will you convene a patient advisory board?
    • Will you conduct a patient experience survey?
    • Will you engage disability community organizations?

Materials and Resources

*Appendices 0.7 – 0.9 can be accessed in the General Resources chapter↗.

In determining what accommodations your organization will provide, consider all essential activities required in a visit (e.g., scheduling, navigating within the facility, communication during and after the visit, etc.). Patients with disabilities should be able to access each of these essential activities. For example, if you provide after visit summaries, plan accommodations so that patients with visual, cognitive, and communication disabilities can access these materials.

Actions and Tasks

  1. Use your completed Appendix 0.7: Accessibility Screening Tool Template↗ to determine what accommodations your clinic or organization will provide.
    • Plan how equipment will be purchased, including which budgets will fund them.
    • Identify the scope of the project. Consider if the accommodations will be available across the entire organization, or a single clinic.
  2. Decide how accommodations will be provided within a clinic. Aim to integrate the process into existing clinic and system-level workflows when possible. This step can include the following activities:
    • Identify local barriers and facilitators to providing accommodations.
      • For example, determine clinic level readiness and motivation for providing accommodations and potential pitfalls.
    • Use the Accommodations Implementation Planning Worksheet (Appendix 3.4) to specify site or clinic goals, strategies, timelines, milestones, and measures for providing accommodations.
    • Create a workflow map, a visual representation of the actions, decisions, and tasks to be performed for successful provision of accommodations. Appendix 0.6: Project Planning↗ includes example workflow maps. Consider the following details:
      • Who will purchase the necessary equipment for disability accommodations?
      • How many of each accommodation will the clinic need?
      • Where will the accommodation be located?
      • How or when will new supplies be ordered?
      • How will the accommodations be maintained?
      • What infection control issues need to be considered?
      • Who will schedule if the accommodation involves providing a service?
    • Determine what can and cannot be adapted in the process for providing accommodations. For example, could there be different processes for different types of accommodations?
    • Determine the resources needed to provide accommodations. For example, you will likely need to dedicate time for staff to complete trainings.
  3. Following decisions made on workflows, processes, and roles, revisit the composition of the implementation team. Determine if additional individuals from departments or units that will be involved in any aspect of the process to provide accommodations should be included.

Materials and Resources

*Appendices 0.5 – 0.8 can be accessed in the General Resources chapter↗.

Ahead of implementation, consider the following actions to ensure staff, patients, and your organization’s systems are prepared to provide and use accommodations.

Actions and Tasks

  1. Identify, purchase, or develop necessary resources and accommodations.
  2. Ensure that identified accommodations can be documented in the electronic health record (EHR). (See Chapter 2: Documenting Disability Status and Accommodation Needs↗ for additional information.)
  3. Determine who will provide consultation to assist with training for staff and providers on use of accommodations.
    • This person will offer expert guidance, feedback, and problem-solving to a site longitudinally.
    • This can be a practice facilitator or similar role.
  4. Determine who will provide technical assistance for both providing accommodations generally and the use of each accommodation.
  5. Determine how accommodations will be maintained.
  6. Create resources and trainings on how to use accommodations for staff and providers (see Appendix 3.7: Accommodations Training Table).
  7. Identify or develop tools and reminders to encourage use of accommodations (see Appendix 3.4: Accommodations Frequently Asked Questions).
  8. Identify or develop patient-facing education materials to disseminate information on available accommodations to patients.
  9. Determine how success will be defined for providing accommodations, including appropriate metrics (e.g. were requested accommodations provided, patient, staff, and clinician satisfaction with the process, etc.).
    • Specify how you will monitor or assess whether patients are receiving requested accommodations.
    • Develop an evaluation plan to reflect your definition of success.

Materials and Resources

*Appendix 0.5 can be accessed in the General Resources chapter↗

Roll out the implementation plan developed in previous steps to provide accommodations.

Actions and Tasks

  1. Track and communicate rates of providing accommodations to responsible individuals (e.g., clinic leadership, those providing accommodations) and the implementation team.
  2. Review site-level data on provision rates and determine if changes in workflow or strategies are needed.
  3. Review site-level data to determine if additional accommodations are needed.
  4. Make and document all needed adaptations.
  5. Conduct Audit and Feedback, an implementation strategy that includes providing site-level staff, provider, or team-level data on providing accommodations to those assigned to perform tasks.
  6. Recognize high performing staff, clinicians, or specific clinics or sites to recognize and celebrate high provision rates.

Materials and Resources

Appendices

NAME DESCRIPTION
Appendix 3.1: Accommodations Implementation Team (PDF, 291 KB)↗ A list of all the individuals who could participate on the implementation team.
Appendix 3.2: Accommodations Needs Assessment (PDF, 482)↗ A worksheet to review the current landscape of an organization, identify mission, priorities, gaps, strengths, and specific goals for providing accommodations.
Appendix 3.3: Accommodations Implementation Planning (PDF, 480 KB)↗ A worksheet to identify the future direction and processes that will be followed for implementing accommodations.
Appendix 3.4: Accommodations Frequently Asked Questions (PDF, 285 KB)↗ A Frequently Asked Questions (FAQ) document for staff about providing accommodations.
Appendix 3.5: Accommodations Barriers and Strategies (PDF, 437)↗ A list of potential barriers to provide accommodations and possible strategies to address the barriers. Barriers are organized categorically.
Appendix 3.6: Accommodations Monitoring Progress and Adaptations (PDF, 298)↗ A worksheet to track progress and adaptations to the implementation plan.
Appendix 3.7: Accommodations Training Table (PDF, 315 KB)↗ A training table that outlines who may be trained, what challenges, topics, or attitudes training could address, when to conduct training, and how.

References

  1. Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 42 U.S.C. §12101 et seq. (1990). https://www.congress.gov/bill/101st-congress/senate-bill/933
  2. Iezzoni LI, McKee MM, Meade MA, Morris MA, Pendo E. Have Almost Fifty Years Of Disability Civil Rights Laws Achieved Equitable Care? Health Affairs. 2022/10/01 2022;41(10):1371-1378. doi:10.1377/hlthaff.2022.00413
  3. Office for Civil Rights. Section 504 of the Rehabilitation Act of 1973. U.S. Department of Health and Human Services. Updated January 7, 2025. Accessed October 3, 2025, https://www.hhs.gov/civil-rights/for-individuals/disability/section-504-rehabilitation-act-of-1973/index.html
  4. ADA National Network. The ADA and Caregivers: Frequently Asked Questions. Accessed October 8, 2025, https://adata.org/factsheet/ada-and-caregivers
  5. Stransky M, Jensen K, Morris MA. Adults with Communication Disabilities Experience Poorer Health and Healthcare Outcomes Compared to People without Communication Disabilities. Journal of General Internal Medicine. 2018;33(12):2147-2155. doi:doi: 10.1007/s11606-018-4625-1
  6. Krahn GL, Hammond L, Turner A. A cascade of disparities: Health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews. 2006;12(1):70-82. doi:10.1002/mrdd.20098
  7. Krahn GL, Walker DK, Correa-De-Araujo R. Persons With Disabilities as an Unrecognized Health Disparity Population. Am J Public Health. 2015/04/01 2015;105(S2):S198-S206. doi:10.2105/AJPH.2014.302182
  8. Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Report. Jul-Aug 2004;119(4):418-26.
  9. Altman B, Bernstein A. Disability and health in the United States, 2001-2005. 2008.
  10. Iezzoni LI. Eliminating health and health care disparities among the growing population of people with disabilities. Health affairs. 2011;30(10):1947-1954.
  11. Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Campbell EG. Incidence of Accommodations for Patients With Significant Vision Limitations in Physicians’ Offices in the US. JAMA Ophthalmology. 2022;140(1):79. doi:10.1001/jamaophthalmol.2021.5072
  12. Iezzoni LI, Wint AJ, Smeltzer SC, Ecker JL. Physical Accessibility of Routine Prenatal Care for Women with Mobility Disability. Journal of Women’s Health. 2015/12/01 2015;24(12):1006-1012. doi:10.1089/jwh.2015.5385
  13. Nondiscrimination in Health Programs or Activities. 45 CFR §92 (2024). Accessed April 7, 2026. https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-A/part-92

The development of Chapter 3: Providing Accommodations was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award number R01DC020188. We thank the members of the implementation mapping advisory board for their contributions to inform this chapter.

We would also like to express our gratitude to Kori Eberle, Holly Darnell, Dr. Carol Haywood, Jennifer Halfacre, Dr. Tina Studts, and Ellie Mellor for their contributions and review of this chapter. Additionally, we would like to thank the members of DEC’s Leaders workgroup and Standards & Guidelines workgroup for their input and suggestions.

additional chapters

Introduction to Implementation Guide
Chapter 1: Building a Disability Accessibility Program
Chapter 2: Documenting Disability Status and Accommodation Needs
Chapter 4: Effective Communication
General Resources
Under a yellow dividing line, an image of a gear overlays DEC's logo with the text "Implementation Guide" to the left in light blue font.

Large print version available upon request.

Additional chapters are in development.

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