Calling the COVID-19 pandemic a “battlefield” for people with developmental, intellectual and physical disabilities, the state Department of Human Services has made a number of changes to ensure continued and equitable care.

“This population is particularly vulnerable for COVID-19,” said Kristin Ahrens, deputy secretary for the Office of Developmental Programs.

A large number of people with disabilities has underlying conditions that may make the virus more severe. Not only that, Ahrens said, but social distancing may not be possible for a swath of the population the department serves.

“We also serve a population that is dependent on care, so the concepts of social or physical distancing can't be applied in the same way for people who require another person to assist them,” she said.

Intellectual disabilities may also make facing the pandemic more challenging.

“Just understanding the virus, the pandemic and the danger it poses … those are made more challenging for people who have an intellectual disability or autism,” Ahrens said.

Continuity of care

Despite the closures of a number of care facilities — such as pre-vocational or adult day services — to lower the number of people congregating in an area, the department has made moves to ensure the continuity of care for disabled Pennsylvanians.

The department has been granted a number of “flexibilities” from the federal Centers for Medicare & Medicaid Services and has tried transitioning to as much telemedicine as may be possible during the ongoing crisis.

That includes behavioral support for individuals with intellectual disabilities, who may be hardest-hit during the stay-at-home order in effect for Pennsylvania.

“We know the pandemic is challenging for most, if not all of us,” Ahrens said. “The stay at home, the kind of isolation and alienation that is happening is very challenging, but, again, particularly for people with intellectual disabilities and autism, we need to make additional efforts to address wellness.”

In addition, disability support specialists now have the ability to be at the side of patients in health care settings. While this has not been allowed before, Ahrens said, the federal CARES Act now permits such specialists to serve in that capacity in perpetuity.

“Importantly, we have an agreement with the federal government that we can, through our service system, pay for a direct support professional to assist someone in a hospital setting to make sure that their needs can be communicated, that they can understand the diagnosis or treatment that the health care professionals are working with them on,” she said.

For patients with physical disabilities, the department has tried to ensure that the loss of one type of service does not bleed over. For example, when adult day services were closed, the department worked with providers and the federal government to ensure eligibility for wraparound services, according to Kevin Hancock, deputy secretary for the Office of Long Term Living.

That office continues to work with managed care organizations — such as AmeriHealth Caritas — to provide “key recommendations” on navigating the crisis, he added.

One major concern among those with disabilities, officials said, is that they have in the past noticed a bias in care.

“It's a concern that makes a lot of sense, and I think we share that concern and very much appreciate it,” said Teresa Miller, department secretary.

Officials said they would work to ensure there would be no discrimination in care, even in following triage guidelines for patients with COVID-19.

“We're also very cognizant of the fact that this fear that many people with physical disabilities have is based on a history, and we're going to be very vigilant to do everything we can to ensure it doesn't occur during this crisis period,” Hancock said.