Aging and the rehabilitation process: An overview of the 15th Mary E. Switzer Memorial Seminar.

The 15th Mary Switzer Memorial Seminar, entitled "Aging, Disability and the Nation's Productivity," was held in Washington, D.C., June 3-5, 1991, and was hosted by the National Rehabilitation Hospital (NRH).

Welcomes were provided by Richard S. Materson, M.D., Medical Director, Jan Galvin, Director, Rehabilitation Engineering Center of NRH, and Martin Sicker, Director, Worker Equity Department, American Association of Retired Persons (AARP). Carl E. Hansen provided welcomes on behalf of Harry Smith, NRA President, and Robert E. Brabham, Executive Director of NRA.

Nell Carney, Commissioner of the Rehabilitation Services Administration (RSA), set the tone and direction of the three-day program with a moving keynote address. She stated that "working with older Americans with disabilities offers a unique opportunity for expansion of our vocational rehabilitation and independent living (IL) programs. At the same time we can make significant contributions to the nation's economy and enrich community life with the inclusion of older Americans."

Planning for the Seminar

The Switzer Planning Committee developed Seminar objectives, and provided the format and subtopics which served as the Seminar's foundation. The subtopics were then translated into a series of action papers: * Employment of the Older Worker with a Disability: An Overview, by Kathy Sisco, Aging in America, Inc.; * The Role of rehabilitation: Serving the Worker with a Disability, by Jerold D. Bozarth, University of Georgia at Athens; * Toward Employer Flexibility through the Employee Life Cycle: The Case for the Older Worker, by Paul E. Rupert, New Ways to Work, Inc.; * Meeting the Health Care Needs of an Aging Workforce: Empire Strikes Back! by Steven W. Leclair, National Industrial Rehabilitation Corp.; * Attitudes and Legal Issues: the Older Worker with a Disability, by Malcolm H. Morrison, National Association of Rehabilitation Facilities.

The action papers and discussions covered a range of ideas and recommendations. In addition, the Seminar stimulated a number of special papers, such as Aging with a Disability (a Consumer's Point of View); A Minority Point-of-View as It Applies to Older Workers; Applications of the Americans with Disabilities Act (ADA); Aging, Habilitation and Persons with Developmental Disabilities; Labor Union Issues and the Older Worker,- and Opportunities for the Mature Worker in the Part-time and Temporary Job Market as a Viable Alternative.

The deliberations also focused on trends in the U.S. economy, impact of the global economy, the changing nature of the workforce, models of employment, retraining, and transfer of skills.

The Seminar brought together the views of consumers, labor, business, education, rehabilitation professionals and policy-makers. The following comments reflect reactions of some of the Scholars to the action papers.

Sisco's paper provides a good overview of what it means to be employed or unemployed and aged. She is quick to assert that many older people need to work to maintain their financial independence. Also, on a broader scale, the marketplace appears to need older workers as numbers of younger people available for work decline.

It is often thought that early retirements and other departures from the workforce are money-saving by nature. Surely, the thinking goes, we lost a little experience, but we also lose the higher salary and replace it with a younger person with new blood and fresh ideas to whom we will be paying less money. Sisco points out a message that needs to be brought home very ardently- that early departure from the workforce is costly to the displaced worker, to the employer and to the nation.

Several excellent and well-tried ideas are summarized in the paper, e.g., job sharing, Projects with Industry (PWI), taking good and mutual advantage of the older person's flexibility as it relates to time, responsibility, perks and salary needs. It is incumbent upon all of us according to Sisco to plan for the future with what is and will continue to be a burgeoning population. - Richard P. Oestreich

Clearly the nation's workforce is graying but the employer response is not equal to the severity of the challenge. In addition, according to the author (Sisco), many older Americans now require the income and benefits harvested from extending their work lives while often lacking the skills to be competitive in a workplace characterized by advanced technology. These issues suggest the need for critical policy and program initiatives.

Sisco notes that some employers are meeting the challenge by job restructuring practices, innovative benefit packages, education and training. It would be interesting to know more about these employers. Are they among the Fortune 500? What percentage of total jobs do they represent? What motivates them to support programmatic initiatives for older workers?

Sisco posits as a model for integration of the older worker, Aging in America, Inc. and Projects with Industry (PWI). It would be instructive to know the results of testing this model in various locations and under various conditions in order to determine guidelines for a successful placement process. -Katherine D. Seelman

More needs to be said about how to improve and educate employers about the potential of older workers and disabled older workers in particular. The bottom line is that federal legislation (Rehabilitation Act) must create opportunities for the older disabled workers in order to have access to vocational rehabilitation and vocational rehabilitation counselors. Rehabilitation must be educated to explore work options with older clients beyond homemaker status.

The reality of increased life expectancy creates many more years of productive activity. Older persons do not need 20-25 years of retirement. It is critical for older disabled persons (visually impaired) to receive rehabilitation while maintaining a job- learning adaptive techniques, equipment, job modification and environmental modification- on-the-job. -Susan Jay Spungin

Given Bozarth's statement that "the most basic person-centered value is that the authority about the person rests in the person rather than in an outside expert," and the author's development of that concept, it is implicit that employers must become better educated about disability and the older worker so that stereotypes and myths which have been externally generated can be dispelled. This will result in improved access to employment for older disabled workers since they will be considered for employment based on their individual qualifications, with reasonable accommodation as needed.

Educational efforts should be focused on smaller employers, where stereotypes and myths about the capabilities of older workers and disabled workers may not yet have been challenged.

Rehabilitation specialists can assist in increasing employment opportunities by linking with employers to present the qualifications of clients in relation to the job skills needed for a particular position.

Linda I. Workman

Vocational counseling as we know it is a particularly American phenomenon. Its existence is dependent on a broad social commitment, supported by our national heritage and by law, that people are free to make and are responsible for making certain choices for themselves. Because the freedom to choose is meaningless in the absence of choices, diversity of opportunity is also a fundamental element in counseling. The freedom of individuals to choose for themselves the whether and what of rehabilitation, is premised on the same fundamental beliefs about human nature and human rights as underlies our democracy itself This article reminds us that people are capable and responsible for directing their own lives. We can do much to help, however.

Legislation and current practices should be examined to assure that opportunities are maximized for older persons and that basic rights are respected. Current practices refer to the training and work of health care and rehabilitation professionals as well as employment policies and practices. The government is not only responsible for laws and policies, but for its own personnel practices as well.

It would perhaps be helpful for everyone to remember that "older persons" is a minority to which we may all aspire. As older persons, we may find ourselves still expecting respect for our abilities and fights. We may still want to be responsible directors of our own lives. -Richard Blake

People who experience a late onset of disability frequently take a very fatalistic and passive approach toward an acquired disability. Disability is thought of as a disengagement from common life activities, of approaching the end, and sometimes as an accelerated course toward death. Disability is not dealt with as coping with a new and different challenge.

People who experience a late onset of disability expect reduced functioning as a result of aging and are often passive when it comes to seeking any type of rehabilitation assistance. In contrast, people with disabilities active in the Independent Living fL) movement develop an assertive approach toward coping with disability, an approach viewed as an important survival skill. Independent living is highly valued, fought for, and risks to maintain or achieve independence are encouraged. -June Isaacson Kailes

The paper by Rupert presents an important topic concerning the older worker, primarily the potential of being exploited in the workplace by the currently popular phenomenon of utilizing contingency workers. "Contingency" began as a way for employers to "save" adding to their permanent workforce and perhaps as a way to avoid paying for benefits. Rupert presents an alternative strategy to meet employer needs which he terms "equiflex," involving a restructuring of work time, schedules, job design, and job supervision. Basically, it is a departure from the "all or none" way of looking at work. Rupert argues that the result benefits both employer and employee. Clearly there are some specific research related needs. The need for better data in the form of Bureau of Labor statistics reports with different categories and more specific worker characteristics is a good beginning toward developing better policy decisions. That the workforce and work are changing is a given, perhaps, but there is need for direction on how to restructure both the private and public sector so that the result is a win-win situation. - Paul Leung

Implications for Action

The Switzer Scholars developed a number of recommendations and implications for action that require immediate attention in order to maximize the potential of older persons with disabilities: * To enhance service delivery, it is recommended that people who are older be encouraged to play a more assertive role in their own medical and human service care by challenging traditional methods of delivery of health and service to assure their participation in ensuring the high quality of those services. * That disability awareness be incorporated into all education systems, public and private, at all levels (K-12). It is recommended that the interpersonal issues be addressed as well as those which are potentially personal, to prepare students for their own possibly disabling injury or disease. Backdrop for this training should be the understanding that disability is a natural occurrence of the human condition. * There should be encouraged development of cooperative agreements between vocational rehabilitation agencies, such as RSA and the Council of State Administrators of Vocational Rehabilitation CSAVR), and groups such as the National State Units of Aging (NSUA). * Older persons with disabilities should be established as an RSA priority. Vocational rehabilitation should give greater emphasis to the older worker as part of its mission and will need to include: a) better training of counselors with regard to the older person; b) more creative use of jobs, scheduling along the lines proposed by the Rupert paper), and a review of current closure guidelines and outcome criteria to allow greater flexibility for reporting success; and c) increased utilization of Title VII of the Rehabilitation Act (Independent Living) when Title I (Vocational Rehabilitation Services) is not appropriate, so that an array of services or options is available to older persons. * Specific areas needing research include the role and impact of family, cultural/ethnic/racial, and cohort variables on the rehabilitation of the older person. In addition, there is a need for further research to explore the diversity and individual talents that older persons bring to the workplace and society. * Joint training endeavors should be encouraged between business industry/labor, vocational rehabilitation and groups/organizations interested in older persons to better prepare older persons for workforce participation. * Research efforts in vocational rehabilitation should be developed that examine the use of various rehabilitation counseling models and the enhancement of independence and/or productivity of older persons. * As a possible first step, not as a substitute, establish a high-risk pool for coverage. This would make coverage available to those who are unable to purchase insurance because of high-risk status. * Establish a basic set of expectations for post-retiree health benefits looking toward setting a policy based on research. * Information should be provided to older and disabled workers about the range and potential value of flexible work options that could be made available to them. This would include practical suggestions for negotiating these options with the employer. * That "retirement" be redefined in our society. Incentives to working longer should be explored, such as short-term project employment, tax credits and deductions, desirable benefits, and options for extended work life. All options should be based on personal choice. Perhaps the greatest work incentive would be the elimination of the limit on earnings which people on social security can receive for work. * That human service professionals exercise rapid response in interventions so as to begin assistance to people with disabilities as soon after the onset or occurrence as possible. It is recommended that more and better low vision services be provided to people who are older and who need them.

It should be noted that the 15th Switzer Monograph will contain the complete set of recommendations and implications for action.

Conclusions

The 15th Mary Switzer Memorial Seminar is now part of rehabilitation history. The proceedings will be published this fall as the 1991 Switzer Monograph.

The Switzer Memorial Committee is appreciative of the many persons and organizations involved in the Switzer Memorial Seminar and its publications. Our thanks to the Planning Committee members: Laurel Beedon, Richard Drach, Thomas J. Fleming, Joan Kelly, Bernard Nash, Ralph N. Pacinelli, Bernard Posner and Martin Sicker; to the sponsors of the Seminar including AARP, The Dole Foundation, E.I. Dupont de Nemours and Company, National Rehabilitation Counseling Association (NRCA), President's Committee on Employment of People with Disabilities, and the National Rehabilitation Hospital, which graciously hosted the Seminar; and, of course, the Switzer Scholars for their tireless efforts in making the Seminar a memorable one.

Switzer Scholar Richard Oestreich noted the challenge of the century's final decade: "The lack of knowledge about the relationships among age, health and labor force participation is indeed an area that needs further study. What is painfully true is that the combination of advanced age and disability places a double whammy' on job seekers. The labor market is difficult enough to enter for someone with only one of these perceived drawbacks, i.e. disability or age. Employer assumptions about diminished capacity due to age and disability are still very prevalent in the late 20th century.

"Since employers are reluctant to hire these dual diagnosed' job seekers, rehabilitation agencies often shy away from serving them- they are screened out of the system.

The research that has been done needs greater dissemination. Research findings indicate that the variables which concern employers, such as attendance, productivity, dependability and good judgment, all favor the older worker. What is needed is a national policy on the aged to pair with the needed policy on people with disabilities. The professions have been asking for years for a coordinated federal policy in each of these areas. With the passage of the Americans with Disabilities Act, perhaps now is the time for action."