Two workers loading a truck

Who Applies for Disability – and Who Gets it

Blue-collar workers who end up applying for federal disability benefits find themselves in that position for a variety of interrelated reasons.

A dangerous or physically demanding job can either cause an injury or exacerbate a medical condition that could lead to a disability. And people with limited resources in childhood often develop health problems earlier in life, and their circumstances can limit their access to job opportunities, making them more likely to end up in dangerous or physically demanding jobs.

A new NBER study untangles all these factors to clarify who applies for disability and which applicants ultimately receive benefits through Social Security’s rigorous approval process.

Researchers at Stanford and the University of Wisconsin linked a survey of Americans 50 and older to occupational data describing the level of environmental and physical hazards they’ve faced during decades of working. Next, socioeconomic measures of their upbringing – the adults’ descriptions of their childhood health, education, and parents’ financial resources – were layered into the analysis. Finally, the researchers repeated the process, replacing childhood health with genetic data on their predispositions to various disabling illnesses.

Blue-collar and service workers are known to apply for federal disability benefits at higher rates than white-collar workers. But the researchers showed that low socioeconomic status in childhood – by limiting the options for less strenuous jobs – played an even bigger role than workplace demands in whether the workers applied for the benefits.

However, when it comes to who is approved for benefits, physical and mental job requirements were key – and socioeconomic status plays no role. This makes sense because the heart of Social Security’s approval process is a determination that a disabled person is unable to do his previous job or another job appropriate to his age and experience.

An applicants’ health is, by definition, always central to whether he qualifies for disability. The final step in the researchers’ analysis used genetic data to get a picture of the applicants’ underlying health – as distinct from the health problems originating from a disadvantaged childhood. …Learn More

Diverse Population Uses Nursing Homes Less

Son with father in wheel chair

Since the 1980s, the share of the U.S. population over 65 has grown steadily. At the same time, the share of low-income older people living in nursing homes has declined sharply.

New research by the University of Wisconsin’s Mary Hamman finds that this trend is, to some extent, being driven by an increasingly diverse population of Hispanic, Black, Asian, and Native Americans. They are more likely to live with an adult child or other caregiver than non-Hispanic whites, due, in some cases, to cultural preferences for multigenerational households.

Nursing home residence is also declining among older white Americans. However, in contrast to the Black population, whites are increasingly moving into assisted living facilities. This creates what Hamman calls a “potentially troubling pattern” of differences in living arrangements that might reflect disparities in access to assisted living care or perhaps discriminatory practices. Notably, the researcher finds that the Black-white gap in assisted living use persists even when she limits her analysis to higher-income adults.

Eight states have seen the biggest drops in nursing home use: Florida, Georgia, Louisiana, New Jersey, New Mexico, North Carolina, South Carolina, and Tennessee. Many of these states have experienced fast growth in their minority populations or have more generous state allocations of Medicaid funds for long-term care services delivered in the home.

Growing diversity is actually the second-biggest reason for lower nursing home residence, accounting for one-fifth of the decline, according to the study, which was funded by the U.S. Social Security Administration and is based on U.S. Census data.

As one might expect, the lion’s share of the decline – about two-thirds – is due to policy, specifically changes to Medicaid designed to encourage the home care that surveys show the elderly usually prefer. …Learn More

ACA Eased the Financial Burden on Families

Woman and baby at the doctors

The Affordable Care Act (ACA) has reduced families’ medical costs significantly.

The ACA’s main goal was to provide coverage for the first time to workers who lack employer health insurance. But the expansion of free or subsidized health care to millions of parents with low and modest incomes has improved their financial stability and freed up money for their families’ other critical needs, concluded a new University of California at Davis study.

The main way the ACA expanded coverage was by giving states the option of providing Medicaid to workers earning up to 138 percent of the federal poverty level. The law also increased the number of children with health insurance, because federal and state outreach during the Medicaid expansion raised parents’ awareness of two separate insurance programs that had long been available to children: Medicaid and the Children’s Health Insurance Program. To help families with modest incomes, the health care law put a cap on their annual medical spending.

Prior to the ACA’s passage, out-of-pocket medical costs were a high financial burden for 15 percent of U.S. families. That has fallen to about 10 percent of families in the years since passage, the researchers said.

What qualifies as a high cost burden depends on the family’s income. One example: the researchers determined that a family earning $75,000 had a high cost burden if they paid more than 8.35 percent of their income for out-of-pocket deductibles and copayments.

However, the study is not a current picture of the situation, because it was based on data from health care spending surveys in 2000 through 2017, prior to the pandemic. During the past year, millions of people were laid off and lost their employer health insurance when they may need it most.

But the ACA’s benefits are clear, the researchers said. Another aspect of the reform was to allow workers who earn too much to qualify for Medicaid to purchase subsidized private health insurance on the state exchanges. The law capped the total that workers spend on health care – once they reach the cap, their care is fully covered. …Learn More

Is Job Automation Connected to Disability?

Grocery store clerk with a mask on

Manufacturing workers file more applications to the federal disability program than any other workers. What seems new is that jobs like administrative assistant and retail worker aren’t that far behind.

Is one possible explanation that the computerization of once-routine occupations like these plays a role in decisions to apply for disability benefits?

Consider the example of a retail worker with a bad back who is laid off, or perhaps she quits because she struggled to handle the cognitive challenges of increased automation. Even simple tasks such as processing customer transactions or locating a product at another store now require computer skills. And the worker’s skills may not match up with the technical qualifications needed to find a new job in a labor market where routine jobs are rapidly disappearing.

Given her disability, the worker might decide that her best – or only – option to ensure she has some income is to apply for disability benefits.

Job Automation ChartA study by Mathematica researcher April Yanyuan Wu did not find direct evidence that this skills mismatch triggers applications. But her findings suggest it might be a factor.

Wu provided new statistics on the types of jobs once held by disability applicants and on the changes over time in the job attributes, compared with the changes in job attributes facing the general working population.

Between 2007 and 2014, for example, the share of the applicants’ former jobs that required computer skills rose by 18 percentage points, outpacing the increase for the labor force overall. At the same time, jobs requiring moderate cognitive ability also increased more for people with disabilities than it did for all workers.

Stress is a telling indication of the challenges of increased job automation. The growth in high-stress jobs once held by people with disabilities was much larger than for workers overall, according to the study, which was funded by the U.S. Social Security Administration. …Learn More

Caring for a Parent Can Take Financial Toll

Parent and adult child with masks

Last spring, as COVID-19 tore through the nation’s nursing homes, many people agonized over whether to pull their elderly parents out and assume responsibility for the care.

The fall surge in the virus is no doubt causing more handwringing as adult children again weigh the challenges of home care against concerns about their parents’ physical and mental well-being.

One practical consideration is the impact on the work lives of parental caregivers, who are overwhelmingly women. Recent research has found that “there are long-term costs associated with caregiving reflected in [lower] earnings even long after caregiving has taken place.”

The research involved women in their 50s and 60s with at least one living parent or in-law, though they generally provided care to a parent rather than an in-law.

Workers sometimes downshift their careers in the years prior to retiring, but caregiving can affect whether older women work at all, the researchers found. Among the caregivers they followed, the share who were working fell by nearly 2 percentage points, to about 56 percent, after their duties began. And the caregivers who remained employed worked fewer hours after taking on a parent’s care.

Women also earned less over the long-term if they had spent time as a caregiver. They saw about a 15 percent decline in their earnings by the age of 65 – or nearly $1,800 per year, on average – according to an update of a study initially funded by the Social Security Administration with subsequent funding from the Sloan Foundation. …Learn More

Man using stand up desk

Disability Accommodations Help Workers

This big number may surprise you: one out of every four adults feels they need some type of accommodation by an employer for a medical condition or disability.

This finding comes from a study in the Journal of Policy Analysis and Management that established a very inclusive standard for determining the need for employer accommodations. The researchers concluded, after following individuals 18 and older in their study for four years, that their employment rate was higher when they received support.

The Americans with Disabilities Act of 1990 requires employers to provide workers and job applicants with a “reasonable accommodation.” But disabling conditions aren’t always visible, and many people never ask employers for assistance. In addition, some employers – particularly small firms – may see accommodations as too costly.

In their 2014 supplement to a periodic RAND survey, the researchers found that 23 percent of workers and unemployed individuals said “yes” to a broad question designed to get a more accurate estimate of need than standard surveys: Does, or would, a special accommodation for your health “make it easier for you to work?”

This group was made up of workers who were already receiving an accommodation, as well as employed and unemployed individuals who felt they could use such support.

Workplace accommodations range from small things like buying a standing desk for an office worker with acute sciatica to reassigning a warehouse worker to a less physical task after he develops back problems. About half of the people who said an accommodation would help them received one – and the benefits were clear.

Between 2015 and 2018, their employment rate held steady at around 85 percent. But the rate for the people who weren’t being accommodated fell sharply, from 92 percent to 72 percent, according to the study funded by the Social Security Administration. …Learn More

Two older workers

Older and Self-Employed – a Diverse Lot

Self-employed workers who are 50 and older fall into a hierarchy of sorts, a new study finds.

The largest group is the 75 percent who work independently in jobs like freelancer and gig worker. Their average earnings are low – $18,000 a year – and they are more likely to be women or Hispanics.

The other 25 percent of the self-employed older workers are primarily white men and are evenly divided between business owners and managers who work on a contract basis. These individuals tend to be doctors, lawyers, or executives in industries ranging from finance and construction to retail.

To get a better handle on who is choosing self-employment and why, University of Michigan researcher Joelle Abramowitz analyzed 2016 survey data from the Health and Retirement Study. These data included not only older workers’ employment status but also specific information about their employers, industries, and occupations.

The self-employed account for roughly one out of five older workers, but the arrangement is especially popular among boomers over 65 – a third of the workers in this age group are self-employed.

Abramowitz’s research, funded by the U.S. Social Security Administration, finds a lot of diversity in the jobs the self-employed do and in their perceptions of work.

The low-paid independent workers dominate jobs like caregiver, cleaner, farmer, artist, and beauty industry worker. Many view themselves as “retired” and say they would rather not work but apparently need to supplement their retirement income.

In contrast, the owners and managers are far less likely to see themselves as officially retired. Compared with the independent workers, they earn considerably more and are wealthier. The net value of their financial, housing and other wealth exceeds $1 million on average.

Their attitudes are different too. …Learn More