There's an artificial divide that often pops up in conversations on American life, something that the Independent Living Movement (ILM) is not immune to. While it's easy to split up the concerns facing disabled Americans into rural and urban areas, those working to support consumers in these areas are quick to point out that the division isn't so easy even when the core services that the ILM is based upon are the same.
The Association of Programs for Rural Independent Living (APRIL) was started in 1986 to bring those rural voices to the table. Executive director Billy Altom, who has been with the organization since 2007, says that most IL organizations need to be thinking about the needs of rural consumers because catchment areas – the physical borders of where an organization supports consumers – often include both rural and urban spaces. APRIL is based in Little Rock, Arkansas, with staff in Montana, North Carolina, and New York, but Altom says that while the names and places may change, core issues like transportation and social isolation stay the same.
One of APRIL's first big projects was achieving federally recognized charity status in 1994 in pursuit of a transportation voucher program − a program that provided a process for consumers to hire the transport they needed rather than relying on systems that did not meet their needs.
The organization also started a yearly conference, which now has a youth offshoot that works to maintain connections both during the events and between them.
When asked what areas of conflict pop up when discussing the needs of rural people with disabilities, Altom points to funding and how grants and supports are allocated to service providers.
"There's equality, but there's not equity a lot of times and that's where the rural areas get screwed."
Funding systems at various levels focus on the number of people being served, something that APRIL's Director of Training and Technical Assistance, Mary Willard, says doesn't take into account, like the extra travel time or the lack of population density that some cities, states, and county-level support systems are grappling with. How do you increase the quality of living when funded primarily based on the cut-and-dry number of people you've helped?
"The urban centers, a lot of times, get a lot more money than the rural centers because we're looking at the number of people that you're serving, not necessarily the outcomes that you're getting. And so, you may only serve one consumer in a two-hour period, because you had to drive an hour to get to them, versus an urban person who goes to, you know, an apartment complex with and serves 20 people in the same hour."
Altom's concept is called "windshield time," the lost commuting stint that makes connections to consumers complicated to build and maintain over time. That dislocation and isolation Willard says also make nursing home diversion and deinstitutionalization a challenge. Where a disabled person who is moved into a nursing home in an urban area may still be in the same city as their family and support systems – even as they battle to live in the community – Willard says that they see cases where consumers are being moved 70 miles or further away from those same supports.
"It's more common because there are fewer resources for them to access. Getting personal care assistants or a direct care worker to come out to your farmhouse is a lot harder and not only is institutionalization more common but folks are, in rural areas, more often sent to communities far away from support in their home."
That social isolation and attempts to decrease it are informed – according to Altom – by the knowledge shown by the youth who are involved with the organization. He calls it a form of "virtual transportation."
"That's where the youth were so valuable, they were more adept already at how to stay in touch with each other. So, we were using a lot of their ideas and stuff to go, 'Hey, how do we share this?'"
That element of peer support has been at the foundation of APRIL since its inception. As a member organization that works primarily with other service providers, Willard says that the ability to link organizations together and build knowledge is precious within the ILM.
"We really try to put the consumer choice philosophy at the forefront of everything we do. And so, if we're going to do one-to-one mentoring, I meet with those organizations. Sometimes they specifically want an organization that's rural, sometimes they might want another executive director who's blind or low vision, sometimes they might want somebody who has a great youth program. So we really just try to base it on what it is that they're looking for."
From there, APRIL collects people and resources to host a call and create further connections. Altom says that the most common issue identified in broader discussions at all levels of the system and its funders is transportation. He believes that transport is too easy to latch onto, that it gets viewed as "sexy" and tends to obscure broader concerns like deinstitutionalization, isolation, and loneliness. He points to the "proximity" of it all and how centers like Boston or Chicago – larger urban locations – can learn from what rural consumers face.
"It's not just transportation, people need to really realize that there are many issues in rural America. And at the same time, I always say that if it works in rural America you can make it work in urban America."
You can find more information about APRIL on their website.
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