A ‘new normal’ following COVID-19 and the economic crisis: Using systems thinking to identify challenges and opportunities in disability, telework, and rehabilitation

Abstract

BACKGROUND: The novel coronavirus (COVID-19) that emerged in late 2019, and later become a global pandemic, has unleashed an almost unprecedented global public health and economic crisis. OBJECTIVE: In this perspective, we examine the effects of COVID-19 and identify a likely ‘new normal’ in terms of challenges and opportunities within the fields of disability, telework, and rehabilitation. METHODS: We use a systems thinking lens informed by recent empirical evidence and peer-reviewed qualitative accounts regarding the pandemic to identify emerging challenges, and pinpoint opportunities related to health and changing employment infrastructure of people with disabilities and rehabilitation professionals. RESULTS: From our interpretation, the key leverage points or opportunities include: (1) developing disability-inclusive public health responses and emergency preparedness; (2) enabling employment and telework opportunities for people with disabilities; (3) addressing the new requirements in rehabilitation service provision, including participating as essential team members in the care of people with infectious diseases such as COVID-19; (4) embracing the added emphasis on, and capacity for, telehealth; and (5) developing greater resilience, distance learning, and employability among the rehabilitation workforce. CONCLUSIONS: The COVID-19 pandemic has become increasingly challenging to the lives of people with disabilities and rehabilitation professionals; however, key challenges can be minimized and opportunities can be capitalized upon in order to ‘build back better’ after COVID-19.

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

“…During the first wave of the COVID-19 pandemic, many healthcare services (e.g., outpatient, day services, some in-patient rehabilitation services, assistive devices programs), essential for people with disabilities (e.g., to maintain or recover health and function, manage chronic conditions, prevent secondary conditions, benefit from psychosocial support), were either shutdown or operating at a reduced capacity due to lockdown restrictions. In other words, if they were open, they were operating without sufficient human resources, beds, or other healthcare resources that were diverted to fighting the pandemic [9,14,48,71,80,84,107].…”

“…Any reduction in physical inactivity or person-level deconditioning can lead to novel disability risks and exacerbate existing ones [80,84,101]. Especially in older individuals with neurocognitive disorders or other impairments, a forced reduction of motor/physical activity can cause a progressive loss of personal and instrumental autonomy, as well as a possible worsening of other aging-related clinical concerns, such as sarcopenia, with a subsequent increased risk of falls and other complications [78,84,108].…”

“…The reduced social participation and loneliness are known risk factors for healthrelated consequences and have been shown to increase risk of anxiety, depression, malnourishment, dementia and cognitive decline in older adults [63,102,106,112]. Older adults with cognitive and sensory impairments, who are already excluded from social participation due to various reasons, have been asked to distance themselves even further, deepening any existing isolation [76,80,93,106]. For example, those living in long-term care facilities can become separated from one another and the outside world, and thereby experience profound isolation and loneliness [51,63].…”

Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis

“…In residential care settings, shielding and self-isolation were difficult during the first wave of the pandemic. This was due to the: initial unpreparedness of the facilities at the pandemic outset, shared use of essential living spaces, crowding and shared rooms, proximity to other residents, residents’ difficulty understanding new rules imposed suddenly, difficulty in maintaining standards of hygiene during home visits, multiple shift staffing patterns, staff working in multiple settings, and high levels of personal care assistance required from staff (e.g., with eating, toileting, or transferring from bed to wheelchair) [ 16 , 30 , 31 , 36 , 38 , 39 , 43 , 51 , 53 , 54 , 59 , 70 , 78 ]. Indeed, stemming from the latter reason, many articles pointed out that a wide range of people with disabilities who rely on assistants for basic activities of daily living have greater risks of infection [ 6 , 32 , 36 , 41 , 49 ].…”

“…Globally, another analysis showed that pages of the World Health Organization’s website, March–May 2020, were only 60% compliant regarding web accessibility guidelines [ 75 ]. Additionally, people with sensory processing and visual impairments may need to rely or depend on touch and tactile senses for stimulus or to perform their routine activities or outdoor movement, and thereby face greater infection risks [ 33 , 38 , 40 , 43 , 49 ].…”