The boys were identical twins William and Dale, 10. They were the fourth generation in this family to receive federal disability checks, and the first to be declared no longer disabled and have them taken away. In days that had grown increasingly tense, as debts mounted and desperation grew to prove that the twins should be on disability, this was always the worst time, before the medication kicked in, when the mobile home was filled with the sounds of children fighting, dogs barking, adults yelling, television volume turned up.
And so went another morning, loud and chaotic, right up until the moment someone dropped the puppy.
As it fell the four feet to the ground, the trailer suddenly quieted. The four children stopped fighting. The two adults stopped yelling. Then the weeks-old puppy hit the scuffed linoleum floor, whimpered softly, and events, no longer suspended, began to unfold again.
“It’s dying,” Dale said, looking at the cocoa-colored dog, which had gone limp. “It’s dying. It’s dying.”
“It might have snapped its neck,” Kathy said.
William looked at the puppy, then at the medications collected above the refrigerator, then at his mother, Franny, who wasn’t saying anything.
“Mommy, give him some medicine to keep him alive,” William said.
“He’s dead,” Dale said.
“Give him some pain medicine!” William said.
“Your puppy just died,” Dale said.
“Give him some pain medicine!” William said again.
Talk of medications, of diagnoses, of monthly checks that never seem to cover every need — these are the constants in households like this one, composed of multiple generations of people living on disability. Little-studied and largely unreported, such families have become familiar in rural communities reshaped by a decades-long surge that swelled the nation’s disability rolls by millions before declining slightly in 2015 as older beneficiaries aged into retirement benefits, according to interviews with social workers, lawyers, school officials, academics and rural residents.
How to visualize the growth in disability in the United States? One way is to think of a map. Rural communities, where on average 9.1 percent of working-age people are on disability — nearly twice the urban rate and 40 percent higher than the national average — are in a brighter shade than cities. An even brighter hue then spreads from Appalachia into the Deep South and out into Missouri, where rates are higher yet, places economists have called “disability belts.” The brightest color of all can be found in 102 counties, mostly within these belts, where a Washington Post analysis of federal statistics estimates that, at minimum, about 1 in 6 working-age residents draw disability checks.
As the number of working-age Americans receiving disability rose from 7.7 million in 1996 to 13 million in 2015, so did the number of households with multiple family members on disability, climbing from an estimated 525,000 in 2000 to an estimated 850,000 in 2015, according to a Post analysis of census data. The analysis is probably an undercount.
A separate Post examination of census data found that households reporting at least one disabled adult are three times as likely to report having a disabled child, too, although most households affected by disability report only one disabled member. Multigenerational disability, The Post found, is far more common in poor families.
“I’ve been aware of it my whole professional life,” said Michael L. Price, a demographer who retired from the University of Louisville in 2013. “In eastern Kentucky and other rural areas, you’re more likely to have intergenerational households, not just two but three generations. You have grandparents, very young grandparents, living together with grandchildren or in close proximity. And families don’t separate, so it sets it up not only for the next generation, but for two generations, that ‘This is what’s there, this is what you’re dependent on.’ ”
Other experts, however, say the phenomenon has little to do with generational dependence. “I hesitate to use a term like ‘culture.’ It’s not a specific, measurable metric,” said Kathleen Romig, an analyst with the Center on Budget and Policy Priorities, who studies disability in the United States. “Certain things like toxic stress or nutrition or preterm births or parental depression or genetics” offer a more revealing context for understanding generational disability.
And yet others say it’s about money.
Ruth Horn, director of social services in Buchanan County, Va., which has one of the country’s highest rates of disability, has spent decades working with profoundly poor families. Some parents, she said, don’t encourage their children academically, and even actively discourage them from doing well, because they view disability as a “source of income,” and think failure will help the family receive a check.
“It’s not a hard thing to limit a person,” Horn said, adding: “It’s generations deep.”
For this family in Pemiscot County, crowding around their dazed puppy, the momentum was beginning to waver. The boys, who started receiving benefits after their premature birth, had recently lost them as the government stepped up its periodic reviews, which rose from 925,000 in 2010 to 2.1 million in 2016. Now their grandmother and mother, certain the twins were autistic, were trying to convince the government that it had made a mistake.
They knew it wouldn’t be easy but hoped that a psychological assessment of the children, due any day now, would provide just the proof they needed. In their minds it had come down to this: Prove the boys were autistic, get the checks back and climb from crushing poverty into manageable poverty.
Kathy set the puppy down on the kitchen table, and it took a wobbly step, then another.
“I’m going to name you Miracle,” she said softly. “Because it’s a miracle you’re alive.”…