I often wonder if it would be easier to push out a second, accessibility-friendly version of the site on a subdomain. Something like acc.example.com that screen readers and other accessibility tools would check for when they access example.com.
We used to do this back in the WAP days: wap.example.com, and even in the early iPhone days with i.example.com, mobile.example.com, or m.example.com.
I believe it would save time on some projects.