Approximately 18 million people in the U.S. have diabetes. This brief uses Rehabilitation Services Administration data to provide a picture of people with diabetes using the Vocational Rehabilitation system

Foley, Susan

Woodring, Jonathan

English

University of Massachusetts Boston: ScholarWorks at UMass

University of Massachusetts BostonScholarWorks at UMass BostonResearch to Practice Series, Institute forCommunity Inclusion Institute for Community Inclusion6-1-2005Research to Practice: Diabetes and VocationalRehabilitation Employment Services andOutcomesJonathan WoodringUniversity of Massachusetts BostonSusan FoleyUniversity of Massachusetts Boston, susan.foley@umb.eduFollow this and additional works at: http://scholarworks.umb.edu/ici_researchtopracticePart of the Disability Law Commons, Labor and Employment Law Commons, and the PublicPolicy CommonsThis Occasional Paper is brought to you for free and open access by the Institute for Community Inclusion at ScholarWorks at UMass Boston. It hasbeen accepted for inclusion in Research to Practice Series, Institute for Community Inclusion by an authorized administrator of ScholarWorks atUMass Boston. For more information, please contact library.uasc@umb.edu.Recommended CitationWoodring, Jonathan and Foley, Susan, "Research to Practice: Diabetes and Vocational Rehabilitation Employment Services andOutcomes" (2005). Research to Practice Series, Institute for Community Inclusion. Paper 13.http://scholarworks.umb.edu/ici_researchtopractice/13IcINSTITUTE FORCOMMUNITY INCLUSIONIJune 2005Issue 38PracticeResearchtoDiabetes and Vocational Rehabilitation Employment Services and OutcomesJonathan Woodring, Susan Foley, & Lauren MillerInstitute for Community Inclusion University of Massachusetts Bostonwww.communityinclusion.orgIntroductionThe Vocational Rehabilitation (VR) system provides employment supports to a range of people with various disabilities. This brief report is part of a series examining select populations that fall under the rubric of the National Institute on Disability Rehabilitation and Research’s concept of “emerging disability.” Certain populations are exhibiting high or changing rates of disability, including people in poverty, single mothers receiving welfare, underserved communities of recent immigrants, and specific cultural and racial groups. Particular chronic health conditions are rising rapidly and differentially among cultural and racial groups. Diabetes is one of those conditions, with about 1.3 million people newly diagnosed each year (American Diabetes Association, 2005).According to the American Diabetes Association, approximately 18 million people in the U.S. have diabetes (see www.diabetes.org/diabetes-statistics/national-diabetes-fact-sheet.jsp). The prevalence is higher among African-Americans, Latinos, and American Indians and Alaskan Natives, and among subpopulations, particularly Mexicans, Puerto Ricans, and American Indians in the southeastern United States (American Diabetes Association, 2005). Having diabetes in and of itself does not necessarily qualify any given individual for disability services. However, for some individuals, diabetes can be serious enough or can lead to secondary conditions that would qualify a person for VR services. The leading complications of diabetes are heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease, and amputations (ADA, 2005). The American Diabetes Association reports that the cost of diabetes is approximately $132 billion per year, with about $40 billion of that amount related to disability, work loss, and premature death. This report uses the Rehabilitation Services Administration case closure data to provide a picture of people with diabetes using the VR system. It compares individuals with diabetes mellitus listed as the cause of primary impairment closed in year 2003 to those without diabetes listed as the cause of primary impairment.Demographics: Who Are People with Diabetes Using the VR System?About 2% of people using VR services have diabetes as the cause of their primary impairment. Demographic differences between people with diabetes and those without are provided in Table 1. People with diabetes tend to be about nine years older on average and have higher rates of college attendance than the general population of VR consumers. About one-quarter of both groups are African-American, but the percentage is slightly higher for people with diabetes. Although the majority in both groups are men, a higher percentage of people with diabetes are women.Table 1: Demographics General population (N=607,738)People with diabetes(N=10,023)Race (%) Non-Hispanic Black 22.5 25.7 Non-Hispanic White 65.5 59.7 Hispanic 9.5 11.8 Native American 1.2 1.6 Asian/Pacific Islander 1.3 1.2Gender (%) % Female 45.3 48.4Age Mean age 36.0 45.5Education (%) Less than high school 31.9 29.5 HS diploma or equivalency 48.3 45.1  Some college 13.9 18.1  College degree or more 5.9 7.42 • Institute for Community Inclusion • Research to Practice, Issue 38Primary ImpairmentsThe top five most frequently occurring primary impairments are shown in Table 2. The most frequent impairments in the general population are cognitive, psychosocial, and mental im-pairments. For people with diabetes, the impairments listed the most often are physical or sensory in nature. The top five impairments are known to be secondary conditions related to diabetes. Cognitive and psychosocial impairments did not register in the top five for people with diabetes. Table 2:  Top Five Primary Impairments ListedRank orderGeneral population (N = 607,738)People with diabetes(N = 10,023)Primary impairment % Primary impairment %1 Cognitive impairments 23.0 Other physical impairments 49.92 Psychosocial impairments 20.6 Blindness or other visual impairments23.83 Other mental impairments 11.6 General physical disability 18.74 Other orthopedic impairments6.7 Orthopedic/neurological impairments3.25 Orthopedic/neurological impairments6.4 Mobility and manipulation impairments1.6Economic IndicatorsPeople with diabetes are less likely to receive Supplemental Security Income (SSI), either at application or at closure, and more likely to receive Social Security Disability Insurance (SSDI). People with diabetes are also more likely to receive Medicare than the general group but receive Medicaid somewhat less frequently. Very few people in either group receive either general as-sistance (GA) or welfare (TANF) benefits. Table 3: Economic Indicators at Application and Closure (2003)General population (N=607,738)People with diabetes(N=10,023)Social Security (%) SSI at application 16.6 11.2 SSI at closure 16.3 10.9 SSDI at application 12.5 15.0 SSDI at closure 13.4 17.0Insurance (%) Medicare at application 8.6 12.6 Medicare at closure 9.3 13.7 Medicaid at application 23.5 19.7 Medicaid at closure 22.5 19.5Other public assistance TANF at application 3.9 4.2 TANF at closure 2.6 3.0 GA at application 4.3 4.4 GA at closure 2.6 3.3VR Services ReceivedThe cost of services is about equal between the two groups. However, patterns of use differ by specific types of services funded. People with diabetes receive the following services more frequently than the non-diabetic population: diagnosis and treatment, disability-related training, and rehabilitation technology. People with diabetes receive vocational training, on-the-job training, job readiness training, job search service, and on-the-job supports less frequently than the non-diabetic population.Table 4: Services Received (2003)General population (N=607,738)People with diabetes(N=10,023)Cost of purchased servicesMean (standard deviation) $2,160 ($5,552) $2,220 ($5,232)Services provided (%)Assessment 59.9 59.2Rehabilitation counseling and guidance 47.0 49.6Diagnosis and treatment 29.0 37.3Transportation 18.0 17.0Other services 15.1 15.9Job placement services 17.6 15.4Job search services 17.0 14.0Information and referral 10.2 12.1College/university 8.6 9.9Disability-related training 2.4 9.6Miscellaneous training 7.4 9.1Maintenance 9.1 9.0Rehabilitation technology 4.7 8.7Occupational/vocational training 8.7 7.4On-the-job supports 9.6 5.0Job readiness training 7.1 4.6On-the-job training 2.6 1.5VR Closure TypeType of closure rates are about identical across the two groups. About one-sixth are closed prior to eligibility determination, and another quarter closed prior to the development of an Individual Plan for Employment. About 40% of all individuals who approach the VR system reach an employment outcome. Table 5: Distribution of Closure Type (2003)Type of closure (%) General population (N=607,738)People with diabetes(N=10,023)Employment outcome 35.1 39.5Services initiated, no employment outcome 25.1 24.2After eligibility determination, before Individual Plan for Employment22.8 20.8Before eligibility determination 13.9 12.9Other 3.4 2.6Employment Outcomes: Type of Employment, Mean Weekly Wages, and Mean Weekly HoursThe most striking difference between people with diabetes and those without is in the rate of closure to homemaker or unpaid family worker status. About one-fifth of people with diabetes are closed into this status. Upon further analysis, those closed into homemaker or unpaid family worker status are blind or visually impaired (87%); are women (68%); have an average age of 57; and were not working at the time of application (95%). People with diabetes are closed into integrated employment less often than people without diabetes (74% vs. 85%). Even so, people with diabetes closed into integrated employment earn more. Mean weekly wages are higher for people with diabetes (close to $20), although mean weekly hours are about the same. People with diabetes are much less frequently closed into supported employment than the general population of people receiving VR services (1.6% vs. 8.4% respectively). Table 6: Employment Outcomes (2003)SummarySome of the differences in outcomes and services may be related to the characteristics of the population of people with diabetes receiving VR services. People with diabetes on average tend to be older. More have a college education and a work history. These differences may explain both the higher weekly earnings for some and the greater frequency of homemaker status closures for others. In addition, the higher rates of closure into homemaker status, along with the use of disability-related training, may indicate that about one-fifth of people with diabetes use VR services for independent living goals rather than employment. Points for further consideration:• People with adult-onset chronic conditions that lead to impairments may use VR services for independent living services prior to retirement. Are people retiring by choice or opting out of work due to a lack of accommodations or job opportunities? Does homemaker status constitute a successful closure for older workers who acquire a disability due to the onset of a chronic health condition? • Who are the people with diabetes who would be considered disadvantaged, and how do they fare in the VR system? A portion of the population of people with diabetes who use VR are in poverty programs (i.e., SSI, TANF, GA). For instance, those consumers with SSI, TANF, or GA at application are much more likely to be black or Hispanic and have less education than other individuals with diabetes. Health disparity literature indicates a growth in diabetes among poor, urban, and underserved communities-groups that acquire secondary conditions more frequently. They may face multiple work barriers and be clients in multiple public programs. They may also receive conflicting messages about the goal of employment. • What predicts successful closure into a competitive job for people with diabetes? A forthcoming paper provides data indicating that the type of vocational service received has a relationship to whether or not a person with diabetes closes into a competitive job. The paper is forthcoming after May 30, 2005. More information is available from the authors of this Data Note.References and Sources for More InformationAmerican Diabetes Association. (2005). National Diabetes Fact Sheet. www.diabetes.org/diabetes-statistics/national-diabetes-fact-sheet.jspNational Institute on Disability Rehabilitation and Research. (2005). Brochure on Mission, Goals, and Activities. www.ncddr.org/new/announcements/nidrr_brochure.htmlCenters for Disease Control and Prevention. (2005). Racial and Ethnic Approaches to Community Health (REACH 2010). www.cdc.gov/reach2010Employment outcomesGeneral population (N=213,616)People with diabetes (N=3,958)% Mean weekly earnings ($)Mean weekly hours% Mean weekly earnings ($)Mean weekly hoursIntegrated employment85.0 332.8 34 74.3 355.7 34Self-employment (except BEP)2.3 301.8 28 4.7 228.6 26Supported employment8.4 170.8 24 1.6 236.8 27Other employment outcomes.1 N/A N/A . 3 N/A N/AHomemaker and unpaid family worker4.1 N/A N/A 19.2 N/A N/AInstitute for Community InclusionUMass Boston100 Morrissey BoulevardBoston, Massachusetts 02125NON PROFITUS POSTAGE PAIDBOSTON, MAPERMIT NO. 52094For more information, contact:xxxxxInstitute for Community InclusionUMass Boston100 Morrissey BoulevardBoston, Massachusetts 02125617.287.xxxx (v); 617.287.xxxx (TTY)xxx@umb.eduThis publication will be made available in alternate formats upon request.The authors would like to thank .......Visitwww.communityinclusion.orgto read this newsletter online;find other publications on this topic; orsign up for ICI’s email announcement listResearch to Practice series: Diabetes and Vocational Rehabilitation Employment Services and Outcomes(Issue No. 38- June 2005)This is a publication of the Emerging Disabilities, Employment Outcomes, and Systems Change Project (H133A021503) funded by the National Institute on Disability Rehabilitation and Research at the U.S. Department of Education.

Research to Practice: Diabetes and Vocational Rehabilitation Employment Services and Outcomes

https://scholarworks.umb.edu/cgi/viewcontent.cgi?article=1012&amp;context=ici_researchtopractice

Research to Practice: Diabetes and Vocational Rehabilitation Employment Services and Outcomes

Abstract

Similar works

Full text

Available Versions

University of Massachusetts Boston: ScholarWorks at UMass