Creating an Inclusive Culture for Patients Who Have Disabilities


by LAURA M. CASCELLA, MA, CPHRM P


roviding inclusive and culturally competent care is an essential strategy for engaging patients, improving adherence to treatment, and help- ing address issues related to bias and health disparities. Discussions about culturally competent care often focus on individuals who are racial or ethnic minorities or who identify with the LGBTQ+ community. Yet, another special and diverse population often is overlooked — people who have dis- abilities.


A 2025 cross-sectional analysis of CAHPS measures found that adults who have disabilities reported lower overall satisfaction with healthcare services, less timely care and worse interactions with providers when compared with individuals who do not have disabilities.¹


Additionally, a small but widely publicized 2022 study in Health Affairs showed that people who have disabilities face numerous barri- ers in accessing and finding appropriate healthcare services.² In some instances, the barriers were physical, such as inaccessible office spaces and lack of appropriate equipment. For example, some of the physi- cians interviewed for the study reported sending patients who use wheelchairs to supermarkets, grain elevators, zoos, or cattle process- ing plants to obtain their weight.


In other instances, the barriers were due to inadequate communica- tion, knowledge deficits, or biased attitudes toward these patients. Some of the study’s physician participants noted that patients who have disabilities create a burden on their already busy practices or that these patients feel “entitled” to special accommodations.²


Unfortunately, this study showed that although healthcare providers cannot legally discriminate against patients who have disabilities — per the Americans with Disabilities Act of 1990 (AwDA) — discrimi- nation still occurs and can be difficult for patients to overcome. As a result, these patients might not receive vital care and health dispari- ties may continue to endure.


Certain structural barriers to care noted in both studies — e.g., time limitations, documentation burdens, care coordination, lack of ac- commodations and reimbursement issues — will require interven-


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tions at many levels to help healthcare providers meet the unique needs of patients who have disabilities. However, providers can take steps to proactively address other barriers and build inclusive cultures that support these patients. Strategies to consider include the follow- ing:


• Seek training and education on the AwDA to better understand its implications for patient care and your responsibilities under the law. “As a piece of civil rights legislation, the AwDA includes both public-sector services (Title II) and private services available to the public (Title III) and is not discretionary.”²


• Ask patients about any physical or communication-related accommodations they need when they schedule their appoint- ments. One of the structural barriers to care noted in the Health Affairs study was lack of awareness that a patient requiring ac- commodations was scheduled for an appointment.


• Document in patients’ health records their disability status and any accommodations they require to help prepare for future visits and to ensure adequate support is in place.


• Discuss with patients the process of the exam and any important information they might need to know about preparing for their appointment. For patients who have mobility or visual disabili- ties, make them aware of the layout and accessibility features of the facility.


• Ask patients about their communication preferences and deter- mine whether they need access to language services, interpreters and/or assistive technologies. Healthcare practices that receive


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