Disabilities

Questions persist about how well Social Security Disability Insurance, workers' compensation, Supplemental Security Income, and veterans' benefits protect people who are unable to work. This study examines disability benefit receipt, income, and poverty status for a sample of Americans as they age. The results underscore the precarious financial state of most people approaching traditional retirement age with disabilities. Fewer than half of people who meet our disability criteria ever receive disability benefits in their fifties or early sixties. Poverty rates for those who do are more than three times as high after benefit receipt than before disability onset.

A patchwork of public programs, including Social Security Disability Insurance, workers’ compensation, Supplemental Security Income, and veterans’ benefits, provides income supports to people with health problems who are unable to work. Yet, many Americans who develop disabilities in their fifties or early sixties fall into poverty. With millions of boomers entering their sixties—when work disability rates peak—it’s time to fix the social insurance safety net for disabled workers.

As many as 10 million older Americans and younger adults with disabilities require long-term care, either at home or in nursing facilities. The United States spends more than $200 billion annually for such care. However, our system for financing this assistance-principally Medicaid and family assets, with a small share funded through private insurance—may be untenable as baby boomers age. TPC's Howard Gleckman looks at the way we deliver and pay for these services in a new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America's Most Urgent Health Crisis. He and a panel of top policy experts will discuss how—or whether—long-term care should be included in health reform legislation.

Relatively little is know about the implications for Medicare spending of downward trends in old age disability in the United States between the mid-1980s and the end of the century. This is in part because uncertainty persists about the extent to which the aggregate disability declines reflect improvements in health versus improvements in the technology, service, and physical environment. This study examines Medicare spending and utilization that occurred over the period of declining disability between 1984 and 1999 and how it differed from what might have been expected had disability not changed and discusses implications for the relationship between disability, Medicare spending, and health. Projections are developed under various assumptions about how disability and spending are likely to change over the over the next several years.

One of the most intriguing aspects of recent declines in old age disability is the concurrent increases in use of assistive devices among older persons with disability, and in particularly in use of devices for all disabilities without human assistance. This study updates information on trends in assistive device use and characteristics of device users; examines differences in the hours of care received by persons who do not use devices and those who use devices with and without help; and discusses implications for multivariate modeling of the relationship between device use and hours of help and other outcomes. Data are from the 1984 through 1999 rounds of the National Long Term Care Survey (NLTCS), which has been the key source of earlier information on trends in equipment use.