ACE.D in the Age of the Covid-19 Pandemic

By: Suzanne C. Smeltzer, Bette Mariani, and Colleen H. Meakim

The Americans with Disabilities Act (ADA) was passed 30 years ago, in 1990. This landmark legislation followed many years of hard work and effort by disability advocates and the disability community to improve the access of those with disability to services readily available to others: employment, transportation, public accommodations, education, communications, and health care.  Changes in access to health care in the last 30 years have happened at a slower rate than other areas addressed by the ADA (Peacock, Iezzoni, & Larkin, 2015).  Individuals with disability continue to report receiving health care that is of lower quality than care received by those without disability. This includes nursing care.

A major reason remains the lack of inclusion of content and concepts related to disability in many nursing programs. The NLN Advancing Care Excellence in Disability program (ACE.D) was developed to begin the discussion about disability in nursing education and provide information and materials that can be used to improve the ability to provide sensitive and appropriate nursing care.

It is useful to consider how individuals with disability may be affected by the Covid-19 pandemic and use the ACE.D materials to address disability in the current environment.  The pandemic has highlighted the risks of those with disability to poor health and premature death because of pre-existing conditions and limited access to health care. Personal care assistants and home care nurses may be unable to continue their regular visits because of the risk of transmission of the coronavirus to or from their clients. Additionally, assistance in the home may be hampered by the need for social distancing, a shortage of protective equipment such as masks, gloves, and gowns, as well as concern on the part of home care personnel about risk of transmission.

Some individuals with disability may need medications and other treatments that are becoming increasingly difficult to obtain, or they may have limited access to food or other products needed to maintain their well-being. Those with mobility limitations who have difficulty washing their hands may be unable to obtain the hand sanitizers they rely on, preventing their use as often as recommended.

An unfolding case study in ACE.D describes Mary Lou Brady, a woman with a disability being discharged from the hospital after delivery of a newborn. Her disability needs to be considered in discharge planning to ensure that accommodations needed for baby care are made. During the Covid-19 pandemic, she is less likely to have access to assistance from family and friends because of the need for social distancing. Planning, identifying, and using available resources take on increasing importance if a new mother has a disability, particularly in the middle of a pandemic of easily transmissible infection.

A second unfolding case study in ACE.D describes the experiences of Patrick Lake, a veteran with congestive heart failure who experienced an above-the-knee amputation as a result of a war injury many years ago. As he moves from the hospital to home, consider how the Covid-19 pandemic may affect his health care experiences and how his hospitalization and home health care may be altered because of the pandemic. Planning care for Mr. Lake in both settings, hospital and home, requires nurses to consider his current health status as well as his increased risk for Covid-19. Health promotion strategies take on increasing importance when an individual has increased risk for transmission of Covid-19 because of underlying health issues as well as a disability.

The ACE.D site includes information about assessing individuals with disability and identifies modifications that are indicated when individuals have disabling disorders. The resources identified on the ACE.D site can be helpful to nursing students, nurses in practice, and nursing faculty to explore ways of modifying care to ensure that persons with disability receive the high-quality, sensitive care they deserve.  In this year of the 30th anniversary of passage of the ADA, amidst the Covid-19 pandemic, the importance of being proactive in providing such care cannot be overestimated.

These unfolding case studies can be used virtually to explore the changes in care needed because of the pandemic. Additionally, the ACE.D site includes a guide for integrating standardized patients with disabilities in nursing curricula. Including individuals with actual disability is recommended because of the need for authenticity. However, the Covid-19 pandemic may limit the ability of nursing faculty to include individuals with disability until the pandemic subsides.


References and Resources

ACE.D. (2017). Guide for Integrating Standardized Patients with Disabilities in Nursing Curriculum. http://www.nln.org/professional-development-programs/teaching-resources/ace-d/additional-resources/guide-for-integrating-standardized-patients-with-disabilities-in-nursing-curriculum

ADA National Network. (n.d.) Disability & Covid-19. Fast facts: Symptoms, prevention & data. https://www.adacovid19.org

ADA National Network. (n.d.) What is the Americans with Disabilities Act (ADA) https://adata.org/learn-about-ada

Centers for Disease Control and Prevention. (n.d.). Coronavirus disease 2019 (COVID-19). People with disabilities. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html

Peacock, G., Iezzoni, I. E., & Harkin, T. R. (2015). Health for Americans with disabilities: 25 years after the ADA.  New England Journal of Medicine, 373(1), 892-893. doi: 10.1056/NEJMp1508854

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