Stigma is best understood as a negative reputation that creates real costs—emotional, social, physical, time, and financial—or the perception that costs will be incurred.

In 2015 to 2016, NCOA conducted in-depth interviews with 40 benefits counselors to better understand the phenomenon of stigma, how it manifests among their clients, and the strategies that they utilize to counter stigma during the benefits application process. The findings from this effort are detailed in the report, An End to Stigma, and summarized briefly here.

How stigma manifests

Stigma manifests itself in two primary ways:

• Internal stigma arises from negative perceptions or connotations about oneself that occur when deciding to learn about, apply for, and participate in benefits programs. Shame and embarrassment about participation in the program are the most common manifestations of internal stigma.
• External stigma arises from experiences or perceptions about the benefits themselves. Administrative burdens, such as long applications or difficult-to-reach social service agencies, and misconceptions about the value of a given benefit may lead eligible people to decide the reward is not worth the cost.

The primary consequence of stigma is that low-income older adults do not apply for public benefits for which they are eligible, thereby foregoing a crucial form of financial assistance, which can impact levels of debt and, ultimately, their health and independence.

Messages to counter stigma

Counselors who educate and assist older adults and people with disabilities to apply for benefits are on the frontline in the fight to overcome stigma and encourage people to get the public assistance for which they are eligible. Some of their successful strategies for overcoming stigma, which are outlined further in the report, included:

1. Challenging the narrative of “deserving” and “undeserving” poor
2. Focusing on the structure of the program
3. Correcting misconceptions about the benefit
4. Providing person-centered benefits enrollment assistance
5. Demonstrating the value of a benefit

In addition, there is a role for agency administrators and policymakers to help improve enrollment processes through existing waiver programs such as shorter applications, experimenting with new processes, and improving data-sharing between agencies.