Yonatan Ben-Shalom

How Do Working-Age People With Disabilities Spend Their Time? New Evidence From the American Time Use Survey

We use the American Time Use Survey to examine the extent to which adults with disabilities—defined using both the new six-question sequence on disability and the traditional work-limitation question—spend more time on health-related activities and less time on other activities than those without disabilities. We find that men and women who both reported a work limitation and responded “yes” to any of the questions in the six-question disability sequence spend approximately 40 to 50 more minutes per week, respectively, on health-related activities. We also find that most working-age men and women who report a disability work fewer hours per day than men and women without disabilities. The largest difference is for men and women who report both types of disability; these individuals spend, on average, 5 fewer hours per day in paid work than men and women without disabilities. On average, most of the decrease in paid work time is offset by more time spent on leisure activities (defined as activities that provide direct utility, such as entertainment, social activities, attending recreational events, and general relaxation) and sleeping, which is likely due to these being default activities for individuals whose medical issues and environment constrain them from participating in other activities.

Return-to-Work Outcomes Among Social Security Disability Insurance Program Beneficiaries

We followed a sample of working-age Social Security Disability Insurance (DI) program beneficiaries for 5 years after their first benefit award to learn how certain factors are associated with achievement of four return-to-work milestones: enrollment for employment services provided by a state vocational rehabilitation agency or employment network, start of a trial work period (TWP), completion of TWP, and suspension or termination of benefits because of work. We found that younger beneficiaries are more likely than are older beneficiaries to achieve the milestones and that there exists substantial variation across impairment types. In addition, the probability of achieving the milestones is higher for individuals with more years of education, for Blacks, and for individuals residing in states with low unemployment rates at the time of award. It is lower for beneficiaries with a high DI benefit amount at award, an award decision made at a higher adjudicative level, and/or Supplemental Security Income or Medicare benefits at the time of DI award. We also found large variation in the relationships of both state of residence and award month to these return-to-work outcomes. We attribute these variations to unobserved factors at the state-level, policy changes, and trends in unobserved beneficiary characteristics.

Predicting Disability Among Community-Dwelling Medicare Beneficiaries Using Claims-Based Indicators

OBJECTIVES To assess the feasibility of using existing claims-based algorithms to identify community-dwelling Medicare beneficiaries with disability based solely on the conditions for which they are being treated, and improving on these algorithms by combining them in predictive models. DATA SOURCE Data on 12,415 community-dwelling fee-for-service Medicare beneficiaries who first responded to the Medicare Current Beneficiary Survey (MCBS) in 2003-2006. STUDY DESIGN Logistic regression models in which six claims-based disability indicators are used to predict self-reported disability. Receiver operating characteristic (ROC) curves were used to assess the performance of the predictive models. PRINCIPAL FINDINGS The predictive performance of the regression-based models is better than that of the individual claims-based indicators. At a predicted probability threshold chosen to maximize the sum of sensitivity and specificity, sensitivity is 0.72 for beneficiaries age 65 or older and specificity is 0.65. For those under 65, sensitivity is 0.54 and specificity is 0.67. The findings also suggest ways to improve predictive performance for specific disability populations of interest to researchers. CONCLUSIONS Predictive models that incorporate multiple claims-based indicators provide an improved tool for researchers seeking to identify people with disabilities in claims data.

Employers’ Perspectives on Accommodating and Retaining Employees with Newly Acquired Disabilities: An Exploratory Study

Introduction Timely and appropriate accommodations can help employees who experience disabilities stay at work instead of exiting the labor force. Employers can play a critical role in connecting such workers with the accommodations they need. This qualitative study seeks to inform policy makers who want to improve workforce retention outcomes by uncovering factors that affect whether employers provide accommodations to, and ultimately retain, employees with disabilities. Methods We conducted semistructured interviews with a convenience sample of human resources professionals in 14 Arkansas-based employers, yielding detailed information on 50 cases in which an employee developed or disclosed a disability. We analyzed the interviews using a grounded theory approach and compared cases to identify key themes emerging across subgroups of cases. Results Two organization-level factors and four employee-level factors influenced employers’ efforts to accommodate and retain employees with disabilities: employer resources; employers’ communication with the employee and other stakeholders; employee tenure; employee work performance; active/sedentary nature of employee role; and the severity and type of employees’ health conditions. Conclusions Consistent with prior literature, employers with greater access to resources and better ability to communicate generally made greater effort to accommodate and retain employees with disabilities. However, employers in the study did not deploy these resources and processes consistently when making decisions about whether and how to provide accommodations to workers with disabilities; employee-level characteristics affected their actions. Policy makers should consider intervention approaches that reach workers who may be overlooked by employers with scarce resources.

Pathways Taken by New Social Security Disability Insurance and Supplemental Security Income Awardees

We use administrative data to examine the various milestones achieved and pathways followed by new Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) awardees. Our findings show that 80% of DI-first awardees and 53% of SSI-first awardees either achieved none of the milestones we tracked in the 10 years after their initial award or their only milestone was death or attainment of full retirement age. Furthermore, many DI and SSI awardees who achieved work- or program-related milestones during the analysis period did not make additional progress toward exiting the program. For example, one third of DI-first and one fifth of SSI-first awardees who enrolled in employment services had no other milestones and one quarter of DI-first awardees who completed a trial work period either had no other milestones or their only additional milestone was enrolling in employment services. We also found that approximately one quarter of SSI-beneficiaries who later received DI had their SSI benefits suspended and terminated due to excess income that included DI payments as the only additional milestones. Finally, our analysis reveals great diversity in the paths taken to achieve work- and program-related milestones, which policy makers should consider when designing interventions to help awardees return to work.

Maternal Employment and Household Food Production: Implications for Nutrition and Obesity

This paper explores the mechanisms through which maternal employment affects the quality of household nutrition and the implications for obesity of family members. Using comparable samples from the American Time Use Survey (ATUS) and the Continuing Survey of Food Intake by Individuals (CSFII), I find that maternal employment is negatively associated with time spent shopping for and preparing food and positively associated with the share of household food expenditure spent on food prepared away from home. This substitution of money for time in food consumption can have detrimental effects on the nutrition of both adults and children in the family. In married-couple families, I find that the quality of food-intake falls with maternal employment in all subgroups studied, and that obesity sometimes, but not always, rises with maternal employment. In single-mother families, however, my results suggest a weaker association between maternal labor supply, quality of food intake, and obesity. Overall, my findings suggest that maternal employment can explain very little of the time trend increase in obesity.

Opportunities for Early Intervention to Avoid Prolonged Work Disability: Introduction to the Special Section

Purpose The articles in this special section examine opportunities for early intervention that is intended to retain the jobs of workers who have medical conditions that could put them at risk of prolonged work disability. Methods The first three articles examine options for analyzing various types of disability claims data for targeting early intervention; the fourth article provides new information from 50 case studies on how employers decide to invest in the retention of individual workers. Results Together, the four articles demonstrate that there may be an opportunity to positively affect longer-term outcomes for workers with medical conditions. This would be accomplished by building and expanding on existing systems in order to efficiently identify, and provide timely support to, workers with medical conditions in a critical period during which the decisions and actions of various stakeholders, including the workers themselves, may have a major influence on these outcomes. Conclusions Forthcoming opportunities to develop, implement, and test evidence-based interventions to promote job retention can provide further insight into the value of the options described in the articles.

Impacts of the 2010 VA PTSD Rule Change on Veterans’ Disability Compensation and Reported Cognitive Disability:

In July 2010, the Department of Veterans Affairs (VA) simplified the process of obtaining veterans’ disability compensation (DC) for veterans with posttraumatic stress disorder (PTSD) who served in combat zones but not in combat roles. In this article, we use data from the Current Population Survey (CPS) Veterans Supplement to estimate the impacts of the change in the VA PTSD rule on DC benefit receipt and self-reported cognitive disability. We hypothesize that the easing of eligibility rules led to an increase in DC receipt among veterans who served in combat zones but not in combat roles. It may also have led to reduced stigma among veterans with regard to reporting cognitive disability. Our results are consistent with these hypotheses. Self-reported rates of VA disability and DC receipt increased significantly among combat zone veterans. Self-reported VA disability rating and experience of cognitive disability also increased, but these increases were not statistically significant. During the same period, the rate of self-reported disability other than cognitive disability remained the same.

Working Toward Success Current Evidence on Employment Outcomes for People With Disabilities

There has been a long-standing interest by policymakers in ways to reverse the declining rates of employment and high poverty rates of people with disabilities.