DI 21501.125 Massachusetts APTD/AB State Plan
A. Blindness (4230.1)
For the purpose of Aid to the Blind, an individual is considered blind if he has, in terms of ophthalmic measurement:
Central vision acuity of 20/200 or less in the better eye with correcting glasses; or
A field defect in the better eye in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance of no greater than twenty (20) degrees; or
A person with visual acuity of more than 20/200 which is only achieved by the use of lenses (such as telescopic lenses) that can be worn only for limited periods of time shall be considered as coming within the definition of blindness in “a” above.
B. Permanent and total disability (Chapter I, Section B) — medical eligibility
1. Purpose and objectives
The primary purpose of the DA program is to offer the needy citizens of the Commonwealth, within limits of the program, an opportunity for financial assistance through the MA program, medical evaluation, treatment, and ancillary services as required to further the person's recovery from disability and to promote earliest potential for economic usefulness. The partial physical or mental restoration of a person to self-care, and his usefulness to others is considered a worthwhile goal.
To be eligible for DA a person must have a permanent physical or mental impairment, disease or loss that substantially precludes him from engaging in a useful occupation within his competence, such as holding a job or homemaking.
The term “permanent” refers to a physical, mental, or emotional impairment which can be substantiated by medical findings. The impairment must be of major importance not likely to improve, or which will continue throughout the lifetime of the person, or to respond to any known treatment and is likely to remain static or become worse unless certain therapeutic measures are provided except when treatment is inadvisable, unavailable, or the person refuses treatment and his decision is reasonable. (A refusal of treatment is considered reasonable when the treatment recommended to prevent the progress of the condition is genuinely feared as to the outcome of the treatment, or when the person has religious scruples.)
The term “totally” refers to the ability of the person to carry out those activities necessary to performing specific employment responsibilities or homemaking. Totally involves consideration of age, training, skills, work experience, and the functioning of the person in light of his impairment.
It takes into consideration the activities required of a person in his job, at home his living and working conditions, interests, native capacities, and the extent to which he has adjusted to the loss he has sustained. The concept also includes an assessment of the person's attitudes, reactions, personality traits and motivations. No time factor is involved in the concept of being totally disabled.
3. Social data
a. Importance of work record
A person's employment history should identify not only the specific industry he has worked in but also the job content. It should include a description of the kind of activities required—standing, sitting, dexterity; also his regularity of attendance, reliability, length of time on the job, and dates of last employment. Such information will help SMRT members to relate medical findings to the types of activity the individual is competent to perform.
b. Useful occupations
The term “useful occupation” refers to those productive activities which add to the economic wealth, or produce goods or services to which the public attaches a money value. Certain activities in which invalids and other seriously incapacitated individuals sometimes engage in are not useful occupations for the purpose of this program. Usually these activities include hobbies, activities which do not provide a bona fide job opportunity, i.e., if the individual stopped doing it no one would be hired to replace him. Under the above interpretation, individuals may engage in activity which is part of a training program in their own homes, in schools, sheltered workshops, factories or other places offering opportunity for such training. The determining factor is not location but the presence or absence of supervision and of a training objective, as well as the economic value of what is produced. Thus some persons working in a sheltered workshop may be found to be engaging in a “useful occupation,” but others will not be so engaged since their activities are part of a rehabilitation plan and are not currently of economic significance.
Remuneration which may be received through useful activity of less than full time or unpredictable stability need not necessarily contravene a finding of total and permanent disability. Such earnings must be considered in determination of the eligibility factor of need, along with total income from all other sources. Some persons, because of extremely strong drive or motivation may push themselves beyond advisable physical limits. Social workers should be alert to such situations and clarify with the treating physicians whether the client's activities may exceed his actual physical limitation.
4. The homemaker
A homemaker in this definition is always a person who makes a home for at least one other person. It is never a person living alone. The homemaker is evaluated for her physical and mental ability to engage in a useful occupation in the community, and she must also meet the test of being able to carry on homemaking activities. Bending, stooping, lifting, reaching and carrying are necessary body movements accompanying cooking, washing, hanging up clothes, ironing, cleaning, making beds, and caring for children. Shopping for food and supplies, planning and preparing meals are also important activities in homemaking. The amount of dysfunction of an organ member may dictate how much of the housekeeping work the person can do, but the disability can be estimated only in relation to the facilities the individual has to do the work. The size of the home, the facilities available to care for it as well as the equipment to be maintained are important items to describe.
If the person's performance standards do not meet the usual quality standards of such activities or the demands for providing essential services are not met within the period of time usually taken by such activity, the social worker should describe the situation clearly. In order to help the SMRT, the social worker should specify that responsibilities and duties the homemaker can assume:
with the help of others
cannot do at all
whether there are some activities that are left undone
When the homemaker has a psychiatric impairment of any kind including mental retardation, the worker should describe similar factors and also give information as to what extent the person needs supervision and who, if anyone, provides it.