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Agency for Healthcare Research Quality

Chronic Conditions

Low-income adults with physical disabilities face transportation, accessibility, and privacy barriers

The perils of transportation, accessibility, care interruptions, and privacy affect the health of individuals with physical disabilities living in homeless shelters, nursing homes, and private residences in the Washington, D.C., area, a new study finds.

Pei-Shu Ho, Ph.D., a senior study director at Westat, Inc., and colleagues conducted 2-hour focus groups with 28 working-age adults with physical disabilities living in a homeless shelter (13 people), nursing home (7), or private residence (8) in the D.C. area. Half of the participants had spinal cord injury and paralysis, and all of them relied on Medicaid or a local public program for health insurance. For individuals living in shelters and private residences, transportation was a common barrier to obtaining medical services.

Both public and private transportation services were perceived unreliable, or inaccessible (despite Title II of the Americans with Disabilities Act requiring accessibility). Participants living in the shelters or nursing homes voiced a preference for having a regular physician who was familiar with their medical conditions, so that they did not have to explain their health histories at every appointment. Participants also expressed a desire for access to dental care, which is not covered under the D.C. Medicaid plan.

In terms of physical living space, participants who lived at home or in a shelter faced the most accessibility issues. For example, individuals with physical disabilities who lived at shelters that did not offer wheelchair-accessible bathrooms reported having poor hygiene. Also, having to navigate flights of stairs in a wheelchair at private residences put undue stress on those who depend on wheelchairs for mobility. Shelter and nursing home residents faced privacy and security concerns daily, as neither location offered much of either. For instance, shelter residents with pressure ulcers could not tend to their wounds in a secluded location. Nursing home and shelter residents typically had no place to store valuables or medication.

This study was funded in part by the Agency for Healthcare Research and Quality (HS13977).

See "Health and housing among low-income adults with physical disabilities," by Dr. Ho, Thilo Kroll, Ph.D., Matthew Kehn, B.A., and others in the November 2007 Journal of Health Care for the Poor and Underserved 18(4), pp. 902-915.

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