More than 1.15 million Americans are trapped in a bureaucratic maze where outdated technology transforms what should be a straightforward administrative process of determining qualification for disability benefits into a prolonged ordeal that threatens their survival.
In September 2024, Social Security Commissioner Martin O’Malley said in an testimony before Congress, “Thirty thousand people died in 2023 while waiting for their disability decisions”—a statistic the agency calculated for the first time, making it a significant revelation about the human cost of processing delays that disproportionately impacts older adults.
The disability determination crisis represents one of the most devastating examples of how accumulated technical debt can perpetuate human suffering, particularly among older populations that bear the brunt of these systemic failures.
David Camp, CEO of the National Organization of Social Security Claimants’ Representatives, said, “a disability claimant is waiting for basic income and health insurance. … To wait an extra month could be the month in which the untreated, already cured disease kills,” further noting that although SSA can’t prevent all deaths among those waiting for disability benefits, it has a responsibility to reduce that number.
The Disproportionate Impact on Older Americans
Older adults constitute a significant share of disability applicants, many seeking benefits for age-related health conditions such as cardiovascular disease, arthritis, degenerative neurological disorders, and mobility impairments that can accompany aging. For these individuals, the seven-month average wait for an initial decision—up 86% from 2019, represents not merely administrative delay but a direct threat to health and survival during their most vulnerable years.
Across the first eight months of the 2024 federal fiscal year, which began Oct. 1, the average wait was 230 days, or more than seven and a half months. The intersection of aging and disability determination delays creates a perfect storm where those with the least time to spare face the longest waits.
The statistics reveal a devastating reality for older adults. For those whose initial applications are denied, the journey becomes even more treacherous: the average wait for reconsideration by the SSA, the first step in appealing a denied claim, is seven months. If reconsideration is denied, it takes another 15 months on average to get to the next step, a hearing before a Social Security administrative law judge.
For older adults in their 60s and 70s, these combined delays of up to two years can consume a significant portion of their remaining lifespan. The cruel mathematics of aging means that older applicants are substantially more likely to be among the roughly 10,000 applicants who die and 8,000 who file for bankruptcy while waiting for a decision on their application—their final years marked by financial insecurity and untreated medical conditions.
Structural Ageism Embedded in Technical Debt
The technological failures that plague disability determination reflect and perpetuate structural ageism—systematic discrimination built into institutions that disadvantage older adults. When 30,000 people die waiting for benefits, and a disproportionate number are older adults with age-related conditions, this represents not just bureaucratic inefficiency but institutionalized violence against older populations. The fact that such failures would be utterly intolerable in private-sector applications serving younger, more affluent demographics exposes how society devalues the lives and dignity of older people with disabilities. Legacy systems designed for simpler, single-condition cases cannot efficiently process the medical complexity that can characterize older bodies.
‘For older adults in their 60s and 70s, these combined delays of up to two years can consume a significant portion of their remaining lifespan.’
Second, the digital divide disproportionately affects older adults who may lack the computer literacy or internet access necessary to navigate increasingly digitized application processes. While younger applicants can monitor case status online, upload documents electronically, and communicate via email, many older adults struggle with these technologies, creating additional barriers in a system already stacked against them.
The shift toward digital systems without maintaining accessible alternatives effectively discriminates against older populations with lower technological proficiency.
Geographic Disparities and Cumulative Disadvantage in Aging
Geographic disparities in processing times expose how technical debt creates profoundly unequal aging experiences based on location. These disparities compound existing regional inequalities in aging support infrastructure. States with weaker fiscal capacity cannot invest in system modernization, creating a feedback loop where technical debt perpetuates regional inequalities in outcomes for older adults. This is exacerbated by the “provider tax” system, where states with stronger fiscal capacity can invest in modernizing systems, while economically disadvantaged states remain trapped with outdated infrastructure. Rural areas, which have higher proportions of older residents, often have the worst technological infrastructure and longest processing times, further disadvantaging older adults who have contributed to society throughout their working lives.
The Cascade of Harm in Late Life
For older populations, disability determination delays trigger a cascade of harms that accelerate decline and reduce quality of life during precious years. Older adults unable to work due to age-related conditions face financial catastrophe during the months-long determination process.
Fixed incomes from limited savings cannot sustain basic needs for seven months or longer. Families struggle to support older parents while managing their own financial obligations, creating intergenerational stress that strains family bonds during a period when emotional support becomes critical.
Medical conditions worsen without timely access to healthcare that disability benefits provide. An older adult with untreated diabetes may progress to neuropathy, vision loss, or kidney disease during the determination process. Cardiovascular conditions deteriorate without proper medication and monitoring. Cognitive decline can accelerate without appropriate interventions. The system designed to provide support harms older people by withholding healthcare access during medically critical periods, creating permanent disability that might have been prevented with timely intervention.
The psychological toll proves equally devastating. Older adults who have worked throughout their lives experience profound indignity in being forced to prove their inability to work, while simultaneously being denied the means to survive. The stress of financial insecurity, deteriorating health, and bureaucratic frustration contributes to depression, anxiety and social isolation—conditions that significantly impact health outcomes in older groups. The roughly 8,000 who file for bankruptcy while waiting include disproportionate numbers of older adults, destroying financial security built over lifetimes of work and permanently undermining their capacity to age with dignity.
Barriers to Care Coordination for Aging Populations
The lack of integration between disability determination systems and modern healthcare technology creates particularly severe barriers for older adults who must provide extensive medical documentation across multiple providers. The requirement to manually gather records from numerous specialists, coordinate communications across fragmented systems, and navigate complex bureaucratic procedures proves especially burdensome for older adults with cognitive decline, mobility limitations or lack of family support.
‘The Medical Evidence of Record system requires caseworkers to print electronic documents, scan them into imaging systems, and manually index them.’
The Case Processing and Management System cannot directly interface with electronic health records systems, forcing manual data entry for every medical document. For older adults seeing multiple specialists and accumulating hundreds of pages of medical records, this creates weeks or months of delay. The Medical Evidence of Record system requires caseworkers to print electronic documents, scan them into imaging systems, and manually index them—a process that can take weeks for the complex cases typical of aging applicants with multiple chronic conditions.
The Moral Imperative: Aging with Dignity
The disability determination crisis fundamentally undermines the capacity of older adults to age with dignity—a basic human right that society claims to honor but systematically violates through technological neglect and debt. When 30,000 people die annually waiting for benefits, and older adults bear disproportionate harm, this represents a profound moral failure that demands immediate action. The technology exists to dramatically improve these systems through artificial intelligence solutions: natural language processing that automatically extracts relevant medical information, predictive analytics that expedite clear-cut cases, automated evidence gathering that interfaces with healthcare systems, and document processing that eliminates manual indexing.
Yet technical debt prevents implementation of solutions that could save the lives of older applicants. SSA’s core systems still operate on IBM mainframes designed in the 1980s for batch processing, lacking the application programming interfaces necessary to integrate modern AI workflows. The barriers are not technological, but political and economic—a lack of investment in systems serving vulnerable older adults and a tolerance for technical debt that would be unacceptable in private-sector applications serving younger, wealthier demographics.
A Crisis Compounded: Recent Threats to an Already Failing System
The existing crisis has been dramatically worsened by recent policy decisions. Instead of addressing the technological failures that already claim 30,000 lives yearly, the Trump administration and the Department of Government Efficiency (DOGE), led by Elon Musk, have systematically dismantled SSA’s capacity to serve older adults and people with disabilities.
Roughly 3,000 SSA employees have been terminated or accepted voluntary separations, with proposals to cut upward of 7,000 more. These reductions target the workforce struggling to process the 1.15 million applications trapped in bureaucratic limbo—applications disproportionately filed by older adults.
In March 2025, former Commissioner of Social Security Martin O’Malley warned that due to DOGE’s efforts, Americans could “see the system collapse and an interruption of benefits” within 30 to 90 days. For older adults in their 60s and 70s already waiting months or years for determinations, such a collapse could prove fatal. A Senate analysis examining the impact of these workforce reductions projects that average wait times for disability benefits will double, and—more devastatingly—the number of people who will die waiting for benefits will also double, to roughly 67,000 Americans annually.
This represents a compounding of cruelty: technical debt already creates lethal delays for older adults, and now deliberate policy choices threaten to double the death toll, while making unsubstantiated claims of fraud that stigmatize older adults seeking benefits they’ve earned through decades of work.
SSA’s IT modernization plan, initiated in 2017, aims to replace legacy systems, reduce IT and other operating costs, and re-engineer business processes. The Digital Modernization Strategy, developed as part of this initiative, focuses on retiring legacy systems in favor of newer and more efficient technologies. Specific annual operating costs are not detailed in the available documents. However, SSA’s FY 2025 budget request includes $14.299 billion in administrative funding, which supports various operational expenses, including IT modernization efforts. Regarding projected savings, SSA’s Office of the Inspector General has identified more than $18.4 billion in cost savings through various recommendations, though these are not exclusively tied to IT modernization.
The path forward requires treating modernization as critical infrastructure for supporting older populations, implementing safeguards that ensure equity and accessibility for older adults, and sustained political commitment extending beyond election cycles. Success depends upon recognizing that how we treat our most vulnerable citizens reflects our society’s fundamental values. Until we address these failures, older adults will continue suffering needlessly, their final years held hostage by systems that prioritize bureaucratic efficiency over human dignity. The choice before us is clear: continue accepting a system that kills thousands of older Americans annually through delay, or commit to comprehensive modernization that serves justice for those who built the society we inherit.
James Lomastro, PhD, has more than 40 years’ experience as a senior administrator in healthcare, human services, behavioral health, and home- and community-based services. He is a surveyor at the Commission on Accreditation of Rehabilitation Facilities throughout the United States and Canada. Lomastro is a member of the Coordinating Committee of Dignity Alliance Massachusetts.
For an in-depth look at Transformative Approaches to Social Security Benefits, please check out our new Generations Journal issue coming out Oct. 21. It is packed with useful information.
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