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PubMed2004

Elder law, Medicare, and legal issues in older patients.

Elder law is a specialty area of law directed at the specific needs of older clients and clients with disabilities. This review discusses major legal issues faced by older patients, their families, and their health care providers, including the capacity to consent to treatment, advance directives, and surrogate decision-making. In addition, public benefit programs such as Medicare, Social Security Disability Insurance, Medicaid, and Supplemental Security Income are examined. Available options for long-term care, both institutional and community-based are also highlighted. Finally, elder abuse is discussed. All who provide care to an elder must be aware of the potential signs of abuse and the remedies available.

Advance Care Planning↗
PubMed2003

Diabetes mellitus related morbidity, risk of hospitalization and disability.

OBJECTIVE: To investigate the rates of complications, hospitalizations and disabilities attributable to type 1 and type 2 diabetes mellitus (DM) combined, unless otherwise noted. METHODOLOGY: Risk assessment of DM-related morbidity, hospitalizations and disabilities using data from the medical literature and health statistics on the population. Calculation of morbidity, hospitalization, and disability ratios (MbR, HR, DR) will allow comparison of observed rates in people with DM to those reported in the nondiabetic population. RESULTS: MbRs vary according to the morbid condition studied: approximately 300% at age 45-64 years for ischemic heart disease, 533% for coronary heart disease or stroke, 226% to 388% for chronic heart failure, 560% for peripheral vascular disease, 380% for neuropathy at age 35-74 years, 890% to 2225% for lower limb amputations, 1458% to 3287% for end-stage renal disease. For ocular complications: cataracts, 165% to 232%; glaucoma 140% to 330%; trouble seeing, 180% to 231%; blindness at age > or = 65 years, 517%. Higher values are noted at younger ages. HR: 200% to 409%. DR: 217% to 328%. CONCLUSION: Among diseases, DM is one of the leading and growing causes of hospital admission and disability. Precise risk assessment of morbidity is essential for realistic underwriting of health and disability insurance.

Adult↗
PubMed2005

Sarcoidosis: a review.

Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas found in the lung, lymphatic systems, and potentially in a host of other tissues and organs. Despite intriguing hints of infectious or environmental etiology, causation remains a mystery. The diagnosis, therefore, requires demonstration of granulomatous inflammation in more than one organ and exclusion of any of the known causes of granulomatous disease or local sarcoid reaction. Clinicians and underwriters alike frequently forget the latter requirement. For this reason, the other causes of granulomatous inflammation will be included in this treatise. Although the vast majority of applicants with sarcoidosis exhibit limited or remitting disease, the remaining applicants represent increased risk of both morbidity and mortality. This paper reviews the relevant clinical, radiographic, and laboratory findings that may help identify those applicants with increased or prohibitive risk for life or disability insurance.

Adult↗
PubMed1995

[Work capacity evaluation in occupational disability (supplementary) insurance. What should the medical expert know about industrial practice?].

Up to now it has often been the responsibility of physicians to assess whether an insured person qualifies for disability benefits, although the insurance conditions in fact state that the problem is not purely a medical one. Indeed, it is advisable to take advantage of the expertise available in the field of Occupational Studies when assessing elibility for benefits. The spectrum of occupations is subject to constant change. The "classification of Occupations" published by the Federal Employment Agency in Nuremberg lists some 25,000 occupational designations. Further, several thousand agreements are concluded each year between employers and employees' representatives at various levels and these may need to be taken into account when assessing claims for disability benefits. Occupational Studies is a specialist area in its own right, requiring specific training and experience. The assessment of disability claims calls for close cooperation and teamwork: doctors, insurers and occupational consultants must each contribute their own particular skills to the decision-making process. In the final analysis, however, it is the insurer alone who must take responsibility for accepting or rejecting the disability claim. The present paper starts by discussing the term "Occupational Studies" and goes on to explain the tasks of the occupational consultant. Finally, reference is made to descriptions of occupations as well as workplace features and requirements which the medical expert should take into account when assessing and insured's ability to work in a given occupation.

Disability Evaluation↗
PubMed1987

Work values of disabled beneficiaries.

Although disabled beneficiaries are not expected to work, do they continue to value work? This article compares data on a particular concept of work values, the importance to the self of having a job, for social security disability insurance beneficiaries, other disabled persons, and nondisabled persons interviewed in the Social Security Administration's 1978 Survey of Disability and Work. Descriptive comparisons of these three groups with similar demographic characteristics indicates that belief in the importance of a job does not decline after entitlement to disability insurance benefits. The findings support current efforts to promote re-employment through work-incentive and vocational rehabilitation policies.

Adolescent↗
PubMed1998

[Risk assessment expanded accident insurance for children].

Disability is a well known and tragic event for children. While adults are an established group for specific disability insurance cover, children were often neglected in the past. Although parents, organizations and paediatricans are aware of the risk, children specific incidence rates for disability are hardly available. The only sufficient source for some statistical data are the accident statistics because they represent a substantial group of specific cause related disability for children. Incidence rates for disease related chronic severe impairment or disability in children are either derived by single disease research or actuarial calculation of the German Social Disability Registration. Based on this statistical background, an extended accident insurance for children was introduced in Germany covering both accidents and disabling diseases. The key limitation for all variations of this insurance are exclusion clauses for congential diseases and mental disorders. This insurance requires a new approach in underwriting of the health risks. Because of the substantial number of impaired children, a simple decline of substandard cases are unacceptable. The early experience or medical underwriting shows predominantly health impairments of the following types: allergies, bronchial asthma, ectopic eczema (neurodermitis), disorders of speech and articulation, vision disorders and mental impairments. The suggested solution for underwriting of substandard risks is the predetermination of the possible future maximum degree of disability. The need for underwriting guidelines is supported by the market impact of the new disability cover with thousands of insurance policies issued in the first month after introduction.

Adult↗
PubMed1994

Occupational impairment and disability among applicants for Social Security disability benefits in Pennsylvania.

OBJECTIVE: The study goal was to assess the extent of workplace-related disease and injury among Social Security Disability Insurance applicants. METHODS: A convenience sample of 240 consecutive applicants to the Pennsylvania Bureau of Disability Determination was studied to assess the prevalence of work-related disorders. An applicant had a work-related condition if there was a clear statement of a workplace illness or injury associated with the impairment, or if the applicant had worked at an occupation with a high likelihood of exposures known or suspected to contribute to the condition of interest. RESULTS: Of the 240 applicants, 166 (69%) were awarded disability insurance benefits; a total of 27 (11%) had work-related conditions, including 14 of the 166 (8%) who were found to be disabled. Forty percent of the 27 had a disorder that was musculoskeletal in origin. Of 59 applicants with cancer, 10.2% had some work-related etiological component. Of an estimated 71,680 adult disability insurance applicants in Pennsylvania in 1990, 5134 new insurance beneficiaries had a projected occupationally related disability. CONCLUSIONS: A substantial number of applicants for disability insurance benefits suffer from an impairment caused or exacerbated by prior workplace exposures. These individuals may serve as sentinel events for initiating follow-up surveillance and prevention activities.

Accidents, Occupational↗
PubMed1989

The taxes of sin. Do smokers and drinkers pay their way?

We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.

Alcohol Drinking↗
PubMed2003

Disability payments, drug use and representative payees: an analysis of the relationships.

AIMS: This study attempted to determine: if US federal cash disability payments increase the use of cocaine or opiates among those requalifying for supplemental security income (SSI) disability benefits compared with those who lost benefits; if drug use peaks at the beginning of the month after the receipt of the disability cash disbursement; and if money management by representative payees of requalifying SSI recipients suppresses drug use. DESIGN: A multi-site, prospective, 2 year longitudinal design was used with follow-up interviews conducted every 6 months. Urine samples were collected at the final three follow-up interviews. SETTING: Data were collected in Chicago, IL, Los Angeles, CA, and Seattle, WA, USA. PARTICIPANTS: This study used a randomly selected sample of 740 former recipients of SSI who had received disability benefits for drug addiction and alcoholism (DA&A) in 1996, were between the ages of 21 and 59 years, had not received concurrent social security disability insurance and provided testable urine samples and complete self-report data for at least one follow-up interview. MEASUREMENTS: Independent variables included demographics, SSI status at follow-up, representative payee status, drug treatment participation and income. Time of drug testing was operationalized as the first 10 days of the month versus the last 20-21 days based on when the urine sample was collected. The dependent variables were cocaine and opiate use, determined by urinalysis results. FINDINGS: Participants were 28% more likely to test positive for cocaine use in the first 10 days of the month than later in the month. This effect was general across all subjects and was not restricted to those receiving SSI benefits. No such effect was found for opiate use. Receiving SSI benefits did not increase cocaine or opiate use generally, nor did having a representative payee suppress use. CONCLUSIONS: The findings do not support the contentions that federal cash benefits appreciably increase drug use or that representative payees discourage use, at least when use is defined dichotomously. The 'check effect' for cocaine use appears to be general and not confined to those receiving federal cash benefits. The lack of a 'check effect' for opiate use is probably the result of the difference between a relatively steady state of opiate use associated with addiction and a binge pattern of cocaine use triggered by suddenly flush resources.

Adult↗
PubMed2003

Characteristics of third-party money management for persons with psychiatric disabilities.

OBJECTIVE: The study examined different types of third-party money management arrangements for persons with psychiatric disabilities and consumers' perceptions of their finances in the context of these arrangements. METHODS: Clinical and demographic data were collected through structured interviews and record reviews for 240 persons with a diagnosis of a psychotic or major affective disorder who had been involuntarily hospitalized and were awaiting discharge on outpatient commitment in North Carolina. All consumers were receiving Supplemental Security Income or Social Security Disability Insurance. RESULTS: Third-party money management arrangements were reported by 102 (41 percent) of the study participants. A majority (77 percent) of these consumers had their finances managed by a family member. Consumers with third-party money managers were more likely to have a median annual income below 5,000 US dollars, to have a diagnosis of a primary psychotic disorder, and to have substance use problems. Most participants with third-party money managers reported that they received sufficient money to cover basic expenses, although about half also perceived having insufficient money to participate in enjoyable activities. CONCLUSIONS: Given that treatment for severe mental illness emphasizes social skills training and development of social support networks, financial limitations could undermine therapeutic efforts. It is important that clinicians consider the role of financial concerns when assessing consumers. Additional research should be conducted to better understand the role of financial variables in providing effective mental health services.

Adult↗
PubMedDate not supplied

Employing persons with serious mental illness.

Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. More than a third of persons with serious mental illness also work, and many hold high-status positions. Among those with schizophrenia, a diagnosis associated with high impairment, only slightly more than a fifth are at work, and 12 percent are working full time. Approximately two-thirds are enrolled in federal disability insurance programs. Our analyses indicate considerable diversity of jobs among persons with various mental disorders. Most persons with mental illness want to work, and some with even the most serious mental disorders hold jobs requiring high levels of functioning. Educational attainment is the strongest predictor of employment in high-ranking occupations among both the general population and persons with mental disorders.

Activities of Daily Living↗
PubMed1996

How aware are employees of their benefits? Findings from two companies.

This study examines benefit awareness of employees in two companies. Contrary to previous research, the results show that employees are generally accurate in their perceptions of the benefits available to them. However, the results also show a lack of awareness of unemployment insurance and disability insurance as benefits. In addition, employees were somewhat uncertain regarding costs of benefits to employers. These findings suggest that employers should monitor employee awareness of benefits and target communications to specific problem areas.

Attitude↗
PubMed2001

Group disability income: new policies emphasize employee appeal.

Group disability insurance is a voluntary benefit that offers advantages to both employers and employees. Employees who want this kind of coverage realize that their employers have done much of the homework for them in terms of comparing benefits, rates and contract provisions. Employers recognize an opportunity to add a benefit that may help attract and retain valuable employees with little additional cost or administrative burden.

Consumer Behavior↗
PubMedDate not supplied

Structured and nonstructured exercise in a corporate wellness program. A comparison of physiological outcomes.

The devastating effects from cardiovascular disease are the largest contributors to employers' health care costs, insurance premiums, disability insurance, and worker's compensation. The purpose of this study was to establish baseline data regarding physiological outcomes comparing two participant groups in a corporate wellness program. Results suggest that a corporate wellness program can be beneficial in assisting employees to improve their health behaviors and outcomes.

Adult↗