According to 2016 estimates from the American Community Survey (ACS), about 12.8% of people in the United States live with a disability. This makes it likely you’ll eventually work with a client who has a disability, though you may not be aware of it.
Even if you never treat anyone with a disability, your therapy office must still comply with the standards outlined in the Americans with Disabilities Act. This act protects the right of people with disabilities to access the same health care opportunities as people who are able-bodied.
As a licensed mental health professional, you’re a health care worker, so your practice is considered a place of public accommodation—whether you work for a large clinic or operate a private practice. In other words, your therapy office must be accessible to people with disabilities, even if your office is in your home.
What Measures Does the Americans with Disabilities Act Require?
ADA legislation is sometimes confusing, since requirements vary for small and large businesses and certain organizations such as health care offices.
As a therapist or counselor, you’re likely a compassionate, empathetic professional. You might make it clear on your website or professional advertisements that you treat all people, regardless of gender, disability, or sexual orientation. Perhaps you even work to combat discrimination in your personal life. However, while you may not actively discriminate, not providing reasonable accommodations is a form of discrimination, as is neglecting to make your office accessible.
To comply with the ADA, you’ll need to take steps to make sure your office accommodates all of your clients. If you work out of your home, the part of your house where you provide therapy, including the entrance, hallways, and restrooms set aside for client use, must also be accessible.
If your office is in an older building (built before 1993 and not modified since 1992), it may lack accessible accommodations. Compliance generally involves both removing barriers and providing accommodations for people with disabilities.
Some examples include:
- Installing a ramp if you have steps outside of the building.
- Updating door hardware and making sure all doors can be opened with five pounds of force or less.
- Making sure you have one accessible parking space if you offer designated parking spaces.
- Making sure all doorways and passageways are at least 32 inches wide so people using mobility aids such as wheelchairs or walkers can pass.
- Moving furniture in the office and hallways to allow people using mobility devices to navigate the space.
- Making sure any signs relevant to your practice include Braille and are 60 inches from the floor on the latch side of the door.
- Removing any carpeting not secured to the floor or with a pile of more than half an inch.
- Offering auxiliary aids in your therapy office, such as assisted listening devices, large print or Braille documents, and so on.
- Making sure your website can be accessed by people who are visually impaired.
Reasonable Accommodation vs. Undue Burden
You’re required to remove any barriers and provide any accommodations that are, in the words of the ADA, “readily achievable.” The act does not, however, require you to take on what’s referred to as an “undue burden” when altering your office to support people with disabilities. ADA requirements do take into consideration the size of your small business and your resources.
If you work from a small office or your home, it may not be possible to achieve certain accommodations. For example, you might easily install a grab bar next to the toilet in the bathroom. But you may not have the building space or the finances to increase the size of a bathroom that’s too small for mobility aids like wheelchairs or walkers. Maybe it isn’t possible for you to replace a heavy door with one that can be opened with less than five pounds of force, but you could accommodate a client who can’t open the door by meeting them when they arrive.
You typically won’t be penalized for failing to meet ADA guidelines if you can prove both of the following statements:
- Certain architectural or structural changes are not possible or within your financial means.
- You have taken all possible steps to make your therapy office accessible and offered reasonable accommodations to clients.
Examples of accommodations might include going to a client’s home for your session or offering therapy by phone or webcam (with HIPAA-compliant software). You might also arrange to use a colleague’s office for an hour each week to meet your client.
Paying for Disability Accommodations
As a small business owner, you’re expected to factor the cost of making your practice accessible into your operating costs (within reason). As stated above, you may not have to make renovations that would cause undue burden to your practice, but you’ll have to provide proof. Some options may help ease the financial challenges of paying for disability accommodations.
If you run a small business, removing barriers in your office and making alterations to improve accessibility may qualify you for the Disabled Access Credit. You can receive this credit as long as your practice’s revenue for that tax year is less than $1 million. Businesses of any size can claim a tax deduction of up to $15,000 each year for any costs of removing barriers in an office space.
In some cases, insurance carriers offer reimbursement for the cost of providing service accommodations or auxiliary aids in therapy. Because this isn’t a requirement, it can depend on the type of accommodation your client needs and the insurance carrier. It’s best to check with the insurance provider on a case-by-case basis. It’s illegal to charge a client for the cost of any aid you provide, even if that cost is greater than your session fee.
Addressing Complaints of Discrimination
If a client feels your office you haven’t provided reasonable accommodations for their disability or believes your practice has discriminated against them in some way, they may file a complaint with the Department of Justice and/or begin a civil action (lawsuit).
Once a complaint is filed, the DOJ will then investigate your practice in a compliance review. If you believe you’ve acted in good faith to make your practice compliant with ADA requirements, you’ll have to provide proof of your efforts. If you can’t, you may have to pay a civil penalty of up to $50,000. If you’re found at fault again, you may have to pay up to $100,000.
Possible consequences of operating a therapy practice that’s not compliant with ADA include lawsuits and compliance reviews, both of which can become quite expensive, especially if you’re found at fault. Modifying your office space may seem costly, but if you’re sued for discrimination, you’ll most likely end up paying a great deal more.
- ADA office checklist: Is your office accessible? [PDF] (2008). Office of Compliance. Retrieved from https://www.ocwr.gov/sites/default/files/wp-content/uploads/2010/03/fastfacts_ada.pdf
- ADA update: A primer for small business [PDF]. (2011, March 16). U.S. Department of Justice. Retrieved from https://www.ada.gov/regs2010/smallbusiness/smallbusprimer2010.htm
- Kraus, L., Lauer, E., Coleman, R., & Houtenville, A. (2018). 2017 disability statistics annual report [PDF]. Durham, NH: University of New Hampshire. Retrieved from https://disabilitycompendium.org/sites/default/files/user-uploads/2017_AnnualReport_2017_FINAL.pdf
- Novotney, A. (2018). Evaluate your website for ADA compliance. Monitor on Psychology, 49(2). Retrieved from https://www.apa.org/monitor/2018/02/website-compliance
- Tran, A. (2011). Barriers, psychotherapy, and the ADA. The Therapist. Retrieved from https://camft.org/images/PDFs/AttorneyArticles/Ann/barriers_psychotherapy_ada.pdf
- What is the Americans with Disabilities Act? (2019). ADA National Network. Retrieved from https://adata.org/learn-about-ada