Mar 31, 2017

Why So Many Disability Claims From Rural Areas?

     The Washington Post is running an article on rural disability. There's a far higher incidence of Social Security disability claims in rural areas. The drift of the article is that this is related to the lack of job opportunities in rural areas, i.e., people can't find jobs so they file disability claims.
     I think there is a link between lack of job opportunities in rural areas and Social Security disability claims but I think it's more complicated than this article presents. What happens when there are poor job opportunities in an area but better job opportunities elsewhere? Some people leave to pursue job opportunities elsewhere. Those who leave are on average younger, better educated, smarter and healthier than those who stay. Those left behind are people who are more likely to file disability claims regardless of the job opportunities in their community. Those left behind also have much worse access to health care than those who leave. Health care in most rural areas sucks. Even if you have insurance, it's hard to get good medical care and many in rural areas lack health care insurance. You're more likely to get sick and stay sick if you have poor access to health care.
     Those of us who represent Social Security disability claimants like to talk about demographics and access to health care as factors in determining who files disability clams. Newspaper reporters don't like to write articles about demographics and access to health care. It's boring. They like nice simplistic explanations since those are easier for them to understand and convey to readers.
     By the way, there's nothing new about the higher incidence of disability claims in rural areas. I live in Raleigh, which was a fair sized and relatively prosperous city when I started practicing Social Security law in 1979. Raleigh and surrounding cities such as Durham, Cary and Chapel Hill have gotten much bigger and more prosperous since. This area has always been surrounded by poor rural counties. From the beginning of my practice, I've gotten more clients from the less populous rural areas than from the urban areas. The incidence of disability has always been higher in rural areas.

22 comments:

Anonymous said...

When you started practicing North Carolina was Blue and now its Red. What changes have you seen regarding access to healthcare and disability applications since the switch?

Anonymous said...

the story is a direct response to mick mulvaney's comments, you know they dispatched the reporter Sunday afternoon. Now that Trump is in charge the Post is concerned with real unemployment numbers.

Anonymous said...

Like most issues, I think there are many things in play. Rural areas are usually much less expensive to live in, rent is only a fraction of the cost in more urban areas. These rural areas have an older infrastructure, many buildings and businesses are not ADA compliant making working with a disability more difficult. Transportation programs in rural areas are mostly non-existent and cumbersome at best. Job training programs are sparse, in rural areas you are left without many of the services many in urban areas take for granted. Healthcare, as pointed out, is no exception, and mental/behavioral health is nowhere to be found.

The story of Spencer in the article also notes he is a convicted felon. That is another strike against getting employment, rural or urban. That's a topic for another story.

Anonymous said...

Sounds like you're talking your book, Charles. The question of why we have so many disability applicants, particularly in rural areas, is certainly complicated. But the WaPo article rings true based on my observations. If, as you claim, youth migration and access to healthcare explains the trend, then we would see similar trends in much of the undeveloped world, where healthcare is much worse and cities are rapidly growing with new job-seekers. But that's just not the case. Visit any small town in Mexico or Vietnam or Nigeria, and you won't see 30% of the population disabled, despite much harder conditions then we have here.

The ugly truth is that good-paying blue-collar jobs are disappearing. Many people don't want to work full-time at minimum wage jobs flipping burgers or cleaning bathrooms. Throw into the mix drug addiction (including opioids), convictions keeping people from finding jobs, young children with daycare more expensive than parents could afford at minimum wage, the underground cash/barter economy, representatives offering easy money on TV, and you have the perfect recipe to incentivize disability applications. Yes, it's complicated. But the baby boomers have spent a generation living comfortably at the expense of this country's long-term fiscal health. The result is that many people cannot work for many reasons, only some of which are health-related, and now disability is the last safety net.

Anonymous said...

Another very important event is the absolute shredding of state workers compensation systems by giant corporations, chambers of commerce and the insurance industry. People in their late forties and fifties have had industrial accidents and have received shitty care, limited compensation and no vocational rehab and are dumped back into society. Yes, they turn to one of the last safety nets and usually go through a very hard waiting period for any help and usually lose what little they have left. If anyone has lived comfortably off of this society it's the assholes on wall street who committed fraud, made fortunes, and dumped their shit on all of us to bail them out and make them richer than ever. These people on disability are shooting for basic survival and that is all. Maybe soon we can kill this final safety net and become more like the shitty countries you pointed out 6:07. As for our long term fiscal health I'm quite certain the wall street boys will be back soon to fix that.

Anonymous said...

As for talking your book, I have found that most of those advocating for austerity are advocating it for someone other than themselves. Good example would be wall street bankers that complain about entitlement programs while increasing their bonuses after taking government bailouts.

Anonymous said...

Who cares about fourth rate countries like Nigeria and Mexico. If we really work at it and make it a national priority, we can have the very best third world disabled rural peon class in the world! Let them eat dirt like their kin did! Things like healthcare and enough money to scratch by are highly over-rated.

Anonymous said...

I would say roughly half my clients say something like "I know people on disability, they don't deserve it, but *I* do and why is it so hard for me to get it?"

Anonymous said...

I do care quite a bit about other countries because working at SSA is like dealing with the UN clientele each and every day. Ethnocentric has no place there at SSA , neither does bigotry. However, Many people from all walks and components are now coming out of the closet with their true colors.

Anonymous said...

People can no longer afford to live in big cities. So they are moving out. The rents are too high and they are climbing higher still. Landlords are getting more and more greedy. So where can you live? In a rural area the rent might be cheaper.

If your sole income was social security, would you be able to afford to live in a big city? I doubt it. You would be lucky to afford a trailer park outside of a suburb.

Dina Padilla said...

Baby Boomers created the largest world financial health and the first to go out on employer created work injuries. MANY OF THEM didn't get the work benefits as promised like health care & pensions which were siphoned off by their very own employers, thanks to wall st and & D.C. Millions of them living on the least amount of SSA benefits that the SSA & WC INSURANCE CARRIER saw fit. Living no better than their rural counterparts who worked in jobs for low pay that no one else would work for. We're a country that doesn't care about their on workers than any other banana republic, thanks to wall st and their cohorts in D.C. or is it that opportunity was just a temporary fake front for what was made inevitable by corporations and those in D.C. who really never gave a damn because they never really go what they worked for just like our vets not being able to get their owed and deserved benefits No one should have to fight so hard for what they were promised in lieu for their hard work.. Workers have been and still are the most expendable.

Anonymous said...

Simple answer... White blue-collar have not advanced in education or skills. Now that most jobs require computer related skills they find themselves frighteningly behind the immigrants. Yet they feel it is their country because it was their ansectors who got here killed of the natives and captured the land. Now they feel entitled to what this richest country produced by they feel unable to produce. Along the same reasoning they have elected on of their own into the top spot. But he has turned on onto them and their representatives.

Anonymous said...

Without seeing these people's medical records we have no idea what shape they are in. Unfortunately, we are dealing with a population here that has genetics, education and hard physical labor working against them. Not surprising many end up disabled. Maybe they can all okie out to California and become plastic surgeons. Eight individuals in the western world now control more wealth than the bottom half of the world's population. The top one percent of the one percent have made out like bandits in this country in the last thirty years often on the back of taxpayer bailouts. We have a percentage of disabled people in this country. They can be treated humanely or inhumanely. They aren't going anywhere unless you kill them off or incarcerate them. I think there are some very politically connected individuals in this country who are breathlessly waiting for a much larger private prison industrial complex. They will rape the taxpayer and will be corrupt and costly as hell, not to mention totally at odds with democratic principles.

Anonymous said...

Idea. Lets do away with social security disability, Medicaid and all social programs and create areas of rural poverty, hunger and ill health that are so terrible we can qualify for UN amd international aid kinda like Africa does. It will be like making the Mexicans pay for the border wall. Ingenious isn't it!

Anonymous said...

There are only a handful of people in the mainstream media who understand the topic well enough to write intelligently on the topics surrounding Social Security Disability. This one needed to do more research and talk more to people who knew what's really going on.

Anonymous said...

Need to change grid rules, especially 201.09, 201.12, 201.14, 201.17. Those rules reflect problems with education and training not an inability to perform substantial gainful activity due to a disability.

If we had a legislature that actually did its job, then we would have separate programs to help people who lack education and training for sedentary work instead of finding them "disabled" at 45 and 50 years old.

In other words, if the "poorly educated" are unable to do sedentary work because of their lack of education and training, then they deserve better access to education/training - instead of a paltry disability check for the rest of their lives. It's just a way of fostering dependency and anger in rural communities - and look where that has led.

Mir Mohammad Ali Khan said...

Nice to read it !

Regards
Mir Mohammad Ali Khan

Anonymous said...

Healthcare is obviously an issue. Access to good health care is hard to come by in these areas. Mental healthcare, especially is nowhere to be found. Beyond that, one thing that you didn't note that may also contribute is that many of the disabled workers in rural communities performed heavy labor work most of their lives and likely worked through injuries and illness in the past because if they didn't, they'd lose their job or see their pay decrease. They become a worn out worker as a result.

Anonymous said...

@12:03 I disagree. We need more efficiencies like the medical vocational guidelines, not less. Even more so since Congress is showing no signs of acknowledging the staffing problem and allocating the funding to address it. There's a fair number of additional profiles that you could direct a finding of disability for and SSA should be implementing them.

Anonymous said...

Cost of living absolutely is a factor. It is not at all unusual to see someone from a rural area who applies but once you get deeper into their history to see they had lived in a more expensive city and relocated to the rural area to stretch their dollar when they quit working.

Availability of work is a factor as well. My mother-in-law commuted 20+ miles one way every day for her job. My wife before she made the decision to go to college drove 12 miles one way for a few cents above minimum factory job.

Low wage + expensive commute (especially when gas prices were higher) add in some nagging chronic condition and it becomes easier to say I'd be better off on disability because in many cases their take home after the travel costs was no more than what their disability benefit would be. People earning more tend to try to find a way to work around chronic conditions because their benefit won't fund their lifestyle.

Tim said...

12:03 PM The grids where no education or not knowing english make a bigger difference are at 50, 55 and 60. Much less so at 45.

Tim said...

Here's a thought. Maybe doctors in rural areas are older and more sympathetic to their patient' s cause and less influenced by lawyers that don't want them to risk helping someone.