Informal Caregiver Support Policies Change Use of Vocational Assistance Services for Individuals With Disabilities.

Support policies for caregivers improves care-recipient access to care and effects may generalize to nonhealth services. Using administrative data from the U.S. Department of Veterans Affairs (VA) for veterans <55 years, we assessed the association between enrollment in a VA caregiver support program and veteran use of vocational assistance services: the post-9/11 GI Bill, VA vocational rehabilitation and employment (VR&E), and supported employment. We applied instrumental variables to Cox proportional hazards models. Caregiver enrollment in the program increased veteran supported employment use (hazard ratio = 1.35, 95% confidence interval [1.14, 1.53]), decreased VR&E use (hazard ratio = 0.84, 95% confidence interval [0.76, 0.92]), and had no effect on the post-9/11 GI Bill. Caregiver support policies could increase access to some vocational assistance for individuals with disabilities, particularly supported employment, which is integrated into health care. Limited coordination between health and employment sectors and misaligned incentives may have inhibited effects for the post-9/11 GI Bill and VR&E.

Transition pathways for young people with complex disabilities: exploring the economic consequences.

BACKGROUND: Disabled young people with complex needs face particular challenges when they reach adulthood and seek to move from school to employment or further education. There are potentially substantial personal and social costs arising from these challenges. METHODS: We sought evidence from recent UK research, policy and related literatures; undertook exploratory statistical analyses of birth cohort data; and analysed information provided by 30 disabled young people requiring high levels of practical and communication support. RESULTS: The personal, family and social costs that result from unsuccessful transition are substantial and wide-ranging. Health service and local authority expenditure are important elements, but do not allow young people to achieve the educational or employment goals to which they aspire, resulting in considerable costs for the state, whether through missing opportunities to contribute to the economy or through dependence on welfare benefits. CONCLUSIONS: The considerable sums currently spent on disabled children and young people are clearly not enough, or not deployed appropriately, to enable those who reach adulthood to fulfil their ambitions, or to meet government policy intentions for young people to achieve economic well-being.

Workplace accommodations for persons with physical disabilities: evidence synthesis of the peer-reviewed literature.

PURPOSE: To identify and synthesize research evidence on workplace accommodations used by employers to recruit, hire, retain, and promote persons with physical disabilities. METHOD: A structured search of six electronic journal databases was undertaken to identify peer-reviewed literature on the topic published from January 1990 to March 2016. Articles describing or evaluating workplace disability accommodation policies and practices were given a full-text review. Topic experts were contacted to identify additional studies. RESULTS: Details on specific accommodations described in 117 articles were synthesized and organized into three groups comprised of a total of 12 categories. The majority of studies did not rigorously evaluate effectiveness or cost-effectiveness of the accommodations under study. CONCLUSIONS: This evidence synthesis provides an overview of the peer-reviewed literature of value to occupational rehabilitation professionals and employers seeking guidance on workplace accommodation policies and practices for persons with physical disabilities. A wide range of accommodation options is available for addressing physical, social, and attitudinal barriers to successful employment. Besides physical/technological modifications, accommodations to enhance workplace flexibility and worker autonomy and strategies to promote workplace inclusion and integration are important. More comprehensive reporting and evaluations of the effectiveness of accommodations in research literature are needed to develop best practices for accommodating persons with disabilities. Implications for rehabilitation There is a substantial peer-reviewed literature that provides insights into the barriers for persons with physical disabilities and the workplace accommodation practices to address them, though rigorous evaluations of effectiveness and cost-effectiveness are uncommon. Attitudinal and social barriers stemming from stereotypes, ignorance and lack of knowledge are as important as physical barriers to employment for persons with physical disabilities. In addition to physical/technological modifications, accommodations to enhance workplace flexibility and autonomy of a worker, as well as strategies to promote workplace inclusion and integration may facilitate successful employment of persons with physical disabilities.

Implementing the Americans with Disabilities Act. A case report on Sears, Roebuck and Co.

This article examines the employment practices of Sears, Roebuck and Co. in light of its compliance with the Americans with Disabilities Act of 1990. Sears employs approximately 20,000 persons with disabilities, nearly 7000 individuals of whom have orthopedic disabilities. This article describes two illustrative examples of Sears' compliance with the Americans with Disabilities Act and sets forth five essential implications of the Americans with Disabilities Act compliance that are relevant for spine professionals.

Shifting the cost of self-pay for SSI workers in supported employment.

Two provisions of the Supplemental Security Income (SSI) program--the Plan for Achieving Self-Support (PASS) and Impairment Related Work Expenses (IRWE)--can have the implicit result of compensating SSI recipients for work expenses they incur. That is, PASS and IRWE can, in effect, shift all or some of a working SSI recipient's expenses from the recipient to the SSI program. This article describes how PASS and IRWE operate and demonstrates the shifting effect. The analysis focuses on expenses for supported employment.

Expanding ADA coverage to employee benefit plans: recent judicial and administrative developments.

The Americans with Disabilities Act has been heralded as the Emancipation Proclamation for persons with disabilities. The purpose of the law is to provide nothing less than a "clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities." Precisely how the nondiscrimination principles of the ADA will be applied to an employer's provision of health benefits to its employees has been the subject of much debate since the Act's passage in 1990. Although the statutory language and the legislative history support a limited application of the ADA to benefits issues, recent court decisions and enforcement actions by the Equal Employment Opportunity Commission indicate that the ADA may have a much more profound impact in the area of benefits plan design and administration. Moreover, as benefits administrators take a much more active role in managing health care decisions, the ADA may become a vehicle for legal challenges to those decisions that affect the disabled.

Benefit plan limitations after the Americans with Disabilities Act.

Virtually all company welfare benefit plans contain one or more disability-specific benefit limitations. The Americans with Disabilities Act casts doubt on the lawfulness of these limitations. The legislative history of the ADA is confusing, and the EEOC's failure to offer meaningful guidance on this issue further clouds the situation. Based on the Supreme Court's prior interpretation of language similar to that used in the ADA, we believe all disability-specific limitations adopted prior to the ADA are entitled to a "safe harbor"; disability-specific limitations adopted after Congress passed the ADA are still lawful unless the limitations are intentionally used to discriminate in a nonbenefit aspect of employment.

Federal employees: insurance open season.

AIDS: Federal employees can take advantage of a special one-time open season and enroll in life insurance up to slightly over their annual salary, with no physical examination or health questionnaire. Those with a life-threatening illness can now improve their financial condition during this open season, which ends July 21, 1995. This benefit lets them take advantage of a new accelerated benefit option, which allows those with a life expectancy of less than nine months to collect the above amount while they are alive. An estimated one-third of unmarried Federal employees do not yet have life insurance. Tom McCormack of Affording Care, Inc. cautions individuals and says that the best way to get money from a life insurance policy is through a private loan from friends, family, or relatives, in return for naming them beneficiaries.^ieng

Labor pains. Getting a grip on the Americans With Disabilities Act.

This month the Americans With Disabilities Act goes into final effect, requiring employers with 15 or more employees to comply with nondiscriminatory policies for employment accommodation and hiring. How can home care agencies or hospices defend or challenge a claim?

Employer interference with ERISA rights and benefits. DiFederico v. Rolm Company.

DiFederico v. Rolm Company, 201 F.3d 200 (3rd Cir. 2000): A former employee who contended she was terminated because her employer wanted to avoid the cost associated with long-term disability obligations had to prove that her employer had a specific intent to violate Section 510 of ERISA. Section 510 prohibits an employer from interfering with her attainment of rights or benefits associated with an employee benefit plan. Proving specific intent requires proof that the employer made a conscious decision to interfere, and when there is no direct evidence of that intent, courts apply a shifting burden analysis like the one used in employment discrimination cases. After the former employee makes an initial circumstantial showing that she was terminated for a reason that violated Section 510 and the employer articulates a legitimate reason for its action, the former employee must prove that the employer's reason was pretextual.

A new challenge for home care agencies.

The Americans with Disabilities Act will change the employment practices of all home care agencies by prohibiting employers from discriminating against individuals on the basis of a disability. While the act requires an employer to reasonably accommodate all applicants and employees must be reasonably accommodated, home care agencies face a particular challenge in employing and accommodating individuals with a disability who are homemaker-home health aides, nurses, or therapists.