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Hospitals are loosening mask requirements, which worries some vulnerable Vermonters

Masks or cloth face-coverings are one important tool in helping to prevent the spread of the novel coronavirus.

Hospitals across the region have loosened masking requirements in recent weeks as COVID rates have generally steadied.

That includes the University of Vermont Health Network's hospitals in Burlington, Berlin and Middlebury; Southwestern Vermont Medical Center in Bennington; and Dartmouth Health's locations in New Hampshire.

Now, masking is largely up to the individual at those hospitals, although some still require people with flu-like symptoms to mask up. Meanwhile, pandemic-era visitor restrictions are also loosening.

But that's raising alarm bells for some residents who are more vulnerable to COVID and still rely on prevention measures to navigate healthcare settings.

To learn more, Vermont Public's Mary Engisch spoke with Kate Larose. She's the pandemic equity coordinator for the Vermont Center for Independent Living, which advocates for people with disabilities. Their conversation below has been edited and condensed for clarity.

Mary Engisch: Can you share which groups of folks are impacted by this rollback? And how are people feeling about it?

Kate Larose is in a power pose, arms crossed, in front of a building.
Courtesy of Kate McCuin

Kate Larose: So over the past three years, disabled Vermonters have been all but pushed out of education, work and civic life — and all that we had left was health care. And now that's been taken from us, too. What we're what we're being told loud and clear from health care facilities is that harm and death to certain groups are an acceptable price to pay. So this is going to come at the highest cost to Vermonters who are older, disabled, Black, Indigenous, people of color, or low income.

Can you explain, in a public health sense, why loosening masking and visitor requirements is such a big deal to Vermonters with disabilities and other COVID vulnerabilities? What are the consequences of catching this virus for some of these folks?

I want to start by saying that hospitals are not restaurants and they're not grocery stores, right? So many of the highest risk folks we work with at VCIL have shared with us that they're no longer able to be safely out in public; the only places that they go, and oftentimes they need to go quite frequently for health care, are health care facilities. So these are congregate care settings, which represent disproportionately high numbers of people who will have worse outcomes of severe illness and death if they are exposed to COVID.

The Americans with Disabilities Act says places of public accommodation, like hospitals, must provide people with disabilities equal access to their services. Can you talk more about how that law relates to hospitals and to visitors who are vulnerable to COVID?

So you're right, those who are at higher risk from COVID infections — including disabled children and adults, older Vermonters, long haulers and people with certain medical conditions — have federally protected civil rights under the Americans with Disabilities Act. So under Title III, they must be provided with equal access to services and places of public accommodation, including health care, without incurring a greater risk of harm.

The moment they walk through the doors of an unmasked indoor facility, they are at a greater risk of harm. We know that hospital infections are not low. We know that when people do get hospital-acquired infections, the death rates are actually much, much higher.

The Americans with Disabilities Act predated the COVID pandemic. It's been around since 1990 and there has been, through the years, updates to it. But what it states, essentially, is that people who qualify as a person with a disability, it doesn't matter what current COVID policies are — policies and procedures may need to be modified so people with disabilities have the same benefit of existing services.

So there's a lot of different ways that somebody who qualifies under the ADA can assert their civil rights. But generally, some of the things that we've heard secured in Vermont are things like making sure that they are in universally masked settings. That may include having providers wear N95s. That may include accessing places that the general public have access to at a time when the general public is not there; so accessing health care offices before open hours to ensure that they're safe, because we know that one-way masking doesn't work.

It sounds like a lot of folks are thinking it's safe to go unmasked in these places. And they might not be thinking, "Hey, there are other folks in the community that would benefit from everyone still having a mask on."

From an ethical standpoint, it seems that universal masking in a health care setting would be the best approach. But if hospital executives are not going to go with the, "Do no harm" motto, and they're going to go with, "Let's accommodate the perceived convenience of some over the very real health and safety needs of others," then here are some of the other things that can be done.

And I just want to preface this by saying reasonable modifications under the ADA are situation specific and individual specific. So these are not prescriptive. This is not an exhaustive list. But these are some of the accommodations and modifications that we've heard from Vermonters just in the last few weeks that they've secured. Replacing in-person appointments with telehealth or video appointments, of course, where that's possible. Having ambulatory services provide care at home that might include vaccines or blood draws or infusions. Checking in from the car and waiting in the car until folks are being called into the appointment. We've heard from a lot of Vermonters who have actually been shielding themselves for three years only to get COVID for the first time on Medicaid transport to health care facilities. So being able to provide transport with a masked driver is very important.

How might vulnerable Vermonters make these different requests for accommodations that you've mentioned?

The onus continues to be on vulnerable Vermonters. And, you know, I want to start by framing it as when people with disabilities are requesting accommodations under the ADA — this is not asking for a favor or asking for special treatment. This is people asking for their federally protected civil rights.

The specifics of the law does not require that people cite the ADA. It doesn't require that the request be in writing or verbally one way or the other. But what we have found works best to get protections as expeditiously as possible is if people call in advance and ask the scheduler or the nurse who is the best person to request ADA accommodations through. Oftentimes, what we're finding is health care providers are completely unaware of protections under ADA. And so we have to explain a little bit more information about it. Oftentimes, it needs to be elevated to someone in a different department at a hospital. And so putting in a request, being very clear about what it is that they need in terms of the setting or accommodations, modifications.

And this is really important, I think — they don't need to say what their disability is. It's really about, "This is what I need in this environment to have safe access to this setting." We also recommend that people follow up in writing with the request and make sure that they have the contact name of the person they connected with and a date by which that person is going to get back to them, letting them know that the arrangements have been made or that their accommodations have been denied. If their accommodations had been denied, they should reach out to Vermont Center for Independent Living. They can also reach out to disability rights Vermont for additional support.

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