By Dina Klimkina, program manager, The Council of State Governments Center of Innovation
Twenty six percent of adults in the U.S. have some type of disability. These disabilities may impact mobility, cognition, the ability to live independently, hearing, vision or the ability to care for one’s self. Nearly one in four women have a disability, and half of all individuals with a disability are over the age of 65.
Disability is a natural part of the human experience that in no way diminishes one’s right to fully participate in all aspects of community life. While many states have worked to improve the lives of individuals with disabilities through initiatives focused employment, education, transportation and other needs, now more than ever it is important that states address the rights and needs of individuals with disabilities in the wake of the COVID-19 planning and response.
States have taken critical steps to ensure safety, including school closures, crowd limits, state curfews and restaurant and bar closures, among other measures. However, it important that states consider the potential effects on their more vulnerable citizens.
While individuals with disabilities are not inherently at a greater risk for contracting COVID-19, individuals with disabilities may be more affected by disruption of services, including:
- Home and community supports and service provision;
- Access to education;
- Access to information;
- Access to steady employment;
- Access to healthcare; and other critical needs.
Individuals with disabilities may have a challenge with social distancing as some rely heavily on community-based and in-home service provision. Service provision ranges across many categories, including anything from therapy to delivery of goods, meals and medications. States leaders should think strategically about how to ensure services continue to the most vulnerable populations, including the development of plans for food distribution, care for those in quarantine or prescription delivery. Continuity of operations for services and supplies that assist people with disabilities and older adults is critical for ensuring individuals maintain their health, safety, dignity and independence.
For example, California Executive Order N-25-20 ensures that individuals with developmental disabilities continue to receive the services and supports mandated in their individual programs and plans that are threatened by disruptions caused by COVID-19.
Kentucky Gov. Andy Beshear issued Executive Order 2020-257 regarding the state of emergency in Kentucky. The order mandates that only life sustaining businesses may remain open, with the exception of organizations that provide charitable and social services. These organizations include “food banks, when providing food, shelter, and social services, and other necessities of life for economically disadvantaged or special populations, individuals who need assistance as a result of the emergency, and people with disabilities.”
Access to Education
Over 45 states have, to some extent, closed all public elementary, secondary and post-secondary schools. Lack of access to regular school days can be particularly challenging for the 6.7 million public school students with disabilities. School days can provide valuable structure, development, training and sense of community.
Under Title II and Section 504 of federal statute, school officials have an obligation to avoid discrimination of students on the basis of disability and therefore must ensure provision of education services if the student has an individualized education program (IEP) or is receiving services under section 504. However, this applies only if the school is providing instruction to other students. In other words, if a school is not educating other students they are not mandated to provide education services to students with disabilities.
E-learning technology can be used to provide students with high-quality educational instruction during an extended school closure. However, online instruction materials should be provided through adapted accessible communication strategies.
In New York City, school officials have noted that they will soon begin to contact parents to begin arrangements for their students’ individual plans for remote learning. According to officials, teachers will conduct individual education plan meetings by phone, and therapists will provide teletherapy alongside schools’ remote instruction plans. The city has also released resources on Diverse Learning at Home for Special Populations, which includes assistive technology support as well as specific occupational, physical and speech therapy activities for students.
However, some areas are not engaging in online learning due to lack of equity or access for all students. Kentucky’s largest school district is specifically not moving to online learning due to concerns with accessibility and internet access. However, the school district has provided resources for non-mandatory online learning. A Washington State school district acquired 4,000 devices and additional internet access to low-income students but had to revert the plan due to risk of violating access to equitable services. It is critical that at home learning plans do not increase the gaps in education.
Access to Information
Individuals with disabilities must have access to credible and timely information. Any changes to systems which provide services, affect living or employment arrangements or can help individuals minimize their risk of infection must be communicated to all members of the community.
It is critical that state agencies provide public information in a way that is accessible for the most members of the community. State leaders should consider using the following tools to ensure accessibility of information:
- Public announcements should be live-captioned and accompanied by qualified sign language interpreters. Numerous states are ensuring that all citizens have access to the state’s COVID19 updates, including citizens that are deaf or hard of hearing. For example, Rhode Island , Kentucky, Ohio and Illinois ensure there is an American Sign Language interpreter at each of the governors’ daily press briefings.
- Websites must be accessible for individuals with a variety of disabilities, including individuals who use assistive technology. Learn more on how to improve website accessibility here and use the following tool to check your current site.
- Communications should utilize plain and simple language to maximize understanding.
- States can develop tools specifically made for individuals with disabilities that help break down the risks of the virus, for example the Coronavirus Information and Guidance for People with Disabilities developed by the office of Texas Gov. Gregg Abbott.
Access to Steady Employment
Individuals with disabilities are a critical part of the state workforce. Yet, a significant percentage of people with disabilities have difficulties finding, securing and retaining employment. In a time where many individuals are facing possibility of unemployment, state governments must work to ensure that individuals with disabilities are able to continue to work or return to work following social distancing.
To facilitate continued employment, states may want to consider promoting the use of teleworking policies. The Americans with Disabilities Act (ADA) requires employers with 15 or more employees to provide reasonable accommodation for qualified applicants and employees with disabilities. The Equal Employment Opportunity Commission (EEOC) guidance on COVID-19 notes that employees with disabilities may request reasonable accommodations in response to the risk of exposure to the coronavirus. Allowing individuals with disabilities to work from home can be considered an accommodation. To learn more about reasonable accommodation requests and COVID-19 please visit the Job Accommodation Network.
The Stay-At-Work/ Return-to-Work Toolkit is a resource designed to help state officials increase the employment retention and labor force participation of individuals who acquire and/or are at risk of developing work disabilities, whether on-the-job or off-the-job.
Policymakers can also continue to develop innovative workforce policies and strategic workforce development plans, ensuring that individuals with disabilities also have access to high quality meaningful employment opportunities.
For example, during the COVID 19 pandemic, Texas is still working to ensure people with disabilities have access to employment services. The Texas Workforce Commission released a statement that emphasizes that the agency is working hard to continue to provide of services to their customers. One example of overcoming the current situation to ensure that services are still provided is that the Workforce Commission has developed a procedure in which vocational rehabilitation counselors can issue and approve service authorizations electronically. This allows for the continuation of services remotely without human contact.
To learn more about how states can improve their disability employment policies read CSG’s Work Matters: A Framework for States on Workforce Development for People with Disabilities.
Access to Healthcare and Medication
All individuals with disabilities are not at higher health risk for contracting COVID-19. However, many individuals with weakened immune systems or those with disabilities that affect their respiratory capacity may be at a higher risk of serious illness or death from a COVID-19 infection.
Currently, hospitals across the country are experiencing shortages of life saving equipment, including ventilators, personal protective equipment and other critical tools. There are concerns that the lack of capacity within the U.S. healthcare system will result in “rationing of life saving care for individuals with pre-existing illnesses and disabilities.”Some states have begun to explore rationing measures, while others have begun to develop ethics committees and patient selection frameworks based on condition, preexisting health problems and age.
Minnesota, New Jersey, Oregon, Texas and Virginia, have all released executive orders related to consolidating efforts, postponing non-essential treatments and/or conserving resources within hospitals. To conserve equipment and increase safety, the executive order from Oregon prohibited all non-essential procedures and required that all clinics, hospitals and outpatient procedures notify the state’s PPE coordinator off all available equipment and surplus supplies. Similarly, New Jersey Executive Order 109. ordered any business in New Jersey possessing PPE, ventilators, respirators or anesthesia machines that are not required for the provision of critical health care services, to be reported to the state. The order from Virginia permitted the State Health Commissioner to authorize any general hospital or nursing home to increase licensed bed capacity to respond to increased demand for beds resulting from COVID-19.
To comply with federal law, state health departments should follow the non-discrimination requirements of the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act and Section 1557 of the Affordable Care Act in making treatment decisions.
Protecting Individuals in Facilities, Residential Care and Chronic Disease Hospitals
Within medical institutions, best practices indicate that administrators should follow strict hygiene and physical distancing policies, as well as updated more restrictive visitor policies. In the event that individuals living in group facilities are infected, government planners must address how to provide care for those individuals without risking others. Placement of individuals with disabilities, caregivers or service providers must not leave individuals with disabilities without the supports needed to maintain their health and safety.
Connecticut Executive Order No. 7A grants the Commissioner of Public Health the ability to issue “orders restricting entrance into nursing home facilities, residential care homes or chronic disease hospitals that she deems necessary to protect the health and welfare of patients, residents and staff.” Oregon Executive Order 20-10 has also increased screenings and limitations on visitations to hospitals and surgical centers.
In some cases, individuals with disabilities are pre-disposed to feelings of social isolation. Policies requiring social distancing as a way to curb the spread of COVID-19, may put individuals with psychosocial disabilities into greater distress. Greater mental health services may be necessary during the pandemic, including access to telemedicine which may be the most effective way of administering services and practicing social distancing.
States like Rhode Island , Arkansas and Kansas have expanded the availability of telemedicine to their populations. These states have reduced barriers health services by removing the requirement of initial in-person examinations, amongst other provisions. Expansion of telehealth can make a significant impact on both individuals with disabilities, as well as individuals in more rural areas who may find it difficult to access healthcare in the first place.
To learn more about issues facing individuals with disabilities, read the Partnership for Inclusive Disaster Strategies National Call to address the rights and needs of persons with disabilities throughout all COVID-19 planning and response. The document addresses opportunities state government’s have for improving current strategies and calls on governments to close gaps, minimize the impact and optimize community resources.