in the Time of Covid-19
By Ken Winston, AAIDD Texas Chapter Board Member
The COVID-19 pandemic forced organizations providing services to people with IDD to quickly adopt a tele-health/services model of care. In turn clients and families, themselves had to quickly adapt to this novel approach to service delivery. Serving people with an IDD diagnosis has always entailed an in-person model of service delivery. The pandemic-caused sudden pivot to tele-health/services created an uncertainty for state oversight agencies and service delivery organizations concerning whether services being provided downstream were actually being delivered with an in-person level of quality and care. Services to people with IDD, because of a history of institutional care, have always received an elevated level of scrutiny and oversight. How could a service delivery system relying on in-person services for decades turn on the proverbial dime to deliver or monitor services remotely? The challenges were (and still are) real. The infrastructure was not designed to support this level of reliance on virtual communications through platforms such as MS Teams, Zoom, Google Hangout among many others. Would remote service delivery lead to slippage in quality? Would this simply become a modern-day version of the dreaded and archaic form of custodial care? How would environmental factors be assessed? How would professional intuition be affected with virtual communication? This is compounded in instances where clients and families only have the ability to connect by phone.
Access to high quality broadband connectivity is a national priority. Yet for most people with disabilities and their caregivers, access to high quality internet connections or smart phones is not a reality, particularly for those in rural communities. In addition, however, people with disabilities and their caregivers rarely have the wherewithal to access high quality communication devices. These factors combined with the health care emergency dictating social distancing resulted in an abrupt sense of isolation for people across the nation and indeed the world, particularly for those with minimal or structured social opportunities.
State and federal agencies created flexibilities in law and regulations to enable continuity of care under less-than-ideal conditions. Organizations serving people with disabilities utilized federal pandemic initiated funding and private donations to deliver smartphones, iPads with prepaid cellular or internet services to clients with IDD to ensure high quality services in this new reality of remote service delivery. Organizations serving individuals with IDD provided nursing home facilities with smart phones and iPads with prepaid services to ensure their teams could communicate with their clients and the nursing facility staff to monitor for health and ongoing care. The same initiative was implemented for those living on their own, with a hybrid model of care – that is, communicating with the individual remotely, but meeting in-person with full PPEs when needing to assist or transport individuals with trips to the grocery store or pharmacy or medical care.
As state and federal requirements relating to masking and social distancing have been eliminated or relaxed, Texas’ HHS still permits Local IDD Authorities (LIDDA) to monitor services remotely. Clients and families are informing LIDDA teams that they prefer receiving certain services such service coordination, which is about coordination and monitoring, by telephone or videoconference. Reasons cited for this include convenience (appointments can be changed with minimal disruption or ability to reschedule), and for some reasons for continued social distancing dues to health concerns. Teams serving people with IDD and their caregivers always give them the choice if they want to meet in-person. Alternatively, teams are providing services in a hybrid construct – tele-services and at least one in-person meeting monthly. This latter model too has been met with satisfaction by clients and/or their caregivers. But as life appears to be returning to normal (for now) there is the expectation that services be delivered as they were in a pre-pandemic environment. The expectation is that once the public health emergency is officially ended, Texas Health and Human Services will require services to resume in-person service delivery.