HELENA, Mont. -- Montanans with disabilities face multiple barriers to care in the coronavirus pandemic, and those issues are compounded in rural parts of the state.

Fewer than a quarter of Montana counties have Intensive Care Unit beds. Lillie Grieman, project director for the Research and Training Center on Disability in Rural Communities, said that means having to travel long distances in an emergency.

For example, in Toole County, hit hard by the coronavirus, the closest ICU beds are in Great Falls, about 85 miles away.

"Not only do you have to travel far to get to beds," Grieman said, "You're going to a place where there are more people, where there is also an outbreak, and those beds may also still be in high demand. So, that's what I find particularly disconcerting."

Greiman noted that rural communities also have higher rates of people with disabilities, about 18% compared with 12% in metro areas, and the average age also skews higher in rural areas.

Montana is reporting 437 cases and a dozen deaths from COVID-19.

Disability-rights groups have raised concerns that once a person with disabilities gets to the hospital, they could be last in line if resources are scarce. Some of the crisis-care plans in states across the country ration care at their expense.

Travis Hoffman, advocacy coordinator for Summit Independent Living in Missoula, participated in a state work group on rationing care in a doomsday scenario as the virus began to spread. He said the group discussed making medical decisions based on science rather than perceived quality of life.

"Ensuring that decisions about everybody -- not just people with disabilities -- are based off of actual science and concrete medical principles," Hoffman explained, "and that if need be, people with disabilities would be granted reasonable accommodations to receive the care that they need."

The Department of Public Health and Human Services didn't respond by deadline to a request for comment on what rationing plans look like in Montana.

WATERLOO, Iowa -- Advocates for Iowans with disabilities are sounding the alarm over what they describe as a caregiver crisis, pleading with lawmakers to give the issue more priority, so these individuals are not pushed from their homes because of the scarcity of providers.

Tucker Cassidy, a person with quadriplegia from Waterloo, said the workforce shortage has been building for years, but in the past month and a half, it has become much worse.

He noted it is difficult for the agency he works with to send over enough caregivers to help with his daily routine. Stuck in bed more than he is used to, Cassidy admitted the shortage leaves him worried about his future.

"Is this going to be the week that they kick me off?" Cassidy questioned. "And then, where am I supposed to go? You know, I own my own house."

Advocates say the crisis is largely driven by low wages for caregivers. According to Indeed, the average starting pay for in-home caregivers in Iowa is around $13 an hour.

Lutheran Services in Iowa estimates it has been forced to reduce its client base by 350 in recent years. The shortage comes as Iowa touts a budget surplus of $1.24 billion.

Matt Grillot of DeWitt has used a wheelchair most of his life due to a spinal injury. He has been in his own house for the past 18 years, but he has struggled to hire a caregiver in recent months, forcing him to consider alternatives he would rather avoid.

"I have broken down within the last month and started looking at nursing homes and group homes," Grillot acknowledged.

But he said he faces barriers in moving to those places, adding to his stress in planning his care.

Cody Lewton, director of services for people with disabilities at Lutheran Services in Iowa, said they are down roughly 250 caregivers, citing the struggle to pay them enough money.

"It's less than a living wage, and it's only become worse," Lewton observed. "The funding has, over the last 20 years really, has not kept up with the cost of living."

The Iowa Developmental Disabilities Council said it is also concerned about the crisis, adding it will be the group's number one legislative priority next session.

FARGO, N.D. - People with Down syndrome are having a bigger impact on society, and their advocates in the Dakota region say it's time for the public to take notice.

October is Down Syndrome Awareness Month. It's widely known that people born with this condition have an extra chromosome that affects their development, but some say there's more to it.

The New Directions Down Syndrome Association connects parents in a four-state region, including parts of North Dakota. Brandon Tilus, president of its board of directors, said he feels public perception is being outdated by the lives many with Down syndrome are carving out for themselves.

"People with Down syndrome born today have a really good chance of living a life where they're independent, that they get married, that they do all of these things that we expect all individuals to do," he said.

He credited early-intervention programs and advancements in therapy for establishing better outcomes. However, he said strong government funding still is needed to ensure more families have access to these services. According to the Centers for Disease Control and Prevention, Down syndrome occurs in about one in every 700 births.

Tilus said another way to overcome any stigma is for people to make others with Down syndrome feel more at ease in their interactions. He also advises that some ways of communicating should be avoided.

"'I use my hands more to talk to them, because I'm not sure they're going to understand me.' And, those types of things - sort of, coming into an interaction with those individuals with those preconceived notions - I think can make it a little bit more difficult," he said.

Tilus, whose 6-year-old daughter was born with the condition, said the best thing to do is treat a person with Down syndrome like anybody else. All they may need is a little extra time to respond, and be given the opportunity to take the lead in a conversation, to feel comfortable.

SPRINGFIELD, Ill. -- As businesses across Illinois and the nation work to fill open positions, advocates for people with disabilities say they should take a more inclusive approach.

According to federal data, the jobless rate for people with disabilities is 11.5%, compared with slightly more than 5% for the rest of the population.

Kim Mercer-Schleider, director of the Illinois Developmental Disabilities Council, said with workforce shortages across many industries, there is no reason for people with disabilities to be underemployed.

"I would ask for employers to be open to taking a look at, what positions do you need to have filled?" Mercer-Schleider suggested. "How can they be broken up or looked at differently, that capitalizes on somebody's skill set?"

She noted it is important to acknowledge some people might need accommodations in some areas, but can really thrive in others. October is National Disability Employment Awareness Month, and she pointed out it is the perfect time to reflect on how to make hiring practices more inclusive.

Mercer-Schleider added it is also important to make sure the hiring process itself is accessible. She observed some online applications are not compatible with screen readers, for instance.

"Are your materials accessible? Can they be accessed with assistive technology, etc.? Are you opening up the door wide enough?" Mercer-Schleider outlined.

She emphasized the pandemic also has shown more flexible work is possible, for instance, working from home is a viable option for people who may have mobility issues or lack transportation. She hopes employers will embrace it as an option for accessibility beyond the COVID crisis.