RehabWire - Volume 11, Number 8, August 2009

Economics and Disability

Research in the economics of disability falls under Disability Demographics. It may also fall within the Health and Function, Employment Outcomes, and Participation Priorities.

NIDRR Grantees on the Cutting Edge.

Demand-Side Employment Placement Models Syracuse University (H133A060033) led by Peter D. Blanck, PhD, JD. Shelley Reeves, Project Officer.
Abstract: This project sets out scientifically rigorous and evidence-based methods to develop, identify, and evaluate employment demand-side models. It translates the findings into valid and practical tools for large and small businesses in different market sectors to improve employment outcomes. It evaluates the relative efficacy of these tools alongside supply-side research outcomes. The project generates new knowledge to better understand market-driven workforce trends in large and small firms and different market sectors, and to inform employment practices to prepare individuals with disabilities for the present and future workforce. The project has a systematic plan and logic model for knowledge translation and dissemination aimed at providing employers best practice and practical tools to improve employment outcomes of people with disabilities.
Find out more at: bbi-empdemand.syr.edu/

DBTAC: Southeast ADA Center - Region IV Syracuse University (H133A060094) led by Peter Blanck, PhD, JD, Shelley Kaplan. Shelley Reeves, Project Officer.
Abstract: The DBTAC: Southeast ADA Center (Southeast DBTAC) provides technical assistance, training, and information dissemination for Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee. Southeast DBTAC meets ADA- related information, training, and technical assistance needs of multiple public and private stakeholders through the provision of five core services: (1) information dissemination, (2) education and training, (3) technical assistance, (4) information referral, and (5) public awareness events. The Southeast DBTAC’s research plan extends the state of knowledge about employer corporate culture and business practices, and ADA impact on civic action to reduce and eliminate barriers to full civic, social, and economic participation for Americans with disabilities. The Southeast DBTAC is lead by a consortium that includes four nonprofit institutions recognized for their knowledge of civil rights protections and impact across covered environments, access, and use of assistive technology (AT), employment and independent living, and consumer self-direction and advocacy.
Find out more at: www.sedbtac.org

Asset Accumulation and Economic Self-Sufficiency (AAESS) Syracuse University (H133A080014) led by Michael Morris. Delores Watkins, Project Officer.
Abstract: Building upon research conducted by the Asset Accumulation and Tax Policy Project (AATPP), the current project provides understanding of economic status of working age adults with disabilities, and policy and system barriers to asset accumulation and community participation. Two intervention studies contribute individual and system level knowledge impacting asset accumulation, economic self-sufficiency, and community participation of persons with disabilities. Intervention One: Resource, Employment, Assets, and Learning (REAL) opportunity study, evaluates the impact of asset building strategies on economic status and community participation of 360 individuals with disabilities during the project in 2 pilot sites. Intervention Two: Building Economic Success Together (BEST) Accounts study, offers a comprehensive menu of accessible, user-friendly, affordable products and services in response to evidence from AATPP. Data analysis is used to identify increased use of asset building strategies, reduced dependence on payday and predatory lenders, reduction of debt, changes in economic status, and savings. Thematic analysis of focus groups and interviews produce knowledge on individual and system factors that diminish or facilitate opportunities to advance asset accumulation, self-sufficiency, and community participation measures of social, civic, and economic activities. AAESS continues collaboration with the IRS to design and conduct an updated and extended benchmark study in 2009 to further research on economic status of taxpayers differentiated by disability and demographics to help design future research. The project includes creation and dissemination of asset development and financial literacy curricula to complement other poverty-alleviation strategies.
Find out more at: disability.law.uiowa.edu/lhpdc/projects/assetdevtaxpol.html

The Rehabilitation Research and Training Center for Economic Research on Employment Policy for Persons with Disabilities at Cornell University (1998-2003) produced a series of research briefs on the Economics of Disability. Download them at bit.ly/42hkye

Personal Assistance Services (PAS) in the 21st Century University of California, San Francisco (H133B080002) led by Charlene Harrington, PhD, RN;H. Stephen Kaye, PhD;Mitch LaPlante, PhD;Robert Newcomer, PhD. David W. Keer, Project Officer.
Abstract: This rehabilitation research and training center focuses on: (1) improving access to Personal Assistance Services (PAS) by individuals with disabilities; (2) improving the workforce to support individuals with disabilities; and (3) understanding the complexities of the economics of PAS. This project: (1) analyzes trends in the met and unmet needs for PAS in the United States, and the changing demographics of the PAS population, and makes national and state projects of need; (2) investigates the relationship between need and economic status for working age and older groups; (3) tracks and analyzes trends in PAS participants, services, and expenditures and federal and state Olmstead-related initiatives to expand PAS; (4) identifies state PAS policies and barriers to meeting the need for PAS; and (5) analyzes state PAS intervention strategies and factors which impact the success of expanding PAS services. Additionally, this project develops health promotion and educational tools, supports, and interventions to improve the health of caregivers and PAS users; addresses the needs of children and their family caregivers through focused research on the impact of family caregiving on employment; and examines the needs and supports for aging minority caregivers and the amount and type of caregiving provided by family or friends. Moreover, this project gathers and makes available existing strategies, and develops a model approach for emergency PAS. While monitoring and analyzing trends and demographics of paid PAS workforce, this project identifies and tracks state strategies to improve PAS worker wages and benefits; monitors state trends in the number and diversity of PAS workers, their compensation, turnover, and vacancies; and evaluates the effectiveness of state efforts. This project also identifies and makes available comprehensive information about developments in state training requirements for PAS workers and evaluation of these programs; collects and analyzes primary data on workplace PAS, AT, and employment supports; and analyzes barriers to employment among Medicaid PAS beneficiaries and whether AT lessens the need for PAS. Finally, the RRTC analyzes the role of tax laws that affect reimbursement for PAS.
Find out more at: www.pascenter.org

Assessing the Impact of Medicare-D on SSDI Beneficiaries Washington State University (H133G070055) led by James J. Kennedy, PhD. Kenneth D. Wood, PhD, Project Officer.
Abstract: This project employs a multi-method, repeated-measures design to assess the impact of Medicare-D on younger beneficiaries in four distinct but interrelated studies: (1) quantitative analysis of access and utilization rates among beneficiaries under age 65, using successive panels of the Medicare Current Beneficiary Survey; (2) qualitative research on the impact of Medicare benefits on employment and continuity of medical care, based on repeated focus groups at two sites; (3) formulary analysis of coverage for critical medications among competing private Medicare Advantage and Prescription Drug Plans in Washington State; and (4) ongoing policy analysis of legislative and regulatory changes in Medicare and SSDI. Tracking the impact of the new drug benefit is particularly important for younger adults with disabilities who become eligible for Medicare through the Social Security Disability Insurance (SSDI) program. Although younger beneficiaries comprise only 14.1 percent of the total Medicare population, they account for about 17 percent ($71.6 billion) of total program expenditures. Despite their economic and political importance, younger beneficiaries with disabilities are routinely overlooked in published Medicare research and policy analysis. Through dissemination of research findings, this project enhances awareness in the research and policy community of the unique Medicare-D concerns of younger beneficiaries with disabilities, consistent with the ultimate goal of improving access to affordable health services for people with disabilities.
Find out more at: www.spokane.wsu.edu/Academics/Health_Sciences/HPA/medicare/index.asp

Please note: These abstracts have been modified. Full, unedited abstracts, as well as any available REHABDATA citations, are available at naric.com.

A study of assistance programs in the UK and US found that "...households containing individuals with disabilities need more income to attain the same standard of living as households that contain no such individuals, but are otherwise comparable."
Stapleton,D., Protik, A., and Stone, C. (2008) Review of international evidence on the cost of disability. August 28, 2009. research.dwp.gov.uk/asd/asd5/rports2009-2010/rrep542.pdf

a graph with an up-pointing arrow. Image by Christina Ferarri, Italy, courtesy of Stock Exchange www.sxc.hu

Current Literature: Selections from REHABDATA

Shei, P., Livermore, G. (2009) Long-term poverty and disability among working-age adults. Journal of Disability Policy Studies, 19(4), 224-256. NARIC Accession Number: J56267. Project Number: H133B040013.
Abstract: Study used data from the Survey of Income and Program Participation spanning from 1996 to 1999 to estimate the prevalence of short- and long-term poverty among working-age people with and without disabilities. Disability measures were constructed for sensory limitations, functional limitations, limitations in activities of daily living (ADLs), limitations in instrumental ADLs, and work disability. Depending on the disability measure used, annual poverty rates were 2 to 5 times higher among people with disabilities compared to those without disabilities. The relative long-term poverty rates among those with disabilities are much higher than the relative short-term poverty rates. People with disabilities represented 47 percent of those in poverty in 1997 according to an annual measure of poverty and 65 percent of those in poverty networks.

Krause, J., Terza, J. (2008) Earnings among people with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 89(8), 1474-1481. NARIC Accession Number: J55103. Project Number: H133G010009; H133G060126.
Abstract: Study identified differences in conditional and unconditional earnings among participants with spinal cord injury (SCI) attributable to biographic, injury, educational, and employment factors. A 2-part model predictive model was developed using biographic, injury-related, educational, and work-related factors. The three parts of the model included factors associated with employment status, conditional earnings, and unconditional earnings. Conditional earnings reflected the earnings of employed participants, whereas unconditional earnings reflected all participants with $0 in earnings recorded for those unemployed. Results indicated that sex and race were significantly related to conditional earnings, even after controlling for educational and vocational variables. Additionally, conditional earnings (employed participants only) were related to 16 or more years of education, number of years employed, the percentage of time after SCI spent employed, and working in either government or private industry (not self-employed or family business). There was a greater number of significant variables for unconditional earnings, largely reflective of the influence of the portion employed (those not working having $0 in earnings).

The Cochrane Collaboration of Systematic Reviews of Healthcare Interventions includes more than 26,000 economic evaluations of healthcare interventions from the National Health Service’s Economic Evaluation Database. These articles help healthcare providers determine the cost effectiveness of a given intervention or treatment. Abstracts of these and other reviews are freely available at www.thecochranelibrary.org

Burkhauser, R., Larrimore, J. (2008) Trends in the relative household income of working-age men with work limitations: Correcting the record using internal current population survey data. NARIC Accession Number: O17260. Project Number: H133B031111; H133B040013; H133B980038.
Abstract: Paper addresses constraints in the data used to examine the economic well-being of working-age people with and without disabilities. Previous research measuring the economic well-being of working-age men with work limitations relative to such men without work limitations in the public use version of the March Current Population Survey (CPS) systematically understates the mean household income of both groups; overstates the relative household income of those with work limitations; and understates the decline in their relative household income over time. Using the internal March CPS, the authors demonstrate this by creating a cell mean series beginning in 1975 that provides the mean reported income of all topcoded persons for each source of income in the public use March CPS data. Using a cell mean series with the public use March CPS, they closely match the yearly mean income of working-age men with and without work limitations over the period 1987-2004 in the internal data and show that this match is superior to ones using alternative methods of correcting for topcoding currently used in the disability literature. Information is provided regarding levels and trends in the relative income of working-age men with work limitations from 1980-2006, the earliest year in the March CPS that such comparisons can be made.

Cook, J., Razzano, L. (2007) Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness. Journal of Rehabilitation Research and Development (JRRD), 44(6), 837-850. NARIC Accession Number: J54481. Project Number: H133B050003.
Abstract: Study examined the effects of co-occurring disorders on work outcomes among individuals with severe mental illness who were participating in supported employment. At 7 study sites, at total of 1,273 people with severe mental illness and co-occurring conditions were randomly assigned to a supported employment program or a control condition and followed for 2 years. Analysis examined work outcomes including earnings, hours worked, and competitive employment as well as whether psychiatric disability was disclosed to coworkers and supervisors. Results indicated that those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Where Can I Find More? A quick keyword search is all you need to connect to a wealth of disability and rehabilitation research. NARIC’s databases hold more than 75,000 resources. Visit www.naric.com/research to search for literature, current and past research projects, and organizations and agencies in the US and abroad.