Learning Objectives
By the end of this section, you will be able to:
- Define disability and identify common diseases that contribute to disability
- Discuss the chronic effects of disability on a patient’s wellness continuum
- Examine the legal and ethical considerations of providing equitable care for an individual with a disability
Chronic disease has the potential to negatively affect all aspects of everyday life for those with such a diagnosis. This is especially true for those diagnosed with multiple chronic conditions. These conditions can result in physical disabilities and take emotional, mental, and financial tolls on a person’s overall health and well-being. Fortunately, in the past several decades, legislation has been passed and financial resources have become more readily available for individuals with disabilities related to chronic illness. However, there is still much work to be done to ensure equitable and adequate treatment for individuals with disabilities, both within the health care system and in everyday life.
Disability
A disability is a limitation in function or performance of everyday activities. Disabilities often occur because of chronic illness. They vary from person to person but can include the inability to effectively see or hear, perform ADLs, work a job, or complete school assignments. One in four Americans lives with a disability that affects their everyday life (CDC, 2023c). The most common disabilities in the US include:
- cognition: difficulty concentrating, remembering, and making decisions
- hearing: complete deafness or severe hearing loss
- mobility: difficulty walking or climbing stairs
- self-care: difficulty performing ADLs
- vision: complete blindness or severe loss of eyesight
Individuals with disability are also at higher risk for having obesity, smoking, and developing additional chronic conditions, including heart disease and diabetes, all of which negatively affect overall health and well-being (CDC, 2020).
Effects of Disability on a Patient’s Wellness Continuum
Though many people may assume wellness is simply the absence of illness, it is a multidimensional concept that includes several different components (Figure 9.3):
- emotional health
- meaningful spiritual life
- mental health
- physical health
- positive relationship with one’s environment
- positive relationship with one’s financial status
- positive relationship with one’s occupation
- satisfying social life
In addition to being multidimensional, wellness exists on a continuum: there exists a wide variety of individual definitions of health. Figure 9.4 illustrates the illness–wellness continuum. On one end of the continuum is premature death; the other end represents a high level of wellness. The middle portion of the continuum represents individuals who may have some aspects of wellness and some aspects of illness. Therefore, even with a chronic disease diagnosis, individuals may still fall somewhere on the high end of the continuum if they ensure they are improving other aspects of wellness beyond just physical health.
Health care and nursing have begun to prioritize preventive health and self-care, which allows patients to achieve higher levels of wellness along the continuum and results in an overall improved state of health and well-being, despite physical or mental disabilities (Martínez et al., 2021).
Physical Impacts
Many physical barriers can affect the everyday life of individuals with disabilities. Individuals with physical disabilities are often unable to access certain places or resources because they physically cannot get there. This includes situations such as curbs or stairs without ramps, elevators, or other accessible options; lack of automatic doors; poorly lit environments; narrow sidewalks, doors, or aisles; bathrooms or parking spaces that are inaccessible; and lack of aids to help those with hearing impairment communicate.
Emotional and Mental Impacts
The physical barriers obstructing individuals with disabilities and the impacts of these barriers on a person’s wellness are relatively easy to visualize. The emotional and mental impacts of disabilities are often more difficult to envision because they may not be physically present. Nevertheless, the experience of living with a disability, particularly in an unaccommodating or biased society, can have an even more detrimental impact on an individual’s emotional and mental well-being. Studies have shown that individuals with disabilities are five times more likely to experience mental distress than those without a disability (CDC, 2023c).
Financial and Social Impacts
In addition to their physical and mental impacts on health, disabilities can also have substantial negative impacts on a person’s financial and social well-being. For example, individuals with disabilities are less likely to be employed, which results in an increased risk for living in poverty and experiencing the detrimental health effects associated with low socioeconomic status, such as lack of access to dental care or being unable to afford healthy food options. Individuals with a disability who are employed will likely have to miss work periodically due to their disability, which may affect their income and potentially their employment status if their employer is unwilling to accommodate these absences. In terms of education, people with disabilities are less likely to have completed a high school education, which limits their ability to find employment (CDC, 2023c).
Although unemployment and limited education affect the financial status of the person with a disability, there are also social impacts to consider. Unfortunately, there is a stigma surrounding people with disabilities: society often views them as weaker or “less than” those without a disability. This stigma undoubtedly contributes to the unwillingness of some employers to hire individuals with disabilities and fuels biases within society. Though there has been a recent shift within society to be more inclusive of all people, there continues to be discrimination—the unjust or prejudicial treatment of certain people—against individuals with disabilities.
Considerations for Equitable Care among People Living with Disabilities
Though a societal shift toward inclusion and understanding is happening, discrimination toward individuals with disabilities is still common. Discrimination takes place in the workplace, social situations, and many other settings in everyday life. To help eliminate discrimination, the US government has developed several programs that provide funding and other financial resources to individuals with disabilities. An overview of these programs and resources is provided in Table 9.2.
| Resource | Overview |
|---|---|
| Centers for Medicare & Medicaid Services (CMS) | Provides health insurance for low-income individuals with disabilities |
| Supplemental Nutrition Assistance Program (SNAP) | Helps low-income individuals and families pay for groceries (formerly known as “food stamps”) |
| Temporary Assistance for Needy Families (TANF) | Provides a cash assistance payment program for low-income individuals and families |
| Social Security Disability Insurance (SSDI) | Pays for health benefits of individuals who cannot work due to medical conditions or disabilities. A person must work for a certain number of years to earn this benefit and be able to use it. |
| Supplemental Security Income (SSI) | Provides monthly payments to qualified low-income individuals with a disability |
| Children’s Health Insurance Program (CHIP) | Provides health insurance coverage to uninsured children who live in families that make too much money for Medicaid but cannot afford private health insurance |
Children
In addition to the financial resources listed in Table 9.2, legislation has been passed that protects children with disabilities from discrimination. Specifically, the Individuals with Disabilities Education Act (IDEA) ensures that all children with disabilities have access to a free, appropriate public education. This act provides a comprehensive and coordinated approach for implementing early intervention services for infants and toddlers with disabilities to ensure they have the resources they need to be successful in the future. Additionally, this legislation provides the necessary tools and resources to parents and educators of children with disabilities to provide an adequate educational experience regardless of a child’s specific disabilities or limitations. This may include certain accommodations or special education programs that are tailored to the child and their specific disability. However, it is important to note that IDEA is severely underfunded, highlighting the need for more advocacy and federal funding on behalf of children with disabilities (Blad, 2020).
Veterans Living with Disabilities
Veterans are another group at higher risk for physical, emotional, and mental disabilities (Figure 9.5). This group has seen a significant increase in suicide rates, indicating the need for thorough mental health assessment and swift intervention if any signs of suicidal ideation are noted (Sheehy & Schwartz, 2021). Several programs have been developed to care for this specific population. Primarily, veterans have access to health care through the Department of Veterans Affairs (VA). Through the VA, eligible veterans can obtain disability compensation: a monthly, tax-free payment to veterans who are unable to work because of a disability acquired during active service. This may help take the financial burden off the veteran with a disability and improve their overall health and well-being. However, this program is underfunded and at risk of being unable to support the growing needs of this population (Shane, 2022).
Another program available to assist veterans with disabilities is the Wounded Warrior Project (WWP). The WWP is a charitable organization that provides resources to veterans after they return home from war or military conflict. These resources include counseling, rehabilitation services, and social support.
Vocational Programs for Patients with Disabilities
Because a sizable portion of discrimination against individuals with disabilities occurs in the workplace, there has been an increase in the development of vocational programs to help such individuals find and keep employment. Traditionally, these programs have been offered at the state level, so they may vary from state to state in terms of services provided. However, most programs offer employment services such as job training and placement, career counseling, and financial planning. These resources are intended to help individuals with disabilities not only prepare for the hiring process but also keep their job and maintain a consistent employment status.
Americans with Disabilities Act
The Americans with Disabilities Act (ADA), passed in 1990, is a federal law that prohibits discrimination against individuals with disabilities. This law also oversees and mandates that public businesses provide individuals with disabilities an equal opportunity to access services and commercial goods. This is accomplished by ensuring that businesses and workplaces provide reasonable accommodations for those with disabilities. Examples of accommodations for patients with chronic conditions include
- allowing service animals on public transportation and inside businesses
- installing wheelchair ramps and elevator access in place of stairs (Figure 9.6)
- placing handicap parking spaces closer to entrances
- providing sign language interpretation
- providing testing accommodations for individuals with learning disabilities
- providing visual aids to assist with visual impairment
- providing wheelchair-accessible bathrooms
Nurses with Disabilities
There are nurses with an array of disabilities who can still practice nursing. For example, some nurses who have hearing impairments use special stethoscopes for auscultation. Some nurses leave the bedside due to physical injuries that create permanent disability, but they continue to work in other modalities such as informatics, nursing education, case management, and office work. There are also nurses with emotional and mental disabilities who have accommodations in place to ensure they can perform their duties effectively.