Section 4. Special Factors in Aid to the Disabled
Par. 3. Definition of Terms—In general, “permanently and totally disabled” means that an individual has some permanent physical or mental impairment, disease,
or loss that substantially precludes him from engaging in useful occupations within
his competence, such as holding a job or homemaking. The impairment may be physical
or mental, organic or functional, and of such a degree as to interfere with the individual's
faculties, such as senses, reasoning, mobility, et cetera. The impairment may exist
from birth, be acquired during the lifetime of the individual, or result from accident.
The impairment may be obvious, as in the instance of the loss of a limb, or it may
be such that it can be revealed only by medical examination, and it may exist singly
or in combination.
The concept of “permanently and totally disabled” must be understood if the program is to avoid the implication that it is merely assistance
to individuals who can do things for themselves and who are looked upon, or tend to
look on themselves, as no longer effective members of society. As a means of shedding
further light on a concept, the various components of the above definition are described
separately as follows:
Permanently—The term “permanently” refers to a physiological anatomical, or emotional impairment which is verifiable
by medical findings. A physician must provide the county welfare board with the information
which bears on this aspect of eligibility.
The impairment must be of major importance and must be a condition not likely to improve
or which will continue throughout the lifetime of the individual. Any condition which
is not likely to respond to any known therapeutic procedure shall be deemed to be
permanent; furthermore, any condition which is considered likely to remain static,
or to become worse, shall be deemed to be “permanent” if treatment is unavailable, inadvisable, or if the individual justifiably refuses
“Permanence” does not rule out the possibility of vocational rehabilitation or even recovery from
the impairment. Individuals will sometimes respond favorably to treatment after an
unfavorable prognosis or the condition may become arrested. The discovery of new drugs
or other medical advances may also change the prognosis on a previously-regarded permanent
condition. Thus, the term “permanently” cannot be defined in an absolute sense but rather must be defined relatively in the
sense of continuing indefinitely, as distinct from “temporary” or “transient.”
Totally—Like “permanently,” the term “totally” is not absolute since it must be considered in reference to the ability of the person,
as revealed by the facts in his case, to perform those activities necessary to carry
out certain responsibilities, such as those necessary to employment or homemaking.
In addition to medical findings, “totally” involves such other considerations as age, training, skills, and work experience,
and the probable functioning of the person in his particular situation in light of
Substantially Precludes—The term “substantially precludes” has reference to the degree to which an individual's permanent impairment has left
him able to participate in those activites which are essential to holding a job or
homemaking. If an individual is able to perform such activities well enough and with
sufficient regularity to receive regular payments for his efforts or to carry on homemaking
responsibilities on a reasonably continuing basis, he cannot be found to be permanently
and totally disabled.
Useful Occupation—A “useful occupation” generally means productive activity which demands the time and attention of the person
for the ultimate benefit of others. Hobbies, activities which do not provide bona
fide job opportunities, occupational therapy, and training programs designed for seriously
disabled persons are not ordinarily regarded as “useful occupations.”
Homemaking—This term involves the ability to carry on home-management and decisionmaking
responsibilities, and also includes the extent of capacity to provide essential services
within the home for at least one person in addition to one's self as distinguished
from the maid or housekeeper who is hired to perform domestic duties for wages in
a home maintained by others.
The following activities are important to successful performance of the occupation
of homemaking—shopping for food and supplies; planning and preparing meals; washing
dishes; cleaning house (sweeping, mopping, dusting et cetera); making beds; washing
and ironing clothes. In certain settings having primitive facilities, carrying water
and fuel and building fires may also constitute important factors in the ability to
successfully perform home making duties.
Par. 6 Acceptance of Medical Treatment—The applicant with a physical or mental impairment
which is disabling but which is considered to be amenable to some generally accepted
and available therapeutic measure will be expected to follow through with such treatment
as a condition of eligibility. Those who decline treatment will normally be denied
assistance unless it can be shown that their refusal is based on risks that a “reasonably prudent person” would not undertake. The matter of whether restorative treatment must be pursued
as a condition of eligibility for Aid to the Disabled should therefore be considered
from the standpoint of whether the person is unreasonable in his refusal or whether
his life or remaining capacity is actually endangered.
Par. 7. Acceptance of Vocational Training or Employment After Training—The inability
to continue in a certain type of employment or industry does not, in itself, constitute
permanent and total disability within the meaning of this program. Nor does the fact
that a person may have to change occupations or work locations to be reemployed within
the limitations of his remaining capacity. If a person is determined to be capable
of light work such as operating an elevator, answering the telephone, or performing
as a watchman, and work of this nature exists in his community or in a community to
which he can reasonably be expected to move, such a person will be considered unemployed
rather than permanently and totally disabled.