Nursing Home Reform

Abstract

Based on data from the 1982 Social Security New Beneficiary Survey (NBS), the 1991 New Beneficiary Follow-up (NBF), and Social Security administrative records, this study analyzed determinants of the elderly's Supplemental Security Income (SSI) participation, denied application, and nonapplication. In the analysis, SSI application is conceptualized as an outcome of a complex interaction among financial, sociodemographic, health, and informational factors as well as those indicative of elderly persons' subjective perception of need. The findings indeed confirmed that objective financial need does not automatically lead to SSI application. Sociodemographic and health-related factors mediating the objective financial need are identified, although the subjective perception of need and informational barriers requires further evaluation. Policy implications include continued dissemination of information about SSI and relaxation of the resource test to qualify more low-income elderly.     

Options to liberalize Social Security disabled widow(er)s benefits

Each month, 200,000 widows and 6,000 widowers receive Social Security disabled widow(er)s benefits, each benefit averaging about $550. Among the most economically at-risk Social Security beneficiaries, their benefits are permanently reduced. This paper reviews the legislative history of the disabled widow(er)s benefit, identifying key decisions that gave shape to this benefit. Social Security program data and six years of Current Population Survey data (March Annual Demographic Files, 1995-2000) are used to profile the economic status of current and potential disabled widows. The analysis, including comparison with other widows, provides strong evidence of economic need among disabled widows with, for example, 44% of disabled widow beneficiaries, ages 50-59, having below-poverty incomes compared with 15% of like-aged non-disabled widows. We conclude that serious consideration should be given to extending eligibility to all widow(er)s disabled before the normal retirement age; to providing a benefit equal to 100% of the deceased spouse's private insurance amount (PIA); to eliminating the unnecessarily restrictive seven-year rule; and to protecting beneficiaries from losing their eligibility to Medicaid. Even in the context of today's heated Social Security debate, we suggest that a rare opportunity may exist to garner bipartisan support for meaningful, low-cost improvements, in a benefit that primarily targets women.     

Social Security and SSI as safety nets for the elderly poor

Partial privatization of Social Security is being considered as an integral part of the future Social Security program for American retirees. Because privatization creates uncertainty about the amount of retirement income that future retirees may expect to receive, the issue of a safety net is critical. This article presents the findings from an empirical study that investigated the degree to which the current Social Security and Supplemental Security Income (SSI) programs provide a safety net, separately and in combination, to the elderly poor. The major findings were that the Social Security program not only increases the income statuses of both posttransfer and pretransfer poor elderly people considerably, but that the program also significantly equalizes the distribution of income among them. In addition, the SSI program supplements the Social Security program in establishing an even greater safety net, especially for posttransfer poor elderly people. On the other hand, Social Security benefits make the income disparity among races greater between both posttransfer and pretransfer poor elderly people. Implications for policy are discussed.     

Social insurance and children: The relationship between Social Security,economic well-being,and family context among child recipients

The relationship between social insurance, which provides families protection against certain risks, and child economic security is understudied. Using the 2004 Survey of Income and Program Participation (SIPP) matched to Social Security Administration benefit records, this article investigates the economic welfare effects of the child component of the US Social Security program. We examine how the poverty rate of child beneficiaries would change, absent Social Security income, and how heavily the family incomes of these children rely on it, by family characteristics. Our findings reveal that Social Security plays an important role in mitigating economic insecurity among children deprived of a wage-earning parent through disability, death, or retirement. Family structure, earnings, and employment status are identified as key factors moderating the effect of Social Security on child recipients’ financial circumstance.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

Can Benefits and Work Incentives Counseling be a Path to Future Economic Self-Sufficiency for Individuals with Disabilities?

In this paper, I estimate the relationship between benefit counseling and work incentive services and various labor market outcomes in the case of Supplemental Security Income /Social Security Disability Insurance beneficiaries who from 2003 to 2009 participated in the Vocational Rehabilitation programs in New York State. Using the propensity score matching approach, I find that counseling services can increase the probability of successful case closure by 5.2 percentage points. At the same time, these services can increase the earnings and working hours of beneficiaries by $42 and 3.3 h per week, respectively. Moreover, there is a $0.59 per hour increase in the wage rate for service recipients. From these results I conclude that providing benefit counseling and work incentive services helps beneficiaries who have strong employment goals achieve financial independence.     

The Disability Screening Process and the Labor Market Behavior of Accepted and Rejected Applicants: Evidence from the Health and Retirement Study

This paper uses Social Security earnings records linked to data from the Health and Retirement Study to examine the labor market behavior of rejected and accepted disability applicants prior to their application. We find that rejected applicants have substantially lower earnings and labor force participation rates during the decade prior to application than beneficiaries. Also, we find some evidence of a divergence between these groups, with rejected applicants leaving the labor force at a faster rate than beneficiaries as their application date approaches. One interpretation of these results is that the disability screening process on average separates those who are at least partially motivated by adverse economic circumstances when applying for disability benefits from other applicants.     

Social security reform in the twenty-first century: the United States

The paper reviews the history of the Social Security system in the United States in the twentieth century and discusses options for the twenty-first. Because of the steady aging of the U.S. population and the impending retirement of the large baby boom cohort, the Social Security program now is in long-term actuarial deficit. The standard twentieth century approach to this actuarial deficit would be to raise payroll taxes enough to pay for anticipated future benefit increases, but for several reasons that approach may not be so popular this time around. The author's preferred approach is a gradual trimming of long-term benefit growth, plus "add on" individual accounts to provide new saving, for the economy and for the retirement system. The paper also criticizes proposals for Social Security reform made by President Clinton and a committee appointed by President Bush, generally because these proposals do not provide enough new saving.     

Public support for social security

This article reports the results of a nationally representative survey of 1,209 Americans that examines their support for Social Security and six other major social welfare programs. It probes the extent to which members of the public are willing to demonstrate their support, the differences in support among population subgroups, and the extent to which perceptions of Social Security and Social Security recipients predict overall support for Social Security. The authors find high levels of support among members of the public, including a willingness both to write letters to congress members and to pay higher taxes. Some groups of citizens—especially blacks and those who classify themselves as liberals—are more supportive than others, but the differences are not great and contribute little toward explaining the variance in support. The perceptions that the program makes a worthwhile contribution to society and that recipients have no alternative sources of income other than Social Security contribute the most toward predicting overall support for Social Security.     

Spinal Cord Injury

ABSTRACT

This article provides an overview of spinal cord injury (SCI) that is useful and informative for social workers and other health care professionals who work with this population. Social workers new to the specialty of spinal cord injury must expand their knowledge base of this chronic injury. Social workers contribute to the rehabilitation process through assessment, education, and discharge planning. This article also may be used to inform persons with spinal cord injury and their families and to encourage them to engage in dialogue about SCI in the earliest stages of treatment and rehabilitation.     

Aging,Health, and Social Policy:

Seven major turning points in the evolution of U.S. aging policy are identified and reviewed: (1) the Social Security Act (2) the Great Society (3) the federalization of Old Age Assistance (4) the enactment of comprehensive social services (5) Social Security improvements (6) New Federalism, and (7) medical cost-containment policies under Medicare and Medicaid. In the 1980s, significant and growing problems of uninsurance and underinsurance for health care have re-emerged. Simultaneously, state Medicaid programs are characterized by their increasing variation and inequities, while there has been a decline in access for the poor. The future of aging policy will be decided in the context of four socio-demographic realities: (1) population aging (2) trends in mortality and morbidity (3) the relationship between income and health, and (4) aging as a woman's issue. The article concludes with a call for a recommitment to the public interest and to public solutions which affirm that health care is an inalienable right.     

Low Confidence in Social Security Is Not Warranted

The public's low confidence in Social Security is unwarranted. Social Security as discussed here means the old-age, survivors, and disability insurance program (OASDI) but does not include Medicare. Its financial condition is excellent in the short range and sound in the long range, based on intermediate-cost estimates. Those who believe otherwise are too pessimistic about our demographic and economic future. The OASDI cost rates are expected to remain at today's level for the next three decades, and will rise starting about 2020. The cost rates are expressed as a percentage of taxable payroll. Because the taxable payroll as a proportion to total compensation is projected to decline, the cost rates in the future will rise even when benefit payments do not. This problem could be solved by a method that effectively taxes total compensation at a constant percentage rate. Another reason for cost rates to rise is population aging. It is possible to reduce the cost rates if educational and work environments are made more hospitable to long worklives. Although population aging is a basic reason for OASDI costs to increase, only about two thirds of such costs are for retirement benefits. The rest is for disabled workers and families of workers.     

An ergonomic analysis of work in the process of professional rehabilitation in Brazil

The purpose of this study is to describe the use of the Ergonomic Analysis of Work (EAW) in the process of rehabilitating workers, insured by the National Institute of Social Security (INSS) in Brazil, and to conduct a brief analysis of the instrument used by this body. Information obtained from EAW enabled the demand, the requirements of the activity and the skills needed to perform the tasks in the workplace to be determined, thus aiding the decision of the INSS as to rehabilitating the workers and their return to their jobs.     

A Review of the Racial Biases of Social Welfare Policies

Social welfare policies are crucial in advancing the well-being of individuals, yet they recreate the social disadvantage they attempt to ameliorate. Notably, these policies have perpetuated racial inequality in our society by implicitly or explicitly disadvantaging certain groups. This paper presents a review of the biases of social welfare policies. Using components of social construction and critical race theories, this paper highlights the ways the design and implementation of policies are racially bias. Among the policies it examines are mothers' pension, Social Security Act, and the Personal Responsibility and Work Opportunity Reconciliation Act.     

Plagiarism and the Web

TechNotes is a new occasional column in the Journal of Social Work Education designed to bring to readers’ attention new developments in technology of relevance to social work education. In this first column, Robert F. Vernon, associate professor, School of Social Work, Indiana University/Purdue University at Indianapolis, Shirley Bigna, assistant director, Krannert Memorial Library, University of Indianapolis, and Marshall L. Smith, professor, Social Work Department, Rochester Institute of Technology, describe technology that can help educators to deal with plagiarism.     

Teaching Clinical Social Work Skills Entirely Online: A Case Example

While numerous disciplines have eagerly embraced innovative educational technology, many social work educators have not been among early adopters. Social work's focus on the human connection and hands‐on practice skills can seem antithetical to technology‐mediated education. Nevertheless, social work programs are implementing distance learning and Internet‐mediated courses, and some schools are offering entire social work courses online. Leading the way in this regard is the Florida State University College of Social Work, which has developed and implemented the first CSWE‐accredited, entirely online Master of Social Work program. The purpose of this paper is to describe the development, design, and implementation of one skills‐based clinical course in this program, with the goal of sharing information in a way that will further the discussion of the risks and benefits of online education as well as provide guidance for educators who may be interested in developing a skills‐based online course in the future.     

Restrictiveness of Eligibility Determination and Medicaid Enrollment by Low-Income Seniors

Medicaid is an important source of supplemental health care coverage for low-income seniors, yet little is known about the effect of state policy on Medicaid enrollment by eligible elderly. Data from a nationally representative survey were used to examine Medicaid enrollment by elderly, low-income Medicare beneficiaries living in states that liberalize or restrict Medicaid eligibility criteria using the 1986 Omnibus Budget Reconciliation Act or provision 209(b) of the 1972 Social Security Act Amendment, respectively. Controlling for demographics and health status, residence in states applying these laws was significantly, though modestly, associated with Medicaid enrollment. Additionally, 73% of eligible elderly Medicare beneficiaries were not enrolled in Medicaid, and most have serious chronic health problems. These findings suggest that a significant number of eligible elderly are not enrolled in Medicaid and that liberalizing or tightening Medicaid eligibility criteria can have an impact on Medicaid enrollment by low-income elderly patients.     

Using the Medicare buy-in program to estimate the effect of Medicaid on SSI participation

This article assesses the importance of receiving supplemental health insurance on participation in Supplemental Security Income (SSI) for the elderly. The implementation of the Qualified Medicare Beneficiary (QMB) program offered a substitute for Medicaid, and expanded health insurance eligibility to a higher income level. Using a sample of elderly respondents aged 66 to 75, I find that the QMB program reduced SSI participation. More than half of the QMB participants were previously covered by SSI and Medicaid. The calculations suggest that the QMB program was not as expensive as it might first appear because of reductions in SSI expenditure.     

Community Needs Assessment

Abstract

Comprehensive geriatric assessments of older adult residents of a senior-only development of New York City Housing Authority (NYCHA) conducted by a physician-investigator found that the majority of senior residents suffer from chronic health conditions such as cardiovascular, arthritis, diabetes, take more than five medications, have scored high on body mass index and are at nutritional risk. Surprisingly majority of residents function on their own and need no help in instrumental activities of daily living (IADL) and activities of daily living (ADL). They have very good mental health and only a very small proportion suffer from depression.

The majority of the residents has a personal physician and is covered by Medicare. All of the residents are of low income, 38 percent of the residents living on Supplemental Security Income (SSI) and the rest living on Social Security. Racially/Ethnically 66 percent of seniors are Black, 26 percent are Hispanics, 8 percent are White and less than 1 percent are other. Forty-seven percent of the residents are 75 years in age and over.     

Representations and complaints procedures

One of the potentially more onerous responsibilities of programme providers offering Diploma in Social Work Courses, is the strong recommendation in CCETSW PAPER 30 at Paragraph 3.2.4.2 to establish a clear procedure for handling complaints. This article seeks to outline the potential difficulties in establishing such a procedure, discusses some of the principles which in the writer's view are necessary core conditions for an effective procedure and outlines a possible model for practice. This model was consulted with students, practice teachers and university based teaching staff. Consultation with the full membership of the Diploma in Social Work Partnership and with the wider university is not completed at the time of writing. It is hoped that a subsequent article will outline the final structure of the model agreed upon and its operation on a trial basis for 12 months from Spring 1992.

The writer has had experience of developing and operating a complaints procedure for workers in voluntary social work agencies in New Zealand and also for foster carers in a London borough. The article draws on experience in those two very different settings, as well as the experience of working to develop a procedure for the Diploma of Social Work course.