DESCRIPTION OF THE US WORKING AGE DISABLED POPULATIONS LIVING IN INSTITUTIONS AND IN THE COMMUNITY

This study provides national estimates of the size of the US working age disabled populations in institutions and in the community, and describes these populations along a number of dimensions. By using data from the Institutional Population and Household Survey Components of the 1987 National Medical Expenditure Survey, the study represents the first time that these populations have been studied using comparable data. The working age disabled population was identified as persons between the ages of 21, and 64 who experienced difficulty with at least one of the activities of daily living (ADLs). Using this definition, approximately 1% of the total US population was found to be working age disabled (n = 2.6 million). Of these, 11% (n = 282000) resided in long-term care facilities. Significant differences were observed between the institutionalized population having mental retardation (MR) and those with physical disabilities only. Relative to the MR population, members of the physically disabled population had more severe limitations in ADLs, entered the facility at a later age, had much shorter stays, and were more likely to have a spouse and children who might provide support for community-based living. However, some physically disabled persons were admitted early in life for very long stays, similar to the situation for most persons with MR. Comparisons of the working age disabled populations in institutions and in the community showed that those in the community had fewer ADL limitations than their institutionalized counterparts and were much more likely to be married. Although a surprisingly large proportion of the community-based disabled population lived alone (23%), 70% lived with at least one relative. Help with ADLs was usually provided by a relative living in the same home; little use of community support services was reported. Finally, a significant proportion of disabled young adults currently living with their parent(s) appear to be at high risk of eventual institutionalization.