Questions & Answers of ADA

Health Facilities

IMPORTANT NOTE: Ultratec provides this information pertaining to the ADA requirements solely as a convenience for our customers. We cannot provide legal opinion or legal advice regarding possible positions that may be adopted by administrative agencies or the courts as to any aspect of the Americans with Disabilities Act.

Please feel free to use these resources as needed for your local advocacy efforts.

TTY, TDD and Text Telephone all refer to the same device.

What does the Americans with Disabilities Act (ADA) require for telephone accessibility for patients and visitors who use TTYs?

Several types of telephone accessibility are required under the ADA:

  1. Patients who are deaf or hard of hearing must be able to make TTY (text telephone) calls within the health facility.

    "A public accommodation that offers a customer, client, patient or participant the opportunity to make outgoing telephone calls on more than an incidental convenience basis shall make available, upon request, a TDD for the use of an individual who has impaired hearing or a communication disorder."

    Title III, Federal Register, July 26, 1991, Section 36.303 (d)
  2. Specific areas in the hospital must also be equipped for TTY use.

    "If a public pay telephone is located in or adjacent to a hospital emergency room, hospital recovery room, or hospital waiting room, one public text telephone shall be provided at each such location."

    Title III, ADA Accessibility Guide - ADAAG, Federal Register, July 26, 1991

What equipment do I need to comply?

To comply, TTYs, along with signaling devices, are needed. A nonprinting TTY is suggested for patients to use in their rooms. Some TTYs allow for a direct connect set up in which the user is able to dial directly from the keyboard. A printing TTY offers a built-in printer which is useful for recording information from calls to the admissions desk, appointment desk and to the emergency room.

For public areas, the Public TTY is preferred because it is designed for public use. It is built-in, offering convenience for both the TTY user and hospital staff.

What is a TTY (text telephone) and how is it used?

A TTY, or text telephone, is a device that allows people to type and read words to communicate over the telephone instead of speaking and listening. TTY conversations are conducted by two parties, both of whom must use a TTY. A TTY works by transmitting tones (in response to what is typed) through the telephone line to another TTY machine on the other end of the conversation.

What is a public text telephone (or TTY)?

A public text telephone is a TTY that is designed for public use. The Public TTY, manufactured by Ultratec, is an example of a public text telephone. The TTY is housed in a metal drawer mounted underneath an existing pay phone. The drawer automatically opens when TTY signals are received. When not in use, the drawer is closed, protecting the Public TTY from vandalism. It is easy to install on an existing pay phone and is approved by major telephone companies for use with their equipment.

What are the benefits of installing a Public TTY vs. having staff responsible for loaning and collecting equipment for public phone use?

The Public TTY is a permanent, built-in, vandal-resistant solution to the need for 24 hour telephone accessibility as required by the ADA. It requires no staff involvement. There is no staff training required. Once signs are posted, patients and visitors can access the TTY at any time, resolving such issues as security (who is going to make sure equipment is returned?). With the Public TTY, the drawer closes and the public phone is ready for the next call.

How many TTYs should health facilities have on hand for patients to use in their rooms?

The table in the Federal Register (Vol. 56, No. 144, 9.1.3 Sleeping Accommodations for Persons with Hearing Impairments) shows that a facility with 101 to 150 "elements" (beds or rooms) must have at least five of them accessible to patients with "hearing impairments." A facility with 76 to 100 elements must provide at least four accessible beds or rooms. Even a facility with only one element must offer accessible accommodations. This means having TTYs and signalers available for patient use. This is in addition to the TTYs specified by ADA for use at public phones near waiting rooms, recovery rooms, and emergency rooms.

ADA Requirements for Guests who are Deaf or Hard of Hearing

Newly Constructed or Renovated Facilities
Taken from the ADA Accessibility Guidelines
Total Rooms No. of Rooms that must be accessible
1 to 25 1
26 to 50 2
51 to 75 3
76 to 100 4
101 to 150 5
151 to 200 6
201 to 300 7
301 to 400 8
401 to 500 9
501 to 1000 2% of total
1001 and over 20 plus 1 for each 100 over 1000

Do patients need instruction in TTY use?

Most people who use TTYs are familiar with them because it is their primary means for using the telephone. However, models of TTYs can vary. Brief instructions on a laminated card could be included with the TTY upon delivery to the room.

Will TTY equipment work with my phone system?

Yes, Ultratec's TTY equipment is FCC approved and designed to be compatible with most standard, analog telecommunications systems. Check with your telecommunications service provider to ensure compatibility.

Which TTY features are useful for the patient?

A nonprinting TTY that provides the patient with direct connect phone access is preferred. Direct connect allows the patient to dial via the keyboard without an additional phone making phone use more convenient and the bed tray less cluttered.

If I provide a TTY for the patient, does that mean that phone service is then fully accessible?

No, you also need to provide a signaling device which will alert the patient when the telephone rings. The Simplicity Telephone Ring Signaler is a signaling device which connects directly to the telephone line and to a lamp in the room. When the telephone rings, the lamp flashes on and off. Watchman is U.L. Listed for safety. It does not provide a ground pin so you need to check the electrical requirements for your facility.

Which health facilities need to comply?

According to the Americans with Disabilities Act:

"The term 'hospital' is used in its general sense and should be interpreted broadly."

Title III, Federal Register, Vol. 56, No. 144

This includes hospitals, nursing homes, psychiatric centers, clinics, and urgent care centers.

How can I let patients know that my hospital is TTY accessible?

International TTY Symbol

Signs that say "TTYs available here" or "TTY Accessible Telephone," along with the international TTY logo (see illustration) will let your patients and visitors know that you have equipment for their use. Post signs in public areas or near a TTY-equipped telephone. You should also mention the availability of equipment in the literature you include in your patient information packets. Most health facilities also list their TTY numbers in their directory listings.

The media is also very interested in accessibility and will often run your press releases, especially if they are accompanied with a photograph that helps to tell your accessibility story.

How Can Ultratec Help with Compliance?

For patient use:

Ultratec offers several models of desktop TTYs that are suitable for guests, customers and patients as well as the Simplicity Telephone Ring Signaler which alerts TTY users to an incoming call by flashing a lamp on and off.

For hospital staff:

Ultratec recommends the Superprint 4425, an advanced printing TTY with Direct Connect and Auto Answer.