Homelessness is often blamed on substance abuse, mental illness, or other conditions perceived as “treatable,” but neglected. A wrench is thrown into this line of thinking when we consider that around half of chronically homeless people are physically disabled.
Chronic homelessness is a term used by the US Interagency Council on Homelessness to describe repeated or extended episodes of homelessness. According to this agency, 43 percent of chronically homeless people suffered from physical disabilities in Los Angeles in 2017. This means there are significant barriers facing the physically disabled from getting and keeping housing.
It means our society isn’t addressing the root of the problem.
Physical disabilities can be present from birth, like blindness or epilepsy. One can also acquire a disability later in life. Examples of physical disabilities acquired later, and which often result in homelessness, are amputations and spinal cord injuries. These conditions leave a person dependent in some way on accommodations. They prevent them from accessing many jobs available to the rest of us.
Older adults are particularly at-risk for homelessness related to physical disabilities. In Los Angeles County, a study showed 89 percent of the older homeless population had physical disabilities. They were as follows:
- Dental problems (60%)
- Eye problems (50%)
- Hypertension (50%)
- Arthritis (50%)
- Back problems and/or pain (40%)
- Diabetes (30%)
- Heart problems (30%)
- Stroke (20%)
These statistics show two things:
- older homeless adults usually suffer from multiple physical disabilities, and
- older homeless adults suffer disabilities far beyond what is normal for housed older adults.
A study from Harvard shows that only 41 percent of all adults ages 65-79 have a disability impacting self-care or mobility.
When a person suffers more than one type of disability, they face not only increased barriers, but loss of hope as well. As health becomes poorer and conditions more complicated, treatment costs increase. For homeless people, it’s a tunnel with no end in sight. It also begs the question:
Do disabilities cause homelessness, or is it the other way around?
The answer is both.
When people are disabled, they have more difficulty gaining employment. Transportation and mobility issues keep them from accessing services as well. Arthritis can prevent someone from writing. A stroke can leave someone unable to speak.
Medical bills due to physical ailments can begin a chain reaction that eventually leads to homelessness. Costly treatments, hospitalizations, and tests can run hundreds of thousands of dollars. For people without medical insurance, and often even for those that do, this debt can be insurmountable. Paying medical debts can win out over paying the rent or mortgage.
In terms of how homelessness causes disabilities, homeless people are three to six times more likely to become ill than housed people. Frostbite from exposure to cold and skin infections from unhygienic living conditions can result in permanent disabilities.
Finally, if a person is homeless, they probably are not getting adequate medical care, making existing issues even worse. Conditions like diabetes can become crippling or deadly when not treated properly. Not only do they deepen a person’s struggles with homelessness–they can dramatically reduce lifespan.
Isn’t There a Federal Program for This?
What people are referring to when they talk about receiving “disability” is either Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Both are federal programs designed to help the aged and/or disabled. Each has a separate approval process and eligibility criteria.
In order to receive SSDI, potential recipients must have worked a minimum number of years. They must also have paid into Social Security to a sufficient extent while working.
SSI is available for people who have never worked or haven’t worked enough. Rather than work history, it’s based on financial need. A person’s income and assets will be used to determine whether they qualify for SSI benefits.
When SSI Fails
There can be surprising reasons for getting denied SSI/SSDI benefits. There are also factors limiting how much a person can receive, or prevent someone from applying at all. Being homeless comes with many complications to receiving disability. Shockingly, only 40 percent of homeless people qualify for SSI or SSDI.
Some homeless people qualify, but don’t get approved. Of the 40 percent who actually qualify, only 14 percent go on to receive benefits. Factors directly related to homelessness can play against the approval process. For example, living in a homeless shelter can mean less SSI money.
There are several reasons people get denied disability, despite being homeless and disabled. They include:
- Not having enough medical records. In order to be granted disability benefits, applicants must be able to prove, through medical records, they are unable to work. Homeless people who haven’t received adequate medical care, whether due to transportation, cost, or other reasons, won’t have that evidence.
- Not having a relationship with a doctor. A successful applicant must have a long-standing relationship with a doctor demonstrated in their medical records. Visits with a nurse practitioner or physician’s assistant do not count.
- Physical inability to complete paperwork. This could mean inability to write or access a computer.
- Human error. Mistakes can occur on the part of the person applying for disability as well as the government. The application process is complex, with many pieces needing to come together for someone to be granted disability. If the applicant lacks knowledge or understanding of the process, they are more likely to make mistakes and get denied, even if they actually do qualify. If one piece of the puzzle gets lost, it can mean denial.
Solutions for Disabled and Homeless People
There are a number of ways physically disabled people who are homeless can still access help and be successful. However, it takes targeted interventions. Often it means supporting interventions that exist, but are not diligently enforced.
There is a national program, called SSI/SSDI Outreach, Access, and Recovery (SOAR), which is specifically aimed at people who are homeless or at-risk of homelessness who also have a medical or mental health impairment. Caseworkers work directly with applicants to walk them through the application process and help them complete paperwork. This is a program we can work to build awareness of and advocate for.
Other resources to promote are:
- Legal aid programs. Free legal aid is an invaluable resource to homeless people. Having a lawyer assist with the disability application process, or with an appeal after denial, can mean the difference between getting approved and giving up hope.
- Advocate for compliance with laws requiring handicap accessibility. The Americans With Disabilities Act and the Fair Housing Amendments Act are the two main laws governing homeless shelters and their accessibility to disabled people. They make it illegal to discriminate against disabled people, as well as require wheelchair ramps, grab bars, and other accommodations.
- Educate yourself and others on medical care resources in your community. Many hospitals and clinics offer programs providing low-cost or free care to underserved populations. Mobile medical clinics are another great option if available. There are many programs which provide free or low-cost dental care to homeless people, as well.
Of course, contacting your legislators and advocating for more accessible healthcare is always an option. If people are becoming homeless, or falling deeper into it, because of a physical disability, we have a responsibility to intervene. We can make life easier and more comfortable, even when a disability cannot be removed. Disability doesn’t have to mean an individual has no chance at success or happiness.