Correction: Due to an error in the Post’s data analysis, an earlier version of this story misstated the number of counties with the nation’s highest participation rates in federal disability programs. The correct calculated estimate is 102 counties, not 136. The story, maps and graphics have been revised. For further explanation of the data error, please see the revised methodology box.
The lobby at the pain-management clinic had become crowded with patients, so relatives had gone outside to their trucks to wait, and here, too, sat Desmond Spencer, smoking a 9 a.m. cigarette and watching the door. He tried stretching out his right leg, knowing these waits can take hours, and winced. He couldn’t sit easily for long, not anymore, and so he took a sip of soda and again thought about what he should do.
He hadn’t had a full-time job in a year. He was skipping meals to save money. He wore jeans torn open in the front and back. His body didn’t work like it once had. He limped in the days, and in the nights, his hands would swell and go numb, a reminder of years spent hammering nails. His right shoulder felt like it was starting to go, too.
Between 1996 and 2015, the number of working-age adults receiving federal disability payments increased dramatically across the country — but nowhere more so than in rural America. In this series, The Washington Post explores how disability is shaping the culture, economy and politics of these small communities.
But did all of this pain mean he was disabled? Or was he just desperate?
He wouldn’t even turn 40 for a few more months.
An hour passed, and his cellphone rang. He picked it up, said hello and hung up — another debt collector. He rubbed his right knee. Maybe it would get better. Maybe he would still find a job.
His mother had written a number the night before and told him to call it, and he had told her he’d think about it. She wanted him to apply for disability, like she had, like his girlfriend had, and like his stepfather, whom he now saw shuffling out of the pain clinic, hunched over his walker, reaching for a hand-rolled cigarette. Spencer got out of the truck. He lit his own.
“Remember we were talking about it last night?” he asked Gene Ruby. “Remember we were talking about signing up?”
“Yeah,” said Ruby, 64.
“Remember Mama said there was a number you got to call?”
“She’s got the number,” Ruby said. “The Social Security number.”
Spencer kept asking questions. What would Social Security want to know? How often are people denied? But he didn’t mention the one that had been bothering him the most lately: Was he a failure?
“There’s a stigma about it,” Spencer said, thinking aloud. “Disabled. Disability. Drawing a check. But if you’re putting food on the table, does it matter?”
Then: “I could probably still work.”
He put his stepfather’s walker in the truck bed, got behind the wheel, started another cigarette and, pulling out of the pain clinic’s parking lot, headed for home.
Desmond Spencer, 39, and his girlfriend, Tasha Harris, 34, hang out at the house they share with Spencer's mother and stepfather in Beaverton, Ala.
The decision that burdened Desmond Spencer was one that millions of Americans have faced over the past two decades as the number of people on disability has surged. Between 1996 and 2015, the number of working-age adults receiving disability climbed from 7.7 million to 13 million. The federal government this year will spend an estimated $192 billion on disability payments, more than the combined total for food stamps, welfare, housing subsidies and unemployment assistance.
The rise in disability has emerged as yet another indicator of a widening political, cultural and economic chasm between urban and rural America.
Across large swaths of the country, disability has become a force that has reshaped scores of mostly white, almost exclusively rural communities, where as many as one-third of working-age adults live on monthly disability checks, according to a Washington Post analysis of Social Security Administration statistics.
Rural America experienced the most rapid increase in disability rates over the past decade, the analysis found, amid broad growth in disability that was partly driven by demographic changes that are now slowing as disabled baby-boomers age into retirement.
The increases have been worse in working-class areas, worse still in communities where residents are older, and worst of all in places with shrinking populations and few immigrants.
Disability rates by county in 2004
Percent on disability:
Disability rates by county in 2015
Disability rate includes individuals on SSI, SSDI, or both. Data suppressed in some counties due to small population.
Sources: Social Security Adminstration SSDI Annual Report, 2004 and 2015; Social Security Adminstration SSI Annual Report, 2004 and 2015
THE WASHINGTON POST
All but two of the 102 counties with the highest rates — where at minimum about one in six working-age adults receive disability — were rural, the analysis found, although the vast majority of people on disability live in cities and suburbs.
The counties — spread out from northern Michigan, through the boot heel of Missouri and Appalachia, and into the Deep South — are largely racially homogeneous. Sixteen of the counties were majority black, but the remaining counties were, on average, 90 percent white. In the 2016 presidential election, the majority-white counties voted overwhelmingly for Donald Trump, whose rhetoric of a rotting nation with vast joblessness often reflects lived experiences in these communities.
Most people aren’t employed when they apply for disability — one reason applicant rates skyrocketed during the recession. Full-time employment would, in fact, disqualify most applicants. And once on it, few ever get off, their ranks uncounted in the national unemployment rate, which doesn’t include people on disability.
The decision to apply, in many cases, is a decision to effectively abandon working altogether. For the severely disabled, this choice is, in essence, made for them. But for others, it’s murkier. Aches accumulate. Years pile up. Job prospects diminish.
“What drives people to [apply for] disability is, in many cases, the repeated loss of work and inability to find new employment,” said David Autor, an economist with the Massachusetts Institute of Technology who has studied rising disability rates. “Many people who are applying would say, ‘Look, I would like to work, but no one would employ me.’ ”
While disability rates for working-age people have increased nationwide since 2004, rural counties have seen the steepest increases overall.
Change in disability rate for each group of counties in people age 18–64
Disability rate includes individuals on SSDI, SSI, or both.
Sources: Social Security Adminstration SSDI Annual Report, 2004 and 2015; Social Security Adminstration SSI Annual Report, 2004 and 2015
THE WASHINGTON POST
In that position now, Spencer, a slight man with luminous blue eyes, drove deeper into western Alabama. He steered through Walker County, where nearly one in five working-age adults are on disability, and into Lamar County, where the disability rate has more than doubled over the past 20 years, arriving in the town of Beaverton, population 273, where even the 55-year-old mayor is drawing a disability check.
He pulled up to a small house alongside a quiet country road, got out and looked around. There was only forest and hills and sun. “Man, I love it out here,” he said.
“Ain’t going nowhere,” Ruby agreed.
Spencer, who wears mud-caked boots and camouflage and brags of burning trash “like a proper redneck,” has grown so enamored of rural life that he’s sometimes surprised when he remembers that he spent most of his life elsewhere. He grew up just outside of Peoria, Ill., dropped out of school at 14, secured his GED, served two stints in prison for felony burglary before he turned 20 and started working roofing jobs, following other family members into manual labor, like his grandfather who built bridges, and his mother, who worked at a stove factory.
His work as a roofer had been a constant thread through his life, from one state to the next, one job to another. And so it had been again in 2005 when he followed family members to Lamar County, which is 86 percent white and 11 percent black, and was then navigating a long decline in population and manufacturing jobs — one plant moved to Mexico, another to the Dominican Republic. He nonetheless found a roofing job quickly, settling into a life that, for a time, felt as safe as it was comfortable. But then came the recession, and the uneven recovery, and jobs started drying up, and four years ago, as the county poverty rate climbed to 24 percent, the roofing company let him go.
He figured he’d find more work right away. But weeks became months, and he started doing what he calls “odds and ends” — work as a welder, a ranch hand, even a full-time garbage collector — but nothing restored the stability that had gone missing.
He opened the front door to his house. He walked past a small sign in a living room cabinet that said, “BELIEVE in the beauty of your dreams,” and into a bathroom that he had recently remodeled and where another sign said, “DON’T QUIT: Stick to the fight when you’re hardest hit; it’s when things seem worst that you must not quit.”
He had been reading a book lately about the power of positivity. He would sometimes think about it when putting in job applications, or when he was behind his house, looking at his possessions. There was the old Kia that hadn’t run in two years. The pile of aluminum cans for which he’d make 40 cents on the pound. The dozens of used tires a repair shop had paid him to haul away. He never knew what would turn out to be worth something.
He was blessed, he always tried to remind himself.
But increasingly there were days when Spencer knew he was faking a belief, once so strong, that everything would work out. There were days like today, when he sat in a pew in a small church in Lamar County, listening to members of the congregation ask for prayers for health issues:
“My mother-in-law is in the hospital this week, and she has some heart problems,” a man said.
“My body is not cooperating with my job whatsoever,” a woman said.
“I got my back surgery,” another man said. “I hope it takes this time.”
An hour later, Spencer was home again. His knee was hurting once more, as it had on and off ever since he fell from a roof during a construction job two years ago. He’d never had it checked out because he’d never had insurance, and he didn’t mention it now because everyone at the house seemed worse off than he was. His mother, Karen Ruby, 60, who has cirrhosis of the liver, was sitting at the kitchen table with her head in her hands, saying, “I don’t know when I’m going to be able to get back into church.” His stepfather was stooped beside her, next to a wheelchair, smoking a cigarette. His girlfriend, Tasha Harris, 34, a thin, ashen woman whose back was often thrown out, was upstairs in the dark after leaving church early because she hadn’t felt well.
“I need angel food cake,” his mother told him before he headed out to the store. “Write it down.”
“Angel food cake? All right, I’ll be back,” he said, walking toward the door.
“I feel like crap,” said Harris, who had come downstairs to see him off.
“I’m sorry,” Spencer quietly told her, then went outside to his truck and pulled onto the road.
This is how Spencer spends most of his days, ferrying to the dollar store and back, collecting soda, cigarettes and whatever else his family may want, and consoling them when he’s around. Most days he doesn’t mind. He likes feeling like the strong one when it seems as though almost everyone he knows is either applying for or already on disability. Just the night before, during a family dinner, it had struck him again.
“She walks, and it breaks her bones,” his cousin, who applied for disability after a nervous breakdown, had said of another relative receiving disability.
“She falls a lot,” added his aunt, who collects $733 monthly in disability checks because of back pain.
Spencer, listening to the conversation, had looked around. At the table was another cousin, who has bipolar disorder and receives $701 per month. Beside her was her boyfriend, whose mom had applied for disability, too. Spencer glanced at the ceiling and sighed.
“The whole world is on disability,” he said.
“It’s a tough world,” someone else said.
And now that world was spread out before him as he drove through downtown Beaverton, past a value store, a post office that closes at noon, a bank that shuttered during the recession, a gas station that hasn’t been open for as long as Spencer has been here.
He saw a large roadside banner that said, “APPLY NOW IMMEDIATE OPENINGS,” and cursed to himself. He didn’t know how many times he’d gone in that upholstery factory and asked about a job, any job, and was turned away. He saw another factory, this one an equipment supplier, where he thought he’d need an act of Congress to get hired. Up ahead was a horse-trailer shop. Three consecutive months he had gone through the door, and each time they’d said, “Next month, try us.” Meanwhile, he tried to sign up for a welding class at a community college, but failed the enrollment math exam.
He pulled up to the Piggly-Wiggly. He collected cake mix and three 12-packs of Mountain Dew for Harris, who he knows can go through 24 cans in a day, and was driving home, passing everywhere he couldn’t get a job, when he thought of another opportunity. There was still that place that might need help with welding, a skill he’d picked up after he lost his roofing job. He had told himself he’d go first thing on Monday morning. Arrive by 8:30 a.m. Show the enthusiasm and dedication of someone worth hiring.
Walking back into his house, he placed the cake mix on the counter and heard his mother, who was in her room, with the curtains drawn and the television on, holding an unlit cigarette.
“Desmond?” she said, her voice raspy from a case of strep throat. “Is that black lighter in there?”
“Black lighter?” he said.
“I got a sore throat,” she said.
“I don’t see it,” he said of the lighter.
“Me and Gene, neither of us got a lighter now,” she said.
He began placing empty soda cans into a plastic bin and clearing the kitchen table of the dishes from the night before, then heard Harris at the bottom of the steps.
“Baby?” she said. “My head is still killing me.”
“I got you something for your headache,” he said, handing her some medicine and a 12-pack of Mountain Dew, and went back to the kitchen.
“Desmond,” Harris softly called after him.
“Yeah?” he said, returning.
“Do you have a cigarette?”
He gave her one, finished with the kitchen, then limped to the living room. He lowered himself onto the couch, his knee hurting worse than earlier, and flipped on the television.
Something had to change.
Everyone in his life has been telling him what that something is.
You’re hurting more and more, his mother said. And not getting any younger.
There aren’t jobs for you here, a friend said. Think that’ll change anytime soon?
We all need help now and again, his girlfriend said. Don’t be ashamed of being on disability.
You’re a grown man, his stepfather said. Bring in some money.
That was what Spencer was thinking about — money, and not having any — when one day Harris found him sitting alone on the back porch in the quiet, going through another cigarette. “Checks are in,” she said of his parents’ monthly disability payments, which are cumulatively worth $3,616 and support everyone in a house that, at that moment, was low on just about everything.
“We’re going to the store,” Harris said.
“How you getting there?” he asked.
“It ain’t got no gas, though.”
“I got to take your mom to the bank.”
“Maybe she’ll loan you 10 for gas.”
Harris disappeared back into the house, and Spencer went back to his cigarettes and thoughts. It didn’t seem right to him, living off his parents’ disability checks and borrowing money from them. But he felt trapped. He couldn’t leave Lamar County with his mother so sick. And the only money he had coming in was the monthly $425 an elderly friend paid him to tend his horses and keep him company on lonely afternoons, and it was never enough to cover everything. This month it was socks. Harris needed socks. And what kind of man can’t afford socks? His grandfather used to tell him that a man isn’t a man unless he owns land, and now here he was, years later, not feeling like one at all.
He found Harris in the kitchen. “Ask him for $40,” she told him. “And I’ll get 10 more from him to buy socks.”
Gene Ruby was at the computer when Spencer approached him. The question came quickly and quietly. “Could I borrow 40? And give it back to you right here soon?” he asked. “I promise.”
A few hours after pocketing the money, Spencer climbed back into the truck Gene made the payments on and started it with the gas Karen had paid for. Harris got in beside him. They had been together for seven years and rarely disagreed, except for that day two years before when Harris said she was thinking of applying for disability on account of back pain. He told her not to do it. People would look down on them. They would find jobs. Don’t lose hope.
A light blinked on the dashboard.
“Transmission’s hot,” Harris said. “I told you it did that to me the other day.”
He pressed down on the accelerator.
“No, don’t do that,” she said. “Just put it in neutral and coast. Try not to mash the gas at all.”
“We’re running it into the ground, is what we’re doing,” he said, lighting another cigarette.
Harris looked at him. She could tell he was getting frustrated. Just about everything these days made him that way. He had begun complaining more, not just about the truck or the pain in his knees and hands, but about all of Lamar County. He told her there would never be jobs here for them. Maybe she had been right about applying for disability. His injuries weren’t getting better, and he wasn’t getting hired, and how much longer could he ask for help with groceries? Help with gas? Help with transportation? Help with everything?
He moved the truck out of neutral and back into drive. The store was 20 miles up the road in Hamilton, the largest town in the area, with a population of 6,814. Harris’s brother and his wife lived on its outskirts, and in the falling light, they went to visit, pulling up to a tidy mobile home set beside a large field. Harris’s sister-in-law, Chastity, who was working full time at a calling center, came outside. Then followed Harris’s brother, Josh, 28, broad-shouldered and shirtless. They handed a plate of barbecue pork to Spencer and Harris, both of whom had skipped lunch that day. The plate went back and forth between them.
“I just went and got a job at Wrangler,” Josh said of a distribution center in nearby Hackleburg.
Spencer stopped eating. He looked up.
“Is that right, man?” Spencer asked, and Josh nodded. “That’s great. I’m proud of you. Man, I’m happy about that. I’m happy you got that.”
“Me, too,” Josh said. “It pays good.”
“Monday, I’m going to go back to that shop where . . . I heard they need help,” Spencer said. “Hopefully, I can weasel my way in there.”
“You can,” Josh said. “Put it in your mind, and you can do it.”
“I had an inspiration book,” Spencer said. “You wake up and put it in your head: ‘God’s got my back. I got this job.’ ”
There was a moment of quiet.
“I’m glad you got that, man,” Spencer said again. “I’m proud of you.”
“Sometimes, it’s just the right place at the right time.”
Spencer and Harris finished the barbecue, hugged their relatives goodbye and got back into the truck. He drove to a strip mall that had a Shoppers Value Foods, a Check Into Cash and a title loan shop. He glanced at a sign outside a Sonic fast-food restaurant: “Now Hiring All Shifts.” He sometimes considered applying for a fast-food job. But how, after making $20 an hour at some jobs, could he take one paying $7.25?
He parked and went inside the grocery store.
Desmond Spencer howls with one of his mother's dogs. Several wheelchairs around the family’s house and two on the porch are used for seating. Spencer strives to remain upbeat about his situation, saying, “I'd rather be fake happy than real sad.”
Spencer was looking at a piece of paper on the coffee table. It was the number to the Social Security office his mother had given him. He and Harris sat on the couch in the living room, and she handed him a telephone.
“You got to call,” she said.
“I’m nervous,” he said.
“Don’t be nervous,” she said. “They’re not going to reach through the phone and get you.”
He didn’t say anything for a moment, just held the phone.
“What do I do and say?” he asked.
“Call that number and do whatever they tell you to do.”
He took in a breath and exhaled slowly.
“I guess I’ll call,” he said, punching in the number, and then came a voice on the other end, with that question again, the one he rarely had the courage to ask himself:
“Are you disabled?”
“Yes, ma’am,” he said.
“How long have you been disabled?”
“How are you supporting yourself?”
“Living off my mom.”
“Is this a permanent disability?”
“Uhh,” he began. “I don’t think . . . ”
He looked at the floor and leaned forward.
“Yeah,” he said quietly. “Yeah, I don’t think it’s getting no better.”
He scheduled an appointment for an interview at the local Social Security office the following month. He hung up, stood and, appearing dazed, told Harris, “I didn’t like it at all.” She gave him a sympathetic look and left him alone on the couch.
He was there again four days later on a Monday morning.
The entire house was dark. Spencer was in his pajamas, watching television. Harris was soon beside him, also in pajamas. “I think I’m getting sick,” she said, and he didn’t answer. She went to another room and came back with Ruby’s laptop, which she uses every Monday morning to look at job listings.
“I ain’t checked it in a week,” she said.
“Oh my God,” he sighed, flipping through channels.
“Do you know anything about pop-ups?” she asked, looking at the computer. “Man, I’ve had, like, a hundred pop-ups.”
“Look, the new ‘Walking Dead,’ ” Spencer said, coming to another channel.
She pulled up her email and clicked on one that listed service positions within 25 miles. “Okay,” she said. “Here we go.” She saw three postings: “Customer Service/Telecommute,” “Telecommute Consultant” and “Product Tester.” She didn’t investigate any of them, instead going back to her inbox. She found another email with more listings.
“Erber?” she asked. “We don’t even have an Erber place around here.”
“Uber,” Spencer said.
“Uber, Erber, whatever,” she said, closing the computer.
An hour passed, then another, and Spencer stayed on the couch. He would not apply for the welding job today. He wanted to focus on securing disability.
“I got to go get dressed,” he said, looking down at his clothing. “What a loser.”
He returned in torn jeans and, with nothing better to do, went outside. He limped to the truck and fiddled with jumper cables. He set a fire inside an iron bin and burned some trash. He inspected a sheet of aluminum he had found, wondering how much he could sell it for. He walked into the woods and walked out. He looked at the road. A car hadn’t passed in a long while. It was 1 in the afternoon. The day already felt over.
About the data:
Editor’s note: The Post’s earlier calculated estimates of working-age disability rates for counties incorrectly included some non-disabled children. The Social Security Administration data tables for residents receiving benefits in each county mix disabled adult children and non-disabled minor dependents in the same category. The Post has revised the estimates to remove the minor dependents. Below is an explanation of the methodology for the revised estimate.
There are 13 million working-age Americans — ages 18 to 64 — receiving disability payments. This number includes every working-age person who receives benefits through the Supplemental Security Income (SSI) program, the Social Security Disability Insurance (SSDI) program or both. The Social Security Administration publishes those numbers for the nation for each year dating to 1996. An annual rate was calculated using working-age Americans.
The Washington Post calculated a disability prevalence estimate among the working-age population at the county level. The Social Security Administration publishes county recipients of SSI and SSDI disabled workers. The SSA also publishes county-level counts of people receiving support under both SSI and SSDI. Those figures were subtracted to avoid double counting. SSA does not publish county figures for two smaller groups of working-age disabled beneficiaries in the SSDI program, disabled adult children and disabled widows and widowers. SSA publishes broader categories with a mix of disabled and non-disabled beneficiary children and widows and widowers at the county level. The Post used published figures for the disabled adult children and widows and widowers groups in each state to apportion the number across the counties according to each county’s share of the state’s beneficiary children, widows and widowers. The estimated rate was created with the county working-age population. To make a rate the Post uses resident population age 18-64. Beneficiaries move from disability programs to retirement programs. Under current rules some beneficiaries do not reach full retirement age until between 65 and 66, but the SSA tables do not provide counts of that group by state or county.
The Post classified counties from urban to rural using qualifications defined by the six-step scale of the Centers for Disease Control and Prevention’s National Center for Health Statistics. Counties were grouped into three sets to divide metro areas with at least 1 million people, smaller metro areas and non-metro areas.
Spending figures were taken from the proposed 2017 federal budget and SSA’s projected payments for 2017. Social Security Disability Insurance ($149 billion) was combined with Supplemental Security Income for people with disabilities ($43 billion). The spending does not include money states spent to supplement the programs.
Five-year data from the Census Bureau’s American Community Survey were used for county-level demographics. The county estimated rates and the numbers used to create those rates for 2004 and 2015 are available here.