Page images
PDF
EPUB

if their disabilities have lasted for 12 consecutive months or if they are expected to last for at least. 12 months.

Since eligibility for a benefit is limited by the relationship of the parent to the social insurance system, the disabled-child beneficiary group should not be interpreted as representative of persons in the general population of the United States who are aged 18 or over and have similar disabilities. There are many disabled during childhood in families where the parent has not retired or died or become disabled enough to qualify for disability benefits. Social security program data does make it possible to know the minimum range of the dimensions of the group that has managed to survive into adulthood despite severe perinatal and childhood abnormalities. Some insight into the complexities of their handicaps is also provided, and certain questions are raised about their health and their social and economic needs for fruitful examination and planning.

In the main this article discusses the geographic distribution and the personal and medical characteristics of the 205,000 adults who qualified as disabled children under the social security program during 1957-64-the first 8 years of the program-and the 34,000 who were unable to qualify through 1963.

WHERE ARE THE DISABLED?

Disability, whether the result of trauma or disease, carries with it both a personal and a community need for a wide variety of services specially planned to identify and help those so afflicted make the best possible improvement and adjustment in their situation. The availability and use of resources for case finding, medical and psychiatric treatment, and rehabilitation; for training and employment of those who could possibly work at some level; and for financial support and protective care-are essential determinants of the levels at which the disabled will function.

Whether the disabled live in cities or towns, on farms, or in other rural areas, in what part of the country they reside and in which State or other political subdivision-all are important considera

tions in arriving at the answers to questions on the level of resources needed and their availability, use, and accessibility. Since health care and treatment facilities tend to be clustered around population centers, the more distant the disabled are from these centers or the greater the inconvenience of travel to them, the less likely are they to be used.

It is likely, for example, that some handicapped persons on farms in Alabama, in the depressed areas of Kentucky or West Virginia, in rural Michigan, or in New York City or Los Angeles have similar disabilities. What accommodation they make may depend, however, not only on their personal reaction to the disablement or their motivation toward independence but also on as elementary a consideration as where they live. The extent to which there is community recognition of their needs and available financial and professional resources to meet these needs makes for considerable variation in the effect of the disability on the individual and on his family and community.

[blocks in formation]

For the purpose of this discussion, a county was defined as urban if at least half its population resided in "urbanized areas and in places of 2,500 inhabitants or more outside urbanized areas." The Bureau of the Census, in the 1960 Census, defines the urban population as comprising "all persons living in (a) places of 2,500 inhabitants or more incorporated as cities, boroughs, villages, and towns (except towns in New England, New York, and Wisconsin); (b) the densely settled urban fringe, whether incorporated or unincorporated, of urbanized areas; (c) towns in New England and townships in New Jersey and Pennsylvania which contain no incorporated municipalities as subdivisions and have either 25,000 inhabitants or more of a population of 2,500 to 25,000 and a density of 1,500 persons or more per square mile; (d) counties in States other than the New England States, New Jersey, and Pennsylvania that have no incorporated municipalities within their boundaries and have a density of 1,500 persons or more per square mile; and (e) unincorporated places of 2,500 inhabitants or more . . . the population not classified as urban constitutes the rural population."

[blocks in formation]

1,264 42.5 1,709 1,393 64.7 1,409 28.6 3.518 1,777 58.2 1,277

57.5

579

19.5

Mississippi.

1.84

759

35.3

334

15.5

71.4

1,165

23.6

41.8

446

14.6

[blocks in formation]

1 For the purpose of this report, a county qualified as urban if at least onehalf its population resided in urbanized areas and in places of 2,500 inhabitants or more outside urbanized areas. U.S. Census of Population, 1960.

population was rural (table 1). This ratio of 2 urban beneficiaries to 1 rural beneficiary did not obtain in all States. Childhood disability beneficiaries in rural counties far outnumbered those in urban counties in 13 midwestern and Southern States and in Vermont. The combined ratio for these areas was 1 urban beneficiary to 2 rural.5

5 Arkansas, Georgia, Iowa, Kentucky, Mississippi, Nebraska, North Carolina, North Dakota, South Carolina, Tennessee, Vermont, Virginia, and West Virginia.

There are wide and apparently unpatterned differences among the individual States, as well as between urban and rural populations, in the prevalence of beneficiaries who were disabled in childhood. On December 31, 1964, 1.5 persons per 1,000 aged 18 and over in the United States were receiving a childhood disability benefit (table 2). Prevalence rates in the individual States, however, ranged from 0.43 and 0.44 per 1,000 in Nevada and Alaska to 2.5 and 3.0 in Kentucky and West Virginia.

On the basis of the most recent data from the Bureau of the Census on the distribution of urban and rural population in counties of individual States, the prevalence rate for childhood disability beneficiaries in the United States as a whole was 0.87 per 1,000 for the urban population and 1.35 per 1,000 for the rural population (table 3). All but 12 States showed a higher rate for the rural population. More information than is at hand would be needed to explain these interstate and urban-rural differences in prevalence rates. Many factors could contribute to these differences, including the characteristics of the residents and their relationship to the social insurance program, the prevailing nature, pattern, and particularly the availability of medical

6 Based on Estimates of the Population of States, by Age, Color, and Sex: July 1, 1964; Series P-25, No. 293, Bureau of the Census.

TABLE 3.-Childhood disability beneficiaries: Number per 1,000 persons in urban and rural population, December 31, 1964, by State

[blocks in formation]

and preventive health care services both at present. and when the abnormality began; population trends that is, the extent of in-and-out migration among young healthy residents; and the location of residential, custodial, and long-term treatment institutions, especially those for the mentally ill or retarded. The presence in a community of a large mental hospital could influence the prevalence rate in the community, but the extent to which this happens cannot be estimated. West Virginia had the largest proportion of its childhood disability beneficiaries residing in rural counties (78 percent) and the highest overall and rural prevalence rate of all States (2.14). With three-fourths of its psychiatric hospitals and institutions for the mentally retarded population also in rural counties, this State had the lowest proportion of disability applicants in such institutions (8 percent).

FAMILY CLASSIFICATION

The 183,522 persons who received benefits as disabled dependents in December 1964 were adult sons and daughters either of deceased workers (50 percent), of workers who retired because of age (46 percent), or of workers who themselves received a social insurance benefit because of severe disability (4 percent). Over the years, the proportion of childhood disability beneficiaries

who had survived the insured parent has increased. It was 39 percent in 1959, 45.3 percent in 1962, and 47.5 percent in 1963. More than one-half (58 percent) of those with a deceased insured parent were either the sole survivor or the only person in the immediate family who qualified for a dependent's benefit on the wage record of a deceased worker. About two-fifths were in families headed by widows, the majority of whom were aged 62 or older. About 12 percent of these disabled persons had brothers and sisters who received benefits because they were either under age 18 and dependent or aged 18 and over and disabled.

When intrastate differences in the distribution of these persons by status of the parent wage earner are examined, considerable variation becomes apparent. In Connecticut, a highly industrialized State, for example, and in the District of Columbia, where most employment is Government employment and, in general, not covered under the social security program, 56 percent and 59 percent, respectively, of the beneficiaries were children of a deceased wage earner parent, proportions considerably above the national average of 50 percent. Conversely, in Arkansas, Iowa, Minnesota, Mississippi, and New Mexico, the proportion of these beneficiaries who were children of deceased wage earners was substantially under the national average 41.1, 43.5, 42.6, 41.7, and 41.2 percent, respectively. Equally significant

[blocks in formation]

parents of beneficiaries in urban population c ters were more likely to be dead.

MOBILITY STATUS

Although they were severely disabled a needed a substantial amount of personal ca most beneficiaries were managing in some w without institutional confinement when the applications were filed. About 1 in 10 was so li ited in ability to get around that he was confin to the home. Most were able to get about outsi the home either alone (26 percent) or with t help of another person or of a device of sor kind (36 percent). Twenty-six percent were institutions, primarily for the treatment of tube culosis or chronic disease or because of ment disorders. Information on how many of the beneficiaries or how many additional beneficiari are now institutionalized is not available. The is nothing to suggest however, that fewer of the are so confined than earlier; in fact, it is a fa assumption that the proportion has increase particularly among those who came on the rol in the first years of the program.

When beneficiaries residing in the individu States are compared with respect to the levels their mobility when they applied for benefit many differences are apparent, particularly in th proportion institutionalized or ambulatory ou side the home. Except perhaps for the bedbound chairbound, and institutionalized, the othe gradations of "ambulatoryness" are so subjectiv and likely to change from day to day that appears unwise to form other than genera opinions about the ability to move about inde pendently. With these reservations, differences i State patterns of mobility for disabled-chil beneficiaries seem significant and suggest area for future study. In Massachusetts, for exampl where 5,628 disabled persons qualified for benefit between 1957 and 1963, 2,613 or 46.5 percent wer in institutions, 45.8 percent were ambulatory and only 7.5 percent were confined to the hom In West Virginia, only 7.9 percent were in inst

7 Among the 183,522 disabled child beneficiaries in cu rent-payment status on December 31, 1964, 20,000 had a institution as a "representative payee." This number ex cludes persons in an institution who did not have a repre sentative payee and persons in an institution for whor another person-parent or relative-was the payee.

tutions, 81.5 percent were ambulatory, and the number confined to their homes (10.5 percent) approximated the national average of 10.6 percent (table 5).

Information presently available for study is not conclusive, but there appears to be a positive relationship between whether the parent of a disabled child beneficiary is dead and whether or not that beneficiary is in an institution. In 32 States the proportion of applicants who were institutionalized when they applied for benefits exceeded the proportion who applied in the Nation.

as a whole (26.2 percent). In 23 States the proportion of beneficiaries in current-payment status on December 31, 1964, who were entitled on the wage record of a deceased parent was greater than for the United States (50 percent). Twenty of these latter were among the 31 States that comprised the first group.

DIAGNOSES

The abnormalities that were severe enough to qualify these applicants for benefits were typical

TABLE 5.-Childhood disability allowances: Number of children found disabled in 1957-63, and percentage distribution by mobility status at time of application, by State

[blocks in formation]
« PreviousContinue »