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click image for full size Other articles in Part 3 Working poor dominate poverty rolls Graphs: poverty rate trends; poverty and education; geographic area Suburbs thrive; cities, rural area fall behind Women and children most likely to be poor Most poor people don't stay that way Graphs: poverty rate by race, ethnicity; age; household Oregon's children and poverty Elders face poverty as they grow older Poverty and minorities

Disability and chronic poverty story by Bob Rost Chronic is not a happy word. It usually describes a condition of misery that just won't go away. So it is in the case of chronic poverty. People mired in chronic poverty struggle through long periods of their lives with meager resources. Chronic poverty is often a fact of life for individuals with physical disabilities and mental disorders, and for people with alcohol or drug problems. Many work to support themselves as best they can. However, 22 percent of Oregonians with a physical disability live in households with incomes below the federal poverty level, according to the Oregon Progress Board's 1998 Benchmark Report. A physical disability, according to the Oregon Vocational Rehabilitation Division, involves "a severe physical or mental impairment" that prevents a person from performing daily tasks without outside help and is an obstacle to getting and keeping a job. Amputation, arthritis, burn injury, cancer and head injury are among the causes of physical disabilities. A developmental disability, unlike a physical disability, begins at an early age, continues indefinitely and requires training and support. Examples of developmental disabilities include autism, cerebral palsy, mental retardation and epilepsy. For people with either type of disability, federal assistance benefits are an absolute requirement for survival, according to Katherine Weit, policy advisor for the Oregon Developmental Disabilities Council. These benefits are usually the only source of income for people with disabilities, added Scott Lay, of the Oregon Senior and Disabled Service Division. The benefits come from Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Strict eligibility requirements for SSI put this program off limits to all but the lowest income levels. The maximum benefit available from SSI is $500 a month. The monthly benefit available from SSDI ranges from $200 to $1,500 with an average of $730 per month, or barely above the federal poverty level of $687 a month for a single adult. That's where the poverty starts for disabled people, said Lay. The average monthly SSDI benefit of $730 is often the only income they have, he said. Medicaid benefits can help pay medical costs, but individuals with incomes greater than $500 per month have not been eligible for Medicaid under longstanding rules governing the program. "Disincentives are the big issue surrounding disabled people in chronic poverty," said Weit. "If they need constant help with the activities of daily living, such as dressing or bathing, or they have high cost medical needs, getting employment and receiving the minimum wage will actually put their benefits in jeopardy. "When they go to work, they lose their SSI, SSDI and Medicaid benefits, all of which require a lengthy application process to get in the first place," Weit said. In effect, the problem is that you have to be in poverty to get assistance and you have to remain in poverty to keep the benefit, she said. "People with disabilities who are thinking about going to work have to consider how much money they will lose by getting a job," said Lay, former chairman of the Oregon Disabilities Commission. He's had first-hand experience with this type of situation. Lay became a quadriplegic following a swimming accident in 1969. He needs the help of an attendant at a cost of $1,500 a month. He covers that expense with Medicaid benefits, but up until recently Lay risked losing the benefit if he earned more than $500 a month, according to regulations governing recipients of Social Security disability income. In an attempt to address the work disincentive issue, Congress modified the eligibility standards for Medicaid in 1997. In turn, the Oregon Department of Human Services developed the Employment Initiative program to test a more flexible way of allowing people with disabilities to go to work. Now, physically disabled Oregonians can earn up to $3,500 a month without risking loss of Medicaid benefits. And in some cases, they can earn more than $3,500 a month and still qualify for Medicaid under the Employment Initiative. "Oregon is about the only state that has tried to develop a program like the Employment Initiative that will allow people to be employed up to a fairly high level of income and maintain their Medicaid benefit," Weit said. In addition, new federal legislation, known as the Work Incentives Improvement Act, has passed the House and Senate and been signed into law by President Clinton. The new law will prompt many of the disabled to polish their resumes and prepare to enter the job market. Mental Illness Others who frequently fall into the chronic poverty spiral are those individuals suffering mental disabilities such as depression, schizophrenia and manic depression. "A big problem is that psychiatric illnesses are not covered well by health insurance," said Mary Alice Brown, director of the Laurel Hill Center, a psychiatric rehabilitation facility in Eugene. "There is usually a dollar limit on insurance coverage for these illnesses. When it runs out, families who are involved end up paying out of pocket," she said. The onset of mental illness usually occurs in late adolescence, around college age when individuals are just coming into adulthood, Brown explained. "Usually they are just getting to the point where they will be entering the world of work," Brown said. "The illness prevents them from attaining the skills and knowledge to become employed. Effective treatment is time-consuming and expensive." These illnesses are cyclic, Brown added. The affected person may be well for a time and then may suffer a relapse. People with chemical dependencies-drugs and alcohol-also fall into chronic poverty, and worse. In addition to being unemployable due to alcoholism or habitual drug use, people with chemical dependencies also run a high risk of sustaining physical injuries or getting caught up in the criminal justice system, said Vicki Decker, coordinator for the Northwest Frontier Addiction Technology Transfer Center in the Oregon Department of Human Resources. "Many people think poverty causes chemical dependency," said Decker. "In fact, the opposite is more often the case. Dependency causes the individual to fall into poverty." People become chemically dependent for all kinds of reasons, Decker explained. Many people become alcoholics or addicted to drugs because it's their way of coping with a life trauma. Or, in the case of alcohol, some people have family predispositions to alcohol abuse, she said. "This pattern of abuse often begins in teenage years," said Decker. "In most cases, average adults who are drinking don't reach that stage of debilitation where they are losing jobs until their disease has progressed quite a way. "Usually they seek their first treatment in their 40s," Decker continued. "As a rule an alcoholic will quit a job before he or she is fired." She added that drugs like heroin and methamphetamine have similar effects, but take a much greater physical toll on the individual over a much shorter time span. "Their health or mental state becomes impaired, and they end up getting hurt or breaking laws," Decker said. "Then they have the expenses of paying for health care or paying fines, or possibly serving time in a correctional institution." Even though the troubles that accompany drug and alcohol addiction are daunting, Decker says prospects for recovery are good if help is available. "There is ample proof that treatment for individuals suffering from chemical dependency is effective," said Decker. "The problem is that we're seeing a reduction in the availability of treatment while the need continues to grow." According to Decker, publicly funded resources for treatment of chemical dependency have declined over the past 15 years, and insurance companies have reduced coverage for problems related to chemical dependence. "If individuals suffering from drug and alcohol addictions can get into recovery programs, they can become viable citizens," Decker said.   Article 9 of 10 in Part 3   back to top

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