Greater need for handwashing: In contexts where people lack sufficient access to assistive products, such as crutches or wheelchairs, people with disabilities, older adults and older adults with disabilities may need to touch the ground or surfaces to move around and so need to wash their hands with soap and water more often. When assistive products like crutches and wheelchairs are available, these items can pose a risk for contamination since immediately after handwashing with soap, people need to touch the product which may not be clean.

Impairment related limitations: People with physical impairments may have difficulties rubbing their hands together thoroughly. People with intellectual and cognitive impairments, including dementia, may not remember when, how or why hands should be washed or recognise the significance of handwashing in reducing risks.

Limited support from caregivers: People with disabilities, older adults and older adults with disabilities may be reliant on caregivers to help them to practice regular handwashing. In some cases caregivers may not prioritise the needs of the individual. In other cases caregivers offer limited support because they lack information on how to support another person’s WASH requirements, and they may not have the required social support or guidance to do so. Additionally, evidence from Zimbabwe, India, Tanzania, Cambodia and Uganda show that older adults also care for others during the COVID-19 pandemic.

Inaccessible handwashing infrastructure: People with disabilities, older adults and older adults with disabilities may be less able to independently collect, carry or pour water (resulting in a reduced quantity of water available for handwashing) and may have more difficulties reaching soap and water or using standard handwashing facilities. These gaps can become more pronounced during outbreaks as hand washing facilities are rapidly scaled up. For example, this was noted in Sierra Leone during the Ebola crisis, where people with disabilities reported not having access to a toilet or water source. During the COVID-19 pandemic, up to 31% to 62% of older adults in Zimbabwe, Iraq, Uganda, Tanzania, Rwanda, India and Ethiopia reported that there were not enough WASH facilities. Many worried that existing facilities were contaminated and that they would be unable to access facilities during lockdown.

Inaccessible information or hygiene promotion programmes: For people with sensory or intellectual impairments – including older adults with visual impairments - hygiene promotion materials may be more difficult to read or comprehend. Often in humanitarian responses it is uncommon that these communication materials are designed in a more accessible way. For instance, during COVID-19, 46% of older adults in Zimbabwe faced challenges accessing COVID-19 related information, whilst many older adults with disabilities in Cambodia reported major barriers. Results were similar in Uganda, but the barriers increased for older adults with disabilities, and for older women compared to older men.

People with disabilities, older adults and older adults with disabilities are also more likely to remain at home while others in the household attend hygiene promotion events or kit distributions. There are often both physical and social barriers that contribute to this.

Why should we include people with disabilities and older adults in the COVID-19 response?

Are people with disabilities and older adults at a higher risk during the COVID-19 pandemic?

What do we know in general about disability, ageing and WASH access?

How can we ensure people with disabilities, older adults, older adults with disabilities and their caregivers are included in all COVID-19 hygiene promotion programmes?

How can our organisation assess whether our COVID-19 response programmes are inclusive?