Disabilities

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.

This project uses data from the 2005/2006 National Health Interview Survey to provide a profile of the prevalence of different types of disability and employment among TANF recipients. We find that prevalence of disability varies widely depending on the specific measure used. Using narrow and broad composite disability measures, anywhere from 10 to 40 percent of TANF recipients have a disability and almost one-fifth have a family member with a disability. Disability prevalence among Food Stamp recipients is similar to TANF but low-income mothers have lower prevalence on almost all measures. Employment among TANF recipients with disabilities is considerably lower than among recipients without disabilities.

The Ohio Department of Rehabilitation and Correction and the Corporation for Supportive Housing Ohio Office developed a pilot program that provides permanent supportive housing to individuals released from several Ohio prisons. The Pilot intends to reduce recidivism and homelessness/shelter usage and decrease the costs associated with multiple service system use. The Urban Institute is evaluating the Pilot to explore whether it is meeting its intended goals. This Interim Report covers the first year of the evaluation—describing the Pilot and its eligibility requirements; the UI evaluation methods; and the characteristics and preliminary outcomes of the Pilot's first 57 clients.