RESUMEN
BACKGROUND: Employment has long been an area of concern for people with disabilities. National samples in the United States are needed to understand the experiences of people with disabilities related to employment. OBJECTIVES: (1) Describe and evaluate associations between personal and health-related factors with employment after disability, and (2) describe and evaluate associations between facilitators, barriers, and work-related external factors with maintaining a longest held job after disability. METHODS: We recruited a national sample of people with physical disabilities from panels assembled by a United States market research organization; by selection, 1309 were working and 491 were not. We evaluated the likelihood of employment and maintaining employment after disability onset using Poisson regression. Model 1 evaluated factors associated with employment; Model 2 evaluated factors associated with maintained employment. RESULTS: Model 1: Older age, decreased ability to pay bills on time, and assistive device use were associated with decreased likelihood of employment after disability onset. Non-Black minority identification, fatigue, and higher physical function were associated with increased likelihood of employment. For Model 2, the likelihood of maintaining a longest held job was associated with acquiring a disability at work, receipt of job accommodations, valuing opportunities for advancement and health benefits, having a helpful living situation, and helpful human resource attitudes. Decreased likelihood of maintaining a longest held job after disability onset was associated with job dissatisfaction and supervisors' attitudes. CONCLUSIONS: This work highlights opportunities for employers to focus efforts on job accommodations and support in the maintenance of employment after disability.
RESUMEN
BACKGROUND AND OBJECTIVES: Self-direction is an approach that allows older adults and people with disabilities to determine the home- and community-based services they receive, including the ability to hire caregivers of their choice. Self-direction has been shown to improve outcomes for the service recipients. The promotion of choice and control in self-direction may also affect family caregivers. We conducted a systematic review examining the impact of self-direction on a broad range of caregiver outcomes. RESEARCH DESIGN AND METHODS: We conducted a systematic review guided by PRISMA guidelines. Literature search was conducted in 8 databases. We appraised risk of bias using the Joanna Briggs Institute critical appraisal checklists and assessed certainty of evidence using the GRADE framework. RESULTS: Sixteen studies meeting inclusion criteria were included. We found, with moderate certainty, that self-direction is associated with improved caregivers' personal and social well-being. Caregivers also reported reduced unmet needs and increased access to care for the care recipients under self-direction. Self-direction did not appear to reduce caregiving hours. With less certainty, self-direction was also positively associated with increased respite care use, perception of choice, and intention to continue caregiving by caregivers. DISCUSSION AND IMPLICATIONS: Beyond delivering person-centered services that improve recipient outcomes, self-direction may also improve the outcomes of family caregivers.