August 30, 2011

Individuals with disabilities, the currently preferred term used to describe disabled or handicapped persons, refers to those whose physical or mental impairments so interfere with life’s activities, including working, that they are set apart from those without disabilities.

Disability, like beauty, is in the eyes of the beholder. Whether the beholder is the Social Security Administration, an employer, an insurance company, a retail business, the bureau of motor vehicles, a doctor, or a partner, an individual may or may not be considered disabled.

Insurance companies and health professionals sometimes measure disability in terms of how many activities of daily living (ADLs) a person can perform independently. The Mayo Clinic separates ADLs into Basic ADLs required for an individual to care for themselves in a limited environment: Dressing, Eating, Ambulating, Toileting, Hygiene (acronym DEATH, ironically), and Instrumental ADLs, the higher level abilities required to function in the community: Shopping, Housework, Accounting, Food Preparation, Transportation (SHAFT). For people with physical, developmental, and age-related disabilities, and their advocates, these are the concepts that help identify appropriate housing and resolve placement issues.

Another touchstone is the Social Security Administration’s definition of disability, focused more on an individual’s ability to work and make a living in our competitive world. Social Security assessment proceeds through a five-step sequential evaluation. To be disabled, a claimant must (1) not be working at a level known as substantial gainful activity, (2) suffer from severe medically determinable impairment that lasts more than 12 months, (3) either meet a listed impairment or suffer from an impairment so severe that it (4) prevents return to past relevant work performed in the last 15 years and (5) prevents entry into other jobs existing in significant numbers in the national economy.

A blind or paraplegic person may meet a listing, and be what we would all call disabled, but if she is gainfully employed, she is not disabled under the first step of the Social Security definition, and would receive no benefits.

For private long-term disability insurance coverage, and even short-term disability coverage, a distinction is often made between own occupation and all occupation coverage. Whether a person’s impairments prevent her from performing the duties of her own occupation is one measure of disability. Sometimes after a period of a year or two, the policy will require the disabled person to prove that she is not unable to go back to her old job, but unable to go to work at any job. Since there is still no parity legally required between physical and mental disabilities, long-term disability insurance coverage sometimes has a 2-year limit on coverage for mental impairments.

The workers’ compensation system differentiates among permanent partial, temporary total, and total permanent disability, and may assign a percentage disability for the loss of a limb or the loss of use of a body part or organ.

Under the Americans with Disabilities Act, disability refers to the inability to perform the bona fide occupational qualifications (BFOQs) required to perform all the duties of one’s job.

Who makes these decisions? On what medical evidence are such findings of disability based? Sometimes the opinions of one’s own treating physicians or other health care professionals are given the most weight; sometimes it is the opinion of the independent medical examiner or panel of physicians employed by the company or government that is determinative of the claim. It is important that each individual find out whether his or her employer’s disability coverage is provided through an insurance company, regulated under state law, or through a self-funded or Employment Retirement Income Security Act (ERISA) plan that is exempt from state insurance regulations and is governed instead by the U.S. Department of Labor.

More women (20.7%) than men (18.6%) suffer disabling conditions, and while bad backs are the leading cause of disability for both genders, women are twice as likely as men to suffer from arthritis. While fewer women suffer from mental disorders (not mental retardation and learning disabilities) than men, women are twice as likely to struggle with depression.

As Tolstoy put it, all happy families resemble one another, but each unhappy family is unhappy in its own way. Healthy people do not typically gather in support groups focused on peculiar ways in which they are healthy, unless you consider a bowling league or an investment club as a celebration of physical or mental health. Disabled people and their families often connect with other disabled people and their families, linked by the disease or impairment that has changed their lives. Syndromes and symptoms, diseases and diagnoses give disabled people something in common that goes beyond shared suffering, an unspoken language that only the victims, and perhaps their caregivers, understand. Undoubtedly, for better or for worse, a disability shapes a person’s day and life in ways the rest of us can only read about and try to imagine.

SEE ALSO: Activities of daily living, Americans with Disabilities, Act, Capacity, Health insurance, Social Security disability benefits

Suggested Reading

  • Asch, A., & Fine, M. (Eds.). (1988). Women with disabilities: Essays in psychology, culture and politics. Philadelphia: Temple University Press.
  • Beisser, A. (1988). Flying without wings: Personal reflections on loss, disability, and healing. New York: Bantam Books.
  • Jans, L., & Stoddard, S. (1999). Chartbook on women and disability in the United States. An InfoUse Report. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research.
  • Mathews, G. F. (1983). Voices from the shadows: Women with disabilities speak out. Toronto, Ontario, Canada: Women’s Educational Press.
  • National Institute of Mental Health (NIMH). (2001). Women hold up half the sky, fact sheet on women and mental health research (NIH Publication No. 01-4607). Betlesda, MD: Author.

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