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www.cuipr.cornell.edu

A Review of Disability Data for the Institutional Population of Working Age

Peiyun SheDavid C. Stapleton

Cornell Institute for Policy Research

Presented to participants of the Cornell StatsRRTC Conference on:The Future of Disability Statistics:What We Know and Need to Know

October 5, 2006Washington, DC

Cornell University

Institute for Policy Research

Motivation

• Limited disability data and research for the institutional population versus the non-institutional population, especially for working-age people.

• Impact of trends in institutionalization on trends of disability prevalence in the non-institutional population and the distributions of their socio-demographic characteristics.

• Difficulty in assessing the effects of policy efforts in promoting people with disabilities to live in the community.

• Possible effects of trends in institutionalization on persistent declines in employment among non-institutional working-age people with disabilities.

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Group Quarters (GQ)

• Non-institutional GQ– Military quarters– College dormitories– Other non-institutional GQ (e.g., group homes, shelters,

etc.)

• Institutional GQ– Correctional institutions– Nursing homes– Other institutions (e.g., mental hospitals, juvenile

institutions, etc.)

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Data Sources

• 1990 and 2000 Census• Population estimates from the Bureau of the Census• BJS surveys

– Survey of Inmates of Local Jails

– Survey of Inmates of State and Federal Correctional Facilities

• National Nursing Home Survey

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Institute for Policy Research

Outline

• The size and distribution of the institutional population.

• The size, distribution, and characteristics of the institutional population with disabilities.

• Disability prevalence for people living in correctional institutions and nursing homes.

• Rate of institutionalization over time.• Gaps in coverage, timing, and disability definitions.

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Size and Proportion of the Institutional Populations,1990 and 2000

Source: Census 1990 and 2000.

3.33(1.3%)

1.77(0.71%) 1.12

(0.45%) 0.45(0.18%)

4.06(1.4%)

1.72(0.61%)

1.98(0.70%)

0.36(0.13%)

0.000.501.001.502.002.503.003.504.004.50

AllInstitutions

NursingHomes

CorrectionalInstitutions

OtherInstitutions

Nu

mb

er i

n m

illi

on

s

1990

2000

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Distribution of the Institutional Population by Institution Type, 1990 and 2000

Source: Census 1990 and 2000.

53

33

13

4249

9

0

10

20

30

40

50

60

Nursing homes Correctionalinstitutions

Other institutions

Per

cen

t1990

2000

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Institutional Population of Working Age (18-64), 1990 and 2000

Source: Census 1990 and 2000.

1.52(0.98%)(45%)

2.26(1.3%)(56%)

0.00

0.50

1.00

1.50

2.00

2.50

All Institutions

Nu

mb

er i

n m

illi

on

s

1990

2000

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Age Distribution of the Institutional Population by Institution Type, 2000

Source: Census 2000

0 1

38

9

98

4491

1

19

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nursing Homes Correctional Insitutions Other Institutions

Under 18 18-64 65+

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Distribution of People in Various Age Groups by Institution Type, 2000

Source: Census 2000

07

95

13

86

1

87

7 4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Under 18 18-64 65+

Nursing Homes Correctional Insitutions Other Institutions

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Census 2000 Disability Measures

• Self-care (bathing, dressing, or getting around inside the home)

• Mental (learning, remembering, or concentration)

• Physical (walking, climbing stairs, reaching, lifting, or carrying)

• Sensory (blindness, deafness, or a severe vision or hearing impairment)

• [Go outside home] (going outside the home alone to shop or visit a doctor’s office)

• [Employment] (working at a job or business)

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Disability Prevalence by Living Quarters, 2000

Source: Census 2000

12 11

22

54

0

10

20

30

40

50

60

All Housing units Non-institutional GQs Institutional GQs

Per

cen

t

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Distribution of People with Disabilities by Living Quarters, 2000

Source: Census 2000

Institutional GQs, 6.4%

2 million

Housing units, 91.3%

31 million

Non-institutional GQs, 2.3%0.8 million

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Working-age People with Disabilities Living in Institutions, by Gender and Race, 2000

• The share of males is much larger than the share of females (7.7% versus 1.7%).

• They are also disproportionately African American (38.6% of those ages 18-49 and 22.4% of those ages 50-64).

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BJS Surveys Disability Measures, 1996 - 97

• Physical disability• Sensory disability (vision, hearing, speech)

• Learning disability (such as dyslexia or attention deficit disorder)

• Mental disability (mental or emotional condition)

• Work disability (limitation in the kind or amount of work one can do)

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Disability Prevalence in the Incarcerated Population,1996 - 1997

Source: BJS Surveys

37

10 10 9

31

1210 10

23

11

5 5

0

5

10

15

20

25

30

35

40

Any disability Physical Mental Learning

Per

cen

t

Jail State prison Federal prison

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Changes in Incarceration Rate by Age and Sex, 1989 - 91 to 1996 - 97

Source: Authors’ calculations.

297

66 66

638

1,474

1,690

1,110

476

87

1,242

97

472

1,113

1,262

926

669

0

200

400

600

800

1000

1200

1400

1600

1800

All ages 18 - 24 25 -34 35 - 44 45 - 54 55+ Male Female

Inca

rcer

atio

n r

ate

(per

100

,000

)

1989/91 1996/7

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Disability Prevalence in the Nursing Home Population, 1999

Source: NNHS

8577

66

9588

76

0102030405060708090

100

Bathing Dressing Three or moreADLs

Per

cen

t

Under 65 65+

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Changes in Nursing Home Residence Rate by Age, 1977 to 1999

Source: Authors’ calculations.

6,595

24,219

661,080

4,297

18,250

1,47387

0

5000

10000

15000

20000

25000

30000

Under 65 65 - 74 75 - 84 85+

Nu

rsin

g h

om

e re

sid

ence

rat

e (p

er 1

00,0

00)

1977 1999

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Institute for Policy Research

Gaps in Survey Coverage

• Institutional GQ: Nursing home and incarcerated populations are covered in periodic surveys, but not residents of other institutions.

• Non-institutional GQ: Limited information for the homeless and military populations.

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Infrequent Collection

• Census long form survey: once per decade.• BJS surveys: roughly every six years (1989-91,

1996-97, and 2002-04).• NNHS: biennially from 1995 to 1999, and the

most recent one five years later, in 2004.• Some major national household surveys: annually.

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Disability Definitions

Disability Census

2000

BJS Surveys 1996-97

NNHS 1999

Sensory limitations × × ×

Functional limitations × × ×

Mental disability × × ×

Activities of Daily Living × ×

Instrumental Activities of Daily Living

× ×

Work disability × ×

Learning disability ×

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Discussion

• Change in the size and composition of the institutional population.

• Relatively high disability prevalence in the incarcerated population and the growth in incarceration.

• Decline in the nursing home residence rate.

• The inclusion of the GQ population in the ACS from 2006 forward.