10 Employment, Housing, Poverty and the Disability Community
Michael L. Clarkson-Hendrix, MSW, PhD
Mallory Cyr, MPH, Equity & Inclusion Consultant, LLC
Much of the literature on the economic issues of disabled people  has focused solely on their disability status and lacked attention to mechanisms within the cultural structure of the United States that marginalized their multifaceted lived experiences. This chapter focuses on an intersectionally-informed and anti-oppressive social work perspective on the economic issues of disabled people. We begin by providing an overview of disabled people with various social identities in the arena of employment, housing, and poverty. Then, we discuss the voices of disabled people in disability-related debates in this arena. We provide policy and practice implications for working with disabled people in this arena, and we conclude the chapter with a case study.
Disability and Social Identity in the Arena of Employment, Housing, and Poverty
A social identity is the lens through which other people view an individual based on their embodied, hidden, or inherited characteristics (Morgaine & Capuos-Desyllas, 2015). Characteristics can include, for example, gender, race, disability status, and sexual orientation. These identities are constructed through interactions with the social environment where social meanings are created and assigned to them. These meanings are tied to culturally-bounded values and create assumptions of inferiority and superiority between people, which are related to privilege and disadvantage. Individuals have multiple identities that intersect granting privilege in some areas and disadvantage in others.
This section focuses on the prevalence, history, service trends, cultural elements, and relevant policies to disabled people, including the intersection of disability and other various social identities in the arena of employment, housing, and poverty. Whether visible or hidden, disability status is a social identity that has been tied to assumptions of inferiority and consequently disadvantage for disabled people for people in this arena.
Disabled people experience disparities in poverty, employment, and housing. In the year 2018, an estimated 26% (about 5,023,300 out of 19,302,500) of non-institutionalized, disabled people aged 21 to 64 in the United States were living in poverty while, in contrast, an estimated 10% (about 16,587,7000 out of 165,681,000) of non-institutionalized, non-disabled people within the same age group were living in poverty (Erickson et al., 2021). Similarly, in 2018, an estimated 37.8% (about 7,316,900 out of 19,338,800) of non-institutionalized, disabled people ages 21-64 in the United States were employed while 80% (about 133,159,200 out of 166,425,00) of non-institutionalized, non-disabled people in the United States were employed (Erickson et al., 2021). In the same year, Black/African American people with disabilities were employed at a lower percentage (30.5%) compared to compared to Whites (39.2%), Asians (44%), and Hispanic (40%) disabled people (Erickson et al., 2021).
As for housing, it is estimated that only 4% of the nation’s housing is considered accessible to disabled people (National Academies of Sciences, Engineering, and Medicine, 2017). For those living in United States Department of Housing and Urban Development (HUD)-assisted units (i.e. affordable housing), only 30 percent of households with disabled members who requested accessibility features in their housing actually received them (Dawkins & Miller, 2015). Kiesel (2018), a disabled writer, has argued that the disparity between the costs of housing, low disability payments, and the experience of labor market discrimination has made housing unaffordable for many disabled people. The disparity in the capacity for home ownership experienced by disabled people prevents the accumulation of a significant asset that has been used to transmit wealth intergenerationally.
The Connection Between Poverty and Disability
Poverty and disability have been closely linked in the United States. Hughes and Avoke (2010) identified that federal poverty policy has historically exacerbated the experience of disability for United States citizens by failing to address this connection. Disability has been a cause and effect of poverty. Disabled people frequently experience barriers to employment or are underemployed. People with disabilities have been disproportionately relegated to low-skill, low-pay, stagnant jobs that suppress their quality of life, particularly disabled people who are Black, Indigenous peoples, or people of color (Hughes & Avoke, 2010; Toldráa & Santosb, 2013).
For disabled people, poverty has been about more than money. Poverty has represented a cumulative series of barriers to economic independence, and the denial of adequate resources for income, health care, education, and housing has resulted in unnecessary chronic stressors for this population (Hughes & Avoke, 2010). Incomes for disabled people have lagged significantly far behind the nondisabled population. In particular, Social Security’s Supplemental Security Income (SSI)  and Social Security Disability Insurance (SSDI)  programs provide a poverty-level income that has created barriers to work for people with disabilities by reducing health and social benefits for work (Mackelprang, 2013). SSI and many state-level programs require people with disabilities to be in poverty, and have limited assets to qualify, which disincentivizes work. In turn, if disabled people work too much or earn too much, they can lose the benefits that enabled them to work. This then exacerbates the socially stigmatizing narrative that people with disabilities do not want to work, when in fact it is the system that creates this cycle of poverty.
Employment, Poverty, and Disability
Stigma, Disability Hierarchy, and Microaggressions in the Hiring Phase
Disabled people have historically experienced stigma during the hiring phase in employment situations (Gewurtz et al., 2016). A stigma has been defined as “a mark of disgrace (either literal or figurative) attached to characteristics or behaviors that are defined as undesirable in a given society” (Robbins et al., 2012, p. 306). Stigma due to appearance in the case of visible disabilities or conduct for individuals with non-visible disabilities has obstructed disabled people from being selected for employment when interviewing for jobs. A scoping literature review on the topic of hiring people with disabilities found that the level of stigma influencing hiring preferences was related to the type of disability (e.g., physical disability, mental health disability, intellectual disability, sensory disability; Gewurtz et al., 2016). Although this finding was somewhat supported in consultations with key informants with disabilities, these informants also had differing opinions about the nature of stigma in the hiring process. Some informants with physical disabilities indicated they felt the stigma had more to do with the visibility of the disability rather than the type of disability. It should also be noted the review did not analyze disability status within the context of other social identities (e.g. race, gender, sexual orientation).
We contend that the disability hierarchy also influences discrimination during the hiring phase. The disability hierarchy is a complex, context-dependent differential valuation of disabled people that defines who can and should be accommodated and integrated into society based on the intersection of a variety of factors (Schalk, 2020). Based on this definition, applicants who most approximate the ideal of the white, English-speaking, male, cisgender, heterosexual, non-veteran, and non-visibly disabled adult would be the most likely disabled people that receive interviews. People who were also married, thin, symmetrically-featured, and with anglicized names would be prioritized. In contrast, those who less likely approximate these social identities would be more vulnerable to hiring discrimination.
Microaggressions have been a challenge faced by disabled people during the hiring phase. Microaggressions have been defined as “everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, that communicate hostile derogatory, or negative messages to target persons based solely upon their marginalized group membership” (Sue, 2010, p. 3). Similar to stigma, visibility of disability status has been correlated with experiencing ableist microaggressions (Kattari, 2020), and increased microaggressions have been negatively associated with positive mental health outcomes (Kattari, 2020; Lui & Quezada, 2019), although much of this knowledge has not been situated within the context of multiple social identities. During the hiring phase, disabled people may experience microaggressions such as non-relevant “physical requirements” (e.g., must be able to lift 25 lbs.) in job postings, being asked to disclose their disability status in inappropriate situations, observing a lack of people with their disability status in positions of power within the agency, or extensive requests for proof of disability status, which may compound stress experienced as part of the hiring process.
Barriers to Access in Employment Situations
Access to employment for disabled people has been identified as a complex issue intertwined with the experience of labor discrimination (Mondéjar-Jiménez et al., 2009; Nind & Seale, 2009). The residual social welfare (i.e., piecemeal) policy approach to addressing barriers to mass unemployment or underemployment for disabled people in the United States has failed to recognize the challenges of poverty-level wages (e.g., getting access to health care, adequate housing) and the increased expenses of living with a disability (e.g., home health aides, accessible transportation, mobility devices or equipment, housing with proper accommodations) on the well-being and quality of life of disabled people (Hughes & Avoke, 2010). Employers have been increasingly relying on online job postings and applications. However, people with disabilities have not routinely been included in usability testing for these systems and accessibility problems have been continuing to occur (Lazar et al., 2012; O’Halloran, 2014).
Disabled people who are employed also face barriers to accessing accommodations. Disabled people have reported needing to spend their personal rather than work time to keep up with changes in assistive technology (Okungu et al., 2019). Negative reactions from employers when requesting accommodations have been described by some people with cerebral palsy and spinal cord injuries, especially those accommodations that cost money (Graham et al., 2018). People with multiple sclerosis have disclosed they feared disclosing their disability in the workplace and were overlooked for job promotions or were terminated after disclosing their disability (Reed et al., 2017). In the field of intellectual and development disabilities, staff are also vulnerable to a lack of belief in the employability of people with these disabilities, particularly people with the most significant intellectual and developmental disabilities (Wehman et al., 2018).
Brought about by the COVID-19 pandemic, universal attention to remote work set-ups and improvement to websites and software to facilitate remote work have impacted the experiences of disabled people in hiring and employment. Some individuals with disabilities have reported experiencing less stigma in virtual rather than in-person interviews since the individual has more control over the disclosure of their disability (Schuster, 2021; Smith, 2021). Although remote work arrangements are being increasingly recognized as a reasonable work accommodation (Crosgrove et al., 2015; Strickland, 2021), the COVID-19 pandemic rapidly accelerated the proliferation of technology to support this accommodation. The proliferation of an accommodation that had been inconsistently applied previously has been identified by disabled people as a bittersweet victory (Bohra & Willingham, 2021) and exposes the continuing influence of ableism (Ocean, 2021)..
Housing, Poverty, and Disability
Disability status has been intertwined with housing disparities, which have been compounded by economic deprivation. Access to affordable, accessible housing in proximity to employment is central to equality of opportunity, resources, and well-being, especially for adults of color, who have experienced the life-long effects of segregation (Hughes & Avoke, 2010; Humber, 2014; Sullivan, 2017). Problematic state and federal housing policies have spatially concentrated economically deprived disabled people, especially disabled people from minority groups, particularly people who are unemployed or underemployed and female head of households (Emerson & Brigham, 2014; Martone, 2014; McCarty, 2008). Many public housing programs (e.g., Section 8) have very limited access to accessible housing, which results in longer wait times and fewer options for housing in these programs for many disabled people, most notably people with mobility disabilities. Frischmuth (2014), a disabled person and housing advocate, reported experiencing a housing system that located difficulties with maintaining housing as personal problems without equal attention to social and economic systems as well.
Before providing information on service trends in the arena of poverty, employment, and housing, it is vital for the reader to understand that service trends that are relevant to people with different disabilities vary greatly. For example, service trends regarding individuals with developmental disabilities will be different from service trends for people with sensory disabilities. It is beyond the scope of this chapter to capture these nuances, and readers are encouraged to supplement what is discussed in this section with individual exploration on the service trends for specific disability groups and populations.
The reader is also encouraged to bear in mind that service trends are intimately linked with national, state, and local policies and programs. A trend in one region may not be a trend in a geographically different location. This knowledge is presented to again encourage readers to supplement the information that is presented within this section with exploration of their local, state, and national program and policy context.
A targeted approach is needed to move disabled people out of poverty. Poverty has been increasingly recognized as not solely a lack of income, but rather as a multidimensional construct composed of barriers and deprivations (Hughes & Avoke, 2010; Lang et al., 2019; Trani et al., 2016). Worldwide, poverty alleviation services are recognizing their services need to be particularized for disabled people in contrast to other people living in poverty (Opoku et al., 2019). These services would provide differential levels of cash assistance to supplement needs related to disability status that also recognize the local economic context. Access to targeted educational and vocational services that acknowledge the geoeconomic educational and employment landscape would also be assistive. Programs that address residential and community physical-environmental access needs for disabled and non-disabled people would also be beneficial. Barriers concerning healthcare and access to quality education and public services need to be addressed to move disabled people out of poverty (Lang et al., 2019; Mactaggart et al., 2018).
Models for disability inclusion in employment have been focused on employment mainstreaming and social firms. Social firms take many forms including “social enterprises, affirmative businesses, adapted enterprises, cooperatives, collectives, consumer/survivor-run businesses” (Corbière et al., 2019, p. 39). In many employment models, organizations have explicitly situated disability inclusion as part of their organizational development strategies (e.g., Ndzwayiba & Ned, 2017). These organizations are typically profit-driven. In contrast to these organizations, social firms are explicitly organized to achieve social goals in addition to economic ones (Krupa & Lysaght, 2016).
Social firms can range from a workforce exclusively of disabled people to a workforce where disabled people are integrated and work alongside non-disabled people. Another emerging model of employment is entrepreneurship where disabled people create their own businesses to meet generative and economic needs (Mandiberg, 2016; Shaheen, 2016).
Employment is intimately intertwined with health care access in the United States (US). US employers have typically offered health insurance as an employee benefit with employment-related health insurance operating as the most prominent gateway to health care access (Gorenstein, 2017; Knipsel, 2020). Health insurance access has facilitated affordable medical care and financial protection from unexpected health care costs (Office of Disease Prevention and Health Promotion, n.d.), however, the pairing of employment and health care access has proliferated the societal idea that health care access is a privilege rather than a right (Gorenstein, 2017; Knipsel, 2020). The Ticket to Work and Work Incentives Improvement Act of 1999 (TTW) was a federal policy that attempted to address disabled people’s concerns about the loss of health insurance access due to employment. However, the outcome of the implementation has been limited in addressing this concern (Please see the “Key federal policies” section for further information on TTW). State-level initiatives have also been developed to help with concerns about loss of health insurance access with community employment.
Disabled people experience disparities in employer-sponsored health insurance access and coverage compared to non-disabled people in the United States. In 2019, approximately 46% of people with disabilities had private health insurance coverage compared to approximately 76% of people without disabilities (Rehabilitation Research and Training Center on Disability Statistics and Demographics, 2020). Although employment in higher wage firms can provide access to employer-sponsored health insurance, this access is much less common in low-wage jobs, where persons with disabilities have been disproportionately socially located (Antonisse & Garfield, 2018). For disabled people with employer-sponsored health insurance coverage, historically this coverage has not adequately covered their needs (National Council on Disability, 2009), and, for those in low-wage jobs, health insurance premiums can be unaffordable (World Health Organization, 2020). For those who are only able to work a part-time job, the employer may not offer benefits, including health insurance.
Supported work sites for people with intellectual and developmental disabilities often pay disabled people poorly. The connection between supported work sites and wage disparities reflects an ableist perspective to labor participation (Blonk et al., 2020). In other words, due to harmful attitudes concerning labor participation for people with intellectual and developmental disabilities, they are socially isolated in segregated work settings where subminimal wages can be enacted. Notably, the United States Commission on Civil Rights (2020) has advocated for the abolishment of supported work sites due to their practice of paying subminimum wages in segregated work settings, which has been rife with abuse and in conflict with civil rights laws. A cost study has shown that, compared to supported work site employment, support employment in non-segregated work settings has resulted in significant financial benefits for both the disabled person as well as taxpayers (Cimera, 2011).
Despite The U.S. Supreme Court’s Olmstead Decision of 1999, which determined institutionalized disabled people who were capable have the right to leave institutional care and live in community-based living spaces (Mackelprang, 2013), disabled people continue to face challenges in finding and maintaining these living spaces. Disabled people have been vulnerable to geographic concentrations of socioeconomic disadvantage when housing solutions failed to consider location and neighborhood context (Aitken et al., 2019; Callaway & Tregloan, 2018). In other words, disabled people experiencing this disadvantage undergo segregation in their communities. Initiatives have focused on housing accessibility without consideration of needs within neighborhoods and communities (e.g., Bhakta & Pickerill, 2016). Individual development accounts, accounts where individual savings are combined with matching funds through housing policy, have some evidence of a positive impact on home ownership for people with disabilities, especially among women of color and single parents who are disabled (Huang et al., 2016).
The social identity of disability intersects with other identities in employment, housing, and poverty. The interaction of racial and ethnic identities, particularly Black identities, with disability status in employment has been examined. Bailey and Mobley (2019) identified that much of the Black experience has been shaped by an understanding of Black bodies as a productive labor force in the United States, which has been intimately intertwined with Black peoples’ experience of slavery. The slave economy prioritized the value of Black bodies’ utility to a white society. The impact of this white compartmentalization of value raised the stakes for Black people identifying as disabled since identifying as a Black, disabled person acknowledges a compromised relationship with labor and the ability to generate capital. This coupling of Black bodies and labor has made identifying as disabled an unviable option for most Black people (Bailey & Mobley, 2019). Black, disabled, and proud groups have been mobilizing to speak to this concern .
Legal and cultural institutions have been reluctant to acknowledge the compounding and complex forms of employment discrimination experienced by disabled people of color, especially Black people with disabilities (Abrokwa, 2018). Evidence has shown the interaction of racial, gender, and disabled identities sort workers with disadvantaged identities into lower-level and part-time work in the United Kingdom (Woodhams et al., 2015). Disabled British mothers have also identified unsupportive managers as a barrier to maintaining employment (Skinner & MacGill, 2015). For example, mothers identified that managers gave their jobs to someone else when they returned from maternity leave and/or were inflexible about the hours the mothers could work, which made covering childcare difficult.
Miles (2019) identified an intersection between racial, gender, and disability identities with housing for African American women with physical disabilities in the United States. Using surveys and in-depth interviews with 32 women, Miles examined and explored participants perceptions of barriers and facilitators to home ownership. The application of a feminist intersectional disability framework to the data revealed participants’ relationship to care strongly contributed to their self-concept. The “Strong Black Woman” schema (i.e., caregiving, resilient, independent, sacrificing, enduring, etc.) with its expectations influenced how participants viewed themselves and were viewed by others as receivers, managers, and providers of care. Receiving care was inconsistent with the schema, which resulted in decreased self-concept. Managing and providing care was consistent with the schema, which promoted a positive self-concept. The material reality of owning or not owning a home was not connected with self-concept appraisals.
Key Federal Policies
Federal policies in the arena of employment, housing, and poverty reflect an evolution from a focus on social protection toward a human rights approach. Table 1, while not inclusive of every federal policy related to employment, housing, and poverty, highlights key policies illustrating this paradigmatic shift within the last century. In the left column of the table, the year the policy was passed is presented. The middle column provides the name, and the right column provides a brief description of the policy relevant to the economic needs of disabled people.
Key Federal Employment, Housing, and Poverty-Related Policies Relevant to Disabled People in the United States
|1917||Smith-Hughes Act||Established federal-state vocational rehabilitation programs for disabled veterans|
|1918||Smith-Sears Veterans Rehabilitation (Soldier’s Rehabilitation) Act||Expanded federal vocational rehabilitation programs to veterans of World War I|
|1920||Smith-Fess (Civilian Rehabilitation) Act||Began vocational rehabilitation for all disabled Americans. Patterned after the Smith-Sears Veterans Rehabilitation Act.|
|1935||Social Security Act||Made federal vocational rehabilitation programs permanent. Provided an income maintenance system to people who were unable to work. Included provisions for “crippled children”.|
|1936||Randolph-Sheppard Act||Gave states the authority to license qualified persons with blindness to operate vending stands in federal buildings.|
|1938||Wagner-O’Day Act||Required federal government to purchase designated products from workshops for persons who were blind.|
|1943||Vocational Rehabilitation Amendments (Bardon-LaFollette Act)||Made substantial changes in the federal/state program of rehabilitation. Broadened the program’s financial provisions, and expanded services to include physical restoration, and each state had to submit a written plan for approval by the federal agency as to how federal/state dollars would be used. Expanded services included, on a limited basis, persons who were mentally handicapped and mentally ill. Fostered separate agencies for general rehabilitation and rehabilitation of persons who were blind.|
|1954||Vocational Rehabilitation Amendments||Reshaped roles of federal and state government in rehabilitation programs. Increased federal funding to states, and increased services to persons with mental retardation or mental illness.|
|1965||Vocational Rehabilitation Act Amendments||Expanded services to include persons with socially handicapping conditions, such as alcoholism, lack of education, and prison records. Established a National Commission on Architectural Barriers, deleted economic needs as a general requirement for services.|
|1968||Vocational Rehabilitation Act Amendments||Added follow-up services for maintaining a person with a disability in employment.|
|1968||Architectural Barriers Act||Required federally funded or utilized buildings to be accessible to the “handicapped”.|
|1973||Rehabilitation Act||Provided protections to people with disabilities in federally involved programs including hiring practices, architectural, and transportation barriers and employment as well as extended and revised grants to states for vocational rehabilitation services|
|1978||Rehabilitation Act Amendments||Provided for the establishment of federally funded Centers for Independent Living to be directed by people with disabilities.|
|1986||Rehabilitation Act Amendments||Defined and established supported employment as an acceptable goal for vocational rehabilitation services.|
|1988||Extension of the Fair Housing Act||Although established in 1968, the Fair Housing Act was amended in 1988 to prohibit discrimination in housing based on disability.|
|1990||Americans with Disabilities Act||Civil rights law that mandated equal access and nondiscrimination in employment and hiring practices, public accommodations, telecommunications, and societal services (e.g., insurance) in all areas of society.|
|1992||Rehabilitation Act Amendments||Emphasized employment as the primary goal of rehabilitation, and stated that eligible individuals must be provided choice and increased control in determining their vocational rehabilitation goals and services.|
|1999||Ticket to Work and Work Incentives Improvement Act||Created private-sector employment networks to provide vocational services to disabled people.|
|2008||Americans with Disabilities Act Amendments||Revised definition of “disability” to encompass impairments that substantially limit a major life activity.|
|2014||Centers for Medicare & Medicaid Services, Settings Rule||Ensured Medicaid-funded Home and Community Based Services (HCBS) provide people with disabilities opportunities, to live, work, and receive services in integrated community settings.|
Note. Sources for this table were Colorado State University (n.d.), Findley (2020), and Mackelprang (2013)
As shown in the table, initial policies focused on disabled veterans, who were considered “worthy” of societal support (Mackelprang, 2013). Subsequent policies expanded how disability was defined and focused, for the most part, on rehabilitative services and supports. With the passage of the Architectural Barriers Act of 1968, Congress took a first step in ensuring physical access in housing and employment venues for disabled people (Findley, 2020). The table also shows a number of amendments to the Rehabilitation Act of 1973 moving from a focus on protections to people with disabilities in employment to employment as the primary goal of services and service participant choice in services. Although the extension of the Fair Housing Act in 1988 prohibited discrimination in housing based on disability, this type of discrimination has continued to be a significant problem throughout the United States (Findley, 2020).
The Americans with Disabilities Act (ADA) of 1990 has been considered the most significant disability civil rights law since it expanded rights to disabled people in all areas of society rather than just governmental entities and organizations receiving government funds (Mackelprang, 2013). The ADA acknowledged the pervasive discrimination and lack of access in employment and public housing that disabled people experienced. Although the ADA expanded civil rights, the policy did not provide entitlements to support its implementation or guarantee benefits. The policy left it to the individual person with the disability to identify their disability and accommodation needs and left no financial support to businesses to make workplace or housing modifications. As well, the fact that “reasonable accommodations’ and “undue hardship” were not defined within the act left people with disabilities in a vulnerable space when negotiating accommodations. The ADA has been criticized as hardly reducing discrimination at all and disappointingly ineffective in reducing workplace discrimination (Findley, 2020).
The Olmstead legal case was a precedent-setting interpretation of the ADA. The Supreme Court’s ruling held that Georgia’s unnecessary and undesired institutionalization of two women with developmental disabilities and mental health conditions was discriminatory (Olmstead v. L. C., 1999). More broadly, state and local governments were required to administer services in the most integrated setting appropriate to the needs and wishes of individuals with disabilities. The Olmstead decision has received scholarly attention in the areas of aging (Bartels, 2011; Bartels et al., 2003; Bartels & Van Citters, 2005; Palley & Rozario, 2007; Yong, 2007; Zendell, 2007). State implementation of the Olmstead decision was a significant challenge as many states were not financially or procedurally prepared to transition disabled people from institutional to community-based care (Bartels & Van Citters, 2005; Jackson et al., 2003).
Although the social work profession has played an important role in the implementation to the Olmstead decision (Yong, 2007; Zendell, 2007), Flynn (2010) identified United States health policy should move from a focus on cost-driven compliance with the Olmstead decision to a rights-based health service system in alignment with the ADA. The Olmstead decision has transformed the Medicaid program, which has been noted to have a bias towards institutional services (Milne, 2012), with a push to expand home and community-based services (HCBS). Olmstead related cases have continued to be litigated since the original decision and used to encourage states to expand community-based services and move people out of institutions (Ng et al., 2014). Cremin (2012) identified that advocates and individuals with disabilities are applying the Olmstead decision’s interpretation of the ADA integration mandate to non-residential institutions as well such as sheltered workshops, child protective services, and assisted outpatient treatment.
The Ticket to Work and Work Incentives Improvement Act of 1999 (TTW; Public Law 106-170) is a federal policy related to employment for people with disabilities. The intention of the policy was to address the low incidence of disability insurance beneficiaries returning to work (Dean et al., 2003; Thornton & O’Leary, 2007), with a crucial piece of the legislation being the creation of a large, diverse supply of active private-sector rehabilitation service providers, called employment networks (ENs), that would essentially compete with existing state vocational rehabilitation agencies (SVRAs; Dean et al., 2003; Silva, 2007). Although the act was authorized in 1999, the TTW program was not initiated until April 2002 (Dean et al., 2003). Disabled people and disability advocates voiced several concerns about the program. One concern was that people with significant disabilities, which were costlier to support in employment, would be tracked into SVRAs rather than ENs due to the outcome-contingent funding structure of TTW. This funding structure would create two separate but unequal service systems (Blanck et al., 2002). Disabled people feared that participating in the program would result in the loss of existing medical and cash benefits (Hanson et al., 2019; Hernandez et al., 2007). People with disabilities reported feeling overwhelmed with the amount of the informational materials they received on the TTW program (Hanson et al., 2019). TTW implementation was challenged by the recession of 2001-2002 (O’Day & Revell, 2007), and the supply of ENs was low during the initial years of implementation due to the perception by providers that the program was too risky and cumbersome relative to potential payments offered (Silva, 2007; Thornton & O’Leary, 2007). In 2008, the Social Security Administration revised TTW regulations to address implementation barriers. However, although provider and beneficiary participation increased substantially after the revision, the proportion of participants forgoing benefits for work declined (Hyde & Stapleton, 2015).
Disability-Related Debates from the Perspective of Disabled People in the Arena of Employment, Housing, and Poverty
People with disabilities have identified a concern that the disability benefit systems (e.g., Medicaid, SSI, SSDI) in the United States trap them into poverty. Interviews with disabled people living with HIV and/or type 2 diabetes revealed the people interacted with a complex, inflexible, and bureaucratic disability benefit system that resulted in their destitution (Whittle et al., 2017). “Brian”, a type 2 diabetes participant of the study, disclosed:
The shit that Social Security puts a person through, and you can type that word ‘shit’ in there, is inhumane. The first thing, they deny you. Then you wait two-and-a-half years. The waiting period is, like, ridiculous. You know, and all these hoops you have to jump through. Well, in that period of time that you’re waiting, some of us can’t work. And there it went. So I went from a fantastic with a totally cool income, living in my own home, and I do mean home, having everything, to that…I went to $80, $86 a month, actually, in cash [GA], you know, and food stamps of $127, or something like that. Those food stamps were very handy. But needless to say, I was on the street, and so on and so forth (Whittle et al., 2017, p. 185).
Cyr (2019), one of this chapter’s authors, a disabled woman, public health professional, and advocate, has discussed the dehumanizing process to determine eligibility for Medicaid, which is essential for access to critical medical services for disabled people. She reported her demoralizing experience of the Medicaid eligibility assessment in her blog, after going through the process independently as an adult for the first time. She wrote:
In my life, my illness is not at the forefront. My LIFE is. I power on, day-to-day, working to change the healthcare system for others in similar situations. I network, I spend time with my family, I get coffee with my friends, I watch mindless reality TV, I do things every other 25 year old does. Then at the end of the day before heading to bed, I happen to get hooked up to an IV for 12 hours when I sleep. No big deal. Another day in the life…But when it comes time to prove eligibility it’s ABOUT being sick – not able to be independent or successful. It’s not about proving how hard you have worked to achieve a good level of health and independence. It’s playing a game, to see if you “win” the services you need to ultimately be independent and alive (Cyr, 2019, para. 7 & 8).
Disabled women living with fibromyalgia have also discussed a struggle in having their chronic pain legitimized by disability benefit bureaucrats, especially Black women who encountered the intersection of sexism and racism (Pryma, 2017). In contrast to several of the white women involved in the study who reported their claims were legitimized when backed by extensive medical documentation, “Candace”, a working-class Black woman diagnosed with fibromyalgia reported she was only able to break through to her disability judge about the pain and disability she experienced by sharing her graphic story of sexual assault and trauma. She reported:
So they kept on denying me…Well I went further on my own and filed my own second appeal. And it wasn’t until I got graphic with my life story, I feel, that they awarded me my long term disability…I had written appeals before. I had kept it very professional. I had…you know…I didn’t disclose a lot of personal details of myself or my life or anything of that nature. And then I finally just went…went totally graphic. And once I went totally graphic then they awarded it…Doesn’t look like I was raped, doesn’t look like I was molested, but yet I was. You know, I don’t look like a lot of things, and this illness doesn’t look like I’m sick. But I am. And I…I need this (Pryma, 2017, p. 71).
Disabled people have argued they want to work, but they encounter ambivalence to their inclusion in employment settings. Some people have argued their contributions in open employment settings were not socially valued (Rustad & Kassah, 2021). Other disabled people have identified they have encountered barriers to maintaining their employment including narrow and dismissive attitudes from coworkers and supervisors, and experiences of stigma and discrimination in the workplace (Meltzer et al., 2020). “Mindy”, an intellectually disabled, Australian woman in sheltered employment, discussed how employers’ assumptions about her ability to effectively complete her role negatively affected her search for work in open employment. She said:
I got knocked back a lot because of employers. That was a bit more challenging. Maybe because of people’s attitudes…just looking at my disability, thinking that you are not able to do the job. Not listening. That kind of stuff (Meltzer et al., 2020, p. 94).
Disabled people have identified additional challenges. Challenges include inefficient systems to provide accommodations to their needs (Scanlon et al., 2020), and employer’s unwillingness to provide accommodations for their disabilities in the work setting (Blajeski, 2020). Black disabled workers with sickle cell disorder have reported they have been pushed out of employment because employers have disregarded the self-care needed to manage the condition (Dyson et al., 2021).
People with disabilities have argued they experience economic segregation in the housing market. In most areas, the amount of money a person receives from SSI, or is allowed to have in order to be eligible for services, is frequently not enough to pay market rent, let alone buy any type of property. Interviews with intellectually disabled people, their family members, and support service workers identified a number of people were not able to choose where they lived and with whom they lived due to disability support packages that failed to include housing costs (Fisher et al., 2021). People with intellectual and developmental disabilities (IDD) and their advocates have reported the coupling of housing and support services needs to be broken, that they are not included in broader discussions of affordable housing, and that a lack of individualized funding support to personalize housing opportunities limits their housing choices (Verseghy et al., 2019). A significant reason this coupling of housing and support services occur is because housing options for people with IDD often include group settings that could be based on level of need and are often paid for by government entities like Medicaid, which, as mentioned previously, has a bias towards institutional care. Living with family members who serve as caregivers is a common alternative if other supports cannot be identified. These forced options can segregate disabled people into rural or more suburban areas that are away from community support and resources like public transit. These barriers are all components that exacerbate the social and economic inequities for disabled people.
Disabled people, their families, and their advocates have identified that people with disabilities are experiencing a housing crisis (The Arc, 2021). In response to this housing crisis, the Arc, a national community-based organization advocating for and with people with IDDs, state their overall position on this issue as follows:
People with intellectual and/or developmental disabilities (IDD), like all Americans, have a right to live in their own homes, in the community…Adults should control where and with whom they live, including having opportunities to rent or buy their own homes, and must have the freedom to choose their daily routines and activities (The Arc, 2021, p. 24).
Most housing structures are not designed to be accessible for those who use mobility devices or have physical limitations. Several “loopholes” allow buildings to get by without meeting ADA accessibility requirements. For example, buildings whose construction commenced prior to January 26, 1992 do not have to meet accessibility guidelines (Department of Justice, 2010). Buildings, including housing, designated as historical properties have been granted exceptions to accessibility requirements if the alterations to meet accessibility guidelines are not feasible, or threaten or destroy the historic significance of the building. Minimal modifications can be made that may make the building compliant but may not truly meets the needs of a disabled residents.
The Fair Housing Act requires Federally-assisted new-construction housing developments with 5 or more units to design and construct 5% of the dwelling units, or at least 1 unit, whichever is greater, to be accessible for persons with mobility disabilities. However, the policy does not require that those units be rented to or reserved for tenants who have disabilities (United States Department of Housing and Urban Development, n.d.). This makes it even more difficult for disabled people to find and secure truly accessible housing.
The interaction of disability status along with other social identities impact outcomes related to employment, housing, and poverty for disabled people. Class, gender, and racial identities have explained how people with disabilities experience economic discrimination differently in their daily lives (Guerrero-Arias et al., 2020). Concerning employment, research has shown that the intersectional effects of gender, ethnicity, and disability sort disadvantaged men into lower-level and part-time work alongside women who experience gender discrimination (Woodhams et al., 2015). Additionally, veteran status has been shown to negatively impact on requests for accommodations within the workplace (Gonzalez et al., 2020). Military norms aligned closely with masculine gender norms may influence a stoic response to work limitations and independent problem solving of work-related limitations.
Policy and Practice Implications for Working with Disabled People in this Arena
This section focuses on the application of the theoretical perspectives and the practice model from chapter 2 to the arena of employment, housing, and poverty. Social identity-related practice implications are presented.
Application of Theoretical Perspectives
Critical Cultural Competence
When working with disabled people in the arena of employment, housing, and poverty, social workers need to recognize the personal and positive elements that disability culture brings to the workplace and community. At the same time, social workers need to align with the social model of disability in its critique of ableist employment, housing, and poverty systems. In working with individuals and families in this arena, social workers must attend to the power dynamics inherent in hiring and working phases of employment. Differences in the power between property owners and landlords need to be accounted for and the influence disability benefit bureaucrats wield needs to be kept in mind. Continual self-reflection and critical examination are necessary to recognize one’s own values and biases related to who is deserving of employability, access to safe, accessible, visitable housing, and disability benefits. Social workers must avoid essentializing disability experiences, identities, and contexts within the workplace and community.
Social workers should apply a comprehensive appreciation and understanding of a person’s and communities’ experiences when working with disabled people in the arena of employment, housing, and poverty. A disabled person has personal and social identities. These identities impact their lived experience and economic realities. Individuals with disabilities may or may not identify as disabled or understand the role their disability plays in their identity. A disabled person’s social location determines advantages and disadvantages in employment, housing, and experience of poverty. Interlocking systems of oppression, such as ableism, racism, sexism, heterosexism, and ageism, often exclude disabled people from workplaces, housing options, and economic resources. Disabled people are often defined by non-disabled people in employment and housing settings through an ableist lens, which puts their disability in the forefront at the expense of other personal and social identities.
Recognition of ableism in discourse and practice are vital in the arena of employment, housing, and poverty. Ableism prevents the full inclusion and the economic participation of disabled people in our society. Recognizing multiple oppressions, including ableism, and working with disabled people to challenge these oppressions allows social workers to practice anti-oppressively within this arena. Social workers need to deconstruct dominant notions of the employability, housing needs, and economic entitlements while centering on individual, community, and societal change. Specific practices in this arena include: critical consciousness raising; deconstruction; viewing disabled persons as experts on their economic needs; empathy; addressing grief and loss in employment and housing as well as other arenas as they intersect and emerge; reframing employment and housing difficulties; advocacy; mediation to address economic barriers; peer support; and community engagement. The contributions disabled people and communities bring to the workplace and community need to be recognized and emphasized to disrupt ableist narratives.
Application of the Practice Model
A focus on self-reflection and self-assessment of the employability and housing rights of disabled people is crucial for this step of the model. Social workers recognize and disrupt dominant cultural paradigms about who can work, who deserves safe, accessible, and visitable housing, and who is entitled to disability benefits. Although pre-engagement is an initial step, social workers assume this self-reflection and acknowledgement continue throughout the other steps of the model.
This step begins with the recognition of the limits of the social worker’s knowledge on the employability, housing needs, and eligibility for disability benefits. This recognition spurs the social worker to connect with key players and systems to learn about what is needed to access services. The social worker arrests their preconceived notions of disabled people’s capacities and meets the disabled person where they are at in terms of their identity as an individual with a disability. Being open to learning from disabled people is critical to this step. The social worker applies inter-identity/inter-cultural engagement techniques in this step.
Social workers need to center the client’s narrative when considering employability, housing needs, and disability benefit eligibility. Recognizing that disability and intersecting social identities are socially constructed and play out in the arena of employment, housing, and disability benefit systems is vital. Social workers should routinely identify circles of support, both formal and informal, when working in the arena of employment and housing.
Interventions must respect the dignity of risk and support self-determination in employment and housing decisions. Engagement of the circle of support is crucial to the provision of social work services in this arena. Securing employment and housing would be considered initial goals and workplace and community inclusion should be fostered. Social workers must remember: “nothing about us without us” in employment and housing services and prioritize the individual’s goals, desires, and interests when considering an intervention.
Social work services need to honor the dignity of risk in terminating services in the arenas of employment, housing, and poverty. When at all possible, disabled people should be allowed to decide when they are ready for services to end. Social workers should recognize power dynamics and imbalances between and among the worker, client, and employment, housing, and disability benefit institutions.
Measures of progress or success in these arenas need to be co-constructed with clients. The client’s narrative of their experience needs to be at the forefront when evaluating employment, housing, and poverty-related services.
Social Identity-Related Practice Implications
Race and Ethnicity
For Black people with disabilities, the recognition of the multigenerational sociohistorical experience of slavery is paramount to practice in the arena of employment, housing, and poverty. Social workers need to assess for and address historical and current grief and loss associated with Black people’s continuing economic discrimination. Practitioners need to assess for the Black client’s comfort with identifying as disabled given their experience of racial discrimination in this arena and work with these clients to engage circles of support that can assist them in locating their identity within the disability community. The narratives of legal and cultural institutions that have been reluctant to acknowledge the compounding and complex forms of employment discrimination experienced by Black disabled people need to be deconstructed. This deconstruction needs to extend to corporate discourses that disproportionately relegate Black disabled people to low-skill, low-pay, stagnant jobs. Social workers need to promote the social value to employers of hiring Black people with disabilities. Finally, for Black people with sickle cell anemia (or sickle cell disease), employers need to be pushed to respect the self-care needed to manage the condition. In the arena of housing, practitioners need to be sensitized to the Strong Black Woman schema and work to engage circles of support that can assist women socialized to this schema to allow them to receive support in addition to giving care to others. Finally, the chronic pain experienced by Black women with fibromyalgia needs to be consistently legitimized by disability benefit bureaucrats.
The social identities of Indigenous people and people of color are critical in social work practice in the arena of employment, housing, and poverty. Social workers need to advocate that disabled Indigenous people and people of color be given equitable access to high-skill, high-pay, dynamic jobs that enhance their quality of life. The consciousness of employers to the impact of the disability hierarchy on hiring for Indigenous people and people of color with disabilities needs to be raised. Legal and cultural institutions that engage in employment discrimination need to be held accountable. Housing that is affordable and accessible needs to be provided in proximity to employment rather than spatially segregated by race. For clients who have a goal of home ownership, individual development account access is needed.
The awareness of patriarchy is integral in addressing the needs of disabled people within the arena of employment, housing, and poverty. Social workers need to raise the consciousness of employers and clients to the influence of gender within the disability hierarchy in the hiring and working phases of employment. The elimination of the influence of this hierarchy is needed. Practitioners need to mediate between employers and disabled women and non-binary people who are primary caregivers to support these people with maintaining their employment. Advocacy for primary caregivers to keep their jobs when they return from family leave as well as flexibility in their working hours to accommodate child care needs are also imperative. Social workers need to recognize family medical leave policies are a benefit used by disabled people with chronic conditions who may need extended leave, not just in the instance of child birth. Although cisgender women experience sexism in the workplace that results in their disproportionate allocation to lower-level and part-time work, social workers must also be vigilant to this disparity in cisgender and transgender men with disabilities, transgender women, and those with non-binary gender identities. Client and class advocacy are vital to addressing problematic state and federal housing policies that spatially concentrate disabled individuals who have fewer financial resources, particularly cisgender women who are heads of the household. When working with cisgender and transgender women and non-binary disabled people who are in the process of applying for disability benefits, social workers need to be sensitized to how their chronic pain has been rejected within the disability benefit system and work with these people’s circles of support to advocate for their voices to be heard by bureaucrats.
Disrupting heterosexism within the arena of employment, housing, and poverty is an important aspect of anti-oppressive social work practice with disabled people. Social workers need to raise the awareness of employers to the social value of lesbian, gay, and bisexual people (LGB) as employees. LGB disabled people may be vulnerable to closeting their sexual identities, particularly in institutionally-based housing settings, due to fears of structural and physical violence.
Scenario: You are social worker in a supported housing program serving people with co-occurring disabilities. The program provides rental assistance and case management services to clients. Here are the details of the case:
Judy was recently admitted to the supported housing program, and you were assigned as her social worker. Judy was referred by her clinical social worker at the outpatient clinic after she was terminated from her part-time job as a clerk at the local grocery store due to excessive absenteeism. Judy was diagnosed approximately 10 years ago with fibromyalgia and recently had a “flare up” where her the pain got so bad she was not able to go to work. Judy receives services from the outpatient clinic for Post-traumatic Stress Disorder (PTSD) and depression. Between taking medication for her mental health conditions and attending weekly therapy with her clinical social worker, Judy’s mental health has been stable for the last couple of years. The clinical social worker made the referral because Judy discussed that she would like to work again as she feels better and wanted to keep her current apartment.
You meet with Judy for an initial session to explain the services provided by the supported housing program and to learn about Judy’s goals. Judy answers the door and navigates to her living room as she walks using a cane. She makes a wincing face as sits in a recliner and motions for you to take a seat on the couch. Judy is in her early 40s and white. She identifies her preferred pronouns as “she” and “her.”
After explaining the supported housing program to Judy, you ask what goals she would like to discuss. She states she would like her old job back and that she misses her work friends. She lets you know that she wants to stay in her current apartment. This is her “home.” Exploring the idea of the job a bit further with her, you ask her about her aspirations in the arena of employment. She says, “stay right there,” gets up, and walks slowly with her cane into a different room. You notice she stumbles at points when making the turn out of the room into a hallway. You think to yourself, “If only there was a handrail in that hallway, she probably would get around much easier.” Judy returns a couple of minutes later with a dark brown cupcake with mocha-colored frosting on a small plate. She encourages you to take a bite, you do, and taste a sweet, chocolate/coffee/mocha confectionary masterpiece. As you remark about the fabulous flavor, Judy says, “I always dreamed of opening a small business where I could sell my cupcakes.”
Over the next couple of meetings with Judy, you learn more about her history. She had a relationship with a significantly older man, Rusty, in her late teens and had two daughters, Jessica and Jenna. Initially, her relationship with Rusty was happy, and they got along well. However, over time, he became increasingly jealous, possessive, and physically violent. She was able to leave the relationship and put a restraining order in place against Rusty. For her, leaving the relationship was about protecting her girls. Her girls are now adults, and since that time, Judy has primarily had relationships with women and a couple of men. She currently has a girlfriend, Sofia, who she spends time with frequently. Judy reports she receives Medicaid and SSDI due to her mental health conditions and her fibromyalgia, but she says she needed to “fight like a dog” to get the SSDI with the assistance of a lawyer since “no one believed me about the fibro.” “I even had to fight with my doctors for them to see I was in a ton of pain.”
Since Judy says her PTSD and depression are in a good place, you ask her more about her experience of living with fibromyalgia. She says, “I experience the ‘fibro fog’ almost all the time. The challenging thing is the pain, it’s all over my body, and I have good and bad days. I’m tired a lot, but I can’t get good sleep when I have a flare up. I have trouble getting things done and the migraines can be over the top! When the flare ups get bad, I can only stand or walk for an hour or two before I need to sit, but even when I sit, I can’t be down for a long time due to the pain and stiffness. I have difficulty reaching things. Look around this apartment, I can’t reach the top cabinets in the kitchen or the boxes of food on the bottom cabinets. I also use my cane since I can tumble if I am not careful. Getting around can be a real hassle.”
- What might be a dominant cultural paradigm concerning who should work or who deserves safe, accessible, and visitable housing that you might self-reflect on and be prepared disrupt?
- What are some limits of your knowledge on the employability and housing needs of people with PTSD, depression, and/or fibromyalgia?
- Who might be members of Judy’s circle of support?
- How could you engage Judy’s circle of support to assist her with achieving her employment and housing goals?
- What power dynamics and imbalances might occur among you, Judy, and the employment and housing institutions surrounding her? How would you address them?
- What might be some measures of progress that could be co-constructed with Judy in alignment with her goals?
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- The language of “disabled people” and “people with disabilities” are both utilized within this chapter to reflect that identity-first and person-first language has been utilized in social work practice with the disability community. ↵
- SSI provides cash to meet basic needs for food, clothing, and shelter. To be eligible for SSI, a person needs to be age 65 or older, blind, or disabled, and have limited income and resources. To lean more about SSI, please read the following overview: https://www.ssa.gov/ssi/text-over-ussi.htm” ↵
- SSDI provides cash benefits to people who have a substantial work history and have a medical condition that prevents them from working for at least 12 months or is expected to end in death. Since SSDI requires a significant work history, many people are unable to qualify, especially people born with disabilities. For more information on SSID, please see the following overview: https://www.benefits.gov/benefit/4382 ↵
- Some examples of these initiatives include the National Black Disability Coalition (https://blackdisability.org/nbdc.info/), the HCBU Disability Consortium and AHEAD (https://www.blackdisabledandproud.org/), and the National Black Deaf Advocates (https://www.nbda.org/content/college-youth) ↵
- Although key federal policies are reviewed in this section, the reader should also note the importance of state policies and programs, which are beyond the scope of this section to review. Federal policies provide a basic skeleton for policy to support employment, housing, and poverty, but the bulk of supports are facilitated via state-level policies and programs. Therefore, readers are encouraged to explore policies in this arena in their own locale for more specific information. ↵
- In alignment with the practice model of this textbook, this section centers on the voices of disabled people in these debates rather than the voices of policy and service providers. Policy makers and service providers also have pertinent debates (e.g., how to move from segregated to integrated employment, how to plan for employment beginning in the transition years, how to best support real choice in living arrangements). Readers are encouraged to explore beyond this chapter to identify policy maker and service provider debates in employment, housing, and poverty. ↵
- The term “sheltered employment” is used here in alignment with the source of the information, which is a study from Australia. The reader should note that the terminology used in the United States for this type of employment is different. This type of employment is commonly referred to as a “sheltered workshop” setting. ↵