Rural People with Disabilities
People with disabilities who live in rural areas where essential services are scarce often face difficulties seldom encountered in urban areas. Access to adequate housing, transportation, employment, educational programs, and specialized healthcare may be limited in many parts of rural America. Community organizations, healthcare facilities, local governments and other rural entities can help people with disabilities by collaborating and creatively using limited resources to provide needed services.
For information related to services for veterans with service-related injuries, see Rural Veterans and Access to Healthcare.
Frequently Asked Questions
- How many people with disabilities live in rural areas?
- What is independent living? How can rural communities facilitate independent living for people with disabilities?
- What is the Medicaid Home & Community-Based Services (HCBS) Waiver Program? How can home and community-based services allow rural people with disabilities to maintain independence?
- What resources are available for farmers with disabilities?
- What transportation services can rural communities provide for people with disabilities?
- What programs are available to help rural organizations provide housing options for people with disabilities?
- How can rural healthcare facilities improve access to care for people with disabilities?
- What is the role of care coordination in improving health outcomes of people with disabilities?
- How can health promotion programs be designed to work for rural people with disabilities?
- Who can I contact for information and training focused on serving people with disabilities?
How many people with disabilities live in rural areas?
According to the U.S. Census Bureau's 2014-2018 American Community Survey 5-Year Estimates, approximately 9 million people in the U.S. rural, civilian, noninstitutionalized population – 15.1% of the rural population – have disabilities. The map below shows percentages of people with disabilities in nonmetropolitan counties.
What is independent living? How can rural communities facilitate independent living for people with disabilities?
The term independent living can simply refer to an arrangement in which people with disabilities live in a community rather than in a medical facility. Interpreted more broadly, it is a philosophy which promotes the idea that people with disabilities have the same civil rights as people without disabilities, and should make their own decisions about how they will live, work, and participate in society. This approach focuses on ensuring that communities meet the needs of all people who live there. The independent living movement puts decision making in the hands of the individual, rather than a medical or service provider.
For more information about independent living, contact the National Council on Independent Living and the Association of Programs for Rural Independent Living (APRIL). To find an independent living center in your state, see the Independent Living Research Utilization's Directory of Centers for Independent Living and Associations.
What is the Medicaid Home & Community-Based Services (HCBS) Waiver Program? How can home and community-based services allow rural people with disabilities to maintain independence?
The HCBS Waiver Program allows states to use Medicaid funds for provision of long-term care services in home and community-based settings, rather than in institutions or other isolated places. Programs can provide both standard medical services and non-medical services, including:
- Case management
- Homemaking services
- Home health and personal care
- Adult daycare
- Rehabilitation therapy
- Respite care
States can also propose other types of services that may help people stay in their homes, or to move from institutional settings to their own homes and communities. For a list of HCBS waivers available in your state, see Medicaid.gov: State Waivers List.
The National Council on Disability's 2015 document Home and Community-Based Services: Creating Systems for Success at Home, at Work and in the Community provides an overview of regulations relating to HCBS, a literature review of available research, and recommendations for government agencies.
What resources are available for farmers with disabilities?
The National AgrAbility Project, sponsored by the U.S. Department of Agriculture, assists farmers, ranchers, and other agricultural workers with disabilities. The program comprises a National Project and State/Regional Projects, each consisting of a collaborative partnership between a land grant university and at least one nonprofit disability organization.
Assistance is available to people working on small and large operations. The AgrAbility website provides a directory of contacts for state and regional AgrAbility Projects. For additional resources specific to your state see RHIhub's State Guides.
What transportation services can rural communities provide for people with disabilities?
Rural people with disabilities often have difficulty finding adequate transportation. Those who require specialized medical care available only in larger cities may find transportation issues to be particularly challenging. Some communities with existing transportation systems have added flex routes, on which additional stops may be added as needed. Other rural areas have voucher programs, which allow low-income riders to use transportation services at reduced or no cost.
The National Aging and Disability Transportation Center promotes cooperation between the transportation industry and the disability community to increase mobility for people with disabilities. It offers resources, training, and technical assistance.
For more information see RHIhub's Transportation to Support Rural Healthcare topic guide.
What programs are available to help rural organizations provide housing options for people with disabilities?
The U.S. Department of Housing and Urban Development (HUD) manages the Section 811 Supportive Housing for Persons with Disabilities program, which provides funding to nonprofit organizations to develop and subsidize rental housing with access to supportive services for very low-income adults with disabilities.
The USDA/Rural Housing Service (RHS) offers several programs that help rural people with disabilities. These include Rural Development Single-Family and Multi-Family Housing Programs, which offer loans to build or improve housing, or provide affordable rental housing. Program descriptions are available on the RHS site. For application information, contact your state USDA Rural Development office.
Housing Resources for People with Disabilities lists a variety of federal, state and local housing programs targeted for people with disabilities. For information about meeting the need for accessible rural housing, see the Housing Assistance Council's Housing for Persons with Disabilities in Rural Areas.
How can rural healthcare facilities improve access to care for people with disabilities?
The Americans With Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 require healthcare facilities to provide facility and healthcare services access for people with disabilities. This can include:
- Accessible routes into the buildings and service areas
- Provision of auxiliary aids and services to ensure effective communication
- Accessible parking
- Accessible restrooms
- Adequate signage for people with vision problems
- Accessible treatment and diagnostic equipment
A 2017 report from the Centers for Medicare and Medicaid Services (CMS), Increasing the Physical Accessibility of Health Care Facilities, provides a summary of accessibility-related laws and regulations, examples of federal and state government plans to increase accessibility, and possible solutions for healthcare facilities to improve accessibility. Highlights include:
- Understanding the needs of people with disabilities
- Monitoring and reporting information on accessibility
- Reducing financial barriers for providers
- Increasing provider awareness and training
For more information, see the Rural Health Information Hub's Access to Care for Rural People with Disabilities Toolkit, the Americans with Disabilities Act requirements for Effective Communication, and the United States Access Board document Standards for Accessible Medical Diagnostic Equipment.
What is the role of care coordination in improving health outcomes of people with disabilities?
Care coordination involves multidisciplinary teams and networks of both clinical and nonclinical providers. Shortages of healthcare providers and social support services in rural areas can make care coordination for people with disabilities even more of a challenge.
Providers who participate in care coordination can help people with disabilities avoid unnecessary or duplicative tests and conflicting treatment plans, and in this way lower costs and improve efficiency. The Rural Policy Research Institute's 2015 document Care Coordination in Rural Communities: Supporting the High Performance Rural Health System notes that close-knit rural communities may actually be at an advantage in terms of effective health information exchange in care coordination, due to local knowledge and relationships.
For more information, see the Rural Health Information Hub's Rural Care Coordination Toolkit.
How can health promotion programs be designed to work for rural people with disabilities?
Health benefits can come from even small amounts of physical activity that do not require special equipment, according to Increasing Physical Activity among Adults with Disabilities from the Centers for Disease Control and Prevention (CDC). Aerobic exercise for rural people with disabilities may consist of activities as simple as walking briskly or wheeling oneself in a wheelchair. Working with resistance bands can serve as muscle-strengthening exercise.
The CDC also notes that healthcare professionals can play an important part in encouraging physical activity for their patients: Adults with disabilities whose doctors recommended exercise were 82% more likely to be physically active, but only 44% of those patients with a disability had received an exercise recommendation at a doctor visit within the previous year.
The University of Montana's Research and Training Center on Disability in Rural Communities sponsors health promotion workshops designed to be provided by organizations serving people with disabilities:
- Living Well with a Disability – a 10-week peer-facilitated workshop including units on Physical Activity and Eating Well to Live Well
- Working Well with a Disability – a 6-week peer-facilitated workshop including units on Balance through Physical Activity and Eating Well to Live Well
Who can I contact for information and training focused on serving people with disabilities?
The Research and Training Center on Disability in Rural Communities conducts research, and offers training and technical assistance to providers with the goal of improving the lives of people with disabilities who live in rural communities. Contact them at 888.268.2743.
The ADA National Network serves people and institutions with responsibilities under the American Disabilities Act. They provide information and offer guidance through phone calls, email, and in-person consultations. To contact an ADA specialist, call 1-800-949-4232, or use the network's email form.
Last Reviewed: 11/26/2018