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Aging America: implications and impact on vocational rehabilitation.

David W Corthell, Ed.D

Daniel McAlees, Ph.D.

People who are older are no less heterogenous than any other segment of the population. Simply put, older people in need of rehabilitation services bring vastly differing expectations, support systems, personalities, and resources to the experience of disablement. Being older and disabled does little to describe this population, and the circumstance Of being older does nothing to predict the rehabilitation needs and outcomes for a particular individual.

That will be the impact of the aging of America on rehabilitation services? For the most part, vocational rehabilitation (VR) services in the United States have been directed toward aiding people with disabilities to enter the competitive workforce. Today, however, the nature of the workforce population is rapidly changing. Most notably, the number of older workers is steadily increasing, the number of younger workers is in a period of decline and it is expected that a greater proportion of the population who are older will leave the workforce due to disability and early retirement.

Currently, over 50 percent of workers with a disabling condition are people aged 45 or older. Consequently, it is expected that a greater number of people 45 or older will seek assistance from VR agencies. The question rehabilitation agencies must address is What is the agency role with regard to people with disabilities who are older, whose disability may be either latelife or lifelong?"

Our Nation's Aging Population

Currently, approximately 30 million people in the United States are over the age of 65. This number represents about 12.3 percent of the nation's population, or about one of every eight Americans. The number of older Americans has increased by 4.3 million, or 17 percent, since 1980; this compares to an increase of only 6 percent for the under age 65 population. Predictions are that in 2030 that number will approach 64-73 million-more than two and one-half times the number in today's over age 65 population.

A cause of this phenomenal growth in older Americans is the increase in life expectancy People reaching age 65 have an average life expectancy of an additional 16.9 years (18.6 years for women and 14.8 years for men). America's older population is expected to continue to grow in the future as life expectancy grows and larger numbers of people reach age 65.

Although the growth will slow somewhat during the 1990's, due to the relatively low birth rate of people born during the 1930's, it is expected to increase dramatically between 2010 and 2030. At that time, the baby boomers" of the late 1945-1970's will reach their sixties. Older people are expected to represent about 13 percent of the nation's population by 2000 and about ?? percent of the nation's population by 2030, or about one out of every five Americans.

Older Workers. About 3.1 million older Americans (some 11 percent of the people over age 65) were in the labor force in 1987, either working or actively seeking work; included were 1.9 million men and 1.2 million women. Americans who are older constitute some 2.6 percent of the nation's labor force although they make up over 17 percent of Americans.

Income. The major sources of income for older Americans includes Social Security (35 percent); asset income (24 percent); earnings (24 percent); public and private pensions (15 percent); and transfer payments such as Supplemental Security Income (SSI), unemployment and veterans' payments (2 percent). Unfortunately, some 12.2 percent (or 3.5 million) elderly Americans live below the poverty level and another 8 percent (2.3 million) live at the "near-poor" level (that is, income between poverty-$5,447 in 1987- and 125 percent of this level). In all, over 20 percent of older Americans are near or below the nation's poverty level. A significant number of these people are women and minorities who historically have earned far less than white males.

Workforce Demographics

The most significant workforce issues are:

* the potential for severe labor shortages after the turn of the century;

* the lack of workers having the specific skills and education necessary for making the marketplace operational; and

* the aging of the workforce. The primary cause of the labor shortage is the combined effect of a decreasing number of 16- to 25-year-old people entering the workforce and an increasing number of workers choosing early retirement. Along with the shortages, the proportion of women and minority participants in the workforce will increase.

Disability/Worker Characteristics

Americans who are older tend to have a higher rate of functional impairments than do younger Americans and make up the majority of the population of people with disabilities. People over age 45 make up 50 percent of the workers with disabling conditions. However, as noted in the table on this page, workers aged 45 and older possess particular characteristics and do make significant contributions to the nation's workforce.

Several national surveys have been done to assess the numbers of Americans who are older with functional limitations. One survey (National Center for Health Statistics 1987) reported that Americans with functional limitations who were older and living in the community had the following percentages of functional limitations: walking, 19 percent; bathing, 10 percent; getting outside, 10 percent; getting in and out of bed (transferring), 8 percent; dressing, 6 percent; toileting, 4 percent; and eating, 2 percent. More importantly, however, more than 77 percent of people included in the NCHS survey had no activities of daily living (ADL) difficulties.

Conditions Affected by Age

Age is an important factor when considering whether a disability will be mitigated or aggravated during the lifespan. Trends in increased longevity have shown that age-associated conditions play an increasing role in the lives of America's aging population. Although certain conditions can become less problematic with age (an example of one such condition is autism), most are aggravated by age.

Some conditions become more problematic with age either because of premature aging or because the conditions present an inherent liability due to the interaction of aging and the long-term effects of that condition. Early or premature aging among certain people with mental retardation is a problem that will confront rehabilitation professionals. This is most prevalent among people with Downs syndrome, a condition associated with mental retardation. Premature aging means that the physical aging process is evident by the time most people with Downs syndrome are chronologically in their forties.

Some conditions are beginning to show heretofore unexpected effects due to aging. Some examples include post-polio syndrome and cerebral palsy. People with these conditions experience faster muscular deterioration with advancing age, as muscle cell reserves are used up sooner due to the life course of the physical condition (possibly due to compensatory overuse of impaired limbs). With cerebral palsy, it has also been noted that there is a greater coincidence of arthritic symptoms with advancing age. While the research in this area is still rudimentary, rehabilitation personnel should be sensitive to potential physical problems experienced by older adults with polio and cerebral palsy and needs for counseling.

As people age their body systems, whether sensory, systemic or musculoskeletal, are more susceptible to the effects of disease and injury; recovery is slower and the person's psychological processes may be more involved. People with congenital conditions of the heart, lungs, eyes, and hearing will often experience further reduction in the function of these systems.

Over 30 percent of people who are elderly also have chronic physical conditions which may create constant and/or nagging pain; but these are not life-threatening conditions unless they suddenly become acute. Some of these chronic conditions are diabetes, osteoarthritis, congestive heart failure, Parkinson's disease, fracture sequelae, and shoulder pain. Cancer and Alzheimer's disease are also among the serious health problems of older people.

Employment Issues

A number of issues and barriers to employment experienced by older workers with disabilities can be identified; among them are ageism, attitudes, current practices, laws and priorities, counselors training, support systems, social security and pensions, uninformed employers, transportation, and current retirement trends.

Overriding all other issues is ageism (that is, age bias), which is the most obvious and pervasive problem faced by older workers seeking employment. Although the Age Discrimination in Employment Act of 1967 offers some protection, many subtle and unintentional types of discrimination continue. Acceptance of the age biases can prevent people who are older from seeking beneficial employment. These workers may underestimate their own value or abilities and thus be discouraged from seeking employment.

One state that studied its success with applicants who were older found that consumers 45-54 years of age were more likely to have successful rehabilitation outcomes than those below age 20. In addition, the successful people who were in this age range tended to enter the same occupations as younger people in the national workforce.

According to studies completed in 1985 and 1986 and reported by the American Association for Retired Persons (AARP), older workers are willing to work. AARP noted the following:

* About 40 percent of retirees would rather be working.

* Active workers aged 63 and older enjoyed working and valued being active and useful.

* The most influential incentive to delay early retirement was flextime or part-time work. Other important ones were phased retirement (or opportunities for temporary employment) and job redesign.

* Training (whether skill or special assistance) is a key element in the successful employment of older workers.

More attention will need to be given to designing jobs and working conditions that are deliberately tailored to the distinctive capabilities, limitations, needs, and preferences of older workers who remain employed. This restructuring of work incentives, work options and benefits packages needed is found to benefit all workers regardless of age, disability, sex, and cultural background.

Recently, informed employers are beginning to value workers for their experience, knowledge, work habits, and attitudes. On these characteristics, older workers are perceived to rate very high. Older workers are frequently seen as being more highly educated than younger workers and as having a knowledge of basic communication skills that younger workers are found to lack. As a result, some employers respect workers who are older for their wit, wisdom and experience.

Many retirees are returning to the workplace to supplement social security income even though the laws put heavy restrictions on their earnings. Retirees aged 62-64 may earn up to $6,480 before their benefits are affected. For every two (2) dollars earned above this limit, benefits are reduced by one (1) dollar. For retirees aged 65-69 the earnings limit is $9,360; and for people aged 70 and above there is no limit. Beginning in 1990, however, these limits were changed so that people 65-69 now lose only one (1) dollar of benefits for every three (3) dollars earned.

Myths and the Older Worker

Older people themselves have commonly held myths that may jeopardize the rehabilitation process. Many older people with disabilities do not perceive their condition as a disability. They are just getting old" and expect functional abilities to decline. Thus, they do not perceive rehabilitation services to be appropriate for them. They may even shun such services in order to avoid the stigma of having a disability, or they may hide physical ailments out of fear that their jobs or social contacts could be jeopardized.

Vocational rehabilitation counselors are familiar with disabled consumers who are concerned about loss of benefits by returning to work and whose motivation may also be affected by the belief that disability benefits will be lost immediately if they return to work. The aware VR counselor encourages these clients to discuss work return issues as they affect financial status. VR counselors will often refer these clients to written material or other information sources to correct these misperceptions. The same concerns are held by older disabled people.

Employer Myths

Successful ob placements are highly improbable without the involvement of the employer in the rehabilitation process, since myths held by employers can influence the outcome of an attempted placement. Not too long ago, these myths regarding the worker who is older led to the "Detroit syndrome" (Lawrie, 1990): devalue them, discount them and dump them. However, employers may be rethinking this syndrome in the face of federal anti-age discrimination laws, manpower shortages and other reasons.

Past business climate led to pragmatic decisions by employers as they strove for greater labor efficiency. Many achieved this goal by cutting what they perceived to be the most economically unproductive portion of their work forces-the older workers. It was once believed that workers as they became older cost more in terms of benefits, that they were absent due to sickness more often, that they were not as productive, and that they had more accidents. However, except for health insurance, which is still being examined, recent studies show that these beliefs are not true. A recent study by AARP (1990) concluded that "differences in worker's health insurance among age groups were not large enough to be a major factor in employment. Other employers have been known to say that insurance costs for the older worker are less expensive because the older person typically has fewer dependents, doesn't need pregnancy insurance or leave and may have other health insurance.

Employers may learn from the advocate for older workers that these workers in fact have a stronger work ethic than their younger counterparts, are more diligent workers and in reality contribute more to a product line or service. It is likely that this mature work force will remain on the job longer, which will reduce the high cost of turnover and resultant training costs of incoming employees.

Counselor Myths

As the gatekeeper to VR services, the counselor is in a pivotal position to help the older person with disabilities to become employed. Counselors, like employers and older people, are affected by cultural views and social fears about aging. They are also susceptible to believing that old age begins at 65 years along with social security benefits. Counselors must see beyond chronological age so that they can consider each person as a potential candidate for the full array of necessary rehabilitation services.

The Vocational Counselor and the Consumer

People with disabilities who are older should come to VR agencies if they either want or need to work. Unfortunately, few of the other community service agencies, who also provide services to people who are older, are familiar with the VR agency or the process required of applicants. Consequently, the counselor may find it advantageous to discuss the VR process, particularly eligibility criteria, with these potential referral agencies.

The VR counselor is the central figure in the process of coordinating the services that prepare the disabled job candidate for permanent employment. The counselor must serve as educator, advocate, referral source, and case manager for this candidate. In these essential roles, the counselor creates options for the mature worker, discourages former myths and advocates for the well being of the person served. However, the nature and scope of the rehabilitation service plan is co-determined by the individual and the counselor.

Many of us take the person who is older for granted. Because this individual has been around a long time and has seen and experienced much in all those years we may wonder why a counselor's help would be needed at all. But it is in fact more likely that these clients would be in need of help to maintain or regain focus and control in their lives. It is this idea of maintaining focus and control over one's life that is so very important. The VR counselor must thoroughly understand the importance of including these emotional issues in the client's assessment.

One issue-self-esteem-plays a primary role in this process. The development and maintenance of a sense of meaning and purpose to one's existence are very important issues; and experiences that damage self-esteem usually undermine, sometimes permanently, one's ability to realize inner potential. While other needs, such as the need for financial security, call out for attention, a client's deeper emotional needs for self-respect and a sense of well being may actually be far more important towards maintaining long-term emotional health. Therefore, issues such as a sense of usefulness to oneself and to others must be given high priority in the equation along with financial considerations in any diagnostic assessment preparatory to case management services.

The VR Counselor and Other Agencies

Client needs become more diverse and less routine as numbers of people who are older increase. Fortunately, services designed specifically for the aging population already exist. These are both local and national in their scope. The VR counselor will continue as the focal point where disability issues are addressed and will select from these services as they are deemed necessary. It is important to recognize that other specialists on aging will request information about disability issues or will require support and guidance in working with someone with a severe disability. In addition, linkages between the aging community and the disability community have historically been missing. Oftentimes, the vocational rehabilitation professionals and the gerontological professionals consider their work very separate, when, in fact, coordination between these two professional groups could result in the more efficient utilization of available services and the development of newer, better tailored service programs. The counselor should take the role of facilitator and create strong working links.

Referral of consumers to other services and agencies does not necessarily mean the end of state VR service provision. Another role of the VR counselor is to identify client strengths and to work with the consumer to create employment opportunities. In this regard, casework services and advocacy continue to be essential, and the relationship between the counselor, other service provider and the consumer must be maintained. Important links are thus created that will ultimately serve the best interests of the client, expedite services and increase efficiency of service provision to future clients.

When the counselor finds that there is much activity with cross-referral, a general statement of purpose (e.g., a "cooperative agreement" or "memo of understanding") that defines inter-agency roles should be established for dissemination. The memorandum should identify the contact people-with their titles, addresses, and telephone numbers-for each participating organization. When timeframes are involved, dates should also be included. Most importantly, the memorandum should specify the services offered by each organization and the person responsible for directing these activities. The good memorandum would also include the goals and objectives of these agencies. If there is concern for liability, the person or organization responsible should be identified. Another reoccurring issue in cooperative agreements or memos of understanding is the question of how to publicize the activity. If this is a concern, the memorandum should specify what information needs to be identified in any public advertisement.

The local area agency on aging (also known as the "Triple A's") is an excellent resource for the VR counselor. The National Association of Area Agencies on Aging has published a Directory of State and Area Agencies on Aging and A National Guide for Elder Care Information and Referral. These directories list not only addresses and telephone numbers but also agency directors.

Projects with Industry

Projects With Industry (PWI) are job placement programs funded through the Rehabilitation Services Administration, U.S. Department of Education. These are employment programs designed to provide employment opportunities for people with disabilities. The unique feature of these programs and what contributes greatly to their effectiveness is the establishment of partnerships between private industry and rehabilitation agencies to train and place disabled people into existing jobs. At present, there is only one PWI program designed specifically for people with disabilities who are older: Aging in America, Inc., in New York. It and the other PWI programs are funded at 80 percent by the Federal Government, with an expected 20 percent match from other sources.

Most recently, the U.S. Department of Education has established a funding priority to support PWI programs for older disabled workers (45 years of age and older). Effective in 1992, it can be anticipated that some PWI programs will have a new emphasis for serving this older population. It is expected that an increasing number of PWI programs will be statewide, multistate or national in scope.

Projects With Industry programs may vary from one project to the next, depending on the types of available services; however, all have the requirement to serve and place job candidates with disabilities. All Projects With Industry programs are required to have a Business Advisory Council composed of agency staff and representatives from the business community. This leadership is especially helpful in creating linkages to facilitate placements. State VR counselors may request invitations to participate in these business centered meetings if they wish.

In addition to these PWI programs, the reader will note that other programs designed for the person who is older are beginning to show up at local schools for higher education, in business and in nonprofit community-based settings. Classroom training is another way to explore new contacts for potential employment. It is also a way for the adult to learn state-of-the-art skills while remaining active within the community and thereby maintaining a sense of independence, contribution and fuller self-esteem. Valuable information can be gained by the vocational rehabilitation counselor by remaining in touch with the trainer of these programs. These classroom situations not only help to assess the students aptitude but also help to evaluate transferable skills required for the work setting. Knowledge of transferable skill is important information for job candidates to share with potential employers.

Placement Opportunities

It is the responsibility of the VR counselor to advocate to future employers and involve them in available community rehabilitation programs. The counselor might organize a forum or an advisory council comprised of a team of employers in order to utilize their expertise and elicit their needs. At these meetings, counselors could share success stories of placements, request additional vacancies and seek guidance for future plans. Time should be made available so employers might meet job candidates, if not for existing positions, then for informational interviews; a working dialogue should be developed. These ongoing communications will inspire programmatic and placement needs, including curriculum necessary for reeducation and/or reentry into employment.

Summary

With labor shortages and market demands changing, now is the time to consider alternative methods of training and serving the mature worker. To do this, partnerships must be established among businesses, community service providers and the mature worker. The VR counselor, who is central to coordinating the services that prepare the entering job candidate for permanent employment, must serve as educator, advocate, referral source, case manager, and general resource for this candidate. In this essential role, the state VR counselor creates options for the mature worker, which discourages the former myths and which advocates for the well being of the population served.

Note

1. The content of this paper is taken from Corthell and Fleming (1990).

Bibliography

1. AARP. (Author). (1985). Worker Equity. Workers over 50: Old myths, new Realities.

2. AARP. (Author). (1986). Worker Equity. Work and retirement: Employees over 40 and their views.

3. AARP (1990). Do older workers increase employer health care costs? Working Age, Special Issue. Washington, DC: Author.

4. Corthell, D.W. & Fleming, K. (Eds.). (1990). Aging in America: Implications for Vocational Rehabilitation and Independent Living. Menomonie, WI: University of Wisconsin-stout, Research and Training Center.

5. Lawrie, J. (1990). Subtle discrimination pervades corporate America. Personnel Journal, 53-55.

6. Staff. (1987, June 10). NCHS advance data (No. 133). Washington, DC: National Center for Health Statistics.
COPYRIGHT 1991 U.S. Rehabilitation Services Administration
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:Vocational Rehabilitation and Competitive Employment
Author:McAlees, Daniel
Publication:American Rehabilitation
Date:Mar 22, 1991
Words:3915
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