Disability in the community: inclusion, caregivers and community-based rehabilitation
- Safe practice
Disability comes from a health condition meeting barriers; the nurse removes barriers, supports caregivers and links families to rehabilitation.
What it is
WHO estimates that about 1.3 billion people, 1 in 6, live with significant disability, which results from the interaction between a health condition and environmental and personal factors. People with disability can die up to 20 years earlier and have twice the risk of conditions such as depression, diabetes or stroke, largely because of barriers, including staff attitudes and inaccessible services. Ley 1618 de 2013 orders health providers in Colombia to guarantee accessibility, train staff, offer care close to home (also in rural areas) and run home-care programmes. Ley 1996 de 2019 presumes the full legal capacity of adults with disability. Community-based rehabilitation (CBR) is WHO's strategy to include people with disability and their families in health, education, livelihood, social life and empowerment.
What it requires
- Ley 1618 classifies barriers as attitudinal, communicative and physical.
- Women with disability are 2 to 4 times more likely to experience intimate-partner violence (WHO).
- Gaps in social support leave many people with disability dependent on family caregivers, often women and girls.
- CBR is carried out by people with disability, their families, their organisations, community groups and government services together.
Components
- The person: functioning, goals, preferences and supports for decisions.
- The family and caregiver: burden, skills, rest and support.
- The environment: physical access, communication and attitudes.
- The community network: rehabilitation, education, work and disability organisations.
How it is applied (and why)
- Speak to the person first, not to the companion — the adult with disability decides, with supports if needed.
- Ask about daily function and what the person wants to achieve — rehabilitation follows the person's goals.
- Adapt communication (sign language interpreter, easy-read, more time) — a communicative barrier is a care barrier.
- Check accessibility of the home and the route to the service — physical barriers decide whether care happens.
- Assess the caregiver's burden, health and support network — a caregiver who breaks down harms both people.
- Offer home-based support and family education according to the rehabilitation plan — CBR brings care to the home.
- Link the family to rehabilitation, education, work and disability organisations — CBR works across sectors.
- Record disability and support needs so the person enters the registers and planning — what is not counted is not planned.
In nursing practice
- People with disability are often left out of screening, vaccination and health promotion; include them actively.
- Watch for signs of violence or neglect, especially in women and people with high dependence.
- Depression, diabetes, stroke, obesity and poor oral health are twice as frequent in people with disability (WHO); include them in screening.
- Consent and decisions belong to the person; Ley 1996 forbids restricting capacity because of disability.
Common mistakes
- Talking to the companion as if the person were not present.
- Seeing only the diagnosis and not the barriers.
- Forgetting the caregiver's health and rest.
- Using the person's disability as a reason to skip screening or prevention.
Test yourself
Think of the answer, then tap the question to see it.
How does WHO describe disability?
As the result of the interaction between a health condition and environmental and personal factors.
What does Ley 1996 de 2019 establish?
That adults with disability have full legal capacity on equal terms and may use supports to make legal decisions; disability is never a reason to restrict it.
What are the five components of the CBR matrix?
Health, education, livelihood, social and empowerment.
What are two duties of health providers under Ley 1618 de 2013?
Guarantee accessibility in all services and offer care as close as possible to home, including rural areas, plus staff training and home-care programmes.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Disability (fact sheet) (World Health Organization, 2023); Community-based rehabilitation (fact sheet) (World Health Organization, Regional Office for the Western Pacific, 2018); Ley Estatutaria 1618 de 2013 (derechos de las personas con discapacidad) (Secretaría General del Senado de la República, Colombia, 2013); Ley 1996 de 2019 (capacidad legal de las personas con discapacidad mayores de edad) (Secretaría General del Senado de la República, Colombia, 2019).
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Representative model, for educational purposes only.