As Kareem Nelson, 50, navigated his wheelchair through a Harlem park close to where he was born, he reflected on the financial challenges he faced after being shot and paralyzed at 20 years old. After a one-year rehab process, he soon found himself back in the same position he was in before his injury: unemployed and selling drugs to make a living.
After his injury, Nelson was awarded Social Security disability benefits, which became his main source of income from public programs. With no work history at the time, though, he received just $583 a month, which was not enough to cover his expenses.
“No one person can live off of $583 a month. That is impossible,” he said.
The struggles Nelson faced in establishing financial stability while coming to terms with his disability are still common among gun violence survivors with limited resources. Inadequacies in the victims assistance and disability programs designed to mitigate these challenges have hindered their accessibility and effectiveness.
“There is no [existing] program that can assist a survivor with all of the needs that they may have in the aftermath of being a victim of gun violence,” explained Kimmi Herring, associate vice president of community programs at Safe Horizon, a New York City-based victim assistance organization.
Unable to work temporarily or permanently, survivors can struggle financially as they try to cobble together money from a variety of programs. If they are denied by these programs, or, like Nelson, can’t make ends meet even if they are accepted, they may begin or resume participating in illicit markets for income, putting them at heightened risk for reinjury. Research has shown that survivors of gun violence are more likely to experience a subsequent injury and to be arrested on a violence or weapons-related charge compared to the general population.
Across the country, Black and Brown Americans, who are disproportionately concentrated in under-resourced neighborhoods with high rates of violence, bear the greatest burden of this struggle. Gun violence has been the leading cause of death and disability for young Black men for decades, and is currently the second leading cause of death for young Black women.
A 2021 study of four cities—New York City, Newark, Cincinnati, and Philadelphia—found that communities with high rates of shootings have higher rates of functional disability among young men, defined as acquired difficulty in performing everyday tasks needed for independent living. Nonfatal shootings, in particular, were linked to higher rates of functional disability among this group.
“This is a population that really shouldn’t be dealing with a lot of functional disability, and violence appears to be at least a partial driver of why this might be happening,” explained study co-author Daniel Semenza, a professor at Rutgers University.
The impact of this violence goes beyond direct victims. A follow-up study that surveyed Black Americans found that among Black men, witnessing or hearing about shootings is linked to higher rates of functional disability, while Black women who have been directly threatened with firearm violence are more likely to have poorer functional health.
“Not only are more people sustaining gunshot injuries, but surviving, [which] is resulting in some of these functional disabilities. They’re also living in communities where it’s happening, and they hear about it, and that is shaping their everyday behaviors,” Semenza explained.
Joseph Richardson, a professor at the University of Maryland who studies community gun violence, said a variety of factors drive gun violence in these communities, including concentrated poverty, high unemployment, and easy access to guns. He has witnessed first-hand how a lack of resources for recovery can set gun violence survivors up to struggle both mentally and physically after their injury.
“More than likely…they’ll be discharged back to the same communities where they were injured, without ever having any resources or plan for how to reintegrate back into their community, knowing that they are suffering from physical injuries, some of which may be permanent, and also suffering from the psychological effects of being injured,” he said.
The challenge of returning to work
Gun violence survivors who were working before being injured often face financial instability because returning to their jobs poses both a physical and mental challenge, and sometimes may not be possible. Their recovery can involve adjusting to temporary or permanent physical disabilities such as paralysis; chronic pain; or difficulty walking, standing, or lifting.
In general, people with disabilities face significantly higher unemployment rates, with the gap historically sitting at 40%. They also struggle with holding onto employment or working the same hours as before their injury, and can face workplace discrimination.
“We had people who worked in warehouses, or worked for an airline, or [someone who] was a firefighter, and they couldn’t go back to those jobs because it wasn’t physically accessible for them,” said Candace Coleman, community strategy specialist at Access Living, a disability resource center in Chicago that recently conducted more than 150 interviews with gun violence survivors in that city about their experiences post-injury.
“Once I recovered, [I thought] I should be able to go back and make a life for myself,” said Andre Johnson, 42, who participated in Access Living’s study. He was 22 years old when he was shot and his friend killed in a carjacking incident in his hometown of Chicago. At the time, Johnson was in college studying engineering while working at a local electronics company. One of the bullets struck his spinal cord, leaving him paralyzed. After a recovery and rehab process that lasted about one year, Johnson prepared to get back to where he left off.
“The goal was that: to finish school, and go back into the work that I was doing, because fortunately, it was indoors, so I just spent a lot of time on my computer,” he said.
But the journey was not as smooth as he had envisioned. It took seven years before he felt healthy and capable enough to return to school full time. The process involved navigating various challenges, including finding a supportive living facility that allowed him to live independently, and balancing mental health care with his coursework. After years of persistence, which included spending 10-hour days at college to take afternoon and evening classes, Johnson completed his engineering degree in 2016.
After graduating, Johnson sought work in the technology sector, but rejoining the workforce proved challenging. He had to turn down one job offer because he didn’t have a reliable way of traveling to their offices.
And oftentimes, he said, the health insurance people with disabilities receive through their work fails to cover all of their medical needs.
“One big thing people don’t realize is that even though you can recover [and] be able to work, there’s still an additional cost with disability. You can work the same job, but your [spending] still could be 20 percent more than an able-bodied individual,” he explained.
Even survivors who have suffered more moderate injuries can face challenges returning to work. Michael Vella, a trauma surgeon at the University of Rochester (N.Y.) Medical Center, co-authored a 2019 study that examined the patient-reported outcomes of 183 gun violence survivors in Philadelphia, and found that unemployment among this group increased by 14.3%.
“It’s a correlation, not a causation, so there may be other factors,” he said, “but if we just assume that it is from the gunshot injury, you have to assume it’s from functional limitations due to chronic pain—or probably just as important, the mental health aspect of it.”
Vella said one of the study’s most surprising findings was that almost a third of the patients who were sent home from the emergency room with minor injuries screened positive for PTSD.
“That’s really one of the big implications…that you can have a moderate physical injury, but a major impairment,” he said.
While difficulties working can present immediately after injury, they can also manifest later in a survivor’s life.
“People that I’m representing will have tried to return to the workforce, and maybe have been successful for a number of years. Then, eventually at some point, the gunshot wounds have maybe hastened something physically going on, [such as] you have worsening arthritic issues, maybe you’ve had to now start using a cane to be able to walk,” said Ashley Sappenfield, a Social Security disability attorney who has represented gun violence survivors.
Piecemeal programs
After being shot, Johnson was approved for Social Security disability benefits and crime victim compensation—two of the programs that gun violence survivors turn to in the wake of their injury. In addition, just before his injury, Johnson had purchased a new life insurance policy, which he said became a key source of financial support.
“[Having] that particular insurance over those years, as I was going to the hospital, everything, it provided a kind of a safety net,” he said. “The combination of all of those things made the transition when you acquire disability much easier [for me] than in some cases.”
Indeed, gun violence survivors who must rely solely on the public programs for financial assistance often encounter an insufficient support system, a reality that advocates say results from the nation’s lack of an adequate safety net.
“[The U.S.’s] broad divestment from the well-being of whole communities…means any of us who depend on having a good social service infrastructure find ourselves with less than we need,” said Danielle Sered, executive director of Common Justice, a New York-based organization that develops solutions to violence.
For example, many other Organization for Economic Co-operation and Development (OECD) countries administer short-term national, publicly funded disability programs to replace workers’ wages. Some countries have multiple temporary programs of varying lengths, giving recipients more time to recover before they consider applying for a long-term disability program.
“The U.S. doesn’t have such publicly funded disability systems,” said Na Yin, a professor at Baruch College and co-director of the New York Retirement and Disability Research Center.
Instead, the existence and quality of short-term disability programs vary by state. New York is one of just 14 states that has implemented, or will soon implement, a temporary disability or medical leave program. All of the states’ programs last one year or less, and many rely on private sector provisions.
“After one year, you either go back to work, or if you can’t, [you] consider [Social Security]. It’s a big jump from a one-year recovery from an injury to permanent long-term [disability]. There’s nothing in between,” Yin said.
New York’s temporary disability program is known as Temporary Disability Insurance (TDI). State law requires most employers to provide employees with disability benefits coverage for off-the-job injuries if they have been working full-time for at least four weeks, or part-time for at least 25 days.
Compared to other states, however, the benefits are very low. The program only replaces 50% of a worker’s average weekly wage for up to six months, and the maximum amount is capped at $170 per week—a figure that has not risen since 1989. Hawaii, the state with the next lowest cap, provides a maximum more than four times higher, at $798 per week. TDI also lacks job protections, meaning if someone is fired while on TDI, they have little legal recourse.
“It’s not a workable system for people,” said Moriah Engelberg, a campaign organizer at A Better Balance (ABB), a legal advocacy organization. “If you find yourself in any kind of health crisis, you can lose your job, lose your health insurance, and then only get $170 a week for compensation.”
The program is so out of date that many people don’t know it exists.
“It’s not something that is really talked about. I worked in social services for four and a half years, and I had never heard about TDI,” Engelberg said.
ABB has fought to raise the benefit, and is currently working to pass a bill that would make TDI benefits equivalent to New York’s Paid Family Leave program, which was created in 2016. The legislation would add job protections to TDI; allow for intermittent leave; and, over four years, increase the wage replacement level to 67%, and the cap to 67% of the statewide average weekly wage (an amount currently equal to just over $1,150).
Assemblymember Michaelle Solages, one of the bill’s sponsors, is optimistic that the bill will be passed during the next legislative session, which starts in January.
“I’m very positive about its passage in the next session. We did a lot of work and we gained a lot of ground last session, and this is going to be my top priority,” she said.
For now, without an adequate temporary disability program, gun violence survivors in New York have used another program to make up for lost wages: victim compensation.
Unlike short-term disability, every state has a victim compensation program, which offers financial assistance only to “innocent” victims of violent crime. These programs are financed through a mix of federal and state funds, and eligibility requirements and benefits can differ by state.
A portion of victim compensation funds can be used to make up for lost wages. Because New York’s Office of Victim Services (OVS), the agency that administers victim compensation, is designated as the payer of last resort, those applying for lost wages compensation must first apply for TDI. The maximum OVS amount is much higher than TDI: $600 per week. The actual amount a person receives depends on their previous salary, and the amount they are receiving through TDI.
“If someone brought home $500 a week, [OVS] is going to look at the $170 [from TDI], and the difference of that would be $330, so that’s what they would consider: Are they going to pay you that $330?,” Herring said.
Once someone’s TDI benefits expire, OVS will also make up the difference, at up to a maximum total of $30,000.
Barriers to access
Like TDI, victim compensation has drawn criticism for its lack of accessibility. A 2022 report by Common Justice found that in New York, the funds are underused, especially in communities of color.
“There’s not enough public awareness of the availability of these funds, partly because very often, the way people learn about them is through the police,” Sered said. “If they don’t call the police, they don’t learn about it. Or if they do call the police and the police don’t regard them as a worthy victim, or if their injuries aren’t immediately visible, or are actually more related to post-traumatic stress…they’re often not informed of these funds.”
After publishing the report, Common Justice campaigned for a new state law that goes into effect in December 2025, and eliminates the requirement that applicants report their crime to police to qualify for victim compensation.
“OVS has made a concerted effort to address disparities and inequities in marginalized communities, particularly those affected by gun violence,” wrote OVS spokesperson Janine Kava in a statement.
These efforts have included providing funding to community-based organizations in high gun violence neighborhoods and working with street outreach programs, victims’ advocates, and Common Justice to raise awareness about the availability of victim compensation and expand access to the program.
The application process for these programs can also be a barrier for survivors. Applying for TDI requires information from the claimant, their employer, and their doctor. According to the Workers’ Compensation Board, which oversees TDI, claimants should receive a decision on their application within 18 days of submission. However, Engelberg said that ABB’s helpline has received calls from claimants who have not received a decision within that time frame. She said that delays can often arise when the claimant’s employer doesn’t tell them to submit their application form directly to the employer’s insurance carrier. The claimant submits it to their employer instead, and it can take months for them to realize that the employer failed to submit the form on their behalf.
“None of this is easy or obvious for someone who is not particularly savvy,” she wrote by email.
Andrea Cyr, a spokesperson for the Workers’ Compensation Board, wrote in a statement that the board “strives to make the application process for disability benefits more clear and easier to use for employees and employers.”
In the past year, she said, the board has standardized and simplified the TDI application form, which now clarifies that an employer’s failure to complete their section of the form is not a basis for the insurance carrier to deny the claim. It also notifies claimants that if the employer fails to complete and return its part of the form within three business days, the employee can bypass them and send their application directly to the insurance carrier.
While awaiting TDI benefits, a person can apply for an emergency award of up to $2,500 from OVS—but they must wait to receive a decision on their TDI claim before applying for lost wages compensation. Getting approved for victim compensation can also involve frustrating bureaucratic hurdles, and the wait time to receive a decision was almost four months in fiscal year 2023.
“I’ve worked with many survivors who find themselves extremely frustrated, not only from the incident itself, but now this benefit is not accessible as quickly as one might hope,” Herring said.
Kava said that since implementing workflow changes in February, OVS has reduced the average wait time to 95 days or about three months.
Sered said another drawback to victim compensation is that the program is better suited for people who have regular employment. People who were underemployed or had irregular employment have a more difficult time providing the paperwork necessary to demonstrate their loss of income.
“It’s a really important benefit, but it is mostly available to people who have consistent salary conditions, or where their income week to week is the same, and the pay stub reflects that,” she explained.
Kava said that the documentation required for lost wage claims is unique to each person’s circumstance, but individuals whose jobs don’t have a set schedule are requested to submit tax returns and complete an OVS employment questionnaire to demonstrate loss of income.
Both programs can deny claims from people whose injury they suspect was acquired in the commission of an illegal act. In general, they are unsuited for people who were making money off the books.
“Some of the participants that we work with—they’re in the streets—and some of them do not have jobs, or the job that they had is not legit. They’re suffering from the loss of income, even though it can become illegal [where] their income comes from,” said Carolyn Dixon, who works with victims of gun violence through Life Camp, a gun violence prevention organization based in Queens.
This means gun violence survivors like Nelson, who are more likely to re-engage in risky activity like drug dealing after their injury, are less likely to see financial relief that could help prevent them from doing so. If these survivors are suffering from severe injuries, they may qualify for Social Security benefits like Nelson did. If their injuries are more temporary, or they are denied Social Security benefits, the main remaining option is public assistance through their state’s welfare programs.
These programs include cash assistance and food stamps, but they can vary state to state in terms of accessibility and generosity. In New York, the median amount received for cash assistance is $380 per month for cases without children and $575 per month for cases with children, according to the Office of Temporary and Disability Assistance (OTDA).
Emily Lundgren, a staff attorney at the Legal Aid Society, explained that part of the cash benefit goes directly toward rent payment, in what is known as “shelter allowance.” The recipient can use the remaining portion for any other expenses. For example, an individual in New York City with no other income is entitled to a maximum of $215 in shelter allowance and $183.10 for other expenses. These grant amounts are set by state law, and haven’t risen for over 10 years. Advocates say they fail to meet cost of living needs, especially in New York City.
“I’ve lived here for a long time, and I’ve never known a place where $215 would cut it [for rent]. In addition to that, $183.10 is very little to survive on for a whole month in this city,” Lundgren said.
These programs have also been criticized for a convoluted application process. In New York, this process has resulted in many applicants experiencing delays or being denied despite qualifying for help. In addition, those who do qualify for public assistance must fulfill work requirements, or be approved for a medical exemption, adding an additional hurdle to the process for applicants with disabilities.
OTDA declined to comment.
Returning to work: Community programs provide support
In the absence of government support, some community organizations have started their own programs to help survivors in the wake of their injuries.
Kings Against Violence Initiative (KAVI), a violence prevention organization in Brooklyn, reaches out to survivors through their hospital-based violence intervention program at Kings County Hospital, and their community outreach program in Bedford-Stuyvesant. KAVI’s co-executive director Ramik Williams said that in addition to helping survivors apply for the financial assistance programs, the organization also runs a survivor support program, Safety, Emotion, Loss, and Future (SELF), speaking to the challenges that survivors face in regaining a sense of safety, adjusting to new emotions and loss, and maintaining a focus on the future.
“[It] allows for individuals who are returning to work to establish or reestablish norms, in terms of being able to not be fidgeting when they hear a loud noise, or being able to establish a relationship with a stranger,” Williams said. “You have to learn how to trust again, you have to learn how to be safe again.”
KAVI’s Social Work Coordinator Nathan Aguilar facilitates some of these groups, which meet virtually once a week for 10 weeks and are tailored to participants of similar age, gender, or experience.
“I’m always amazed at how open people are about sharing their experiences, how trusting and how vulnerable people can be when you establish a place [where] they feel safe, where values are respected,” he said.
Interested participants are also matched with a caseworker as they seek employment or education opportunities. Williams emphasized that the process can help people in their recovery by giving them a sense of self-sufficiency.
“Employment and educational opportunities for victims of gun violence add to their healing,” he said. “Yes, there’s the physical portion of the healing, but the mental and emotional portion of the healing is only aided by them gaining a sense of efficacy in themselves. As they achieve more, as they do more, they’re more likely to heal from their traumatic experience.”
Nelson’s experiences attest to this reality, although it took him many years—and another near-death experience—to get to a place of healing. One night, almost two decades after he was first shot, Nelson found himself in a life-threatening situation once again.
“Having to beg for my life that night showed me what life was,” he said. “That was my rock bottom. And that day, I vowed never to deal with the streets [again].”
After the incident, Nelson resolved to create an organization, Wheelchairs Against Guns. Through community events and workshops at New York City schools, he and his staff try to prevent gun violence by teaching young people skills he wished he had had as a child.
“I found my purpose, and that purpose was to [teach] kids tools that I didn’t have growing up. Conflict resolution, critical thinking, how to build and maintain positive self-esteem, and financial literacy…if I had those tools, my decisions would have been different.”
Next week’s article will explore gun violence survivors’ struggles with the Social Security disability system.
Shannon Chaffers is a Report for America corps member who writes about gun violence for the Amsterdam News. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting https://bit.ly/amnews1.
This article originally appeared in the NY Amsterdam News
America’s safety net is failing gun violence survivors as they struggle to return to work
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