2017’s Best & Worst Cities for People with Disabilities

Posted by: Richie Bernardo

When searching for a new place to call home, people with disabilities often have a longer and more complicated list of considerations compared with healthier individuals. In addition to common wish-list items, such as reliable public transportation and diverse entertainment options, people with major health conditions also must think about, for instance, accessibility of facilities or even the cleanliness of the air.

According to the Social Security Administration, one in five Americans lives with a disability, and one in 10 has a severe disability. Managing poor health can be quite expensive, considering the high cost of U.S. health care. To add insult to injury, disability checks for most beneficiaries are insufficient for monthly living expenses — let alone disability-related costs. “At the beginning of 2015, Social Security paid an average monthly disability benefit of $1,165” according to the SSA. “That is barely enough to keep a beneficiary above the 2014 poverty level ($11,670 annually).”

Although disability benefits can increase based on inflation, many people with disabilities rely on low cost of living and wages for financial relief. In 2016, nearly 5.4 million people with disabilities were employed. But the unemployment rate for this group has risen in recent years, concerning those who hope to earn a living in order to cover the shortfall in income.

With the physical and economic challenges of managing a disability in mind, WalletHub’s analysts compared the 150 most populated cities across 28 key indicators of disability-friendliness. Our data set ranges from physicians per capita to rate of workers with disabilities to park accessibility. Read on for our findings, expert insight from a panel of researchers and a full description of our methodology.

1. Main Findings
2. Ask The Experts
3. Methodology

Main Findings

In the overall ranking below, readers who are particularly interested in the best places to live on disability income should focus on the “Economy” category. Likewise, those who place a higher premium on quality of medical care should focus on the “Health Care” category.  

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/7164/geochart-disabilities.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2xbsaBz;  

Overall Rank	City	Total Score	‘Economy’ Rank	‘Quality of Life’ Rank	‘Health Care’ Rank
148	Providence, RI	36.55	139	59	147
149	Anchorage, AK	36.27	55	149	145
150	Worcester, MA	34.81	150	95	139

Ask The Experts < >

• Andrew J. Imparato Executive Director of the Association of University Centers on Disabilities
• Michelle Putnam Professor and Associate Dean for Research at Simmons College

Andrew J. Imparato Executive Director of the Association of University Centers on Disabilities What are the unique financial challenges faced by people with disabilities, particularly those who rely on government assistance? How can these challenges be overcome? Most of the key federal programs that support people with disabilities (e.g., Supplemental Security Income, Social Security Disability Insurance, Medicaid and Medicare) were designed at a time when we did not expect people with long-term disabilities to participate in the labor market. So, those who rely on government assistance to help pay for rent, food, health care, and long-term assistance with things like getting out of bed, getting dressed, using the restroom or eating, may feel trapped in poverty and unable to pursue their career goals for fear of losing eligibility for critical benefits. Also, especially in the SSI program, the amount of the monthly check has not kept pace with inflation, and it is hard to find safe, accessible housing that you can afford as an SSI recipient in many communities across the U.S. In evaluating the best cities for people with disabilities, what are the top 5 indicators?

• Safe, affordable, accessible public transit;

• Quality health care, including access to specialists;

• Access to a reliable direct support workforce;

• Disability friendly state and local government, including a robust Medicaid program with the ability to work and buy into Medicaid on a sliding scale.

• Access to quality, affordable higher education, vocational training, and decent jobs that pay a living wage.

What effect will the recent reforms to SSDI proposed by OMB Director Mick Mulvaney have on the disabled population? Most Republican-led efforts to reform SSDI have focused on cracking down on fraud, not modernizing the program. When initiatives like this have been implemented in places like the UK, it has resulted in people losing critical benefits with some dying prematurely as a result, and huge investments in a privatized bureaucracy that is tasked with cracking down on fraud, with very little evidence that the new approach has improved the integrity of the program. The Americans with Disabilities Act (ADA) was adopted nearly three decades ago. What would 21st century improvements should be made, if any, to this important act? Make it clear that people have an ADA-protected right to live in the community and not be forced into a nursing home or other segregated setting (see Schumer and Sensenbrenner's Disability Integration Act); clarify that the ADA requires websites and the sharing economy to provide access to people with disabilities on an equal basis; improve transportation access across multiple modes; improve access to movies and other cultural and recreational pursuits; don’t allow employers to pay people with disabilities less than the minimum wage for that location; allow for greater damages for egregious violations of the law. What local policies and programs have proven effective in increasing inclusion and improving the quality of life for people with disabilities?

• Visitability ordinances like the one in Atlanta, that improve wheelchair access to residential housing;

• Fair wage laws, like the one in Maryland;

• A robust Medicaid buy-in program for working adults with disabilities, like the one in Massachusetts;

• Quality integrated public schools, where autistic students, students with intellectual disabilities, and others are thriving, like in Madison, Wisconsin;

• Quality adaptive recreation programs, like in Cincinnati and Berkeley;

• Accessible metro, like in DC;

• Decent access to beaches, like in San Diego.

Michelle Putnam Professor and Associate Dean for Research at Simmons College What are the unique financial challenges faced by people with disabilities, particularly those who rely on government assistance? How can these challenges be overcome? Financial challenges for people with disabilities and their families -- of all ages -- include paying out-of-pocket costs related to medical care, long-term services and supports (LTSS) that help facilitate independent living, ranging from paid attendant care to technology devices to modified vans and automobiles, and finding affordable rental housing or being able to afford modifications to one's own to make it an accessible living space. Individuals who receive Social Security Disability Insurance (SSDI) or Social Security Supplemental Insurance (SSI) are restricted in their ability to earn income and still receive either of these public benefits. There are some work-incentivizing programs, like SSDI's Ticket to Work program that helps individuals transition back to employment, that have been successful for many people. But often, people move into SSDI and SSI because work and employment situations are not supportive, not flexible in ways that work for people with disabilities, so it can be easier to leave the workforce than work in a disability-unfriendly environment. Only a very low percentage of persons with significant disabilities are employed (about 30%), which is related more to workplace supports and employment opportunities than interest in working. Finally, for persons receiving SSDI, leaving the program often means losing Medicare insurance. Given the cost of health insurance and variances in the availability of insurance through employers, that's a disincentive. It's hard for individuals to overcome financial challenges related to disability on their own, as often, financial instability is related to institutional and structural factors. Programs like Ticket to Work help, as do individual development accounts which help low-income people save with matched funds. That said, access to affordable health insurance is critical, as is access to affordable LTSS. We have no national policy for LTSS, which is a problem for younger and older adults and their families. The only insurer that truly covers these -- at least to some degree in all states -- is the Medicaid program. In evaluating the best cities for people with disabilities, what are the top 5 indicators? For a city to be disability friendly, it must be:

• Physically -- architecturally and environmentally -- accessible;

• Have affordable housing;

• Have good public transportation or affordable private transportation options;

• Actively voice its support for the inclusion of people with disabilities (of all ages) in the community;

• Demonstrate that inclusion by actively inviting people with disabilities (of all ages) and their families to participate and have a voice in community decisions.

What effect will the recent reforms to SSDI proposed by OMB Director Mick Mulvaney have on the disabled population? I'll first say that I don't think Mick Mulvaney really knows much about who receives SSDI and why. There is always the assumption that the SSDI program has a lot of fraud, and that people who should be working are receiving benefits. There is extensive research on the SSDI program -- which Mulvaney should read -- that shows that many of the factors I noted earlier (disability-friendly workplaces, access to long-term supports and services, need for medical insurance) all matter when moving individuals from SSDI to work. We also know that some individuals "retire" into SSDI first, then move over into OASI -- which is the Social Security Retirement insurance program, when they are of qualified age. There are many reasons for this as well, but many of those are the same reasons I just mentioned. I think cuts to the SSDI program -- I don't see them as reforms -- have no real effect, other than to make workers with disabilities more financially vulnerable, as the more structural and cultural factors are not addressed by these cuts and likelihood of employment remains low for many people who might have SSDI benefits terminated or restricted. The Americans with Disabilities Act (ADA) was adopted nearly three decades ago. What would 21st century improvements should be made, if any, to this important act? I think there is some room for improvement in the ADA -- any civil rights law must be applied and interpreted over time -- as contexts change. My greatest interest is in convincing older adults that the ADA applies to them as well. Typically, we don't think about disability rights -- rights related to accessibility, accommodation, and inclusion as being related to older adults. We just assume disability is part of aging, and older adults should adapt to it. But really, we should be using the ADA to make sure that the environment adapts to older adults’ needs as well. What local policies and programs have proven effective in increasing inclusion and improving the quality of life for people with disabilities? Across the world, cities which are working on becoming age-friendly cities -- an initiative by the World Health Organization -- should also be disability-friendly, if done well. Many cities in the U.S. -- like New York and Boston -- are working on becoming age-friendly. Many local communities also have a variety of disability-awareness training initiatives, to help people without disabilities develop greater awareness about attitudes, actions, processes, and structural factors that facilitate inclusion. Most importantly, though, increasing inclusion and quality of life is more likely to happen by including people with disabilities (of all ages) and their families as partners in local planning and decision-making processes. There is no substitute for working directly with core stakeholders who are experiencing a problem to solve said problem. Maybe Mick Mulvaney should consider that as well.

Methodology

 

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