Elements of Livable Communities for Adults with Disabilities
An Introduction to Mr Clyde Boger
As public housing projects go, Amsterdam Houses in New York City is better than many The location—a busy neighborhood close to one of the city’s cultural hubs
Amsterdam Houses, a housing complex with 14 widely spaced buildings set in park-like grounds, offers a stark contrast to the nearby cultural scene of Lincoln Center, where affluent patrons frequent elegant theaters and events On a cold weekday afternoon, we visited Mr Clyde Boger’s apartment, where the building's intercom was out of service and the front door required significant effort to open The graffiti-free elevator took us to the 11th floor, where Mr Boger has resided for 53 years This long-term residency is typical at Amsterdam Houses, where 92% of the approximately 600 residents aged 65 and older have lived there for over 30 years, and more than half for at least 50 years Notably, 88% of these older residents are people of color, 56% live alone, and 63% have incomes below 200% of the poverty line.
Mr Boger promptly opened the door and invited us in He looked younger than his
At 85 years old, Mr Boger navigates his small apartment with the aid of dark glasses and by holding onto walls and furniture, reflecting his struggles with multiple health issues, including legal blindness, glaucoma, hypertension, high cholesterol, diabetes, and a heart pacemaker Despite losing most of his vision after a stroke in 1983, he maintains a cheerful demeanor as he welcomes visitors into his cramped living room, which appears unchanged since he and his wife moved in back in 1951 Now living alone, the dust rising in the sunlight highlights the enduring simplicity of his surroundings.
Mr Boger, who retired early to care for his wife after she passed away from breast cancer in 1985, faced additional heartache seven years later with the loss of their only son to colon cancer at age 41 Despite his own health challenges, Mr Boger shared insights into his daily routine, highlighting his resilience in navigating life alone after such significant losses.
I wake up around 9:30 AM and prepare a simple breakfast, often cereal or toast After breakfast, I enjoy listening to the news on the radio or watching television, reminiscing about my younger days at the Cotton Club and the Savoy Lunch is delivered by Meals on Wheels between 12:30 and 1:00 PM, right before your arrival Following lunch, I take a nap and later manage my afternoon routine, which includes taking medication for high blood pressure, cholesterol, diabetes, and bladder issues, along with three different eye drops In the evening, I cook dinner—like chicken fricassee—and continue to listen to news on the radio or TV until I go to bed.
Noticing a crutch in the corner of the room, which he did not use while we were in the apartment, we ask Mr Boger how often he goes out:
Oh, I go to the Veterans Administration Medical Center four to five times a month.
I often travel by taxi, which costs just three dollars, to reach the community center for meals and activities Occasionally, a volunteer from the community center walks me there, and another volunteer from the democratic club assists me with transportation to meetings I have a long history of community involvement, having served as a coordinator for the Board of Elections for 40 years and initiating the first tenant patrols in the area during the 1970s.
We ask Mr Boger about food shopping and other household chores:
I have many neighbors and friends who frequently check in to see if I need anything from the store My late wife formed a close bond with a family that had a daughter she cherished as if she were our own Now that girl, who is 43, has two sons aged 4 and 13 Living just down the block, she calls me daily and helps with cleaning and shopping.
16 mother, who’s now in her 60s, does my laundry I sure enjoy it when those boys come over!
When we ask him whether he plans to get surgery for the glaucoma, he shakes his head “no” and explains:
At 85 years old, I enjoy good vision and a fulfilling life I have access to nutritious food, clean clothing, and a comfortable home With friends close by, I feel supported, and I always know who to reach out to when I need assistance.
Living independently requires essential skills and resources, but a recent alarming incident highlighted the challenges that can arise A few months ago, he experienced a severe drop in blood sugar that caused him to pass out at home Despite being unable to see, he persevered and crawled to the phone to contact his neighbor Fortunately, she was available and promptly called 911, ensuring that an ambulance arrived to assist him.
During our engaging conversation, we delved into Mr Boger’s favorite subject—politics His insights were impressive, and he openly shared his views on current pressing issues Before we realized it, the time had flown by, and it was already 4:00 p.m., causing Mr Boger to miss his scheduled nap.
We express our gratitude for Mr Boger's time before leaving, noting that despite his numerous friends and claims of not feeling lonely, he seemed to appreciate the company and conversation As we shake his hand goodbye at the door, we ponder the sustainability of his proud independence.
Mr Boger’s journey of self-reliance began in childhood when he was orphaned and abandoned by his sisters, forcing him to live independently with neighbors Despite these challenges, he worked his way through school, achieving economic independence after three years of college Although he enjoyed a fulfilling life, tragedy struck when his wife was diagnosed with breast cancer, leading to further losses, including his son and declining health Mr Boger’s experiences reflect a broader reality, as 42 percent of individuals face similar hardships, highlighting the resilience required in the face of adversity.
In the United States, over 4.7 million seniors aged 65 and older, representing 14 percent of this demographic, experience sensory disabilities related to vision or hearing Additionally, 20 percent, equating to more than 6.7 million elderly individuals, face challenges when attempting to leave their homes.
Recent studies indicate that disability rates among individuals aged 65 and older are decreasing, primarily concerning Instrumental Activities of Daily Living Nonetheless, people are living longer than ever, with projections showing that by 2030, one in five Americans will be over 65 This demographic shift suggests that the population of seniors with disabilities, particularly those aged 75 and older, is likely to rise Various risk factors, including those present in individuals like Mr Boger, contribute to the increased likelihood of disability as people age.
Disability prevalence varies significantly with age; only 18.6% of individuals aged 16 to 64 report having a disability, while this figure rises to 41.9% among those aged 65 and older Notably, for individuals aged 75 and above, the percentage increases further to 54%.
Race: Among those 65 and older, Asians and non-Hispanic whites have the lowest disability rates (40.8% and 40.6%, respectively), while blacks and Native Americans have the highest (52.8% and 57.6%, respectively) 14
Older adults with low incomes face a significantly higher risk of disability, with 56 percent of those living below the poverty line experiencing disabilities, compared to 40 percent of those with incomes above this threshold.
Ensure Accessible, Affordable, Reliable, Safe Transportation
Terry Szold, a land use planning consultant and adjunct associate professor at MIT, resides in Andover, Massachusetts, and frequently travels for work For the past eight years, she has relied on a scooter for mobility and uses a van equipped with a lift to transport it While she typically navigates her local area without issue, her recent business trip to Washington, D.C., highlighted the challenges she faces when traveling beyond her immediate surroundings.
Professor Szold took Amtrak’s Acela Express train from Boston to
Washington, D.C., and gave it high marks for accessibility She also praised
During her visit to Washington, Szold found the subway system accessible along its main route, but faced challenges when needing to travel to meetings outside downtown She was dismayed to discover a lack of wheelchair-accessible taxis in the capital, forcing her to rely on her husband for assistance He helped her enter a regular taxi and even dismantled her scooter to fit it inside the vehicle Without his support, Professor Szold would have struggled to navigate these obstacles independently.
Szold expresses her frustration regarding the significant challenges faced during her business trip, emphasizing that inaccessible transportation is more than just an inconvenience; it can hinder career advancement for individuals with disabilities She underscores that accessible transportation—whether it be trains, subways, or taxis—is essential not only for reaching destinations but also for accessing job opportunities, medical care, and social activities For people with disabilities, the availability of suitable transportation is crucial as it fosters independence, self-sufficiency, and active participation in community life.
According to the 2003 National Transportation Availability and Use Survey, approximately 25% of individuals with disabilities require assistance from others or rely on assistive devices like canes, walkers, or wheelchairs for outdoor travel Furthermore, nearly 12% of people with disabilities, equating to around 6 million individuals, face challenges in accessing necessary transportation due to limited public transit options, lack of personal vehicles, difficulties associated with their disabilities, or unavailability of assistance.
The survey also found that more than 3.5 million people in the United
Over 1.9 million homebound individuals in the U.S are living with disabilities, with 560,000 citing transportation difficulties as a reason for their isolation Focus group discussions revealed that access to transportation is a significant barrier, particularly for those using wheelchairs and paratransit services Participants shared experiences of being stranded after work, sometimes waiting over five hours for a ride without a central contact for assistance Additionally, those relying on public transportation face challenges like narrow bus stops that hinder wheelchair access, obstructions from construction, and winter conditions that make navigating snow and ice nearly impossible.
The Americans with Disabilities Act (ADA) of 1990 mandates that state and local governments ensure equal access for individuals with disabilities to all government programs, services, and activities, including transportation Title II of the ADA specifically addresses public transportation services, encompassing city buses, rail transit, subways, commuter rails, and Amtrak Public transportation authorities are prohibited from discriminating against people with disabilities and must adhere to accessibility standards for newly acquired or remanufactured vehicles Additionally, transit operators are required to offer paratransit services along existing fixed-route systems, unless doing so would impose an "undue burden." While the ADA does not mandate that all taxis be wheelchair accessible, cities must provide alternative transportation options for individuals with disabilities In major urban areas like Washington, D.C., and New York, accessible transportation remains a critical concern, as highlighted by Terence Moakley, associate executive director of the United Spinal Association.
Despite 48% of people considering taxis a fundamental part of the transportation system, the availability of accessible cabs remains limited, particularly in New York City, where only 5 out of 12,187 yellow cabs are wheelchair accessible While some U.S cities are making strides to increase their fleets of accessible taxis, these initiatives are significantly overshadowed by London's impressive achievement of having 100% of its taxis wheelchair accessible.
Compliance with the ADA transportation provisions is an ongoing effort across the nation Since their implementation, the Federal Transit Administration (FTA) and transit operators have aimed for all buses in fixed-route systems to be fully equipped with lifts or ramps by 2007 By the end of 2001, 83% of transit buses met ADA standards, a significant increase from 35% in 1990 Many communities have achieved complete ADA compliance for their bus fleets, with some, like Austin, Texas, enhancing accessibility through features such as automated audible systems that announce bus stops and Braille signage.
Providing accessible, affordable, reliable, and safe transportation is such an enormous challenge that some states and counties have been thinking
The "United We Ride" initiative is a collaborative effort by various federal agencies, including the FTA and the Departments of Health and Human Services, Labor, and Education, aimed at enhancing transportation services by addressing the lack of coordination among the 62 federal programs that fund transportation This five-year national initiative seeks to create more efficient, cost-effective, and universally accessible transit systems by fostering local partnerships A key component of this initiative is the Framework for Action, which serves as a comprehensive evaluation and planning tool designed to assist state and community leaders, along with stakeholders in human service transportation, in developing or improving coordinated transportation systems.
A number of states and counties profiled later in this chapter – including the State of Florida; Broward County, Florida; counties in Central Virginia; and
Sweetwater County, Wyoming – have been working for some time to increase the options and availability of accessible transportation for people with disabilities through coordinated transportation services.
In his New Freedom Initiative (NFI), President Bush emphasized the need for greater opportunities for individuals with disabilities, asserting that "every American should have the opportunity to participate fully in society and engage in productive work." However, millions of Americans with disabilities face barriers to employment due to a lack of necessary tools and access The NFI 2002 progress report highlights that inadequate transportation is a significant obstacle, particularly for people with disabilities To combat this issue, the Job Access and Reverse Commute (JARC) Program provides grants to state and local agencies to develop new transportation services aimed at assisting low-income individuals, including those with disabilities.
Government has funded more than 200 such programs in 44 states.
This article highlights various state and county transportation initiatives, including the JARC Program, that are improving on-demand transportation by expanding accessible taxi services Additionally, it showcases community-based organizations and individuals who are taking grassroots actions to tackle transportation challenges, effectively influencing local decision-makers to enhance transportation options for individuals with disabilities.
The State of Florida has been working since 1979 to expand transportation services through the Florida Coordinated Community Transportation Program 92
In 1979, the Florida Legislature established a law mandating the coordination of programs funded by local, state, and federal sources to assist individuals identified as "transportation disadvantaged" (TD) This initiative was reauthorized in 1989, leading to the formation of the Florida Commission for the Transportation Disadvantaged (CTD).
The Florida Department of Transportation (DOT) oversees 50 independent commissions that promote local involvement in the planning and execution of coordinated transportation services This initiative is achieved through the establishment of Local Coordinating Boards (LCBs) and Community Transportation Coordinators (CTCs), enhancing community engagement and service delivery.
In accordance with the statute, the CTD contracts with CTCs that serve each of Florida’s 67 counties These coordinators assist in planning and coordinating transportation services for the TD.
Funding: Florida has created a Transportation Disadvantaged Trust Fund
The TD Fund is established to provide a reliable funding source for matching federal grants and facilitating transportation for nonsponsored individuals with disabilities Annually generating around $20 million, the fund is primarily supported by a $1.50 surcharge on vehicle registration renewals Additionally, the state offers a voluntary contribution program, "Put Your Dollar to Work," allowing individuals to donate an extra $1.00 through their vehicle registration form The TD Fund specifically covers transportation for those not served by other programs, with further financial support coming from the Agency for Health Care Administration, the Department of Transportation, the Department of Children and Families, and various local funds.
Service: Service patterns are determined on a county-by-county basis by
Florida's coordinated transportation services, overseen by Local Coordinating Boards (LCBs) and facilitated by over 460 qualified providers, aim to assist individuals who are unable to transport themselves, including clients of human service agencies and those qualifying as Transportation Disadvantaged (TD) Clients contact their service agencies to arrange necessary trips, while non-agency clients who are TD can schedule rides through the Community Transportation Coordinator (CTC) or designated service providers In fiscal year 2003, the network facilitated over 53 million trips, with approximately 60 percent serving individuals with disabilities.
Benefits: The state-directed coordination of transportation services has many advantages:
The number of trips taken though the system grew from 1.5 million in 1985 to 36 million in 1998 to more than 53 million in 2003
Adjust the Physical Environment for Inclusiveness and Accessibility
Environment for Inclusiveness and Accessibility
In 1996, Michele Ohmes, Kansas City, Missouri's ADA/Disability Specialist, faced significant accessibility challenges during her first presentation at the American Public Works Association's International Public Works Congress in Minneapolis After arriving at a riverfront restaurant for a dinner hosted by the Kansas City Metro Chapter of the APWA, she encountered a building entrance that was only accessible via a flight of stairs, creating a barrier for her as a wheelchair user Despite searching for an alternative entrance with a ramp, Ohmes ultimately had to crawl up several steps to reach the restaurant while her colleagues carried her wheelchair, highlighting the ongoing issues of accessibility in public spaces.
The experience shared by Ohmes profoundly impacted the APWA leadership, highlighting the critical importance of accessibility in event planning Following an oversight regarding restaurant accessibility, the APWA has since prioritized inclusivity for all major events Ohmes reflects that many well-intentioned individuals may not grasp the significance of accessibility for people with disabilities until they encounter it personally However, she believes that with proper training and awareness, it is possible to foster understanding and effect positive change in the world.
For individuals using a wheelchair or facing mobility challenges, everyday activities such as entering buildings, dining out, shopping, attending events, or traveling can be significantly complicated Many public accommodations fail to eliminate barriers, leading to frustration in accessing essential services like supermarkets, medical facilities, car rentals, and hotels Ensuring these spaces are accessible is crucial for enhancing the quality of life for people with disabilities.
The Americans with Disabilities Act (ADA), enacted in 1990, aims to ensure access to civic life for individuals with disabilities Title II mandates that state and local governments must make their programs and services accessible, including physical access to facilities and necessary policy adjustments This title also emphasizes effective communication by providing auxiliary aids, such as interpreters, to enhance participation in public events Title III extends these protections to privately owned businesses, prohibiting discrimination against individuals with disabilities in places like stores, restaurants, and schools The enforcement of these provisions falls under the jurisdiction of the U.S Department of Justice.
Since the enactment of the Americans with Disabilities Act (ADA), communities have made significant strides in enhancing accessibility for individuals with disabilities, though progress has not always met the expectations of advocates The ongoing influx of ADA-related complaints to the Department of Justice’s Disability Rights Section (DRS) highlights that many communities often delay access improvements until a complaint is filed, the Department intervenes, and a resolution is negotiated and implemented.
In 1999, the Department of Justice settled with the City of Toledo, Ohio, leading to the removal of barriers and the relocation of various city government activities, including the municipal courthouse, police stations, fire stations, and community services Following this agreement, then-Attorney General Janet Reno urged the Disability Rights Section (DRS) to encourage other U.S cities to tackle similar accessibility issues As a result, the DRS launched "Project Civic," aimed at promoting inclusive practices across municipalities.
Access” 108 and began similar reviews of other local
The DRS conducted on-site investigations in selected cities across all 50 states, as well as in the District of Columbia and Puerto Rico, to assess compliance with ADA requirements By October 2004, settlement agreements were reached with all participating communities, and technical assistance materials were developed to facilitate immediate compliance.
Despite the limited scope of this initiative, the DRS effectively transformed its experiences with selected communities into valuable lessons and technical assistance resources for others One notable resource is a comprehensive manual that addresses common misconceptions and challenges faced by local governments in adhering to Title II of the ADA The DRS emphasizes that city governments must be aware of these issues to ensure compliance and improve accessibility.
May (wrongly) believe that their existing programs and facilities are protected by a
Small municipalities may mistakenly think they are exempt from the requirements of Title II of the Americans with Disabilities Act (ADA) due to their size, but they are not granted a "grandfather" clause that allows them to avoid compliance.
Often fail to ensure that the whole range of the city’s services, municipal buildings, and programs meet Title II’s program access requirements
May (wrongly) believe that they have no duty to make changes to historically significant buildings and facilities to improve accessibility for people with disabilities
Often do not provide necessary curb ramps to ensure that people with disabilities can travel throughout the city in a safe and convenient manner
Public events and meetings frequently lack qualified interpreters and assistive listening devices for individuals who are deaf or hard of hearing Additionally, city governments often neglect to offer materials in alternative formats, such as Braille, large print, or audio cassettes, for those who are blind or have low vision.
May fail to consider reasonable modifications to local laws, ordinances, and regulations that would avoid discrimination against individuals with disabilities
Individuals who are deaf or hard of hearing should not be granted direct and equal access to 911 systems or similar emergency response systems when using TTYs (TDDs or text telephones) or computer modems.
Often fail to modify policies, practices, or procedures when dealing with people with disabilities in law enforcement settings—including citizen interaction, detention, and arrest procedures
Private businesses can significantly enhance accessibility by utilizing the numerous resources available to help them comply with accessibility regulations Many cities have developed their own accessibility standards that often exceed ADA guidelines, with disability advocates and city agencies offering consulting services to developers Additionally, some communities, like Cambridge, Massachusetts, provide financial assistance to businesses looking to improve their accessibility features.
Improvement Program that provides businesses with matching grants of up to
Cambridge offers $35,000 in matching grants for façade improvements aimed at enhancing accessibility for customers with disabilities This funding can be used for restoring architectural details, upgrading windows and doors, and improving signage and lighting Over the past decade, numerous businesses in Cambridge have benefited from these grants, making their establishments more accessible The Cambridge Commission for Persons with Disabilities assists business owners in maximizing accessibility and informs them about federal tax incentives available for removing barriers to access.
One of the biggest challenges in enhancing accessibility for individuals with disabilities in both large and small communities is the high cost of modifying the built environment and implementing necessary accommodations.
Nashville, Tennessee, illustrates the challenges faced in urban areas regarding accessibility improvements In larger cities like Kansas City, Missouri, the high volume of necessary work often leads to delays, prompting complaints from residents about the slow pace of change Additionally, in historic communities, there is a tension between the need for retrofitting older structures to enhance accessibility and the concerns of preservationists who fear that such modifications may undermine the authenticity of these historic sites.
Provide Work, Volunteer, and Education Opportunities
Many individuals with disabilities successfully find employment through personal connections, job fairs, and internships, similar to those without disabilities Some may seek help from state vocational rehabilitation programs, while others can take advantage of the Ticket to Work (TTW) program offered by Social Security Designed for those receiving SSI or SSDI benefits, TTW aims to promote financial independence Beneficiaries can potentially reduce their Social Security cash benefits to zero while still retaining essential services like Medicaid, Medicare, and HUD rental subsidies The TTW program connects individuals with Employment Networks (ENs) contracted by the SSA to provide necessary employment services, supporting their journey toward self-sufficiency.
Marie, like many Americans with disabilities receiving SSA benefits, received her Ticket to Work (TTW) in the mail and explored Employment Networks (ENs) in her area She chose to apply for services from Alpha One, a Center for Independent Living and EN located in South Portland, Bangor, and Presque Isle, Maine At Alpha One, she met with Employment Coordinators and Benefit Specialists, Zahira and Gary, to initiate the development of her Individualized Work Plan (IWP).
—“a consensus between the individual and the EN on the individual’s employment goals and the methods used to achieve them.” 123
From an Employment Network (EN) perspective, it was crucial for Marie to fully grasp the provisions of the Ticket to Work (TTW) program and how employment would impact her Social Security Administration (SSA) and other benefits To facilitate this understanding, her benefits were meticulously catalogued to assess the implications of work on each one This comprehensive evaluation led to the creation of a personalized work plan, referred to as a “guide to independence” by Alpha One, which details the necessary steps for Marie to achieve her employment and financial independence goals Her Employment Coordinators and Benefit Specialists emphasized the critical need to report all work activities to the SSA and relevant state and federal agencies, providing Marie with detailed instructions and template forms to simplify the reporting process.
Marie’s Individualized Work Plan (IWP) included strategies for improving her credit history, securing funding for car repairs to enable her commute to work, and leveraging work incentives associated with her HUD-subsidized housing voucher, Medicaid, and childcare subsidies.
Marie, a high school graduate with part-time retail experience, reached out to Alpha One to explore the TTW option, aiming to secure a position in a retail business that provides management training, with the ultimate goal of becoming a store manager.
On her own, Marie found a full-time job at a local retail store She is now on a management-training track and her goal seems well within reach
Title I of the Americans with Disabilities Act (ADA) ensures that qualified individuals with disabilities have equal employment opportunities The ADA's employment provisions apply to private employers, state and local governments, employment agencies, and labor unions, with nondiscrimination requirements effective from July 26, 1992, for employers with 25 or more employees and from July 26, 1994, for those with 15 or more These requirements encompass all aspects of employment, including recruitment, hiring, advancement, and compensation Compliance with these provisions is enforced by the Equal Employment Opportunity Commission (EEOC), which reported receiving 15,964 disability discrimination complaints and resolving 18,804 charges in FY 2002.
$50 million in monetary benefits, not including monetary benefits obtained through litigation 127
Individuals with disabilities seeking employment must possess the necessary skills, experience, and education for the job and be capable of fulfilling the responsibilities with or without reasonable accommodations Reasonable accommodations refer to modifications in the work environment that enable individuals with disabilities to perform their job duties effectively and access workplace benefits equally Common examples of such accommodations include adjustments to workspaces, flexible scheduling, and specialized equipment.
Physical changes (e.g., installing a ramp; modifying a workspace or restroom)
Sign language interpreters for people who are deaf
Readers for people who are blind
Quiet workspaces to reduce distractions for people with mental disabilities
Training and written materials in accessible formats (e.g., Braille, audiotape, computer disk)
Hardware and software to make computers accessible for people with vision impairments, or who have difficulty using their hands
Employers must provide reasonable accommodations for qualified employees or job applicants unless doing so would result in an "undue hardship," defined as actions that entail significant difficulty or expense The determination of undue hardship considers the nature and cost of the accommodation in relation to the employer's size, resources, and operational structure, meaning larger businesses are generally expected to invest more in accommodations compared to smaller ones.
A 2003 “Work Trends Report” by the John J Heldrich Center for Workforce Development at Rutgers University revealed that only 26% of businesses employed individuals with disabilities The report identified several reasons for this, including employers' discomfort, misconceptions about job performance, beliefs regarding skill deficits, and concerns over accessibility and accommodation costs However, the findings also indicated that 73% of employers found that employees with disabilities did not require accommodations, and among those who did, 61% reported that the average cost was $500 or less.
According to a recent report, 29 percent of respondents indicated that costs were under $100 Additionally, a 30-year study by the Dupont Corporation revealed that 90 percent of employees with disabilities demonstrated above-average performance, attendance, and safety records.
Although there has been a small increase over the last decade in the percentage of adults with disabilities who are employed, 133 the unemployment rate among adults with disabilities is still
The 2004 N.O.D./Harris Survey reveals a significant employment gap, showing that only 35% of working-age adults with disabilities are employed compared to 78% of those without disabilities Furthermore, individuals with severe disabilities face even greater challenges, with only 21% employed versus 54% of those with slight disabilities Despite 63% of unemployed adults with disabilities expressing a desire to work, they encounter numerous barriers, including a lack of suitable job opportunities, transportation issues, insufficient job-related information, inadequate training, and concerns about losing health insurance or Medicaid.
The Federal Government has instituted tax incentives for employers and has established several initiatives and programs to help increase employment opportunities for people with disabilities:
Tax credits are available for small and larger businesses that remove architectural barriers, and for businesses that employ people with disabilities referred from rehabilitation agencies: 138
The Disabled Access Tax Credit offers eligible small businesses a 50 percent tax credit for qualified access expenditures exceeding $250, with a maximum limit of $10,250 per taxable year This credit supports various improvements, including the removal of barriers related to architecture, communication, physical access, and transportation Additionally, it covers making written materials accessible for individuals with visual impairments, providing oral materials for those with hearing impairments, and acquiring or modifying equipment for people with disabilities.
With the Tax Deduction to Remove Architectural and Transportation Barriers to People with Disabilities and Elderly Individuals, the Internal Revenue Service allows a deduction up to
$15,000 per year for expenses used to make a facility or public transportation vehicle owned or leased by a business accessible and usable by people with disabilities
The Targeted Jobs Tax Credit enables employers to obtain a tax credit of up to 40% on the initial $6,000 of first-year wages for new employees with disabilities These employees must be referred by state or local vocational rehabilitation agencies, the State Commission on the Blind, or the U.S Department of Veteran Affairs, and must also be certified by a state employment service.
84 must complete 90 days or 120 hours of employment for his or her employer to qualify for the credit
One of the goals of the NFI is to integrate Americans with disabilities into the workforce 140 Some key accomplishments include the following:
The Access to Telework Fund has been established to enhance work opportunities for individuals with disabilities by facilitating remote work and improving access to necessary technology, including adaptive equipment The Department of Education's Rehabilitation Services Administration has supported this initiative by funding 20 projects aimed at promoting inclusive employment practices.
The EEOC is collaborating with several states, including Maryland, Vermont, Washington, Florida, Utah, and Kansas, to enhance the hiring of individuals with disabilities in state government positions This partnership involves the EEOC reviewing practices related to hiring, retention, advancement, and reasonable accommodations Additionally, the EEOC will offer consultation, outreach, and technical assistance, culminating in a report that showcases best practices to serve as a model for other states.
Increasing the SSA’s budget to fund several demonstration projects aimed at removing disincentives and providing appropriate employment supports for individuals who want to work
Ensure Access to Key Health and Support Services
In 2001, three wheelchair users in Los Angeles agreed to document their daily lives by attaching camcorders to their chairs for 18 months This footage was transformed into "Rolling," a 70-minute documentary by physician-filmmaker Gretchen Berland, showcasing the challenges and triumphs they faced Among the featured individuals is Vicki Elman, a middle-aged woman living with multiple sclerosis.
At just 20 years old, Elman has been navigating life independently while relying on a motorized wheelchair for six years A significant part of the film highlights a particularly challenging moment when her wheelchair malfunctions, showcasing the difficulties she faces in getting it repaired—a situation that is all too common for many in similar circumstances.
Elman faces increasing frustration as she struggles to secure authorization from her insurance company for repairs to her malfunctioning wheelchair, which has been problematic for four months Over Memorial Day weekend, the wheelchair breaks down completely, leaving her unable to reach the repair company due to the holiday With the controls malfunctioning, her feet drag on the ground, causing multiple cuts and bruises On the following Tuesday, Elman visits her doctor to address her injuries and seeks assistance in expediting the wheelchair repair, emphasizing that without it, she cannot perform essential daily activities like getting in and out of bed or using the bathroom.
The doctor expresses concern for Elman's legs during the examination, stating that his office is unable to repair her wheelchair and that he will contact the repair company to expedite the process However, he worries that her condition may deteriorate while waiting for repairs Elman hopes to find a replacement chair, but the company does not offer rentals for the type she requires Consequently, the doctor recommends that Elman receive full-time care and has arranged for her to stay in a convalescent home while her wheelchair is being fixed.
Elman faces challenges entering the convalescent home due to its lack of wheelchair accessibility, and although she is usually independent at home, she finds herself almost completely reliant on staff in the facility After initially struggling to get help, an attendant assists her, but Elman quickly realizes the limitations of her situation When she asks for assistance to use the bathroom, the attendant insists she use a bedpan instead, highlighting her discomfort with the loss of independence This experience marks the end of her filming at the convalescent home, where she remains for four weeks until her repaired wheelchair is finally returned.
Despite facing daily challenges, Elman is a dedicated advocate for disability rights, recently elected president of her local chapter of Californians for Disability Rights After extensive planning, she travels to San Diego to discuss important legislation aimed at improving the lives of individuals with disabilities, including the 1.6 million wheelchair users in the U.S Her proposed Vicki Elman Community Living Act seeks to empower people with disabilities to live independently at home instead of being placed in convalescent facilities, reflecting her commitment to fostering a more inclusive society.
Durable medical equipment (DME) and assistive technology (AT) are crucial for individuals with disabilities to sustain their health and independence However, navigating the complex policies of health plans, particularly public programs, poses challenges, as many have restrictive definitions of "medical necessity." Research from California indicates that requests for DME are frequently denied by managed care organizations due to these stringent criteria Additionally, financial barriers significantly hinder access to necessary assistive equipment, with a 2003 national survey revealing that 20% of users experience serious difficulties affording it.
Obtaining, replacing, or repairing DME and AT is often a complicated task, even for people skilled in navigating health plan coverage issues 175 Old wheelchairs can be expected to break
Wheelchairs typically have a life expectancy of five to seven years, but as they break down more frequently, users may face long delays of a month or more to repair or replace them, as highlighted by Vicki Elman's experience Often, health plans do not recognize the need for a new wheelchair until the current one is completely inoperable This delay can result in users relying on poorly functioning wheelchairs, which can negatively impact their physical health and lead to increased healthcare costs.
Access to suitable and operational Durable Medical Equipment (DME) and Assistive Technology (AT) is just one of the many challenges faced by individuals with disabilities within our fragmented healthcare system A national survey conducted by the Henry J Kaiser Family Foundation highlights these ongoing barriers, emphasizing the need for comprehensive solutions to improve accessibility and integration in healthcare services for people with disabilities.
Individuals with disabilities encounter significant barriers to accessing health care services, despite their higher usage rates, according to the Kaiser Family Foundation Many health service providers lack the necessary resources to adequately address the unique needs of this population While most respondents report having a regular doctor, one in four struggles to find a physician who understands their disability Although a large percentage of people with disabilities have health insurance, 17% face challenges in finding doctors who accept their coverage, a figure that rises to nearly 25% for those on Medicaid, with or without Medicare Additionally, around one-third of respondents identified the costs of prescription drugs and dental care as major issues.
Research indicates that individuals with disabilities, despite their regular interactions with the healthcare system, are less likely to receive essential preventive services compared to the general population This demographic often receives these services less frequently than recommended, leading to overlooked preventive care People with disabilities are equally or more susceptible to chronic conditions and face increased risks for secondary health issues stemming from their primary impairments, such as women with mobility impairments who are at a higher risk for osteoporosis at younger ages Understanding the extent of these health disparities between those with and without disabilities is crucial for improving healthcare outcomes.
Healthy People 2010 180 is including health goals for people with disabilities as a subgroup similar to other populations requiring special attention 181
Individuals with disabilities, like everyone else, prefer to live at home and access necessary health care and support services within their communities However, addressing the diverse health service needs of this population presents significant challenges for states, local communities, consumers, advocacy groups, and policymakers Effective community-based care for people with disabilities often necessitates reforms in healthcare financing and delivery systems, including increased funding for community health centers, enhanced transportation options for those with mobility challenges, integrated housing programs alongside long-term support services, and active participation of individuals with disabilities and their advocates in the planning and delivery of services.
States across the country have made varying strides in enabling individuals with disabilities to live independently by improving access to affordable, quality healthcare and long-term support services Many are exploring cost-effective care options, particularly through managed care enrollment, in response to the rising demand for Medicaid and Medicare services These states advocate for high-quality managed care as a means to enhance access, control costs, and improve care quality for this population A vital aspect of these initiatives is "care coordination," which transcends traditional disease management by addressing the comprehensive medical and psychosocial needs of beneficiaries Successful programs prioritize wellness and prevention while effectively managing both covered and non-covered services.
Minnesota Disability Health Options (MnDHO) and Wisconsin Partnership Program, are profiled in this chapter
To align with the Olmstead 184 decision, which emphasizes providing services in the least restrictive environment, many states are considering supportive housing as a cost-effective alternative to institutional care This model integrates permanent housing options, such as apartments and single-family homes, with essential supports and services tailored to residents' needs Supportive housing encompasses various arrangements, including government-subsidized senior apartments, retirement communities, assisted living facilities, and Naturally Occurring Retirement Communities (NORCs) This community-focused strategy aims to assist three vulnerable populations effectively.
104 need long-term supports and services to live as independently as possible: frail elders, people with significant disabilities, and chronically homeless people
Development of supportive housing for these three subpopulations share many common principles, approaches, and issues 187 These similarities reflect common issues and needs among all three groups, including the following:
Desire to live in normal housing rather than in segregated and restrictive settings
The need for long-term supports and services to live as independently as possible
The desire for personal control, autonomy, and choice
Given these similarities, several models of supportive housing, regardless of the subpopulation they serve, are profiled in this chapter
Other models of supportive housing specifically targeting people with disabilities emerged from the independent living movement 188 Nearly 500
Independent Living Centers 189 have been created that provide various combinations of services, such as attendant care, financial assistance, peer counseling, advocacy, referral, transportation, and assistance with housing
As part of the NFI, the Bush Administration proposed the Medicaid
The Demonstrations Act of 2003 aims to enhance community-based long-term care services for individuals with disabilities, supporting states in executing the Supreme Court's Olmstead decision through funding for various demonstration projects The President's budget allocates $350 million annually for five years, totaling $1.75 billion for the Money Follows the Person (MFP) Rebalancing Initiative This initiative seeks to assist states in developing strategies that promote a more equitable distribution of funds between institutional and community-based services, while also addressing barriers faced by Medicaid-eligible individuals in accessing long-term care in community settings.
Rebalancing the long-term care system means adjusting the state’s publicly funded long-term care supports by increasing the availability of service options in the community and reducing
Encourage Participation in Civic, Cultural, Social, and Recreational Activities
Cultural, Social, and Recreational Activities
Rick Canen, a former Steelcase Corporation employee from Grand Rapids, Michigan, dedicated 30 years to the company, transitioning from factory work to the cafeteria after losing his sight Now retired, he actively participates in advocacy groups such as Concerned Citizens for Public Transportation and Faith in Motion, alongside organizations for the blind like Pilot Dogs, which trains guide dogs Having been diabetic since childhood, Rick lost his sight and welcomed a Labrador retriever named Freedom into his life three years ago He fondly refers to her as an “ice-breaker,” as she helps him gather insights on community transportation needs by sparking conversations with bus riders Together, they visit schools to educate children about guide dogs and attend drivers’ education classes to teach the White Cane Law, promoting awareness and understanding of pedestrian rights for those with visual impairments.
Recently, Rick added yet another activity to his already full schedule He and about a dozen other people, most with disabilities, signed up for “Utter
Words is a communications and leadership group inspired by Toastmasters International, meeting weekly at Disability Advocates of Kent County Participants enhance their public speaking skills and receive valuable feedback from the coordinator and peers Members like Rick aim to effectively convey their passion for disability-related issues to legislators, emphasizing the importance of concise messaging Rick advocates for better health care funding, specifically the need for “money to follow the person,” and has actively presented his case for reallocating long-term care funds from nursing homes to home- and community-based care at the state capital.
115 additional public speaking training, Rick feels he’ll be able to deliver the messages even more effectively
Rick sees himself as a voice for those unable to advocate for themselves due to work commitments He aims to influence transportation and policy changes to ease the burdens faced by these individuals in the future Reflecting on his own experience of limited time to engage with these issues while working, he has made it his retirement goal to give back to the community that supported him during his career.
The 2000 N.O.D./Harris Survey of Community Participation revealed significant disparities in community involvement between individuals with and without disabilities The survey, which included 535 people with disabilities and 614 without, found that individuals with disabilities reported feeling more isolated, participating in fewer community activities, and expressing lower satisfaction with their engagement Specifically, they are nearly twice as likely to feel isolated and 1.5 times more likely to feel excluded from community events While 35% of people with disabilities reported being "not at all involved" in their communities, only 21% of those without disabilities felt the same Although both groups possess similar knowledge about community involvement, individuals with disabilities are notably less likely to participate in religious services, local politics, and cultural events.
A 2000 N.O.D./Harris Survey reveals that low participation rates among individuals with disabilities are partly attributed to insufficient outreach from community organizations The survey indicates that nearly half of people with disabilities, and over 60% of those with severe disabilities, feel that these organizations have not made efforts to engage them In contrast, only 35% of individuals without disabilities share this sentiment, highlighting a significant disparity in community engagement efforts.
116 implication of these findings is that community organizations “need to take a different, more concerted approach to reaching out to this group, in particular those with severe disabilities.” 228
A community cannot be deemed livable for individuals with disabilities if they are excluded from the social fabric and civic, cultural, or social activities Survey results indicate that merely offering activities and information is insufficient; community organizations must proactively promote and facilitate the involvement of people with disabilities to ensure true inclusivity.
This chapter highlights community-based programs that prioritize outreach to individuals with disabilities and emphasize integration as a key objective A truly livable community is one where people with disabilities engage in work, play, learning, and worship alongside their non-disabled peers.
In Phoenix, Arizona, outdoor recreational activities are accessible—and exciting—for people with disabilities
Since 1973, the City of Phoenix Parks and Recreation Department’s
The Adaptive Recreation Services section offers inclusive recreational programs year-round for individuals with disabilities, including children, teenagers, and adults One notable program is River Rampage, a whitewater rafting experience that pairs eight teenagers with disabilities with eight at-risk teenagers Supported by the nonprofit organization River of Dreams, River Rampage has successfully completed its eleventh year, operating three trips each summer.
The Department has launched Daring Adventures, an inclusive outdoor recreation program designed for teenagers and adults, both with and without disabilities While certain activities may involve enrollment fees, participants can opt to fulfill volunteer service hours instead of paying Daring Adventures offers a variety of adaptive programs tailored to meet diverse needs.
Adaptive cycling consists of handcycles for people with mobility impairments and tandem bicycles for people with visual impairments Participants meet for 1.5 hours every week
117 for six weeks to get accustomed to the handcycle or tandem bicycle, and are then eligible to rent them on their own
Adaptive kayaking offers one- and two-person "sit-on-top" kayaks designed for individuals with visual or mobility impairments Participants can engage in a six- to eight-week instructional program, dedicating four hours each week, after which they have the opportunity to rent kayaks independently.
Sled ice hockey is an inclusive sport designed for individuals with disabilities, utilizing adjustable adaptive ice sleds Participants can engage in three sessions lasting 8 to 10 weeks, with one hour of ice time each week The program operates at two different ice rinks located in Peoria and Scottsdale The City of Peoria generously contributes ice time for one session, while the City of Scottsdale offers support for some of the program's staff.
Cross-country skiing is accessible for individuals with mobility impairments through specialized equipment such as skis with Velcro straps for the waist, ankles, and knees, along with shortened ski poles A six-week conditioning exercise program culminates in a weekend retreat in Flagstaff, offered twice annually Additionally, cross-country skiing opportunities are available for those with various disabilities, featuring slopes designed with two sets of parallel tracks that allow sighted skiers to assist visually impaired participants.
The newly introduced hiking and backpacking program aims to provide inclusive outdoor experiences for individuals with disabilities Initially, it will feature recreational hikes on relatively flat terrain, gradually expanding to offer guided hikes of varying lengths and difficulty levels Participants will have access to specialized hiking wheelchairs and assisted hiking chairs to enhance their experience.
Wilderness camping trips are held at Camp Colley, located three hours northeast of Phoenix The campsite features three wheelchair-accessible platform tents with ramps and two accessible portable toilets In 2004, two successful camping trips were conducted at this facility.
Researchers at Arizona State University have gathered data on participants in Daring Adventures programs, estimating that nearly 400 individuals have taken part, with 80 percent of them being people with disabilities.
Putting It All Together
In previous chapters, we highlighted various states, counties, and local communities striving to enhance livability for individuals with disabilities and older adults across key areas such as housing, transportation, the physical environment, employment, health and support services, and social and civic engagement We discussed several federal regulations, programs, and incentives that have empowered local actions to tackle challenges in these domains Although many communities have achieved significant progress and successes in multiple areas, no community has yet fully addressed all aspects within each category.
Communities aiming to enhance livability for the elderly and individuals with disabilities often face significant challenges, including limited resources, restrictive funding, and insufficient collaboration among agencies Additionally, a lack of public and federal support hampers their efforts However, as highlighted in this report, many communities demonstrate creativity and resilience in overcoming these obstacles, making meaningful progress despite the constraints they encounter.
Strategies and Policy Levers to Afect Change
The key factor behind the success of many initiatives highlighted in this report is the establishment of strategic partnerships, which collaboratively aimed to achieve common goals.
Address consumers’ needs in a coordinated and comprehensive manner,
Reduce fragmentation in the service delivery system,
Implement policies and programs that help people remain independent and involved in community life
The San Mateo Strategic Plan serves as a comprehensive framework aimed at enhancing the quality of life for elders and individuals with disabilities in the county Over a decade ago, various agencies collaborated to create a unified strategic plan that addresses the unique needs and preferences of both groups This development process engaged a diverse range of community stakeholders to ensure that the plan's goals reflect the mission of constituent agencies and the aspirations of those it serves Since its launch, the strategic plan has guided the county in improving its service delivery system, with monthly progress monitoring to ensure continued advancements.
Communities highlighted in this report have implemented four key strategies alongside developing strategic partnerships to enhance access to affordable housing, transportation, and employment opportunities These strategies include improving the accessibility of the built environment, aligning health and support service delivery systems with the needs of the populations served, and fostering social and civic engagement These recommendations aim to guide other communities in creating more inclusive and supportive environments.
This report highlights four key strategies that are applicable at all levels of government—federal, state, county, and local—to drive meaningful change across various sectors.
Framework of a Livable Community for Adults with Disabilities:
Strategy 1 Consolidate administration and pool funds of multiple programs to improve ease of access to, and information about, benefits and programs for consumers
This strategy aims to enhance operational efficiency by eliminating redundancies and optimizing resource use A notable example is San Mateo's integration of the Area Agency on Aging into the Aging and Adult Services Division within the county's Health Services Department This consolidation allows for all adult programs to be centralized, ensuring better coordination and service delivery for the elderly population.
Support TIES Line—a centralized, toll-free information and referral
130 telephone line—is available 24 hours a day to help adults enter and navigate the entire county’s health and support services system
STAR, the public transportation authority in Sweetwater County, Wyoming, has successfully consolidated various transportation services previously offered by multiple health and human services agencies By pooling resources from over several agencies, STAR enhances efficiency and accessibility for the community.
10 sources and uses a centralized dispatch system to provide coordinated public transportation that serves people with disabilities and the general public in a rural environment
Strategy 2 Use tax credits and other incentives to stimulate change in individual and corporate behavior and encourage investment in livable community objectives
Strategies to promote affordable housing development often include financial incentives and tax relief measures For instance, Austin's SMART Housing Initiative offers private developers incentives to build affordable homes by granting housing authorities priority access to surplus city properties at below-market prices Additionally, tax policies like the Virginia Real Estate Tax Relief Program for Elderly and Disabled Persons assist thousands of Virginians in lowering their housing expenses, enabling them to stay in their communities.
Tax credits and incentives, including matching funds, can motivate employers to hire individuals with disabilities and promote accessibility in the private sector for both seniors and people with disabilities.
Strategy 3 Provide a waiver or other authority to help communities blend resources from multiple public funding streams to provide and coordinate diferent services
Chapter 6 of this report highlights notable examples of policies that effectively utilize Medicaid waivers and other strategies to integrate funding sources These federal and state-led initiatives aim to enhance the accessibility of home- and community-based support services.
131 community-based services as an alternative to institutional care; support comprehensive, CD care; and generally help states avoid costly fragmentation and duplication of health care services
Strategy 4 Require or encourage a private sector match to leverage public funding and stimulate public-private sector partnerships
This report highlights various initiatives that rely on public-private partnerships to deliver essential services to seniors and individuals with disabilities A prime example is the New York City NORC-SSPs, which receive funding through grants and in-kind contributions from state and local governments, housing and social service providers, and philanthropic organizations These collaborations aim to offer support services in communities with a significant population of older adults.
The Texas Home of Your Own Coalition (Texas HOYO) collaborates with various partners from both the private and public sectors, such as realtors, lenders, and local housing organizations, to assist individuals with disabilities in navigating the entire homeownership process.
This report highlights various community initiatives aimed at enhancing livability for elders and individuals with disabilities across the United States Despite facing numerous challenges, these communities have demonstrated political will and commitment to this important cause Key lessons from the initiatives discussed can provide valuable recommendations for other communities seeking to prioritize livability improvements.
Provide afordable, appropriate, accessible housing
The absence of a unified federal housing policy, along with a confusing mix of unrelated housing programs and agencies, creates a challenging environment for individuals seeking to navigate the housing landscape.
To break through this maze, it is important for the disability and aging communities to build strong partnerships with the “affordable housing” community—an