Understanding the needs of a community is imperative in order to effectively organize natural disaster emergency response. As people begin to assess the damage caused by Hurricane Laura, national, state and local community emergency planners and response teams are working to provide support for thousands of people who have evacuated or have sustained damage to their homes. People with disabilities are one of many vulnerable groups especially at risk during natural disasters.
RTC:Rural’s national disability rate maps are featured in a newly published text book “Ethics in Rural Psychology.” The book was written by Dr. Sara Boilen, a psychologist practicing in northwestern Montana, and published by Routledge on Aug. 3.
We emailed Dr. Boilen with a few questions about her new book. The below questions have been lightly edited.
Q & A with Dr. Sara Boilen, author of Ethics in Rural Psychology
RTC:Rural: What is your new book about? Who is it written for?
Dr. Sara Boilen: The book is a tool aimed at mental healthcare professionals in rural areas and students who may someday serve rural Americans. I provide the reader with a general understanding of rural America (and the complexities of rurality) and an overview of some of the relevant cultural factors therein. I then provide a pathway for navigating the tricky ethical landscape commonly found by practitioners serving in insular communities.
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.
Guest blog post by Dr. Meg Ann Traci, RTC:Rural Knowledge Broker.
While rural America is already known to experience higher rates of health disparities than urban, state and local public health data underscore that the current novel coronavirus (COVID-19) pandemic will continue to harm rural people. COVID-19 is making its way to some of the most rural states of the nation. Just this past week, Alaska’s Kodiak Island Borough had its first diagnosed case of COVID-19 (April 16, 2020); Wyoming experienced its first fatalities (April 15, 2020); and South Dakota is managing 518 cases identified in a meat processing facility (April 17, 2020).
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.
“Not only do you have to travel far to get to beds,” Grieman said, “You’re going to a place where there are more people, where there is also an outbreak, and those beds may also still be in high demand. So, that’s what I find particularly disconcerting.”
RTC:Rural Project Director Lillie Grieman in a recent news article on Public News Service, on why rural people with disabilities are at higher risk during the COVID-19 pandemic.
Rural people with disabilities and barriers to hospital access
Hospital Bed by Sergey Demushkin from the Noun Project
Rural people with disabilities face many barriers to accessing health care, particularly Intensive Care Units and hospital beds. Hospital capacity varies greatly, as does the prevalence of people with disabilities. Typically, there are fewer hospital beds and higher rates of disability in rural places than urban ones.
Project Director Lillie Greiman discusses some of these barriers in a recent news article- read or listen to the news story through the following link:
Recent models from ProPublica, Imperial College, and others predict that millions of people who contract COVID-19 will be hospitalized and many hospitals across the country may not be prepared to treat the influx of patients.
People with disabilities are particularly vulnerable to impacts from COVID-19, both directly and indirectly. While data about how this virus will impact the health and well-being of people with disabilities is currently limited, people with disabilities are often at greater risk of chronic health conditions, and thus may be more susceptible to infection. People with disabilities also face disruptions in services for daily needs, which could exacerbate conditions unrelated to COVID-19.
Overall, individuals who experience disability are at greater risk for being hospitalized either because they have contracted COVID-19 or because pre-existing health conditions have worsened.
Understanding the needs of a community is imperative to effectively plan for any type of emergency response, be it natural disaster or a pandemic. As people around the world are dealing with the COVID-19 pandemic, the needs of people with disabilities should not be overlooked or go unaddressed as members of those communities. To assess the impact of COVID on people with disabilities and their needs, it’s important to understand the prevalence of disability by the functional limitations of people living with disabilities experience in their communities.
According to the American
Community Survey, about 41 million, or 13%, of Americans have at
least one type of disability (ACS 2015). The vast majority (38 million) live in
households with other people and a significant number of people with
disabilities live in group quarters, which includes dormitories, nursing homes,
and prisons.
Approximately 78 million people without disabilities live in
households with a member who experiences a disability. This means that nearly
25% of the US population lives in a household with a member with a disability.
Graphic from poster presentation “How far do you travel for CIL services?” by Kourtney Johnson, Christiane von Reichert, and Lillie Greiman for the 2017 APRIL conference. Text description: icon of a green house in a circle with this text: Households in the US = 116,926,305. Same green house in a circle icon with three figures, one using a wheelchair, with this text: Households with disability* = 29,344,352, or 25%. *All households in which at least one person has a disability. There could be one, or more, people with disabilities in each household. There is a box around the graphic, and on top of the frame is a small figure using a walker as a mobility aid.
Left to right: Christiane von Reichert, Lillie Greiman, and Catherine Ipsen.
On February 11, 2020, RTC:Rural Director Catherine Ipsen and Research Associate Lillie Greiman presented as part of a panel at the Annual Disability Statistics Compendium. Their presentation was titled “Uncovering the intersection of rural and disability.”
Christiane von Reichert, professor of Geography at the University of Montana and a RTC:Rural research partner, was also part of the panel. Her presentation was titled “Using the ACS PUMS to examine disability and migration.”
Click on the image to view disability maps for the state of Alabama.
RTC:Rural’s Disability in America State Profile
Map Series is well underway! We have maps for 17 states posted on
the website so far, and more are coming soon. In the next two months general
disability maps for every state (for example, Montana
and Texas)
and Puerto Rico
will be complete and available on the RTC:Rural website. Once the general
disability rate maps are completed, we will work to produce maps showing different
topics for each state. These include:
Disability rates among females and males
People with vision, cognitive, mobility, self-care, and Independent Living difficulties
Veterans with disabilities
People with disabilities in poverty
Employment, unemployment, and out of labor force rates among people with disabilities
Map of people with disabilities in the path of Hurricane Dorian. See below for larger, downloadable version and text description.
Understanding the needs of a
community is imperative in order to effectively plan for natural disaster
emergency response. As Hurricane Dorian heads toward the Florida coast,
national, state and local community emergency planners are working to evacuate
and shelter thousands of people who are fleeing their homes.
People with disabilities are one of
many vulnerable groups especially at risk during natural disasters. In times of
emergency, people will evacuate with their households, and will need to shelter
with their households. It is not acceptable to separate families and households
in times of crisis. Many family
members are caregivers, so shelters need to be accessible so
that people with disabilities and their families and caregivers can stay
together.