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Beyond 50.03: A Report to the Nation on Independent Living and Disability: Executive Summary

(1) Persons 50 and older with disabilities, particularly those age 50-64, strongly prefer independent living in their own homes to other alternatives. They also want more direct control over what long-term supportive services they receive and when they receive them.

Loss of independence and loss of mobility are what people with disabilities 50 and older say they fear the most as they look to the future. They also say having more control over decisions about the services and help they receive would cause a major improvement in their current lives. For example, a large majority of people with disabilities would prefer to manage any publicly funded in-home services themselves, rather than have an agency do so. In addition, a majority would prefer cash payments for such home care services over services provided directly by agencies.

Policy Implication: Encourage "consumer-directed" long-term supportive services in publicly funded programs such as Medicaid. Such services would help people "stay in charge" and would respect their varying life experiences and preferences. Although the Medicaid program is administered at the state level, federal policy could promote more consumer choice in the types of services offered and the settings in which they are offered.

(2) Disability rates have declined steeply for less severe levels of disability. This decline is good news, because it suggests that early interventions to avert declines in functional status can work. In addition, the proportion of persons 65 and older with disabilities in the community who use assistive technology but do not require human assistance, including people age 85 and older, has increased dramatically since the mid-1980s.

The proportion of persons 65 and older reporting only limitations in "instrumental activities of daily living" (IADLs), such as the ability to pay bills or go shopping, declined nearly 40 percent between 1984 and 1999. However, the proportion of persons 65 and older with two or more limitations in activities of daily living (ADLs), such as bathing and eating, remained almost unchanged.

Interventions that do not require ongoing human help—such as use of equipment—are increasingly important in helping individuals maintain independence. The share of persons 65 and older living in the community with at least one limitation in any ADL and who used special equipment unaided by others has more than doubled since the mid-1980s (from 9% to 20%). In addition, almost one-quarter of persons 50 and older with disabilities who do not use any special equipment say that equipment such as a hearing aid, wheelchair, cane, or walker would make their lives easier.


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