‘All in this together?’ A commentary on the impact of COVID-19 on disability day services in Ireland

Abstract

Disability services in Ireland faced a financial crisis which was exacerbated by the impact of the COVID-19 pandemic. The resumption of day services for people with disabilities placed the bulk of the financial burden on these disability services following initial non-committal governmental support. Disability day services closed in March 2020 with services operating at a much-reduced capacity since this date. This reduction of services has negatively impacted people with disabilities who were already experiencing inequalities in Irish society pre-COVID-19. Will the commitment of financial provision to support resumption of services positively impact on people with disabilities, or are historic inequalities faced by disabled people likely to continue in Ireland?

Keywords:

• Disability
• COVID-19
• day services
• inequality
• service provision

Before the onset of COVID-19, Ireland was on the verge of changing the landscape of service provision for people with disabilities. Ireland’s service provision was originally rooted in the medical model which then began to move towards the social model that started to reflect the different societal responses to disability. In Ireland we have seen disability services undergo different transformations throughout the years; from people with disabilities being supported through placement in large, congregated settings and community based sheltered workshops, to the more current person-centred, human rights-based approach emerging in services (Doyle and O’Brien 2020).

People with disabilities have long been considered a marginalised group within Irish society. On average, people with disabilities experience higher instances of discrimination than those without a disability. They are at a higher risk of social exclusion with less educational attainment and lower employment rates than people without a disability. People with disabilities also experience inequalities in accessing public services such as health and social care services as well as housing and are also more likely to experience poverty or financial difficulties. Globally people with disabilities experience higher rates of social exclusion and poverty, having a disability alone significantly increases the risk of these experiences (Ghosh et al. 2016; Hammersley et al. 2020). Since the onset of COVID-19, services for people with disabilities have dramatically changed - further revealing some of these pre-existing social inequalities.

On the 11^th March 2020, the World Health Organisation (WHO) formally announced the spread of COVID-19 as a global pandemic. Following public health guidance from the National Public Health Emergency Team (NPHET) the Government of Ireland made the decision to close all schools and higher education settings in Ireland from the 12^th March 2020 to try and stop the virus from spreading further in communities. St. Patrick’s Day festivities, a cultural staple in the Irish calendar, were cancelled in the whole of the country and clubs and bars were subsequently asked to close. In March 2020, the Government of Ireland announced further restrictions including the closure of all non-essential businesses and further extending measures imposed previously. Restrictions, banning all non-essential travel and imposing stay at home orders for Irish citizens except for essential activities, were also introduced as well as the ‘cocooning’ of people vulnerable to the impacts of the virus. These restrictions continued until the May 2020 when the government launched their ‘Roadmap for Reopening Society and Business’ which detailed how different businesses and sectors were to reconvene in the following months.

Missing from any official guidance was the closure or reopening of day services for adults with disabilities. Faced with an ever-increasing situation nationally, the majority of day services for adults with disabilities in Ireland closed their services in early March (Health Service Executive 2020a). The majority of the people who were accessing these services were supported in their homes with the majority dependent on families and carers to provide supports in absence of supports from day services. People with disabilities were identified by NPHET as a vulnerable group and as a result were deemed to be at a high risk of contracting the COVID-19 virus. As a marginalised group, people with disabilities face socio-economic barriers that could further increase their likelihood of contracting the virus but also exacerbate the illness. The National Federation of Voluntary Bodies (2020a) argues that services responded by restricting day services in order to keep COVID-19 infection rates low, and to deploy day service staff to residential services to support people with disabilities in residential care.

According to Courtenay and Perara (2020) people with disabilities are particularly vulnerable to the consequences of the COVID-19 pandemic from a social, medical and psychological perspective. They are more at risk of contracting the virus due to difficulty in following social distancing guidelines, dependency on others for care and support, and also due to a lack of accessible information or knowledge. In absence of community supports, people with disabilities are also more at risk of exploitation by others.

Although disability day services closed in mid-March 2020, some day services undertook delivery of supports utilising a variety of means including online/tele supports, and direct support, however, the type and amount of service varied across the country and was at a much reduced level compared to pre-COVID-19 service provision (Health Service Executive 2020a). The HSE also published a range of online resources including publications, guidance documents and webinars in relation to COVID-19 for service providers, people with disabilities and their families/carers to access for support (Health Service Executive 2020b). Unfortunately access to many online or tele resources or supports were limited to those with access to technology, the Internet, or personal support to facilitate access due to other constraints.

Following the subsequent easing of restrictions nationally, numerous calls were made to the HSE to reopen adult disability day services which had been closed since March 2020. In May 2020, the HSE launched the ‘Framework for the Resumption of Adult Disability Day Services’ to support the planning of the key elements of work that needed to be undertaken to plan for the resumption of day service supports. Within the document they clearly outlined that due to the risk associated with COVID-19, services would be operating at a reduced capacity. Remote supports and supports provided in the person’s home, would become a key feature of service provision moving forward.

In early July 2020, the HSE published the ‘Guidance to Support the Framework for the Resumption of Adult Disability Day Services’. This document allowed for services to finalise plans for the reopening of day service locations to people with disabilities at a reduced level. Service providers were to embark on a prioritisation of each service user based on support needs, allocating the amount of service based on the person’s prioritisation score (Health Service Executive 2020c). Unlike the publication of the guidance to support the reopening of schools, which was accompanied by a €375 million support package (Government of Ireland 2020a). The guidance to support the resumption of disability day services was not accompanied by a commitment of government financial support.

People with disabilities and the services which support them were negatively affected by austerity measures undertaken in Ireland following the 2008 economic crisis. According to Morris (cited in Hammersley et al. 2020) after the 2008 economic crisis the Government of Ireland introduced a policy of austerity and spending cuts which negatively impacted on people with disabilities and the services which supported them. Disability voluntary organisations experienced a significant reduction in funding following the economic downturn. Disability services had to bear the increased costs of insurances and regulatory requirements and as such disability services have continued to operate at a deficient level leading to an identified funding crisis before the onset of COVID-19 (Hammersley et al. 2020; National Federation of Voluntary Service Providers 2019).

During the pandemic the Government of Ireland in conjunction with the HSE and Healthy Ireland launched an online campaign “In this Together” where the emphasis was placed on supporting people by providing information on how to look after one another during the pandemic (Government of Ireland 2020b). Disability services who were faced with costs associated with the impact of COVID-19 were initially allocated €10 million by the HSE to help support the resumption of services and supports which was received by a high level of criticism and dismay as it represented only a fraction of the required funding needed (National Federation of Voluntary Service Providers, 2020b). With the lack of any initial substantial financial package to help support the resumption of disability services, and in stark contrast to the financial budget allocated to support education, questions were beginning to be asked as to if we really were ‘all in this together’?

The reduction in supports for people with disabilities, already lacking in additional supports pre-COVID-19, had a severe negative impact on people with disabilities and their families, with resilience levels decreasing in absence of vital supports from day services. People with disabilities were also reported to have an increase in anxiety levels, behaviours of concern and isolation during the period that day service locations were closed (Inclusion Ireland, 2020; National Federation of Voluntary Service Providers, 2020a; House of the Oireachtas, 2020). The financial strain on services were eased somewhat following announcement of the Government of Ireland’s Budget 2021 and the allocation of €100 million to improve disability services in Ireland in addition to €20 million towards the Transforming Lives Programme, the programme developed to deliver on the recommendations of the ‘Value for Money and Policy Review of Disability Services in Ireland Report’, 2012. The National Federation of Voluntary Service Providers (2020c) highlighted that this was only the first step in progressing disability services, and that multi-annual investment is needed to address the needs of people with disabilities in Ireland. While the financial support allocated to services should progress towards increasing service provision, due to the non-committal discourse used within guidance documents on the full resumption of services it could be argued that people with disabilities face a period of uncertainty as to when services will be resumed, if ever, to the same provision pre-COVID-19.