Income maintenance is the main area in which disability categories are used in social security, but in recent years another area has grown in importance, which arises when categories are used to allocate extra resources to people whose cost of living is increased by difficulties in looking after themselves, mobility limitations, or other extra costs such as special diets.
The evolution of social security categories does not always display tidy connections between category definitions and purposes. One result is that disability categories have been used both to resolve work participation issues and award extra benefits for extra costs, without much consideration of whether work incapacity and extra costs really go hand-in-hand. However, some countries are separating these aspects of disability, particularly with a view to promoting employment among people who have significant extra costs but are able to work. In the UK, Disability Living Allowance (DLA) is separately assessed, and may be paid to people who are working. Eligibility for DLA is assessed by looking at a person’s ability to perform various activities of daily life (ADLs), whereas eligibility for income maintenance benefits looks at a person’s ability to perform activities supposedly connected with employment.
To what extent have other countries also constructed new disability categories around the performance of ADLs? This simple question turns out to have a complex answer. ADL assessments are widely used across Europe for the delivery of care services, but they are often used to create fragmented and informal categories. The assessor may consider only the client’s suitability for a particular intervention, or he or she may work out a unique care package for the recipient. Nonetheless, there are trends towards the development of higher-level categories as service delivery is cashed out and care managers are called on to determine budget bands or limits for service recipients.
These higher-level categories are not necessarily understood to be ‘disability’ categories, however. One important issue is that care provision is often dominated by elderly people, whereas work-oriented social security disability categories are confined to the working age population (at least at the commencement of the claim). This means that the category created by ADL assessments may be considerably more encompassing, or unified, than the established social security category. It also need not be understood as a ‘disability’ category; other terms like ‘dependence’ or ‘in need of care’ may be used instead. For example, the introduction of care insurance in Germany and Austria has seen the establishment of ‘care’ categories which encompass the elderly as well as younger people and are not primarily seen as disability categories. The basis for making a categorical distinction within the ‘care’ group between aging and disability is not self-evident. Some states simply operate age limits (including the UK); others try to draw a distinction between ‘normal’ aging and disability based on medical criteria.