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.

In an appeal to the public as Hurricane Ian barreled toward Florida, an advocate for persons with disabilities urged everyone to consider checking in with neighbors, friends or family members who may benefit from a helping hand.

Mandy Bianchi, executive director of the group Ability1st, wrote a column in the Tallahassee Democrat published the morning before the then-Category 4 storm made landfall in Southwest Florida, explaining those who are vulnerable have a lot more to consider during hurricane preparedness, including obstacles such as getting emergency notification and transportation; evacuation; sheltering; access to medications, refrigeration, and backup power.

"For people who need oxygen or a CPAP machine or anything along those lines, if we lose power that is really a frightening situation for people who rely on those type of devices," Bianchi pointed out.

According to the Centers for Disease Control and Prevention, 1 in 4 adults in Florida has a disability, which is more than 4.5 million people.

Bianchi stressed it is important to think before, during and after the storm about any person who might be in need of help, and to check on them. She added if you are scared of what could happen during a storm, they might be even more so, and every little bit counts.

Bianchi's organization works across six Florida counties and provides services to people who are homeless. She is also shedding light on being available to assist those with mental-health needs.

"For people who have mental-health concerns, just knowing that somebody is nearby or can call and check on them, it's just a comforting feeling to know that they are not going to be forgotten about or left behind," Bianchi advised.

Almost immediately after Hurricane Katrina devastated the Gulf Coast in 2005, the National Council on Disability estimated there were roughly 155,000 people with disabilities over the age of 5, or about 25 % of the cities' populations, living in the three cities hardest hit by the hurricane.

Federal agencies such as FEMA, as well as Florida's Division of Emergency Management, provides guidelines on the best ways to plan and support those with disabilities.

Nearly a dozen Iowa youths with disabilities are taking newly developed leadership skills out into the world. A summer academy wrapped up this month, and organizers say this year's class displayed impressive strength in self-advocacy.

The Youth Leadership Academy just saw the graduation of its third class and was able to hold closing ceremonies in-person for the first time after COVID disrupted the previous events.

In interactive sessions, students from ages 14-21 learn about things like goal-setting and civic engagement.

Francine Pace, a college student who was diagnosed with autism at a young age, said she liked the networking training.

"You want them to hear your side, and it's great to hear other people's side and combine and making teamwork happen," Pace explained. "You can overcome a lot of things."

Pace feels the program is a great approach in trying to enact change at the community and state level. She will keep pushing for policies to reduce the state's waiting list for those with disabilities seeking home- and community-based services.

Event organizers say this summer's students already had a range of advocacy experience, which allowed them to bolster the curriculum.

Sebastien Janelle, another college student and academy graduate, said the program helped him focus on personal goals as he looks ahead to his future while living with autism.

"If I want to buy a house someday or, like, if I want to get there, then it is a huge priority to live up with that moment to reach that goal," Janelle emphasized.

The Iowa Developmental Disabilities Council helps lead the academy, along with several partners, including the Center for Disabilities and Development, ASK Resources, the state Department of Human Rights and Access to Independence.

The New York City Council is considering asking the Department of Transportation and the Department of Parks and Recreation to develop a report outlining the best locations for public restrooms in every ZIP code in the city.

Currently, New Yorkers can either use public restrooms in the parks or one of the city's newly installed automatic public toilets.

The new report would specifically address accessibility for people living with a disability.

Sharon McLennon-Wier, executive director of the Center for Independence of the Disabled-New York, described one of the biggest issues with the new automatic toilet facilities.

"If someone is using a motorized wheelchair -- and also, they may themselves weigh a certain amount -- they may not be able to access the public restrooms due to the construction of the flooring," McLennon-Wier pointed out. "Which has a weight limit of, I believe, 700 pounds."

She noted another concern is the time limit on the automatic public toilets. The door remains locked for 12 minutes, which might not be enough time for someone with mobility issues. Some solutions would be to extend the time limit and make the structures more permanent, so the floors are better reinforced.

Public restrooms in parks were recently found to be lacking in New York for people with disabilities. According to a 2019 report from the City Comptroller, 69%, or almost 1,000 of the city's 1,428 park restrooms, do not comply with the Americans with Disabilities Act.

McLennon-Wier hopes additional facilities will provide a wider range of options.

"With disabled folks having to take Access-A-Ride, and having to worry about wait times and their transportation not being readily available, they have to sit and wonder about if they're going to make it to the bathroom," she observed.

McLennon-Wier added that better access to public restrooms would be a benefit to all New Yorkers. She explained many people find themselves having to carefully consider when or where they can eat or drink because they might not have a restroom nearby.