The COVID-19 pandemic has caused interruptions and barriers to service delivery for people with disabilities around the country. When Centers for Independent Living (CILs) offices closed, it affected their ability to offer their usual in-person services, including skills-based trainings and classes.
Staff from RTC:Rural learned first-hand how the pandemic was affecting CILs’ delivery of such classes. Healthy Community Living (HCL), a health promotion and independent living skills program developed by RTC:Rural staff and disability stakeholders, was designed for in-person delivery. With several partnering CILs actively conducting in-person HCL workshops with consumers when the pandemic hit, it triggered a need for discussions, collaboration, and problem solving to adapt the program’s delivery under vastly new conditions.
People with disabilities are often the first to experience economic disruptions, and among the last to recover. Unemployment among people with disabilities spiked to 18.9% in April 2020 and declined to 12.5% in September. Both the initial increase and recent decrease in unemployment was primarily driven by changes in temporary unemployment (unemployed workers who expect to go back to their same job within six months). While temporary unemployment has gone down, permanent unemployment has risen since the recession began, and may indicate that for some, temporary unemployment is becoming permanent.
As the recession wears on and unemployment benefits begin to expire, long-term recovery to pre-pandemic levels may become elusive, yet again leaving people with disabilities behind.
COVID-19 has arrived in rural America. Indeed, the worst outbreaks in October 2020 were in counties with populations less than 50,0001. We knew it was coming2, and yet communities are unprepared to face the significant challenges of caring for COVID-19 patients.
Risks and impacts of COVID-19 are not distributed evenly. This is especially true for people with disabilities and rural residents who face significant challenges to accessing healthcare. For COVID-19, risk increases with advanced age (aged 65 and older), congregate living such as nursing homes and long-term care facilities, and for individuals with several health conditions including asthma, diabetes, blood disorders, serious heart conditions, severe obesity, and for those who are immunocompromised3. Many of these conditions are reported at higher rates among the population of people with disabilities, placing them at higher risk of COVID-19 related complications4.
Social isolation and loneliness are a public health concern because they are associated with poor mental and physical health outcomes and mortality. Social isolation is defined as have few, or no, social connections, and not participating in activities with others. Loneliness is defined as feeling unsatisfied about the amount of social engagement in one’s life.
Before the current pandemic, people with disabilities reported significantly higher rates of social isolation and loneliness than those without disabilities. Inaccessible events and buildings, limited accessible public transportation, social stigma, and lower rates of employment all contribute to these high rates. When restrictions are put in place to help protect people from COVID-19, what happens to these rates?
To learn more about how COVID-19 and public health responses such as stay-at-home orders may contribute to feelings of social isolation and loneliness among people with disabilities, RTC:Rural researchers compared data from two cross-sectional samples collected before and after the first wave of “stay-at-home” orders.
Rural/urban differences in trust in sources and preventative practices
Public health is shaped by community-level action. This is especially important during crises such as COVID-19, where widespread adoption of public health practices is necessary to manage community spread and prevent loss. Consistent information is important for fostering trust and adherence to recommended practices.
We were excited to bring our peer-led self-management program Living Well in the Community to new audiences by facilitating partnerships between Centers for Independent Living and rural hospitals, and begun by teaming up with CILs and rural hospitals in Wyoming and Oregon for the first phase of the project.
And then COVID-19 struck, and like so many things across the country, we needed to adapt, as many hospitals and healthcare settings found themselves dealing with this virus and related difficulties. At the same time, it became dangerous for people to meet in person, especially when the disability community is most at-risk for exposure in this pandemic.
Guest blog post by Dr. Meg Ann Traci, RTC:Rural Knowledge Broker
The devastating and disproportionate rates of novel coronavirus (COVID-19) cases and deaths in institutional settings continues to be part of the national crisis. With data from the 23 states that publicly report data on deaths within long term care facilities, such as nursing homes, skilled nursing facilities and assisted living facilities, the Kaiser Family Foundation estimates more than one in four COVID-19 related deaths in those states (27%) occurred in such settings. The threat within these medical and personal care settings put people with disabilities and others unable to maintain and manage independence in the community, at increased risk. In rural areas, the threat to such institutionalized populations is likely even greater.
While many Americans will suffer in the coming recession, people with disabilities in rural areas are especially vulnerable because they are less likely to have an emergency savings fund, have access to paid leave, or be able to work from home.
Additionally, local and national news headline stories revealed the increased burden of the virus among residents and workers in group quarters such as prisons, nursing homes, and juvenile group homes (non-correctional). The high rates of infection and deaths at a long term care facility in Kirkland, Washington, caught the nation’s attention and refocused the public health response efforts on institutional settings.
Because people living in institutional settings are more likely to report disabilities than the general population and these settings are not evenly distributed between urban and rural areas across the United States, rural people with disabilities have a lot at stake in efforts to address the pandemic and outbreaks in institutional settings.