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The Complete Guide to ADA Compliance for Deaf and Hard-of-Hearing Communication Access
What is the ADA?
ADA.org defines the Americans with Disabilities Act as, “…a federal civil rights law that prohibits discrimination against people with disabilities in everyday activities. The ADA prohibits discrimination on the basis of disability just as other civil rights laws prohibit discrimination on the basis of race, color, sex, national origin, age, and religion. The ADA guarantees that people with disabilities have the same opportunities as everyone else to enjoy employment opportunities, purchase goods and services, and participate in state and local government programs.”
In other words, this federal law protects and preserves the equality and equity of people with disabilities, especially as it relates to employment, business service and product consumption, and involvement with government services.
The ADA consists of 5 Titles of federal mandates. ADA.org defines them as the following:
“Title I: Employment
- “Employers must provide people with disabilities an equal opportunity to benefit from the employment-related opportunities available to others. This includes things like recruitment, hiring, promotions, training, pay, and social activities.”
Title II: State and Local Government Services
- State and local governments must provide people with disabilities an equal opportunity to benefit from all of their programs, services, and activities.
Title III: Businesses Open to the Public
- Businesses must provide people with disabilities an equal opportunity to access the goods or services that they offer.
Title IV: Telecommunications
- Telephone companies must provide services to allow callers with hearing and speech disabilities to communicate.
Title V: Other Important Requirements
- The ADA also includes other requirements for how to implement the law. Examples of these requirements include:
- Prohibiting retaliation against a person who has asserted their rights under the ADA
- Stating that a person with a disability is not required to accept an aid or accommodation if they do not want to
- Authorizing courts to award attorneys’ fees to the winning party in a lawsuit under the ADA
- Directing certain federal agencies to issue guidance explaining the law”
History of the ADA
The Americans with Disabilities Act, otherwise known as the ADA, has one additional name given by its writer and sponsor: the Emancipation Proclamation for people with disabilities.
A powerful namesake referring to the 1863 freeing of enslaved individuals by Abraham Lincoln, this freedom was not one from enslavement, but one of equal access and equity.
The Americans with Disabilities Act, led by Senator Tom Harkin, born in 1939 in Cummings, Iowa, has become the foundation of the disability rights movement.
A champion of these rights, Senator Tom Harkin was the lead sponsor of the ADA in the preparation of its passing in 1990. Senator Harkin set many firsts within the Senate Chamber, but one hit even closer to home.
Lesser known to many disability rights movement advocates, Senator Harkin was deeply inspired and motivated in his work with the writing of the ADA by his Deaf brother, Frank Harkin. Deaf from an early age, Frank represented the vast capabilities of an individual despite their hearing loss in an age with significant lack of inclusion and access.
Growing up as a SODA (Sibling of a Deaf Adult), Senator Harkin developed American Sign Language skills and set a Senate chamber first by delivering his ADA introduction speech both in ASL and in spoken English. Evidential of the impact of equal access, this speech delivery embodied the heart of the ADA. Read more about Senator Harkin here!
According to the US Census Bureau, as of 2022, 13.4% or nearly 44.1 million noninstitutionalized U.S. civilians have a disability.
Who the ADA Protects
ADA.gov defines who it protects as, “A person with a disability is someone who:
- has a physical or mental impairment that substantially limits one or more major life activities,
- has a history or record of such an impairment (such as cancer that is in remission), or
- is perceived by others as having such an impairment (such as a person who has scars from a severe burn).
If a person falls into any of these categories, the ADA protects them.”
The includes a wide variety of disabilities including but not limited to:
- “Cancer
- Diabetes
- Post-traumatic stress disorder
- HIV
- Autism
- Cerebral palsy
- Deafness or hearing loss
- Blindness or low vision
- Epilepsy
- Mobility disabilities such as those requiring the use of a wheelchair, walker, or cane
- Intellectual disabilities
- Major depressive disorder
- Traumatic brain injury”
What “Effective Communication” Means
The Americans with Disabilities Act (ADA) requires covered entities to provide effective communication for individuals who are deaf or hard of hearing, ensuring they have an equal opportunity to access programs, services, activities, and information. Effective communication means that communication with individuals with disabilities must be as clear and understandable as communication with others. Depending on the circumstances and the individual’s communication needs, this may include providing appropriate auxiliary aids and services, such as qualified sign language interpreters, real-time captioning, assistive listening systems, or written communication. The appropriate accommodation should be determined through consideration of the individual’s preferred method of communication and the nature, length, complexity, and context of the interaction.
“Covered entities must provide aids and services when needed to communicate effectively with people who have communication disabilities.
The key to deciding what aid or service is needed to communicate effectively is to consider the nature, length, complexity, and context of the communication as well as the person’s normal method(s) of communication.
Some easy solutions work in relatively simple and straightforward situations. For example:
- In a lunchroom or restaurant, reading the menu to a person who is blind allows that person to decide what dish to order.
- In a retail setting, pointing to product information or writing notes back and forth to answer simple questions about a product may allow a person who is deaf to decide whether to purchase the product.
Other solutions may be needed where the information being communicated is more extensive or complex. For example:
- In a law firm, providing an accessible electronic copy of a legal document that is being drafted for a client who is blind allows the client to read the draft at home using a computer screen-reading program.
- In a doctor’s office, an interpreter generally will be needed for taking the medical history of a patient who uses sign language or for discussing a serious diagnosis and its treatment options.
A person’s method(s) of communication are also key. For example, sign language interpreters are effective only for people who use sign language. Other methods of communication, such as those described above, are needed for people who may have lost their hearing later in life and do not use sign language. Similarly, Braille is effective only for people who read Braille. Other methods are needed for people with vision disabilities who do not read Braille, such as providing accessible electronic text documents, forms, etc., that can be accessed by the person’s screen reader program.” (ADA.gov)
Primary Consideration
When determining appropriate communication accommodations under the Americans with Disabilities Act (ADA), an individual’s preferred method of communication should be given primary consideration because people who are deaf or hard of hearing have unique communication needs and preferences. Covered entities should engage in an interactive process by discussing those needs with the individual to identify the auxiliary aids or services that will provide effective communication. While an individual’s preference is an important factor, the requested accommodation may differ depending on the specific circumstances, such as the nature, length, complexity, and context of the communication. In some situations, more than one accommodation may provide effective communication, allowing the covered entity to choose an equally effective alternative that meets the ADA’s requirements.
Some examples include:
1. Medical Appointment – On-Site ASL Interpreter
A Deaf patient who uses American Sign Language (ASL) requests an on-site, same-gendered, qualified ASL interpreter for a pre-surgical consultation. Because the discussion will involve complex medical terminology, informed consent, and opportunities for questions, an in-person interpreter is the most effective form of communication.
2. Brief Follow-Up Appointment – Video Remote Interpreting (VRI)
A Deaf individual has a 10-minute follow-up appointment to review routine lab results. The patient agrees that Video Remote Interpreting (VRI) is an effective option because reliable internet connectivity, appropriate equipment, and clear sightlines are available, allowing timely communication without the need for an on-site interpreter.
3. College Lecture – CART Captioning
A hard-of-hearing student prefers Communication Access Realtime Translation (CART) captioning during classroom lectures. Because the student relies on spoken English rather than ASL, real-time captions provide effective access to lecture content, classroom discussions, and multimedia presentations.
4. Large Public Meeting – CART Captioning and ASL Interpreting
A city council meeting is expected to attract both Deaf ASL users and hard-of-hearing attendees. To provide effective communication for a diverse audience, the meeting includes both qualified ASL interpreters and CART captioning, allowing participants to choose the accommodation that best meets their communication needs.
5. Job Interview – Individual Preference Through the Interactive Process
A Deaf job applicant requests an ASL interpreter for an interview. During the interactive process, the employer discusses the applicant’s communication preferences and confirms that a qualified ASL interpreter will provide the most effective communication. In another interview for a different applicant who is hard of hearing, CART captioning may be the preferred accommodation instead, demonstrating that effective communication depends on the individual’s needs and the specific circumstances.
Compare the functions and uses of VRI versus on-site services in the diagram below!
Who is Responsible for the Services
The responsibility for providing effective communication generally rests with the covered entity—not the individual who is Deaf or hard of hearing. Public accommodations, healthcare providers, businesses, state and local government agencies, and many other organizations are required to provide appropriate auxiliary aids and services, such as qualified ASL interpreters, Video Remote Interpreting (VRI), or CART captioning, when necessary to ensure effective communication. Organizations may not require individuals to provide or pay for their own communication accommodations. However, not every organization is covered by the ADA in the same way. For example, religious organizations and entities controlled by religious organizations are generally exempt from Title III of the ADA, though they may still choose to provide communication access as a matter of inclusion or may have obligations under other applicable federal, state, or local laws. Understanding an organization’s responsibilities under the ADA is an important step toward creating accessible and inclusive environments for Deaf and hard-of-hearing individuals.
Communication access services, such as qualified American Sign Language (ASL) interpreters, Video Remote Interpreting (VRI), and CART captioning, are generally not billable to a patient’s health insurance because they are considered the responsibility of the covered entity under the Americans with Disabilities Act (ADA) and other applicable laws. These services are provided to ensure effective communication and equal access to healthcare—not as a medical treatment or benefit for the patient. As a result, healthcare providers, hospitals, clinics, and other covered entities are responsible for the cost of providing appropriate auxiliary aids and services when they are necessary for effective communication. The cost of these accommodations cannot be passed on to the individual with a disability or billed to their insurance as a substitute for the provider’s legal obligation.
The ADA has played a vital role in advancing equal access for Deaf and hard-of-hearing individuals, but achieving effective communication requires more than simply meeting a legal obligation. It requires understanding that communication needs vary from person to person and that meaningful access begins by listening to the individual’s preferences and engaging in an interactive process. Whether through qualified ASL interpreters, Video Remote Interpreting (VRI), CART captioning, or other auxiliary aids and services, the goal is to ensure that everyone can participate fully and independently. By making communication access a priority, organizations not only comply with the ADA—they foster inclusion, build trust, and create environments where every individual has the opportunity to communicate, contribute, and thrive.
Q&A
1. Does the ADA require businesses to provide sign language interpreters?
Yes, when a qualified sign language interpreter is necessary to provide effective communication. The ADA requires covered entities to provide appropriate auxiliary aids and services based on the individual’s communication needs and the nature, length, complexity, and context of the interaction. Depending on the situation, this may include a qualified on-site ASL interpreter, Video Remote Interpreting (VRI), CART captioning, assistive listening devices, or other communication accommodations.
2. Who pays for an ASL interpreter or CART captioning under the ADA?
The responsibility for paying for communication access services generally belongs to the covered entity—not the Deaf or hard-of-hearing individual. Healthcare providers, businesses, state and local government agencies, and other covered organizations are responsible for providing effective communication when required by the ADA. The cost of these services cannot be passed on to the individual requesting the accommodation.
3. Can a business use Video Remote Interpreting (VRI) instead of an on-site interpreter?
Sometimes. VRI can be an effective communication solution when it provides clear, uninterrupted communication and the individual agrees it is appropriate for the situation. However, if the technology is unreliable, the interaction is lengthy or complex, or an on-site interpreter is needed to achieve effective communication, the organization should provide a qualified in-person interpreter instead. The goal is always effective communication—not simply using the least expensive option.
4. What is considered effective communication under the ADA?
Effective communication means that people with disabilities receive information that is as accurate, timely, and understandable as the communication provided to others.
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