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.
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
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.
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.”
Project Director Lillie Greiman and RTC:Rural Director Dr. Catherine Ipsen recently co-authored an article in The Conversation about proposed changes to disability benefits and how those could make it harder for people with disabilities, especially those in rural communities, to maintain federal benefits.
In order to create policies and programs that serve the needs of
people with disabilities in rural communities, it is important to know things
about them, such as demographic information and location. The federal
government maintains several large data sets that collect this information.
However, it can be difficult to access rural disability data from these data
sets (see Data Limitations in the American Community
Survey: The Impact on Rural Disability Research).
To address this, RTC:Rural is conducting rural analyses of
existing large data sets to contribute to a national disability statistics
Harnessing the theme of this year’s conference, Project
Directors Dr. Rayna Sage and Lillie Greiman, Director of Knowledge Translation
Tracy Boehm Barrett, and Research Advisor Dr. Craig Ravesloot will give a
presentation titled, “Using Rural IL Power to Address the Needs of People with
Disabilities Living in Poverty.” In their presentation, they will discuss how
poverty affects Independent Living (IL), rural resources that Centers for
Independent Living (CILs) can leverage to help address poverty, and how
community development strategies can address poverty among people with
disabilities living in their community. Dr. Sage will also briefly describe a number
of new opportunities for CILs to get involved in RTC:Rural’s research and rural
community development projects to address local issues that affect IL services.
The passage of the Patient Protection and Affordable Care
Act (ACA) and adoption of Medicaid expansion was associated with substantial
increases in insurance coverage across the United States (see Changes
in coverage and access, MACPAC 2019). However, RTC:Rural
researchers wanted to know how ACA policy changes and Medicaid expansion impacted
people with disabilities, particularly those who live in rural areas.
To explore this question, RTC:Rural researchers analyzed
microdata from the 2008-2013 American Community Survey
Using these data, they were able to compare how insurance coverage has changed
over time for people with and without disabilities in rural and urban places,
and in expansion and non-expansion states.
RTC:Rural is excited to share that we’re relaunching #MapMonday, our weekly map series. Every Monday, we’ll share a new map on our social media channels. Follow RTC:Rural on Facebook, Twitter, or LinkedIn so you don’t miss a map! (But don’t worry if you do miss one—they’re all available on our website).
In the coming weeks, we’ll share maps with overall disability rates, disability rates by difficulty and functional limitation (such as vision, hearing, mobility, and self-care difficulty), veterans, poverty, and employment rates. Continue reading →