Toward Independence
An
Assessment of Federal Laws and Programs Affecting Persons with Disabilities--With
Legislative Recommendations
A Report to the President and to the Congress of the
United States
February 1986
National Council on Disability
(formerly National Council on the Handicapped)
National Council on Disability
1331 F Street NW
Suite 1050
Washington, DC 20004-1107
(202) 272-2004 Voice
(202) 272-2074 TT
(202) 272-2022 Fax
Acknowledgment
The Council wishes to acknowledge and convey its sincere
appreciation to the many individuals and organizations who contributed
to this report. Numerous people with disabilities, parents, service
providers, advocates, business persons, legislative policy advisors,
and other experts from all the fifty states contributed to this
effort by participating in public forums, attending advisory meetings,
and otherwise providing input and assistance to the Council in the
process of developing the ideas and recommendations contained in
the report.
Table of Contents
Letter of Transmittal
Description of the National Council on
the Handicapped
Council and Staff Members
Executive Summary
Introduction
The Population With Disabilities
Assessment of Federal Laws and Programs
Affecting Persons With Disabilities
Current Priorities in Federal Programs
Analysis of Federal Programs in Specific
Topic Areas With Legislative Recommendations
Equal Opportunity Laws
Employment
Disincentives to Work Under Social Security Laws
Prevention of Disabilities
Transportation
Housing
Community-Based Services for Independent Living
Educating Children With Disabilities
Personal Assistance: Attendant Services, Readers,
and Interpreters
Coordination
List of Federal Programs Affecting
Persons With Disabilities
Biographies of Members of the National
Council on the Handicapped
References
Letter of Transmittal
Text of identical letters
sent to the President of the United States, the President of the
Senate, and the Speaker of the House of Representatives)
February 1, 1986
The National Council on the Handicapped is pleased
to issue this report on Federal laws and programs serving people
with disabilities. It was developed in response to a specific statutory
mandate that the Council:
Assess the extent to which [Federal] programs provide
incentives or disincentives to the establishment of community-based
services for handicapped individuals, promote the full integration
of such individuals in the community, in schools, and in the workplace,
and contribute to the independence and dignity of such individuals
... [and] recommend to the President and Congress legislative
proposals for increasing incentives and eliminating disincentives
in Federal programs based on the assessment made... (Public Law
No. 98-221, Section 401a)
The Council developed this report in consultation
with knowledgeable persons with disabilities and experts on disability
service programs throughout the country.
The report summarizes the Council's findings and presents
its recommendations, reflecting the consensus of the Council on
the issues addressed. As requested by Congress in the statutory
directive concerning the report, it includes a listing of Federal
programs serving people with disabilities prioritized according
to Federal expenditures. The recommendations presented in the report
are designed to improve the ability of persons with disabilities
to live with dignity and as independently as possible within their
communities. An Appendix under separate cover presents ten topic
papers providing the Council's detailed analysis and conclusions
upon which the recommendations in this report are based. The ten
topic areas were selected by the Council for in-depth analysis and
study because of their clear importance to persons with disabilities
and to Federal policy regarding disability programs. The Council's
recommendations offer the most constructive and realistic solutions
it has identified to problems in each of these topic areas. The
Council recognizes that there may be some disagreement about what
are the "best" solutions in specific cases, but it is confident
that everyone involved in disability issues will agree that the
issue areas examined in this report are areas that must be addressed
if we hope to achieve a coherent and constructive Federal approach
to disability.
In analyzing Federal programs that affect people with
disabilities and in formulating legislative recommendations, the
Council has been very cognizant of the financial implications of
its proposals, and has consistently sought to develop practical,
fiscally responsible approaches. Indeed, one of the Council's key
objectives has been to suggest ways in which Federal expenditures
related to disability can be more prudently spent, and ineffectiveness
and counterproductivity minimized. The Council is confident that
if the recommendations in this report are implemented, current Federal
expenditures for disability can be significantly redirected from
dependency-related approaches to programs that enhance independence
and productivity of people with disabilities, thereby engendering
future efficiencies in Federal spending.
The Council by no means views the submission of the
recommendations presented in this report as completing its responsibilities
in regard to the issues addressed. The report represents, rather,
an agenda for the Council's work in the future, in conjunction with
other statutory duties assigned to it. The Council will continue
to monitor Federal programs serving people with disabilities, and
to advise the Administration and Congress of its findings. The Council
will continue to analyze the issues discussed herein, as well as
to examine other topics not covered in this report. The Council
expects to increase its coordinative role in the Federal policy
arena by actively pursuing and encouraging communication linkages
among consumers with disabilities and their families and Federal,
State and local policy makers, program administrators, and service
providers. The Council will also continue to attend to a major statutory
responsibility of setting general policies for and monitoring the
operation of the National Institute of Handicapped Research, one
of our Nation's principal resources for investigating and testing
solutions to problems related to disability.
The Council values the opportunity presented by this
report to make a contribution to disability policy, and hopes that
it marks a step toward a more active and productive dialogue among
all the people who influence and are affected by disability policy.
Sincerely,
Sandra S. Parrino
Chairperson
Description of the National Council
on the Handicapped
The
National Council on the Handicapped is an independent Federal agency
comprised of 15 members appointed by the President of the United
States and confirmed by the Senate. Established by the 95th Congress
in Title IV of the Rehabilitation Act of 1973 (as amended by Public
Law No. 95-602 in 1978), the Council was initially an advisory board
within the Department of Education. In 1984, however, the Council
was transformed into an independent agency by the Rehabilitation
Act Amendments of 1984 (Public Law No. 98-221).
The Council is charged with reviewing all laws, programs,
and policies of the Federal Government affecting disabled individuals
and making such recommendations as it deems necessary to the President,
the Congress, the Secretary of the Department of Education, the
Commissioner of the Rehabilitation Services Administration, and
the Director of the National Institute of Handicapped Research (NIHR).
The Council is given explicit authority to establish general policies
for and monitor the performance of NIHR, and to review and approve
standards concerning Independent Living and Projects With Industry
programs. In addition, the Council has been statutorily directed
to submit to the President and the Congress, by February of 1986,
the present report analyzing Federal programs and presenting legislative
recommendations to enhance the productivity and quality of life
of Americans with disabilities.
Whereas many government agencies deal with issues
and programs affecting people with disabilities, the National Council
on the Handicapped is the only Federal agency with the mandated
responsibility to address, analyze, and make recommendations on
issues of public policy which affect people with disabilities regardless
of age, disability type, perceived employment potential, perceived
economic need, specific functional ability, status as a veteran,
or other individual circumstances. The Council recognizes its unique
opportunity to facilitate independent living, community integration,
and employment opportunities for people with disabilities by assuring
a coordinated approach to addressing the concerns of persons with
disabilities and eliminating barriers to their active participation
in community and family life.
The National Council on the
Handicapped
Members
Sandra S. Parrino, Chairperson
H. Latham Breunig, Ph.D.
Robert V. Bush, C.P.O.
Justin W. Dart, Jr.
Joe S. Dusenbury
John S. Erthein
R. Budd Gould
Hunt Hamill
Marian N. Koonce
Nanette Fabray MacDougall
Michael Marge, Ed.D.
Jeremiah Milbank, Jr.
Roxanne S. Vierra
Henry Viscardi Jr., L.L.D. (Hon.)
Alvis Kent Waldrep, Jr.
Staff
Lex Frieden, Executive Director
Brenda Bratton, Secretary
Ethel D. Briggs, Adult Services Specialist
Robert L. Burgdorf Jr., Research Specialist
Marilynne Gisin, Executive Assistant
Naomi Karp, Children's Services Specialist (On detail from
National Institute for Handicapped Research)
Janet Anderson, 1985 NCH Fellows
Laura Rauscher, 1985 NCH Fellows
Elizabeth Defay, Consultant-Editorial
Margaret A. Nosek, Consultant-Independent Living
John Raisian, Consultant-Economics
Executive Summary
The National Council on the Handicapped
is charged by statute with reviewing Federal laws and programs affecting
persons with disabilities and assessing the extent to which they
"provide incentives or disincentives to the establishment of community-based
services for handicapped individuals, promote the full integration
of such individuals in the community, in schools, and in the workplace,
and contribute to the independence and dignity of such individuals."
In this report, the Council presents its findings,
conclusions, and legislative recommendations based upon its review
and assessment of Federal laws and programs. The report includes
a list of major Federal programs serving individuals with disabilities,
ranked according to expenditures, with an estimated number of persons
with disabilities served. From its analysis of such information,
the Council draws three general conclusions:
- Approximately two-thirds of
working-age persons with disabilities do not receive Social Security
or other public assistance income.
- Federal disability programs
reflect an overemphasis on income support and an underemphasis
of initiatives for equal opportunity, independence, prevention,
and self-sufficiency.
- More emphasis should be given to Federal programs
encouraging and assisting private sector efforts to promote opportunities
and independence for individuals with disabilities.
Our nation's current annual Federal expenditure on
disability benefits and programs exceeds $60 billion. This report
proposes some fiscally responsible approaches for spending disability-related
dollars more prudently and productively. The Council is strongly
convinced that present and future costs of disability to the Nation
are directly related to the degree of success we attain in reducing
existing barriers, both structural and attitudinal, and in providing
appropriate services to individuals with disabilities so that they
may realize their full potential and become more independent and
self-sufficient.
The Council has focused in detail upon ten major topic
areas of particular importance to individuals with disabilities.
These topics are discussed extensively in individual topic papers
presented in the separate Appendix to this report. The Council's
legislative recommendations in regard to the ten issue areas are
summarized in the body of the report. They include the following:
Equal Opportunity Laws: The
Council recommends the enactment of a comprehensive law requiring
equal opportunity for individuals with disabilities, with broad
coverage and setting clear, consistent, and enforceable standards
prohibiting discrimination on the basis of handicap.
Employment:
To increase employment among people with disabilities-a
drastically underemployed segment of the population-the Council
recommends several legislative changes, concerning the transition
from school to work, supported employment, private sector initiatives,
job training, job development, and placement.
Disincentives To Work Under Social
Security Laws: The Council outlines several
ways in which provisions of existing Social Security laws--Supplemental
Security Income (SSI), Social Security Disability Insurance (SSDI),
Medicaid, and Medicare-serve to discourage and penalize people with
disabilities if they seek to become employed and selfsupporting.
In response to these work disincentives, the Council recommends
corrective amendments to the problematic provisions.
Prevention of Disabilities:
To promote the prevention of disabilities and to assure
that individuals having disabilities do not suffer unnecessary secondary
disabilities or exacerbation of their impairments, the Council recommends
that the Federal Government mount a national program for the prevention
of disabilities.
Transportation: The
Council recommends amendments to Federal transportation legislation
to achieve the Nation's established policy that "disabled people
have the same right to use public transportation as nondisabled
persons. " Proposals relate to urban mass transit, air transportation,
intercity and interstate buses, and private vehicles.
Housing: To
permit people with disabilities an opportunity to obtain appropriate
housing, which is an important prerequisite to obtaining employment,
living independently, and avoiding costly institutionalization,
the Council makes several recommendations designed to prohibit housing
discrimination and to promote increased appropriate and accessible
housing for persons with disabilities.
Community-Based Services for
Independent Living: To achieve productivity
and independence, people with disabilities require a range of support
services according to the nature and degree of their disabilities.
The Council proposes a variety of measures, including amendments
and funding support under Parts A and B of Title VII of the Rehabilitation
Act, to promote the availability of community-based services for
independent living.
Educating Children With Disabilities:
The Council makes legislative recommendations regarding
educational opportunities for children with disabilities. These
recommendations respond to: the need for special education and related
services during infancy; the need to educate children with special
needs in regular education facilities; and the need to assess progress
made since the enactment of the Education for All Handicapped Children
Act.
Personal Assistance: Attendant
Services, Readers, and Interpreters: Because of the critical
importance of such services in fostering independence and avoiding
expensive institutionalization, the Council recommends a national
commitment to developing a quality system of attendant services,
readers, and interpreters.
Coordination:
The Council recommends that all Federal and Federally supported
disability-related programs be authorized and required to develop
a joint plan for the systematic coordination of services and benefits.
Introduction
Our country calls not for the life of ease, but
for the life of strenuous endeavor.
President Theodore Roosevelt, 1899
As for other Americans, life for people with disabilities
involves striving, working, taking risks, failing, teaming, and
overcoming obstacles. We have all had the experience of seeking
something that eludes us, of trying to reach a goal that seems to
dance just out of reach. Most of us have also had the rewarding
experience of surmounting obstacles to achieve a goal or accomplish
a task, succeeding even though someone else or even we ourselves
doubted we could do it.
A major difference between persons with disabilities
and other individuals is the number, degree, and complexity of the
barriers they face in trying to achieve their personal goals and
fulfillment. Some of these barriers result from the disabilities
themselves-a disability may be considered to be the lack of some
mental, physical, or emotional "tool" which most other people can
call upon in addressing life's tasks. A person with a physical disability,
for example, may be unable to perform certain physical movements
or functions that other people take for granted. A person with a
sensory disability may lack or have significant impairment of one
of the major senses, such as sight or hearing, which for other people
provide important channels for receiving information about the world
around them. An individual with a mental or emotional impairment
may have a reduced ability to deal with the stresses of life or
to sort out the real from the imagined. And people with cognitive
impairments, such as learning disabilities and mental retardation,
have disorders in the ability or rate of accepting, processing,
storing, and recalling information.
But whatever the limitations associated with particular
disabilities, people with disabilities have been saying for years
that their major obstacles are not inherent in their disabilities,
but arise from barriers that have been imposed externally and unnecessarily.
As an international group of experts concluded:
Despite everything we can do, or hope to do,
to assist each physically or mentally disabled person achieve
his or her maximum potential in life, our efforts will not succeed
until we have found the way to remove the obstacles to this goal
directed by human society--the physical barriers
we have created in public buildings, housing, transportation,
houses of worship, centers of social life, and other community
facilities--the social barriers we have
evolved and accepted against those who vary more than a certain
degree from what we have been conditioned to regard as normal.
More people are forced into limited lives and made to suffer by
these man-made obstacles than by any specific physical or mental
disability.
Report of the United Nations Expert Group Meeting
on Barrier-Free Design, International Rehabilitation
Review, vol. 26, p. 3 (1975).
As detailed subsequently in this report, our Nation's
current annual Federal expenditure on disability benefits and programs
is more than $60 billion. Overall Federal spending associated with
disability can be expected to mushroom as the "baby boom" generation
grows older and age-related disabilities increase. The present and
future costs of disability to our nation are directly related to
the degree of success we attain in reducing existing barriers, both
structural and attitudinal, and in providing appropriate services
to individuals with disabilities so that they may realize their
full potential and become more independent and self-sufficient.
If we are unsuccessful, dependency will increase and be accompanied
by increasing costs for services and care as they become more custodial
in nature.
The time is ripe for a careful assessment of disability-related
expenditures and programs to see how effective they are in enhancing
independence and equality of opportunity for people with disabilities.
To this end, Congress has directed the National Council on the Handicapped
to assess the extent to which Federal programs serving people with
disabilities:
provide incentives or disincentives to the establishment
of community-based services for handicapped individuals, promote
the full integration of such individuals in the community, in
schools, and in the workplace, and contribute to the independence
and dignity of such individuals.
(Section 401 of the Rehabilitation Act of 1973,
as amended)
In response to this mandate, the Council has engaged
in a variety of efforts to collect pertinent information and viewpoints.
It has:
- Examined current legislation and programs,
- Collected and analyzed information about exemplary
programs,
- Consulted with experts on programs for persons
with disabilities and consumers of disability services,
- Conducted special seminars and hearings, and
- Conducted forums with persons with disabilities
and their families throughout the country.
Based upon such information, the Council selected
ten topic areas of critical importance for in-depth analysis and
recommendations. The resulting topic papers are presented in a separate
appendix to this report. The major conclusions of the detailed topic
papers, along with an overview of the population with disabilities
and a listing and summary review of Federal programs providing services
to individuals with disabilities, are presented in the body of this
report.
The Population with Disabilities
The social
category of people with disabilities encompasses a wide diversity
of individuals. It includes the neighbor who has just had heart
by-pass surgery, the boy down the street with cerebral palsy, the
business executive who has been hospitalized for severe depression,
the blind woman who works in the office downstairs, the mentally
retarded landscaper at the local plant nursery, and last year's
champion diver at the local high school who now uses a wheelchair
because of a spinal cord injury.
Various estimates place the number of Americans with
disabilities between 20 million and 50 million persons, with a figure
of 35 or 36 million being the most commonly quoted estimate. A precise
and reliable overall figure is not currently available, due to differing
operational definitions of disability, divergent sources of data,
and inconsistent survey methodologies, which together make it impossible
to aggregate much of the data that are available.
Most existing studies of the disabled population employ
one of two major approaches, each of which has its own shortcomings
and limitations. The health conditions
approach looks at all conditions or limitations which impair the
health or interfere with the normal functional abilities of an individual.
This approach usually tends to produce very large numbers of "disabilities,"
because of the inclusion of individuals with health problems that
would not normally result in their classification as disabled or
handicapped. For example, the Health Interview Survey conducted
by the National Center for Health Statistics has estimated that
there are over 160 million impairments and chronic conditions in
the civilian noninstitutionalized population of the U.S. (Mathematica
Policy Research, 1984, p. 3). These figures include large numbers
of various types of circulatory conditions, respiratory conditions,
digestive conditions, and skin and musculoskeletal conditions, not
typically categorized as disabilities. Because of its focus on the
medically oriented notions of health, the health conditions approach
also does not provide adequate data on such conditions as learning
disabilities and mental conditions.
The other major approach to disability data--the work
disability approach--is also problematic. Such studies focus
on individuals' reports that they have a condition that prevents
them from working or limits their ability to work. The 1980 Census
of Population, for example, contains a count of the number of persons
age 16 or above who report the presence of a physical, mental, or
other health condition which has lasted for six or more months that
limits the kind or amount of work that they can accomplish at a
job. Of the total 170 million people ages 16 and above who were
counted in 1980, 22.7 million (or 13.3 percent) reported having
work disabilities. Furthermore, two-thirds of these individuals
(or 15. 1 million persons) report that their disability actually
prevents them from working.
Such work disability figures probably provide a reasonably
accurate gross estimate of the numbers of people of working age
with disabilities. Such studies have their own shortcomings, however.
They underestimate the numbers of people at lower age ranges-the
16 to 24 age group, for example-some of whom are not ready to join
the work force and for whom the self-identification as either work
disabled or not is often not meaningful. They also skew the population
counted. Persons who are out-of-work or who are not seeking work
have psychological motives for reporting themselves as having a
work disability, whether or not they truly have a disability. Independent
disabled persons with a strong work history and who are currently
employed, on the other hand, will often refuse to categorize themselves
as having a work disability, even if they have a significant disabling
condition such as blindness, paralysis, or absence of a limb. For
these reasons, work disability studies tend to underestimate the
total numbers of people with disabilities, and to overestimate the
unemployment and nonparticipation in the labor force rates of people
with disabilities.
The Council has been urging the Bureau of the Census
to incorporate into the 1990 Census some questions concerning the
numbers of persons with various types of physical and mental impairments
in the U.S., so that a more accurate profile of the population with
disabilities can be obtained, thus providing a more reliable data
base for Federal policy, planning, and service delivery. The Council
will issue in the near future a monograph summarizing information
from currently available sources and discussing the needs for additional
disability data. For the purposes of the present report, the remainder
of this section summarizes some pertinent statistical facts gleaned
from existing studies that, in spite of the limitations previously
noted, do provide a rough profile of the population of Americans
with disabilities.
Correlation of Disability and Age
The incidence of disability increases dramatically
with age. According to 1980 Census figures, 3.6 percent of all individuals
ages 16-24 and 5.1 percent of the 25-34 age group report a work
disability. These figures are quite low when compared to those for
older age categories; 22.5 percent of all individuals ages 55-64,
32.2 percent of the 65-74 age group, and 48.5 percent of the 75
+ age group report a work disability. Youths between the ages of
16 and 24 account for 1.4 million (or only 6 percent) of the total
number who report work disabilities, while 4.8 million persons between
the ages of 55 and 64 report disabilities, or 21.3 percent of the
total. Nearly two-thirds of all persons who report work disabilities
are in the age range of 55 and above. The strong correlation of
disabilities with advancing age is illustrated in the Chart 1.
[Chart 1 not available.]
The Working Age Population With Disabilities
According to 1980 Census figures, some 12.9 million
people between the ages of 16 and 64 reported a work disability.
4.2 million (or 32.2 percent) of the persons reporting a work disability
were employed in the labor market at the time the Census was taken.
The number of unemployed persons with a work disability amounted
to 0.6 million. Almost 63 percent of the total number reporting
disabilities were not in the labor force (i.e., neither employed
nor seeking employment) at the time of the Census. Nearly one in
five of all people not in the labor force report a work disability
(19.1 percent), while only 4.4 percent of all who are employed report
a work disability.
Census figures also indicate some correlation between
work disability and poverty. Of the 12.9 million persons of working
age reporting the presence of a work disability, 2.6 million (or
20.1 percent) have family incomes that are below the Federal poverty
threshold. This is more than double the 9.1 percent rate of the
general population which has a family income below the poverty line.
People reporting work disabilities have a higher representation
in the lower family income categories. Of all individuals below
the poverty line, 17.7 percent claim to have a work disability.
In contrast, only 6.4 percent of individuals with family incomes
above twice the poverty line report a work disability. On the other
hand, in spite of the overrepresentation of people who report work
disabilities in the poverty category, nearly four out of five disabled
individuals have family incomes that are above the poverty threshold.
Types of Disability
According to National Center for Health Statistics
figures, in the civilian noninstitutionalized population of the
U.S., there are 18.4 million people with orthopedic impairments
or deformities; 17 million persons with hearing impairments; 8.2
million with visual impairments; 2.1 million with speech impairments;
26.8 million with arthritis; 24.3 million with hypertensive disease;
16.4 million with heart disease; 1.6 million missing extremities
or parts of extremities; and 1.2 million who are partially or completely
paralyzed (Mathematica Policy Research, 1984, p. 2). Another study
found that there are approximately 5.7 million mentally retarded
persons in the U.S., 2.4 million persons with epilepsy, 950,000
who have cerebral palsy, and about 95,000 with autism (EMC Institute,
1979).
Estimates are that some 3 million Americans have been
diagnosed as having a severe mental disorder, with the number of
individuals with chronic mental illness placed at between 1.7 million
and 2.4 million, including 900,000 who are institutionalized (Goldman,
Gattozzi, and Taub, 1981). The National Institute of Mental Health
estimates, however, that fewer than 20 percent of Americans suffering
from any mental disorder seek mental health services from mental
health specialists or general physicians (NIMH, "Mental Health,
United States 1985").
Nearly 6.5 million noninstitutionalized persons use
one or more special aids in order to get around; these include:
645,000 people who use wheelchairs; 689,000 who use a walker; 613,000
who use crutches; 205,000 with an artificial leg or foot; 66,000
with an artificial arm or hand; 2,714,000 who use a cane or walking
stick; 1,492,000 who wear special shoes; 398,000 who wear a leg
or foot brace; and 1,004,000 who wear some other type of brace (Mathematica
Policy Research, 1984, p. 41).
Statistics from the Office of Special Education and
Rehabilitative Services, U.S. Department of Education, indicate
that the numbers of "handicapped children" served under Federally
assisted education programs in the 1981-1982 school year were as
follows: children with specific learning disabilities--1,624,989;
children with speech impairments--1, 136,309; mentally retarded--786,775;
seriously emotionally disturbed--339,629; orthopedically impaired--57,967;
deaf or hard of hearing--74,694; visually handicapped--29,174; deaf
and blind--2,486; multiply handicapped (including those with severe
and profound mental retardation)--71,289; and children with other
health impairments--79,519 (Mathematica Policy Research, 1984, p.
101).
An Assessment of Federal Laws
and Programs Affecting Persons with Disabilities
Complexities, inconsistencies, and fragmentation in
the various Federal laws and programs that affect Americans with
disabilities might suggest that the United States has no coherent
Federal policy on disability. Echoing a chorus of previous commentators,
President Reagan has described "the patchwork quilt of existing
policies and programs, " and has decried the fact that within the
Federal "maze," programs often overlap or work at cross-purposes
(President Reagan, Remarks on Signing Proclamation 513 1, Establishing
the National Decade of Disabled Persons, Nov. 28, 1983). Programmatic
inadequacies and inconsistencies do not mean, however, that there
has been no clear national goal regarding citizens with disabilities.
With surprising consistency, the branches of American Government,
disabled individuals and their families, and service and consumer
agencies have agreed that the overall goal of the nation in regard
to persons with disabilities is to insure the rights of such individuals
to equality of opportunity and to independence.
Confusion and inconsistency have resulted, not from
lack of consensus about the goal, but from the historical and continuing
failure to structure and administer some Federal laws and programs
in such a way as to reflect and further the national goal. The nation's
goal regarding citizens with disabilities may be clear and meritorious,
but Federal programs and laws that should serve as paths toward
this goal have often deviated or even retreated from it. A major
purpose of this report is to suggest ways in which various Federal
laws and programs can be redirected towards the national goal of
assuring equal opportunities and promoting independence for Americans
with disabilities.
Toward independence And Equality For Citizens With
Disabilities
We hold these truths to be sacred and undeniable:
that all men are created equal and independent, that from that
equal creation they derive rights inherent and inalienable, among
which are the preservation of life, and liberty, and the pursuit
of happiness.
Thomas Jefferson, Original draft of the Declaration
of Independence, 1776.
Equality and independence have been fundamental elements
of the American form of government since its inception. The rights
to equality of opportunity and to personal independence have been
recognized and protected in the Declaration of Independence, the
Constitution of the United States, the Constitutions of the individual
States, and in the laws enacted by the U.S. Congress and by the
States.
Consistent with their central importance to all Americans,
the themes of equality and independence have been a major focus
of the Nation's policy toward individuals with disabilities. Regarding
Federal programs that assist individuals with disabilities, President
Reagan has stated:
We believe equal opportunity, equal access, and
greater economic independence must be more than slogans .... By
returning to our traditional values of self-reliance, human dignity,
and independence, we can find the solution together. We can help
replace chaos with order in Federal programs, and we can promote
opportunity and offer the promise of sharing the joys and responsibilities
of community life.
(President Reagan, Remarks on Signing Proclamation
5131, Establishing the National Decade of Disabled Persons, Nov.
28, 1983)
In the proclamation establishing the National Decade
of Disabled Persons, the President further declared:
We must encourage the provision of rehabilitation
and other comprehensive services oriented toward independence
within the context of family and community. For only through opportunities
to use the full range of their potential will our disabled citizens
attain the independence and dignity that are their due.
(President Reagan, Presidential Proclamation
5131, November 28, 1983)
Congress has also endorsed concepts of independence
and equality of opportunity for persons with disabilities. It has
declared:
It is of critical importance to this Nation that
equality of opportunity, equal access to all aspects of society
and equal rights guaranteed by the Constitution of the United
States be provided to all individuals with handicaps; ... it is
essential ... that all individuals with handicaps are able to
live their lives independently and with dignity, and that the
complete integration of all individuals with handicaps into normal
community living, working, and service patterns be held as the
final objective.
(29 U.S.C. section 701 Note (1976))
With broad bipartisan support, Congress has enacted
and authorized funding for such programs as Vocational Rehabilitation
and the Education for All Handicapped Children Act, which provide
concrete initiatives enabling many persons with disabilities to
achieve independence and access to opportunities. In 1978, as part
of a broadened approach to rehabilitation, Congress established
a program of "Comprehensive Services for Independent Living" to
provide grants to the States for the establishment and operation
of independent living centers (29 U.S. C. sections 796 and 796e).
In addition to the Executive and Legislative Branches
of Government, the United States Supreme Court has recognized "the
federal interest in developing the opportunities for all individuals
with handicaps to live full and independent lives" (Community
Television of Southern Cal. v. Gottfried, 459 U.S. 498, 508
(1983)).
In furtherance of these Federal interests in independence
and equality of opportunity, Congress has directed the National
Council on the Handicapped to perform the several assessments contained
in this report assessments of the extent to which Federal programs:
(a) provide incentives or disincentives to the establishment of
community-based services for individuals with disabilities; (b)
promote the full integration of such individuals in the community,
in schools, and in the workplace; and (c) contribute to the independence
and dignity of such individuals. The national goals concurred in
by the President and the Congress have been clearly stated. The
remainder of this report assesses the degree to which Federal programs
conform to these objectives, and proposes modifications and redirections
of such programs to correct those that are deviating from the Nation's
goals regarding people with disabilities.
Current Priorities in Federal
Programs
Congress
has requested that the Council develop a listing, based upon annual
expenditures and numbers of persons with disabilities served, of
the major Federal programs assisting individuals with disabilities.
Such a list is set out beginning on page 55 of this report. A total
of 45 programs are listed and briefly described. From the detailed
listing, statistical information about persons with disabilities,
and the Council's analysis of Federal programs, a few general observations
can be made.
1. Approximately two-thirds of working age persons
with disabilities do not receive Social Security or other public
assistance income.
Data contradict popular misconceptions concerning
the proportion of people with disabilities who are unable to work
and are dependent upon public assistance for support. A relatively
small segment of the population with disabilities receives income
support from programs such as Social Security Disability Insurance
(SSDI) and Supplemental Security Income (SSI) or other public aid
programs.
According to 1980 Census figures, 38 percent of the
noninstitutionalized working-age persons who reported a work disability
were, nonetheless, employed in the labor market and did not receive
Social Security or other forms of public assistance. Twenty-five
percent did not work, but did not receive Federal Social Security
or any other form of public assistance. Most such persons who neither
worked nor received public aid presumably relied for support upon
their families, spouses, pensions, private assistance programs,
or other similar sources. Thirty-two percent of the working age
individuals who reported a work disability did not work during the
Census year and received Federal SSI or SSDI benefits or some other
form of public assistance. (Another 5 percent worked at some time
during the Census year and also received some form of public assistance
income.) The interplay of work disability, employment, and public
assistance is illustrated in Chart 2.
As Chart 2 indicates, roughly two-thirds of the population
with disabilities did not receive SSI, SSDI, or any other form of
public assistance during the Census year. Moreover, these percentages
are only of the persons who identify themselves as having a work
disability; many other Americans having conditions or impairments
that would cause them to be termed "disabled" or "handicapped" in
common parlance do not identify themselves as having a disability
that affects their ability to work. Consequently, the actual percentage
of persons with disabilities who are employed and self-supporting
is quite probably higher, and the proportion of persons with disabilities
who receive income support is probably even lower than indicated
by the Census figures.
[Chart 2 not available.]
2. Federal disability programs reflect an overemphasis
on income support and an underemphasis of initiatives for equal
opportunity, independence, prevention, and self-sufficiency.
Although there are certainly gaps in some existing
programs and some persons who need and are eligible for public disability
benefits who do not get them, the Council believes that such shortcomings
are overshadowed by a more serious misdirection of much of the aid
that is provided, of the type and implications for those persons
who are being served under current programs. Public assistance is
surely necessary and proper to assist persons whose impairments.
are severe and who are unable to be selfsufficient, but the Council
believes that increased priority should be given to the removal
of barriers and disincentives that prevent or inhibit people from
moving off such income support benefits to achieve self-sufficiency
and independence.
From the listing of Federal programs affecting persons
with disabilities (pp. 55-65 of this report and foldout chart),
it is readily apparent that most of the funds expended by the Federal
Government on disability are for public assistance programs. The
first six programs in order of expenditures, and ten of the first
twelve, are public aid programs. Together, these ten large programs
account for over 57 billion dollars in estimated FY 1986 outlays.
Most of these programs are premised upon the dependency of the people
who receive benefits, in the sense that they are not self-supporting.
Eligibility is based upon inability to engage in substantial gainful
activity, or significantly low income. In particular, SSI, SSDI,
Medicaid, and Medicare require applicants with disabilities to demonstrate
that they are not self-supporting.
The Council does not suggest that such public assistance
programs be preemptively terminated or cut back, nor that individuals
appropriately receiving such benefits be "pushed off the rolls."
The Council proposes, rather, that a redirection of certain Federal
programs, as described in its detailed recommendations in this report,
can reduce the barriers to opportunity and independence for people
with disabilities, allowing many more people with disabilities to
remove themselves from Federal aid programs by achieving self-sufficiency
and independence.
3. More emphasis should be given to Federal programs
encouraging and assisting private sector efforts to promote opportunities
and independence for individuals with disabilities.
In recent years, there have been some promising programs
in the private sector to remove barriers and achieve participation
by persons with disabilities. Many private companies have begun
programs to hire and advance employees with disabilities. In 1985,
the President's Committee on Employment of the Handicapped and the
Dole Foundation published a booklet, Disabled Americans at Work,
that chronicles efforts of many of America's major corporations
to train and employ workers with disabilities.
Business leaders such as David T. Kearns, the president
of Xerox Corporation, have spoken out in favor of "full participation"
for citizens with disabilities, arguing that business has an economic
stake in helping individuals with disabilities become employed and
in taking advantage of the pool of potential talent that they represent
(Gatty, 1981, p. 3). E. 1. du Pont de Nemours and Company has made
a point of recruiting employees with disabilities and has monitored
their numbers and progress in the company. DuPont has achieved a
reputation as an exemplary employer of people with disabilities,
and the company's reports are replete with examples of successful
case stories (DuPont, 198 1, pp. 10- 16). In addition to Xerox and
DuPont, other major companies making similar efforts to promote
the employment of persons with disabilities include AT&T; the
Prudential Insurance Company; Sears, Roebuck and Company; Levi Strauss
and Company; IBM; and Control Data Corporation, to name but a few
(Gatty, 198 1, pp. 30-35). Recently, Levi Strauss and McDonald's
have been among the companies whose national television advertising
campaigns have featured people with disabilities portrayed in a
natural, positive context.
A few Federal programs have encouraged and supported
such private sector efforts. Some successful Federal/State rehabilitation
agencies have worked very closely in a cooperative partnership with
private businesses to provide training and employment opportunities
for individuals with disabilities. The Job Accommodation Network
(JAN), operated as a joint venture of the President's Committee
on Employment of the Handicapped, the National Institute of Handicapped
Research, the Rehabilitation Services Administration, and the West
Virginia University Rehabilitation Research and Training Center,
is another example of a Federally initiated program that supports
private sector efforts to increase the opportunities available to
citizens with disabilities. JAN provides a computerized system for
obtaining information about practical accommodations that employers
can make to enhance job opportunities for employees with disabilities.
Congress has provided some limited financial incentives
to private businesses for removing barriers and increasing opportunities
for individuals with disabilities, through such programs as the
Targeted Jobs Tax Credit (which provides a tax credit for employing
workers with disabilities) and Section 190 of the Internal Revenue
Code (which allows a tax deduction for the removal of architectural
barriers). Congress has also created the Projects with Industry
program, which in 1984 spent nearly 14 million dollars through cooperative
agreements with business and industry to develop job opportunities
for people with disabilities in the competitive marketplace (at
an average cost per actual placement of about $1,500).
In spite of these few examples, however, an examination
of the major Federal disability programs reveals very little effort
to encourage, expand, or strengthen Federal/private sector partnerships
that address disability problems. Federal efforts to assist individuals
with disabilities should increase their support for promising private
sector programs and cooperative governmental/private partnerships
that promote increased opportunities and independence for people
with disabilities.
[Chart not available.]
Analysis of Federal Programs
in Specific Topic Areas with Legislative Recommendations
The Council has focused its attention upon
ten major topic areas of Federal programs affecting people with
disabilities. The topic areas are:
- Equal Opportunity Laws
- Employment
- Disincentives to Work Under Social Security Laws
- Prevention of Disabilities
- Transportation
- Housing
- Community-Based Services for Independent Living
- Educating Children With Disabilities
- Personal Assistance: Attendant Services, Readers,
and Interpreters
- Coordination
Each of these topics has been the subject of detailed
discussion and analysis in the individual topic papers contained
in the separate Appendix section of this report. They represent
areas of critical importance to people with disabilities in which
current Federal programs fail to adequately promote national goals
regarding individuals with disabilities, and in which redirection
or alternative approaches are called for. The topic areas were selected
in the interest of producing a manageable and timely report to the
President and the Congress with concrete legislative recommendations,
but the Council is quite aware of many other important issues affecting
people with disabilities that will command the Council's attention
in the future and that may call for legislative solutions. The Council
expects to issue subsequent reports to address topics and issues
affecting classes of people with disabilities, as well as to monitor
the implementation of the recommendations made herein.
The major conclusions and legislative recommendations
of the Council regarding the ten topic areas follow.
Equal Opportunity Laws
If the goals of independence and access to
opportunities for people with disabilities are to be achieved, it
is essential that unfair and unnecessary barriers and discrimination
not be allowed to block the way. Accordingly, the President and
the Congress have called upon our Nation to guarantee equal opportunities
for citizens with disabilities. Congress has enacted several laws
prohibiting discrimination against people with disabilities. One
of the best known of such laws is Section 504 of the Rehabilitation
Act of 1973, as amended, which prohibits discrimination on the basis
of handicap in programs and activities conducted by the Federal
Government or conducted by recipients of Federal financial assistance.
Section 503 of the Rehabilitation Act requires Federal Government
contractors to take "affirmative action" to employ and advance workers
with disabilities. Section 501 places a similar "affirmative action"
requirement upon Federal Government employment. Several other Federal
laws prohibit discrimination on the basis of handicap in certain
other contexts.
A problem with existing laws, however, is that their
coverage is not nearly as broad as laws prohibiting discrimination
on the basis of race, color, sex, religion, or national origin.
Many types of activities, such as employment by agencies engaged
in interstate commerce, public accommodations, and housing, are
covered by laws prohibiting other types of discrimination, but not
by laws prohibiting handicap discrimination. Because of their narrow
coverage, handicap nondiscrimination laws fail to serve the central
purpose of any human rights law-providing a strong statement of
a societal imperative. An adequate equal opportunity law for persons
with disabilities will seek to obtain the voluntary compliance of
the great majority of law-abiding citizens by notifying them that
discrimination against persons with disabilities will no longer
be tolerated by our society.
Other problems with current statutes addressing discrimination
on the basis of handicap include certain difficulties in the statutory
language, the lack of specificity or standards concerning nondiscrimination,
and inconsistencies in interpretation and application of the statutes.
Recommendations
1. Congress should enact a comprehensive law requiting
equal opportunity for individuals with disabilities, with broad
coverage and setting clear, consistent, and enforceable standards
prohibiting discrimination on the basis of handicap.
Such a statute should be packaged as a single comprehensive
bill, perhaps under such a title as "The Americans with Disabilities
Act of 1986." The recommendations which follow spell out more specifically
the components which such a bill should contain in order to create
a comprehensive and effective equal opportunity law for individuals
with disabilities.
2. The equal opportunity law for persons with disabilities
should prohibit discrimination on the basis of handicap by:
- The Federal Government, all of its agencies
and departments, and the United States Postal Service.
- All recipients of Federal financial assistance,
with coverage of all operations of the recipient and not just
a particular program or activity.
- Federal contractors and subcontractors and Federal
licensees.
- All employers engaged in an industry affecting
commerce who have fifteen or more employees; employment agencies;
and labor unions.
- All sellers, landlords, and other providers
of housing covered by Title VIII of the Civil Rights Act of 1968.
- All public accommodations covered by Title II
of the Civil Rights Act of 1964.
- All persons, companies, and agencies that engage
in the business of interstate transportation of persons, goods,
documents, or data.
- All persons, companies, and agencies that make
use of the mails or interstate communications and telecommunications
services for the business of selling, arranging, or providing
insurance.
- i. States, counties, and local governments,
pursuant to Congressional authority to enact legislation abrogating
the States' immunity under the Eleventh Amendment in order to
enforce the Fourteenth Amendment guarantee of Equal Protection
of the Laws.
These provisions would expand coverage of equal opportunity
law for people with disabilities to make it commensurate with the
coverage of other types of nondiscrimination laws and to apply its
coverage to certain particularly problematic types of discrimination
against persons with disabilities. In addition, they would undo
limitations imposed upon the coverage of such laws as a result of
court decisions restricting their application.
3. The law should provide a clear definition and
standards for applying the prohibition of discrimination on the
basis of handicap.
The statute should straightforwardly prohibit "discrimination
on the basis of handicap," without establishing any eligibility
classification for the coverage of the statute. Discrimination on
the basis of handicap should be broadly construed to apply the requirements
of the statute to all situations in which a person is subjected
to unfair or unnecessary exclusion or disadvantage because of some
mental or physical impairment, perceived impairment, or history
of impairment. Discrimination should be defined to include: a) Intentional
exclusion; b) Unintentional exclusion; c) Segregation; d) Unequal
or inferior services, benefits, or activities; e) Less effective
services, benefits, or activities; and f) The use of screening criteria
with a disparate impact upon individuals with disabilities that
do not correlate with actual ability. The nondiscrimination requirement
should expressly include a duty to make reasonable accommodations,
which should be defined as providing or modifying devices, services,
or facilities, or changing practices or procedures in order to allow
a particular person to participate in a particular program, activity,
or job. The duty not to discriminate should also include an obligation
to remove architectural, transportation, and communication barriers,
including meeting the accessibility requirements recommended below.
In addition, there should be a requirement of eliminating discriminatory
qualifications standards, selection criteria, and eligibility requirements,
with a delineation of the standards and legal tests to be used to
determine when such qualifications, criteria, and requirements constitute
discrimination. In addition, a requirement of outreach and recruitment
efforts should be explicitly established; the focus of such efforts
should be upon people with serious disabilities, such as the Equal
Employment Opportunity Commission's current listing of "targeted
disabilities. "
4. The law should delineate specific enforcement
standards, procedures, and timelines for the implementation of equal
opportunity requirements.
The agencies responsible for developing regulations
implementing the equal opportunity law for people with disabilities
should be clearly designated, and timelines established for the
issuance, after public comment, of such regulations. The Architectural
and Transportation Barriers Compliance Board should be directed
to establish binding minimum guidelines for architectural, transportation,
and communication accessibility, as discussed below in Recommendation
5. Consistent with such minimum guidelines, the Department of Housing
and Urban Development should be directed to develop appropriate
regulations concerning housing opportunities (for further discussion,
see the Council's recommendations on Housing); the Department of
Transportation should be directed to develop regulations for mass
transit, air travel, and other modes of transportation covered by
the law (for further discussion, see the Council's recommendations
on Transportation); the Federal Communications Commission should
be directed to promulgate regulations governing its licensees; and
other agencies should be directed to develop regulations for the
areas of their responsibility, including the programs and activities
they conduct, those they license, and those for which they provide
financial assistance. The Equal Employment Opportunity Commission
should expressly be charged with the development of regulations
governing Federal employment and for setting standards for all other
employment covered by the law. An administrative enforcement process
should be provided for individuals who believe that their rights
under the law and regulations have been violated. Successful complainants
should be entitled to injunctive relief, monetary damages, attorneys
fees, and back pay as necessary to remedy the discrimination to
which they have been subjected. A private right of action in Federal
court should be established for complainants if administrative enforcement
has not occurred after a specified amount of time (e.g., 60 or 90
days), and at the completion of the administrative decision-making
and appeals process. The law should authorize the imposition of
fines or the cutoff of Federal finds (including both grants and
contracts) if there is a showing of discrimination in an appropriate
administrative or judicial proceeding; such fines or funding cutoff
should continue until the discrimination is corrected or discontinued.
5. The Architectural and Transportation Barriers
Compliance Board should be given the authority and responsibility
to issue minimum guidelines for universal accessibility and other
standards for the removal of architectural, transportation, and
communication barriers in facilities, vehicles, programs, and activities
covered by the equal opportunity law for people with disabilities.
This recommendation is intended to correct the problems
with the language of Section 502 of the Rehabilitation Act of 1973
as currently worded that have left questions about the extent of
the authority of the Architectural and Transportation Barriers Compliance
Board (ATBCB) to set minimum guidelines regarding transportation
and communication barriers. It would also expand the Board's authority
commensurate with the expanded coverage of the equal opportunity
law recommended in this report. Provisions establishing ATBCB should
also be amended to provide that public members of the Board shall
continue to serve at the expiration of their terms until their successors
have been appointed and are ready to serve.
6. The law should also:
- Direct the Federal Government to use its leverage
as a consumer of goods and services to require that businesses
and companies _from which it rents or makes purchases to make
goods, services, and facilities usable by individuals with disabilities;
- Apply to discrimination in medical services;
- Include an enforceable Bill of rights for Persons
with Disabilities;
- Provide for the dissemination to persons with
disabilities of information concerning their rights;
- Provide a private right of action against Federal
contractors and subcontractors who engage in discrimination against
people with disabilities; and
- Provide an expanded Protection and Advocacy
System in each State to protect and advocate for the rights of
individuals with all types of disabilities, regardless of age
of onset.
Employment
As
for most other Americans, a major prerequisite to economic selfsufficiency
for individuals with disabilities is a job. Employment is an essential
key to successful adult integration into community life. Various
forms of work are associated with greater independence, productivity,
social status, and financial security. Success and quality of life
are often measured in terms of paid employment.
Studies indicate that only one-third of youths with
disabilities leaving school graduate to a job or some form of advanced
education. The absence of a systematic vocational transition process
for youths with disabilities significantly contributes to the unemployment
rates of persons with disabilities. Of the approximately 12.9 million
working age persons reporting a work disability, only 4.2 million
(or 32 percent) were working at the time of the 1980 Census.
Reasons for high unemployment and underemployment
among persons with disabilities include the lack of an effective
transition process from school to work for youths with disabilities;
societal attitudes which cause employers to discriminate against
persons with disabilities; physical and communication barriers in
buildings, transportation, and worksites; and the lack of appropriate
training opportunities for persons with disabilities.
State/Federal vocational rehabilitation agencies,
projects with industry, return-to-work programs (established by
some businesses), and selective hiring authorities within the Federal
Government have increased employment opportunities for persons with
disabilities. Although programs such as these encourage education
and employment, they are inadequately meeting the goal of successfully
integrating persons with disabilities in schools, workplaces, and
the community.
To increase employment opportunities for people with
disabilities, programmatic changes are needed in several areas.
Recommendations
Transition
1. Congress should direct the Department of Education
to designate the State educational agency as the lead agency to
start, develop, and carry out the transition planning process.
This Nation has invested heavily in special education;
to capitalize on this investment, it is necessary for the Federal
Government to assure that each youth in a special education program
be guaranteed a well-developed, organized and coordinated transition
process from school to work.
The regulations accompanying Public Law No. 94-142,
the Education for All Handicapped Children Act, should be modified
to make the State education agency responsible for the transition
process. The State and local education agencies should be responsible
for initiating and carrying out the transition process, including
contacting the appropriate personnel in regular and special education,
vocational education, vocational rehabilitation, community colleges,
developmental disabilities and other agencies from whom each student
receives services. To support this effort, the regulations should
set the following minimum guidelines:
- The planning process should begin no later than
ninth grade, and should include the active involvement of parents
and students.
- A formal written plan with long-and short-term
goals and objectives that include functional skills for employment
and daily living is to be prepared and updated annually by the
lead agency in consultation with the student, parents, and other
involved agencies. Parent and student approval of the plan should
be required in writing.
2. Congress should direct the Department of Education
to strengthen regulations requiring the involvement of education
coordinators and vocational rehabilitation counselors in the transition
process.
Vocational rehabilitation counselors and education
coordinators (including general, special, and vocational education)
should be actively involved in the transition process. In addition
to prescribing such participation, the regulations should provide
minimum standards for the training of vocational rehabilitation
counselors and education coordinators in regard to the transition
process. Training should focus on strategies for involving employers
and families in the transition process, as well as eligibility requirements,
and pertinent special education and vocational education techniques.
These training requirements, coupled with the State education agency
taking the lead for transition services (Recommendation 1, above),
will establish the foundations for a coordinated transition process.
These recommendations can be implemented without additional expenditures
of public funds.
Supported Work
3. Congress should amend the Rehabilitation Act
to add a Title expressly authorizing programs of supported work
for persons with severe disabilities who can be competitively employed
with the assistance of such a program.
The term "supported employment" means paid employment
which: a) is for persons with severe disabilities (such as developmental
disabilities, chronic mental illness, and severe physical disabilities)
for whom competitive employment at or above the minimum wage without
support is unlikely, and who, because of their disabilities, need
intensive ongoing support to perform in a work setting; b) is conducted
in a variety of settings, including worksites in which persons without
disabilities are employed; and c) is supported by any activity needed
to sustain paid work by persons with disabilities, including supervision,
training, and transportation.
If supported work programs were available, a large
number of severely disabled persons residing in residential facilities
could return to the community and become gainfully employed. Some
pertinent figures indicate:
- 499,169 persons with mental illness were served
in 277 state hospitals for $4.5 billion (Goldman, Gattozzi, and
Taube, 1981).
- 243,669 persons with mental retardation were served
in 15,633 residential facilities for $5.9 billion (Smith, 1984).
- 1,396,132 elderly and physically disabled persons
resided in 23,065 nursing homes (Sirrocco, 1983) and other long-term
care facilities at a cost to Medicaid of $12.4 billion (National
Study Group on State Medicaid Strategies, 1983).
If permanent authorization and funding for supported
work programs were in place under the Rehabilitation Act, these
numbers could be significantly reduced. Congress appropriated $3.7
million in FY 1985 for grants for supported work programs. Permanent
funding is needed to sustain these supported work activities and
to develop others.
Funding for supported work programs will provide persons
with severe disabilities an opportunity to work toward independence
by becoming taxpayers rather than remaining dependent upon other
taxpayers. Implementing this recommendation should not entail expenditures
of additional public funds. For example, the Medicaid payment process
could be modified to allow the funds a disabled person receives
while in an institution to follow or accompany the person to the
community to pay for educational and vocational services including
supported work. Medicaid payments for individuals employed in supported
work situations should be much less than if such people remained
in institutions. Likewise, the Title XX program funds day activity
programs for severely disabled persons not eligible for vocational
rehabilitation services. Some portion of funds from this program
should be re-directed to provide supported work services for this
population, since studies show that many severely handicapped individuals
are capable of productive work if given appropriate support services.
This change would not involve an increase in funds or an increase
in persons served. Rather, day activity programs would simply be
encouraged to provide vocational services as part of their programming.
Federal Support for Private Sector Initiatives
4. Congress should extend and expand the Targeted
Jobs Tax Credit Program (Deficit Reform Act of 1984).
The Targeted Jobs Tax Credit (TJTC) Program should
be made permanent with greater first year tax credit allowances.
The TJTC Program should expressly authorize employer tax credits
for: reemploying persons who become disabled on the job, hiring
disabled persons in higher than entry level positions, and assisting
disabled employees who must relocate. Credits should also be allowed
for training disabled employees in high demand technical areas.
The existing TJTC Program gives employers a financial
incentive to provide disabled job seekers an opportunity to demonstrate
their capabilities. The recommendation to extend and expand this
program should result in a net benefit to the Federal Treasury because
the taxes paid by disabled employees assisted by the program should
greatly exceed the tax credits allowed to employers. In FY 1984,
according to the Department of Labor, 38,263 disabled persons were
certified under the TJTC Program.
5. Congress should make Section 190 of the Internal
Revenue Code permanent and expand it to a maximum amount of $75,000
per year
Section 190 encourages accessibility and increases
employment opportunities for persons with disabilities by allowing
a tax deduction for the removal of architectural barriers. This
incentive encourages employers to hire persons with disabilities
and elderly people for jobs suited to their needs and talents. Before
these individuals can become frill working
members of society, the workplace must be accessible.
6. Congress should develop innovative and effective
incentives to promote the establishment of return-to-work programs.
Incentives should be developed to promote the establishment
of return-to-work programs by employers. Return-to-work programs
provide early intervention services (counseling, job analysis, etc.)
for employees who may become disabled by an injury or illness.
According to Hood and Downs (1985), on-job accidents
burdened the 1982 economy with an estimated $31.7 billion in direct
and indirect costs. After adding the $24.9 billion cost of off-job
accidents (about one-third of which was borne by employers), the
1982 total cost of accidents was $56.6 billion. During that year
an estimated 100 million lost work days resulted from disabling
injuries and another 40 million lost days were caused by disabilities
from prior years.
Effective return-to-work programs will reduce the
cost of health and income maintenance programs by reducing the number
of persons with disabilities who are not working. Effective return-to-work
programs have been established by businesses such as Minnesota Mining
and Manufacturing Company, Eastman Kodak, and Control Data.
Job Development and Placement
7. Congress should support the development of area
model centers on employment for persons with disabilities.
Model centers on employment for persons with disabilities
should be established to demonstrate and disseminate information
about innovative or "cutting edge" employment strategies. The functions
of the centers would include: job analysis; job restructuring; dissemination
of state-of-the-art information on employment strategies, vocational
evaluation, models for coordination of special education, rehabilitation,
and vocational education, job development, and placement.
These model centers could be developed through a cooperative
effort of the Department of Labor, the National Institute of Handicapped
Research, the Rehabilitation Services Administration (RSA), State
and local governments, and the private sector, with RSA having the
lead role in establishing and operating the centers.
Job Training
8. Congress should amend the Job Training Partnership
Act (JTPA) to eliminate the income eligibility requirement for persons
with disabilities and to increase the representation of persons
with disabilities on Private Industry Councils.
Although the current JTPA legislation helps to increase
the employment and decrease the dependency of disabled persons,
it has shortcomings. Disabled persons are not being adequately served
by JTPA because unlike its predecessor, the Comprehensive Employment
and Training Act, JTPA does not consider a person eligible because
his/her handicap constitutes a barrier to employment. Income eligibility
criteria must be satisfied in order to receive services. In addition,
few individuals who understand the needs of persons with disabilities
are represented on the Private Industry Councils that direct local
JTPA programs. For this legislation to be of substantial benefit
to disabled persons, the Department of Labor should ensure that:
- The State Job Training Coordination Councils and
the local Private Industry Councils include people who understand
the needs, capacities and capabilities of disabled persons, particularly
including persons who themselves have disabilities.
- State and local plans have provisions for projects
that address the needs of disabled persons.
- Councils place a priority upon and develop methods
for achieving the participation of disabled persons in their programs.
- JTPA programs have vocational education and vocational
rehabilitation components.
- Parents and educators are informed of the programs
available for people with disabilities.
- Data is collected on the number and percentage
of disabled persons served.
Disincentives to Work Under
Social Security Laws
The recommendations
in the previous section focused upon increasing the effectiveness
of Federal efforts to secure employment opportunities for individuals
with disabilities, thus increasing the chances for such individuals
to achieve independence and economic self-sufficiency. Some Federal
programs under current Social Security laws not only fail to promote
employment and independence for citizens with disabilities, but
actually penalize and discourage people with disabilities if they
seek to become employed. These programs-Supplemental Security Income
(SSI), Social Security Disability Insurance (SSDI), Medicaid and
Medicare-provide many severely disabled people with basic life necessities.
Consumer and service provider experiences indicate, however, that
some program provisions encourage dependence and discourage gainful
employment.
Currently the Social Security Administration's (SSA)
process for determining eligibility for SSI or SSDI income benefits
begins with a medical evaluation of the individual's disability.
Only in cases in which the disability is not on the SSA "medical
list" (e.g., blindness, deafness, spinal cord injuries), does the
eligibility determination include both a medical diagnosis and an
assessment of vocational potential. This determination process can
sometimes result in the automatic award of benefits to individuals
with clearly defined medical disabilities who have significant vocational
potential and should be able to work.
A major disincentive to work for many current SSI
and SSDI recipients is that employment in many entry level and
low paying service jobs will often result in reduced income and
the loss of medical and other benefits. The Council also finds evidence
that many people with preexisting medical conditions cannot obtain
adequate health insurance at an affordable cost. This problem creates
an incentive to enter public aid programs since the medical costs
associated with some disabling and preexisting conditions exceed
the working individual's ability to pay.
Recommendations
1. Congress should amend the Social Security Act
to make eligibility for SSI and SSDI programs dependent upon the
presence of a severe medical disability and a functional assessment
to determine vocational potential whenever deemed appropriate.
Whenever the vocational potential of a working age
applicant is at issue, applicants who are not terminally ill should
be required to undergo a functional vocational assessment that establishes
that they will have substantial difficulty working because of severe
vocational limitations of an ongoing nature. Individuals with disabilities
who are refused SSI and SSDI income support benefits because they
are determined to be able to work should be offered vocational rehabilitation
services.
This recommendation is designed to change the focus
of disability determinations from a purely medical standard to one
that assesses the full range of factors that affect the ability
to work of persons with disabilities. It narrows the definition
to prevent those who have a medical impairment but are able to work
from automatically becoming eligible for income support benefits.
To implement this recommendation, the Social Security
Administration should be charged with using its demonstration authority
to develop procedures for conducting functional vocational assessments
and for assuring that adequately trained people are available to
carry out the assessments. For instance, SSA could contract for
this service with independent agencies, such as independent living
centers, vocational rehabilitation agencies, or colleges and universities.
SSA should also enter into cooperative agreements with State vocational
rehabilitation agencies to assure that individuals who are refused
benefits because of their vocational potential are not then refused
vocational rehabilitation services. Applicants should not be required
to undergo a second, duplicative vocational assessment if they are
referred for vocational rehabilitation services.
2. Congress should amend the Social Security Act
to assure that SSI and SSDI recipients who become gainfully employed
are permitted to retain benefits and have access to medical insurance
in circumstances where the loss of such benefits would substantially
negate the income they might earn.
Three steps should be taken to implement this recommendation.
First, Section 1619(a)&(b) of the Social Security Act, which
authorizes continuing cash benefits and Medicaid coverage to working
SSI beneficiaries, should be made permanent, thereby removing the
uncertainty associated with the temporary nature of Section 1619.
Second, Section 1619 provisions should be extended
to SSDI recipients. The formula for determining benefits when earnings
increase may need to be modified since some SSDI recipients receive
comparatively high benefit payments. If the Federal break-even point
for SSI were used for SSDI, benefits might reach inappropriately
high levels.
Third, Medicare and Medicaid coverage should be made
available on a sliding fee scale that reflects income to working
SSDI and SSI beneficiaries who cannot obtain private health insurance
coverage because of their disabilities. Employers should be required
to contribute an amount equal to that contributed to other employee
health insurance plans. Alternatively, cooperative programs with
insurance programs might be developed in which Medicaid would pay
disability-related medical expenses and the private insurer would
be responsible for other medical expenses.
3. Congress should direct the Health Care Financing
Administration to study and recommend cost-effective methods for
providing health insurance coverage to persons with preexisting
conditions who cannot obtain adequate health insurance coverage
from private insurers at affordable rates. The study should be conducted
in consultation with the National Council on the Handicapped, and
findings and recommendations should be reported in hearings before
Congress within two years of the date of enactment of this provision.
Some disabled workers are forced into income support
programs primarily because they cannot obtain private medical insurance
coverage due to the preexisting conditions of disability. Persons
with disabilities who are self-employed often have great difficulty
because they rarely have access to a group insurance program. If
a disabled worker's income is not sufficient to cover both basic
living and medical expenses, the worker may be forced into a public
assistance program in order to obtain the needed medical benefits.
The Council believes that the availability of health
insurance coverage for people with disabilities is an important
incentive to employment, and that the States may be able to provide
leadership in this area. Innovative programs in place in those States
that provide health insurance coverage for uninsured populations
should be examined, and a variety of funding and insurance strategies
should be considered.
Considerable savings can be realized by removing disincentives
to work in current programs: Medicaid benefit payments often decrease
when a person with a disability is employed. Income support payments
will always be reduced as recipients of income benefits become gainfully
employed and income support benefits are reduced or ended. Although
there is no precise method of estimating expected costs and benefits,
the Congressional Budget Office has informally estimated that no
increases in costs are associated with a permanent extension of
Section 1619. Other authorities have projected considerable cost
savings. For instance, in August of 1984, 6,000 SSI recipients earned
over $713 a month, the break even point for going off of SSI payments.
If permanent, continued Medicaid coverage encouraged these individuals
to leave the SSI program, a savings of $324 a month per individual
in SSI payments would result in a projected reduction in cash benefits
of $23 million per year (Bartlett, 1985). The advantages to society
are even greater if personal benefits to the individual, such as
increases in self-esteem and mental and physical health, and economic
benefits to the community, such as the purchase of goods and services,
are considered.
Prevention of Disabilities
A Federal initiative to prevent disability
could substantially reduce the health care costs and human suffering
associated with the high incidence of disability in this country.
Effective preventive measures would reduce the costs of disability
and health care for Americans, reduce Federal spending for disability
in the near future, and decrease the incidence of disability for
future generations.
Studies indicate that preventive measures would greatly
reduce the number of new additions to the disabled population. For
example, an estimated 50% of hearing impairments could be prevented
through the use of inexpensive preventive strategies. A substantial
percentage of the serious birth defects and illness experienced
each year by approximately 250,000 infants could be prevented through
effective prenatal and infant care. Most of the estimated 59 million
nonoccupational injuries that occurred in 1981, including the 27
million accidents that occurred in and around the home, could have
been prevented. Prevention is inexpensive and painless when compared
to the high cost and suffering associated with preventable illnesses
and accidents.
Our Nation has the knowledge, technology, and resources
to mount an effective and successful national program for the prevention
of disabilities. Preventive action could substantially reduce disabilities
resulting from: a) infant birth disorders, illness, and injuries;
b) vehicular accidents; c) heart disease and stroke; d) occupational
accidents and hazards; e) home, recreational and pedestrian accidents;
f) genetic disorders; g) infectious diseases; h) chronic diseases;
i) toxic substances in the environment; j) noise pollution; k) radiation;
and 1) violence. Preventive efforts could also reduce the unnecessary
secondary disabilities or exacerbation of impairments often experienced
by people with disabilities. In addition, Americans should be encouraged
to use healthy lifestyle behaviors which prevent certain types of
diseases and disorders.
The Council urges the Federal Government to mount
a national program for the prevention of disability by providing
leadership and by coordinating Federal prevention-related programs.
Recommendations
1. Congress should enact a law related to prevention
entitled "The Prevention of Disabilities Act."
The Act should have three chief provisions: a) authorize
the National Council on the Handicapped to establish policy and
goals for a National Plan on the Prevention of Disabilities, and
to review and make recommendations regarding implementation of the
Plan; b) require the Office of Disease Prevention and Health Promotion
(Department of Health and Human Services), working with the National
Council on the Handicapped and other appropriate Federal agencies,
to oversee the development and implementation of the National Plan;
and c) authorize a small grant program to support the development
of coordinated, comprehensive, and effective prevention programs
by States and local communities. The grant program should be administered
by the Assistant Secretary of Health. Implementation of this recommendation
should require only a small number of additional staff and some
operational funding to support the implementation of Parts a and
b above. In addition, the small grant program (Part c) would require
only minimal funding support over a five year period.
2. Congress should provide appropriate levels of
funding for special program priorities related to disability prevention.
The appropriation of funds for specific program priorities
should include: a) prenatal care through the Maternal and Child
Health Care program, Medicaid, and the Women, Infants, and Children
(WIC) program (at no less than FY 84 levels); b) preschool educational
services through block grants to State educational agencies; c)
educational programs for professional personnel, parents and children
in disability prevention; d) dissemination of information about
disability prevention to minority groups, children, and adolescents
through public education programs and curriculum units about prevention
in elementary and secondary schools; and e) development of methods
for preventing secondary disability among those already disabled.
3. Congress should direct its Office of Technology
Assessment to conduct a study of the status of primary and secondary
prevention of disability in the United States, and to submit a report
of its findings two years after the issuance of the National Plan
on the Prevention of Disabilities.
The authorization would provide for an objective,
independent assessment through the Office of Technology Assessment
of the status of primary and secondary prevention efforts in the
United States, and of compliance with the National Plan.
Transportation
Another prerequisite for achieving equal opportunities
and independent living for persons with disabilities is transportation-the
ability to get to and from work, stores, medical facilities, recreational
and social settings, and other destinations-to move about the local
neighborhood, the city, the state, and the world. The Urban Mass
Transit Act, as amended in 1970, established services for disabled
people as a basic element of Federal transportation policy-it states
that disabled people have the same right to use public transportation
as nondisabled persons. Specific language promoting this principle
was also included in the Federal-Aid Highway Act of 1973. Since
1970, the nation has begun implementing accessible transportation
systems in compliance with this policy.
Approximately 7.4 million persons are transportation-handicapped,
according to a national survey conducted by the Department of Transportation.
Transportation handicaps vary, ranging from difficulty climbing
stairs, reading signs, hearing announcements, or understanding transit
information, to the use of a wheelchair. On the average, persons
with transportation handicaps have lower incomes than other Americans,
and are more dependent on public transportation to conduct the business
of their daily lives. In fact, a major impediment to employment
for people with disabilities is their inability to reach the job
site. Increasing job opportunities through improved access to transportation
would bring far-reaching economic benefits to disabled individuals
and to society.
Regulations designed to implement legislative requirements
for accessible urban transportation systems have changed several
times during the past 15 years. They have ranged from minimal "special
efforts" and "local options" to requirements based on Section 504
of the Rehabilitation Act of 1973 for almost immediate full
accessibility. Current regulatory efforts have begun to concentrate
on setting performance criteria for the provision of services to
disabled persons. This is intended to assure that services available
to disabled persons are equivalent to those available to nondisabled
passengers. Specifics of system design would be determined at the
local level in response to local conditions and community needs
with significant input from disabled and elderly individuals.
The Council has reviewed the implementation of the
Nation's transportation policy. Its conclusion is that we are far
short of a truly accessible system. A 1982 survey conducted by the
General Accounting Office indicated that nearly three-fourths of
the urban rail stations surveyed are almost totally inaccessible
to wheelchair users. The same study determined that one-third of
the transit systems offering fixed-route bus service did not have
a single bus with a lift. A 1985 American Public Transit Association
(APTA) fact sheet reported that 76% of the 49,000 buses in use in
this country are not accessible.
Disabled persons encounter a variety of additional
problems when attempting to use other forms of transportation. Air
travelers who use wheelchairs face a multitude of problems, ranging
from uncomfortable, dangerous, and dehumanizing boarding procedures
to inaccessible restrooms and boarding areas. Intercity/interstate
bus service, the primary mode of public transportation for people
in rural areas, is almost totally inaccessible to many persons with
transportation handicaps. Modified private vehicles, frequently
the only source of transportation realistically available to many
persons with severe disabilities, are often prohibitively expensive
for individuals and families with limited incomes.
Although the general picture currently appears bleak,
the Council has identified cost-effective, working models of usable,
accessible transportation systems. Seattle, Washington; Champaign-Urbana,
Illinois; Dayton, Ohio; Johnstown, Pennsylvania; and Palm Beach,
Florida, have made significant and successful efforts to provide
accessible public transportation which meets the needs of most of
their citizens in a cost-effective manner. In addition, some interstate
bus systems have attempted to develop accessible bus service, and
some airlines already provide effective, courteous service for persons
with travel disabilities. Amtrak has developed a model transition
plan for accessibility that looks very promising.
The Council has concluded that accessible transportation
is a critical component of a national policy that promotes the self-reliance
and selfsufficiency of people with disabilities. People who cannot
get to work or to the voting place cannot exercise their rights
and obligations as citizens. Accessible transportation will become
increasingly important in coming decades as the baby-boom population
grows older and experiences the increased transportation handicaps
associated with aging.
Providing only "special" van service and modified
private vehicles is too expensive and restrictive an option to meet
the needs of this growing population, as is retrofitting tomorrow
the mass transit systems that are being built or renovated today.
The Nation's experience with accessible transportation over the
last 15 years suggests that workable cost-effective alternatives
are available. The time has come to make our Nation's policy of
accessible transportation a reality.
Recommendations
Urban Mass Transit
1. Congress should amend Section 16 of the Urban
Mass Transit Act to require full accessibility to mass transportation
to be achieved over a realistic period of time; such amendments
should.
- Prohibit discrimination on the basis of disability
by recipients of Federal funds under this Act.
- Require recipients to provide a level of service
to disabled and elderly persons that is equivalent with that available
to nondisabled persons in terms of 1) service range, 2) transfer
frequency, 3) fare, 4) travel purpose, 5) trip decision-travel
time, 6) capacity, and 7) availability.
- Require that all new facilities and vehicles
constructed or purchased with funds under this Act be accessible.
- Require recipients of funds under this Act to
develop specific transition plans for achieving, within a reasonable
period of time, full access and comparable service levels. These
plans should be developed with the substantial and meaningful
involvement of disabled and elderly consumers.
- Create a private right of action for persons
who believe they have been discriminated against by recipients
of funds under this Act.
Full access to transportation can only be accomplished
by combining various modes of accessible transportation, including
fixed-route buses, specialized services, and rapid rail systems.
Such a system can provide to disabled and elderly persons reliable
transportation services that are tailored to local conditions, accessible,
and equivalent in the quality and level of service to that provided
to other citizens. All new facilities and vehicles should be required
to be accessible. By making facilities and vehicles accessible at
the time of construction or purchase, unnecessary, expensive retrofitting
and renovation can be avoided. Disabled and elderly consumers must
be involved in substantial and meaningful ways throughout the process
of planning, implementing, and evaluating transit systems.
The Council also believes that persons who feel that
they have been discriminated against in the provision of transportation
should have individual and collective recourse for resolution of
their rights through the courts. The potential for court action
would also provide a clear incentive to transit authorities to act
in nondiscriminatory ways so as to avoid sanctions which might be
imposed by a court of law.
2. Congress should amend the Architectural Barriers
Act of 1968 to establish the Department of Transportation as a standard-setting
agency for the development of access standards for buildings, facilities,
and public conveyances, including rolling stock and aircraft, which
are designed, altered, constructed or purchased with Federal funds
to insure that they are readily accessible and usable by disabled
and elderly persons.
The Department of Transportation (DOT) currently sets
transportation standards governing such matters as configurations
of vehicles, communications access, appropriate signage, and safety.
This recommendation will clearly establish DOT as the standard-setting
agency for accessible transportation under the Architectural Barriers
Act. The required standards, which should be developed with the
input of the Council, would set forth specific requirements to guide
transit authorities in designing accessible transit systems and
evaluating their effectiveness.
Section 502(B) of the Rehabilitation Act of 1973 directs
the Architectural and Transportation Barriers Compliance Board (ATBCB)
to set minimum guidelines and requirements for standards developed
by the standard-setting agencies under the Architectural Barriers
Act. The combination of setting standards and establishing minimum
guidelines and requirements will provide greater assurance to disabled
and elderly persons that transportation systems developed with Federal
funds will in fact have access features which make them usable in
a meaningful way.
It should be noted that certain technical changes
to the initial text of the Architectural Barriers Act would be needed
to accommodate the addition of DOT. Thus, coverage of "public conveyances"
and things which are "purchased" with Federal funds should be added.
Air Transportation
3. Congress should amend the Federal Aviation Act
to:
- Prohibit discrimination on the basis of disability
by all airlines using Federally assisted airports.
- State that all airlines using Federally assisted
airports are subject to the provisions of Section 504 of the Rehabilitation
Act of 1973 and regulations promulgated thereunder
Currently only a few small air carriers are directly
Federally subsidized and thus covered by nondiscrimination provisions
under Section 504 of the Rehabilitation Act of 1973. These air carriers
provide only a small percentage of this Nation's air transportation.
To assure accessible air transportation for America's disabled and
elderly citizens, Congress should require that all airlines using
Federally assisted airports be prohibited from discriminatory practices
and be subject to regulations promulgated under Section 504. Airlines
should also be required to review and eliminate current practices
and policies which have resulted in discriminatory, ineffective,
and often dangerous service to disabled and elderly persons. Recommendation
2 above, requiring the Department of Transportation and the Architectural
and Transportation Barriers Compliance Board to set standards and
minimum guidelines for access, covers the provision of air transportation.
This will insure accessible airports and aircraft.
Intercity and Interstate Buses
4. Congress should extend coverage of handicap nondiscrimination
requirements to interstate commerce, thus prohibiting such discrimination
by intercity and interstate bus companies.
Intercity and interstate bus transportation is often
the only form of public transportation connecting people in rural
areas with major cities and towns. By prohibiting discrimination
and improving access to this type of transportation, many more people
would be able to take advantage of the many educational, recreational,
and employment opportunities found only in the city. (For further
discussion of nondiscrimination provisions, see the section on "Equal
Opportunity Laws" above.)
Private Transportation
5. Congress should establish a low-interest loan
program based on income to assist disabled persons and families
with disabled children or elderly persons to purchase vehicles or
to make necessary access modifications.
Private transportation provides the only means by
which many disabled and elderly persons can become employed and
participate in educational and recreational programs. In rural areas,
private transportation is frequently the only transportation option.
Since the cost of purchasing and modifying vehicles is prohibitive
for many disabled persons and their families, such a low-interest
loan program is needed to supplement the other transportation options
outlined above. Federal funding for such a program should be provided
up to a reasonable cap amount as established by Congress.
6. Congress should direct the Department of Transportation
to commission a study, based upon its existing authorities and targeting
currently available funds, to assess the impact of increased access
to transportation on employment, education, and quality of life
for disabled and elderly persons.
Little current data is available to document the potentially
great benefits resulting from accessible transportation. Older studies
suggest many benefits, both economically and in terms of life quality,
that are associated with access to transportation. The study called
for in this recommendation would provide more up-to-date documentation
of such individual and societal benefits.
Housing
Securing
appropriate housing is a major prerequisite to social integration
and living independently for persons with disabilities. The lack
of appropriate housing opportunities for individuals with disabilities
frequently results in the unnecessary and expensive institutionalization
of such persons. Available data suggest that the costs of providing
appropriate housing options for disabled people are well worth the
investment because of the significant savings that may be engendered
by enabling disabled people to live in the community, get jobs,
and pay taxes. Various reports of Federal agencies, disabled persons,
and the few formal studies of the subject have documented a serious
shortage of housing options for people with disabilities.
Congress and the Administration have recognized that
private production may not be sufficient to meet the housing needs
of elderly persons and persons with disabilities. The only Federal
construction and rehabilitation loan program that addresses this
shortfall of appropriate housing units is the Section 202 Program
administered by the Department of Housing and Urban Development
(HUD). The traditional Section 202 Program, however, has engendered
certain problems, such as the isolation of persons with disabilities
and a lack of age-appropriate social integration. HUD is currently
reevaluating the program for possible redirection.
HUD administers two major programs that provide rent
subsidies for people with reduced incomes, including those with
disabilities. The older of these two programs-the traditional Section
8 Program-provides housing assistance payments for eligible handicapped
tenants in rent-subsidized housing. Section 8 subsidies have encouraged
housing developers to construct Section 202 housing units because
they create assured rent revenues for the units. The second program-the
Administration's voucher program-has been initiated as a demonstration
project. It appears to be an effective vehicle for providing rent
assistance to disabled and other persons with low incomes, while
permitting such persons the opportunity to select their own places
of residence.
A few local governments have used some of their community
development block grant funds to develop housing programs and units
for people with disabilities.
The Federal Fair Housing Act--Title VIII of the Civil
Rights Act of 1968--prohibits discrimination in housing on the basis
of race, color, religion, sex, and national origin, but does not
address discrimination on the basis of handicap. As a result, housing
providers who are prohibited from discriminating on other grounds
are permitted to discriminate against citizens with disabilities.
Section 504 of the Rehabilitation Act prohibits discrimination on
the basis of handicap by recipients of Federal financial assistance,
but no final HUD regulations implementing this requirement have
been issued.
Recommendations
1. Congress should prohibit housing & discrimination
against persons with disabilities on as broad a basis as race, color,
religion, sex, and national origin discrimination are prohibited
under Title VIII of the Civil Rights Act of 1968.
Recognizing that one of the Nation's largest minorities-that
of persons with disabilities-is omitted from the coverage of the
Fair Housing Act, the Council recommends expanding coverage of housing
nondiscrimination requirements to protect persons with disabilities.
This may be accomplished either by amending Title VIII of the Civil
Rights Act of 1968 to include "handicap" or by enacting a separate
law (for further discussion, see the Council's recommendations on
"Equal Opportunity Laws"). President Reagan has called for expansion
of Fair Housing legislation to protect people with disabilities,
and has noted an apparent Congressional consensus in favor of such
an expansion of coverage (President Reagan, Message to the Congress
Transmitting Proposed Fair Housing Legislation, July 12, 1983, p.
992).
Such a prohibition should make clear that developers,
landlords, and real estate management companies may be required
to make reasonable accommodations for individuals with disabilities.
It should also encompass a requirement of compliance with full accessibility
standards as described in Recommendation 2 below. The statutory
prohibition of discrimination in housing should declare local zoning
ordinances invalid to the extent that they prevent the establishment
or operation of community residential alternatives for people with
disabilities in all housing covered by Title VIII.
2. Congress should require that all housing units
constructed or substantially altered with Federal financial assistance,
Federal loans, Federally subsidized or insured loans, or by agencies
of the Federal Government, should be required to meet accessibility
standards.
In light of data indicating that such modifications
entail a very small percentage of costs of new housing, Federal
agencies should implement a plan and develop regulations requiring
that all housing units be adaptable, based upon Uniform Federal
Accessibility Standards now in effect under the Architectural Barriers
Act of 1968. These standards provide technical specifications for
a universally accessible floor plan, e.g., level or ramped entrances,
wide doors, lower outlets and heating controls, accessible bathrooms
with reinforced walls, accessible kitchens, and lower door knobs
and locks. Pursuant to analysis of the costs of the modifications,
and pursuant to minimum guidelines that should be established by
the Architectural and Transportation Barriers Compliance Board,
requirements for adaptability in housing may also impose additional
requirements for modifiable accessibility, such as adjustable shelves
in closets, and warning devices and flashing lights for people with
hearing impairments. This type of universally accessible housing
unit would be easily modified to meet the individual needs of a
person with a disability. Specific standards for applying such accessibility
requirements should be developed with input from the National Council
on the Handicapped, representatives of the housing construction
industry, such as the National Association of Home Builders, and
organizations of persons with disabilities. HUD should chair a Federal
interagency committee to assist and coordinate the development of
accessible housing units under the jurisdiction of other Federal
agencies, consistent with minimum guidelines established by the
Architectural and Transportation Barriers Compliance Board.
Accessible housing is not only an urgent present need
for citizens who currently have disabilities, but, as the U.S. population
becomes increasingly older with the maturing of the baby-boom generation,
accessible housing will become increasingly more important for the
growing population of elderly citizens. Statistics are clear: many
Americans who do not now have disabilities will incur disabilities
in their later years and will find themselves searching for accessible
housing. Imposition of an adaptability requirement on housing construction
today is one important step toward addressing the growing need for
such housing in the future.
3. Congress should direct the Department of Housing
and Urban Development that programs to provide rent subsidies for
persons with disabilities through both Section 8 certificates and
the housing voucher program should be made permanent and given a
high priority.
The Administration-endorsed voucher program, initiated
as a demonstration project, has proven to be an effective vehicle
for providing persons with disabilities the opportunity to select
their own places of residence. In addition, the traditional Section
8 certificate program continues to serve an important purpose in
assisting disabled people by providing rent subsidies. The Section
8 New Construction program is a major financial incentive for developers
to construct Section 202 housing for disabled persons. Twenty percent
of all Section 8 certificates should be set aside for persons with
disabilities. HUD should clarify maximum rent criteria under Section
8 to uniformly permit persons with disabilities to share apartments
with others. Income eligibility criteria for Section 8 certificates
and vouchers should be based upon actual net income of applicants
with disabilities after the deduction of disability-related expenses.
4. Congress should direct the Department of Housing
and Urban Development to reorganize the Section 202 program to provide
a range of housing options for persons with disabilities, and to
include a program of demonstration grants to agencies such as Independent
Living Centers to develop model housing options, including transitional
living programs, group residences, and other alternatives.
The Administration has recognized that private production
may not be sufficient to meet the housing needs of elderly people
and persons with disabilities (HUD, 1984, p. 61). Consequently,
Section 202 or a similar Federally funded program is needed to stimulate
the construction of additional housing units for people with disabilities.
The traditional Section 202 program, however, has engendered certain
problems, such as isolation of people with disabilities, and lack
of age-appropriate social integration. As HUD is reconsidering the
structure and goals of the Section 202 Program during the current
moratorium on Section 202 construction, the program should be reorganized
to provide several different types of housing options for people
with disabilities. These would include group homes and other disability-specific
residential programs for persons needing supervised supportive living
environments, as well as integrated housing in the community for
the majority of persons with disabilities who do not need such supervised
support.
All housing constructed under such a program should
meet general standards of accessibility, as discussed in Recommendation
2 above. The developer/management of such a project should be required
to provide tenants with disabilities the option of being interspersed
with nondisabled tenants. Tenants with disabilities should also
be integrated with other tenants on an age-appropriate basis.
A HUD program should be established to initiate demonstration
projects to provide funds to agencies such as Independent Living
Centers to develop model housing options for future HUD construction
funding. Such housing alternatives, including transitional living
programs, group residences, and other arrangements, will provide
alternative models to the traditional Section 202 high-rise apartment
buildings, and stimulate more appropriate housing opportunities
for citizens with disabilities and elderly persons.
These recommendations do not necessarily contemplate
any increase in funding of the Section 202 Program, but rather a
reallocation of the use made of Section 202 funds at current spending
levels.
5. Offices responsible for disability issues should
be established with in HUD's Fair Housing and Equal Opportunity
Division and within the Office of Policy Development and Research.
These two offices would provide much needed administrative
focus on disability-related issues within the Department. The former
would serve to guide the enforcement of Section 504 and other legal
and regulatory requirements, while the latter would provide important
input to HUD disability policy direction.
6. Congress should direct HUD to issue appropriate
regulations for the implementation of Section 504 of the Rehabilitation
Act of 1973.
A timeline should be imposed for the issuance of Section
504 housing regulations. HUD should be directed to involve disabled
individuals, the National Council on the Handicapped, and disability
organizations in the process of developing and issuing such regulations.
Such regulations should not permit the imposition upon housing applicants
with disabilities of any standards or criteria, such as neighbor
attitudes or apartment maintenance, unless such criteria are necessary,
nondiscriminatory, and are imposed upon all tenants. HUD's regulations
should provide that recipients of HUD funds are prohibited from
unintentional as well as intentional discrimination on the basis
of handicap. Recipients should be required to assure that practices,
procedures, and facilities do not inadvertently exclude or disadvantage
tenants or potential tenants with disabilities. The regulations
should also require compliance with accessibility requirements as
set out in Recommendation 2 above.
7. Additional programs should be initiated to leverage
existing private sector funding and to provide incentives and financial
resources for the development of housing opportunities for people
with disabilities.
FHA and other governmental and private housing loan
funds should be equally available to persons with disabilities.
Federal housing loan programs whose eligibility criteria include
income-level ceilings should reflect actual net income after the
deduction of disability-related expenses.
Rather than focusing on making and administering housing
loans, HUD should be authorized to "buy down" interest rates on
loans offered and administered by private financial institutions.
Other incentive programs should include:
- Expanding the existing Federal income tax deduction
for the removal of architectural barriers, including increasing
the amount eligible for deduction;
- Instituting low-interest loans or loan guarantee
programs to provide people with disabilities who are eligible
for rent subsidies the option of purchasing a comparable home,
thus reducing the long-term need for rent subsidies; and
- Establishing low-interest loan programs or tax
incentives to encourage private sector construction of single-family
housing, cooperatives, and condominiums for individuals with disabilities.
These proposals reflect the fact that the average
annual per unit expenditure for rent subsidies in 1985 amounted
to $6,459 in Section 202 facilities; $4,659 under Section 8 existing
certificates; and $3,404 under the voucher system. Such amounts
of money could be used to provide interest subsidies that would
enable eligible individuals with disabilities to purchase homes
at low interest rates, and to eventually cease needing any housing
subsidy.
8. HUD and the private sector should be encouraged
to develop training grants, supplemented teaching positions, awards,
and other innovative programs for promoting architectural planning
that incorporates the concept of universal accessibility.
Aspiring architects and planners should be provided
the training necessary to enable them to develop innovative designs
implementing universal accessibility in new and rehabilitative construction.
Such innovations may dramatically transform the design and construction
of housing, public and private buildings, schools, work places,
and public transit systems, and eliminate environmental barriers
to elderly persons and people with disabilities.
Community-Based Services
for Independent Living
The Council has
defined independent living as "control over one's life based on
the choice of acceptable options that minimize reliance on others
in making decisions and in performing everyday activities" (National
Policy for Persons with Disabilities, 1983). Living independently
includes managing one's affairs, participating in the day--today
life of the community in a manner of one's own choosing, fulfilling
a range of social roles including productive work, and making decisions
that lead to selfdetermination. Community-based services that promote
such independence for Americans with disabilities constitute one
of the most promising service delivery strategies for our Nation.
The Council wishes to affirm that the independent
living philosophy and a preference for community-based services
should permeate the services and benefits supported by the Federal
Government. The goal should be to establish core funding for a continuum
of community-based services guided by independent living concepts.
In order to live independently, disabled persons require
a wide range of support services according to their disability type.
Persons with severe physical disabilities usually require assistance
with personal care, domestic tasks, transportation, equipment maintenance,
and modifications of home and work place for architectural accessibility.
Those with sensory disabilities may require assistance with interpersonal
communication such as that provided by readers and interpreters.
Persons with mental impairments who wish to live independently may
require some degree of supervision and assistance with cognitive
tasks. All persons with disabilities and their families can benefit
from a single source of information and referral about services
and service providers.
In 1978, Congress incorporated a program of Comprehensive
Services for Independent Living in Title VII of the Rehabilitation
Act. It was the first Federal legislation to specifically authorize
funding for services needed by people with such severe disabilities
that they do not presently have the potential for employment. It
permits services to be provided to those presently without employment
potential if they may benefit from vocational rehabilitation services
(authorized under Title 1, Part A) which will improve their ability
to engage in employment or to live and function independently in
their families or communities. Part A of Title VII authorizes payments
for independent living services that are provided under approved
State plans. Part B authorizes a grant program for the establishment
and operation of independent living centers that offer, among other
services, the services funded under Part A. Part C authorizes funds
to provide independent living services for elderly blind individuals.
Funding for independent living services under Title
VII is very limited when compared to Medicaid (Title XIX of the
Social Security Act) funding for institutional care for people with
severe disabilities. If community-based independent living is to
become a realistic goal for Americans with severe disabilities,
institutional bias within Medicaid and other programs funded under
the Social Security Act must be replaced by a preference for community-based
services.
Recommendations
1. Congress should require the agency in each State
designated to administer Title VII, Part A of the Rehabilitation
Act to allocate no less than 50% of available funds to purchase
services from independent living centers that meet the standards
approved by the National Council on the Handicapped. No more than
10 % of available funds should be used for administrative purposes.
The remaining funds should be used at the discretion of the administering
agency in any way that assists people with severe disabilities to
achieve independence and productivity in their communities.
Currently States are required to provide assurances
in their State Plans that no less than 20% of the funds received
by a State under Part A are used to make grants to local public
agencies and private nonprofit organizations for the conduct of
independent living services (unless a waiver of this requirement
is obtained from the Commissioner of the Rehabilitation Services
Administration). The Council recommends that this percentage be
increased to 50% to assure that funding for independent living services
is available to and provided by agencies established and operated
for this purpose under Title VII, Part B. Such funding for services
should be authorized only for independent living centers that comply
with the standards approved by the Council.
Coordinated services are essential to the ability
of a person with a severe disability to live in the community. Therefore,
the Council recommends that States applying for Part A funds be
required to submit a plan for the coordinated delivery of services,
including personal assistance services (attendants, readers, interpreters,
and advocates for mentally retarded persons); and accessible housing
and transportation; and for State-wide information and referral
services for all people with disabilities and their families. Administrative
expenses for arranging services should be strictly limited to 10%
of these funds.
The Council recommends that funding for Part A be
continued as a means of ensuring that community-based services are
made available to persons with severe disabilities. Its implementation
should include requirements that independent living facilities and
services comply with standards approved by the Council for program
administration, service delivery, and program evaluation.
2. Congress should provide core funding under Title
VII, Part B of the Rehabilitation Act, for independent living centers
that meet the standards approved by the National Council on the
Handicapped. Such centers should be allowed to apply and compete
for this funding on an equal basis with State vocational rehabilitation
agencies.
Community-based, consumer-controlled independent living
centers were created to assist persons with severe disabilities
to increase their level of independence. As defined in Title VII,
Part B of the Rehabilitation Act, these centers must significantly
involve disabled persons in policy direction and management, and
must offer a combination of independent living services. Part B
of Title VII, which funds over 150 of these centers nationwide,
should be used as an ongoing source of funding to support the start-up
of new centers and to provide core support for established centers,
whether or not these centers have received Title VII funding in
the past. At least 20% of Part B funds should be used to support
the establishment of new independent living programs, with an emphasis
on rural and other underserved areas. The remaining available funds
should be used for core support of established centers.
The standards adopted by the National Council in 1985
for evaluating independent living centers should be enforced as
a prerequisite for the distribution of funds. New centers which
do not meet the standards at the time they apply for Federal funding
should be required to follow a preapplication process and have a
plan to meet the standards before receiving Federal funding. In
addition, independent living centers should be strongly encouraged
to obtain funding from other public and private sources. All centers
should include representatives of the business community on their
boards of directors. A mechanism should be established to provide
incentives for States to match Federal efforts for independent living
centers.
The Council wishes to note that in requiring independent
living centers to be consumer-controlled, it defines "consumer"
as including persons with all types of disabilities. It believes
that those with mental retardation or a history of mental illness,
for example, can serve a vital role as consumer members on boards
or in other responsible positions.
3. Congress should require the Health Care Financing
Administration to study the institutional bias within its programs
for persons with disabilities and to develop appropriate measures
for eliminating such biases. The criteria should be developed in
consultation with the National Council on the Handicapped and be
reported in hearings before Congress within one year from the date
of enactment of this requirement.
An extraordinary amount of the Medicaid funds administered
by the Health Care Financing Administration (HCFA) is spent on nursing
homes and other long-term institutions that primarily provide custodial
maintenance for disabled individuals. The Council believes that
strictly maintenance-oriented institutional programming is indefensible
and unnecessary. Wherever possible, institutions should be transitional
and foster independence. The majority of available funding should
be directed toward assisting all individuals with severe disabilities
to achieve self-direction and independence to the maximum of their
potential, in the most dignified and least restrictive environment.
The Council recommends that Congress require the HCFA
to develop, posthaste, in consultation with the National Council
on the Handicapped, criteria to be used to determine to what extent
Medicaid and other programs administered by HCFA promote community-based
services and discourage placements in institutions. Programs that
serve people with disabilities should be assessed using these criteria,
and the resulting report should be used as a basis for making fundamental
changes in the management and structure of these programs. The Council
recommends that the Congress hold hearings within one year of the
enactment of this requirement to review HCFA findings and plans
for action.
The evaluation criteria should include a focus on
the following topics:
- Comprehensive personal assistant services, including
long-term, short-term (respite), and emergency attendants, readers,
interpreters, and advocates for mentally retarded people.
- Case management assistance for independent living,
including transition services from the hospital to the home, institution
to community, and from parents' home to independence in the community;
and assistance in equipment selection and maintenance, and in
locating sources for other independent living support services.
- Family support and consumer education services,
including financial and personal counseling and training in self-directed
and family provided home care, including the use of equipment
and medication, and independent living skills training.
- Habilitative and rehabilitative training, including
prevocational services.
- Comprehensive medical insurance for disabled persons
who are unable to obtain adequate insurance through their employers
or who are ineligible for other Federal medical benefits.
4. Congress should amend the Internal Revenue Code
to establish a tax credit for taxpayers with disabilities who incur
unreimbursed expenses directly related to independent living, employment,
and efforts to secure employment, including personal assistant services,
special transportation, assistive devices, and other support services.
This recommendation is made as a partial means of
removing the disincentives to work which are inherent in the Social
Security system. While certain tax deductions are currently allowable
under a medical categorization, the regulations are unclear regarding
non-medical, disability-related services which enable the individual
to work or engage in productive activity. Such expenses, up to a
reasonable amount for each type of expense, should be made deductible.
Educating Children with Disabilities
Special education helps this Nation's children
with disabilities to develop the skills they need to live as independently
as possible when they become adults. Although special education
services have progressed greatly since the passage of the Education
for All Handicapped Children Act over ten years ago, the knowledge
and ability to implement "best practices" falls short of what is
needed.
First and foremost, there is a need to encourage the
States to make available special education and related services
beginning at birth. Of an estimated 250,000 children under the age
of two who could use special education services each year, only
60,000 receive services. Just seven States mandate that special
education services should be provided to infants. In addition, the
availability and quality of services for young children with special
needs varies greatly from State to State.
Educational services for infants are typically provided
in the home, with educators and parents working together closely
to enhance the child's educational development. Considerable evidence,
summarized in the Council's detailed topic paper on "Educating Children
with Disabilities" (in the separate Appendix to this report), indicates
that early intervention programs that actively involve parents result
in greater ultimate educational achievement, improve the quality
of life of disabled children and their families, and reduce the
extent of need and therefore the cost of special education services
in later years. As a result, early intervention services produce
considerable tax savings over the long run.
A second critical issue is the need to educate children
with special needs in regular education settings. Students of all
ages and ability levels who are placed in non-restrictive environments
can learn the skills and behaviors needed to fully participate in
society as contributing adults. This does not mean placing students
in the nearest school irrespective of individual needs and abilities,
nor does it mean placing students with disabilities into regular
classrooms when they need special services. In most cases, a free
appropriate public education should be provided to children with
disabilities in age-appropriate regular school buildings that offer
special education and related services. The Council recognizes that
there are situations in which a child's educational needs require
placement in an appropriate private school setting or in a specialized
public school program. Academic programs must be tailored to meet
individual needs while allowing time for disabled and nondisabled
peers to be together all or part of each day.
With technical assistance and careful planning, local
school districts and parents can establish totally integrated educational
programs that are appropriate to a range of needs. School districts
in Albuquerque, New Mexico; Madison, Wisconsin; San Francisco, California;
and Birmingham, Alabama all have major integration programs that
appropriately meet the needs of all children, including those with
the most severe handicaps.
A third issue centers on the need to conduct a national
assessment of the status of special education today. The National
Commission on Excellence in Education and similar studies have not
addressed special education. There is a serious need for a high-level,
in-depth study of trends, issues, and problems affecting the Nation's
system of special education.
Recommendations
1. Congress should amend the Education for All Handicapped
Children Act to encourage States to make available a free appropriate
public education to every disabled child from birth through age
twenty-one.
To effectively serve children with disabilities, equal
educational opportunity under Public Law 94-142, as amended, should
be extended to all children beginning at birth. A report by the
staffs of Congressmen Coats and Miller stated that very early intervention
services which benefit children and their parents result in significant
tax savings in the long run because of reduced special education
expenditures in later years.
The proposed amendments should include the following
provisions: a) each State education agency should be the lead and
coordinating agency for the services; b) an early childhood specialist
should be appointed in each State to ensure that the services are
properly planned and implemented; c) Public Law 89-313 funds should
follow the child from State institution services to pay for needed
community-based services; d) each State education agency and State
Medicaid agency should develop interagency agreements that list
early intervention services (except for the costs of the educator)
as Medicaid reimburseable items; and e) States should develop other
appropriate funding mechanisms to meet their individual needs.
2. Congress should direct the Department of Education
to promulgate and enforce standards for the application of the least
restrictive environment requirement; such standards should clarify
that the primary determinant of which educational setting is least
restrictive is the educational appropriateness of the program.
The least restrictive environment mandate is a major
component of the right to a free appropriate public education for
children with disabilities. The principle has not, however, always
been appropriately applied by State and local education agencies.
In some instances, least restrictive environment has been used as
a rationale for educational programs that are more "mainstream"
than the educational needs of a particular student dictate. In other
instances, the least restrictive environment has not been vigorously
applied and children with disabilities continue to be unnecessarily
segregated. The Department of Education should provide more direct
guidance to education agencies by issuing standards for the application
of least restrictive environment principle. Such standards should
focus upon educational appropriateness as the critical factor in
determining what is the least restrictive program for a particular
child. Determining educational appropriateness, in turn, should
incorporate a presumption against unnecessary social isolation of
children with disabilities.
3. Congress should direct the Office of Special
Education Programs to fund a national technical assistance center
to help parents and State and local education agencies plan and
develop educational options for children with special needs.
To help State and local education agencies and parents
appropriately plan for and meet the range of needs of students with
disabilities, a national technical assistance center should be funded.
This center would provide the staff, materials, and other resources
required to help the 57 State and territorial education agencies
train parents, teachers, students, and administrators to develop
age-appropriate programs for students with disabilities. Materials
and information developed by the national technical assistance center
would be available for dissemination by the network of special education
regional resource centers already in place.
4. Congress should direct the Secretary of Education
and the Chairperson of the National Council on the Handicapped to
establish a National Commission for the Study of Excellence in Special
Education.
Public Law 94-142, as amended, was enacted more than
ten years ago. Its enactment has resulted in major changes in the
provision of special education services in this country. A special
commission should be established to assess what has been achieved
and to determine the most cost-effective methods of fully achieving
the goals of special education in the future. The Secretary of Education
and the Chairperson of the National Council on the Handicapped should
each appoint an equal number of members to the commission. The commission
should be asked to report its findings and recommendations to Congress
within two years of the enactment of this provision.
Personal Assistance: Attendant
Services, Readers, and Interpreters
In
reviewing the types of programs funded by the Federal Government,
the Council has found that there is an undue reliance on institutional
care. The Council believes that personal assistance, as rendered
by attendants, readers, interpreters, and advocates, when provided
in conjunction with other community-based services, can be an effective
and economical means for reducing this Nation's reliance on institutions
and enabling most persons with disabilities to live independently
in settings of their choice. The goal should be to establish self-directed
personal assistant services as one component of a comprehensive
array of community-based services that should be available to people
with disabilities.
People with severe disabilities have a long-term need
for support services. Stable funding and a coordinated system for
providing personal services are needed if our society is to develop
effective community-based alternatives to institutional care. The
Council believes that the following recommendations are essential
first steps in reaching this goal.
1. Congress should establish a national policy that
defines personal assistance and should require the development of
national standards for the delivery of personal assistance services.
A national personal assistance policy should be developed
to assure that programs offering personal assistance are required
to:
- Serve people with all types of disabilities on
the basis of functional need,
- Serve people of all ages,
- Provide for the optimum degree of self-direction
and self-reliance as appropriate for individual consumers,
- Be accessible to people at all income and asset
levels with cost sharing as appropriate,
- Include assistance with personal, cognitive, communicative,
domestic, and other related services,
- Include 24 hour, 7 day a week service, short-term
(respite), and emergency assistance as needed,
- Be available where needed (e.g., home, work, school,
recreation, travel),
- Not create disincentives to employment,
- Offer the consumer a range of employer/employee
and contract agency relationships,
- Provide for outreach and training of consumers
as needed,
- Provide for training of administrators and staff
of provider organizations with an emphasis on preparing organizations
directed and staffed primarily by persons with disabilities to
provide personal services,
- Provide for reasonable wages and basic benefits
for personal assistants, readers, and interpreters, and,
- Require significant participation of consumers
in program policy determination and administration.
The development of a coordinated, effective approach
to the delivery of personal assistant services requires that a comprehensive
definition of these services be incorporated into the Social Security
Act, the Rehabilitation Act of 1973, the Education for All Handicapped
Children Act (P.L. 94-142), the Developmental Disabilities Act,
the Older Americans Act, and Veterans benefits legislation. This
definition should be a product of discussions between representatives
of major disability groups.
A national policy-making body should set standards,
subject to the review and approval of the Council, for the expenditure
of personal assistant service funds to assure that these services
are self-directed and responsive to the varied needs of disabled
persons and their families.
2. Congress should require the Social Security Administration
(SSA), in consultation with the National Council on the Handicapped,
to implement a series of projects, using SSA demonstration authority
and targeting currently available funds, to develop and demonstrate
a cost-effective process and mechanisms for the support of community-based
personal assistant services for persons with severe disabilities.
The rechanneling of some of the funds that support
institutions to support the development of consumer-directed, community-based
systems for the delivery of personal assistant services, as rendered
by attendants, readers, and interpreters, is a challenging task.
It will require careful preparation and step-by-step implementation.
The Council believes that a series of demonstration projects would
be a productive approach to developing a cost-effective national
system of personal assistant services.
A major portion of the resources which support persons
with severe disabilities in institutional settings comes from Title
XIX of the Social Security Act. While other provisions of this Act
enable people with disabilities to receive a variety of social services
and income support benefits, strict eligibility requirements regarding
income and the involvement of medical professionals in the delivery
of services hinder the ability of disabled people to live independently.
For a substantial portion of these individuals, lives of considerably
more independence and productivity would be possible if funding
currently consumed by institutions and services requiring medical
supervision could be made available for personal assistant services.
Changes in the language in specific titles of the
Social Security Act could have far-reaching economic implications.
Such changes should be preceded by comprehensive studies of the
most cost-effective methods for increasing funding for personal
assistant services and ensuring that the guidelines for a national
personal assistance system are upheld. These studies should significantly
involve the input of persons with disabilities in all phases, including
planning and evaluation.
The recommended projects should be funded under the
demonstration authority of the Social Security Administration using
currently available funds. While funded
by SSA, such projects should address the needs of persons who
do not qualify for Social Security benefits as well as those who
do. Such projects should:
- Determine the extent of the national need for
personal assistance,
- Determine the cost of providing services to
meet that need,
- Determine the efficacy of personal assistant
services models,
- Determine the cost-effectiveness of a national
personal assistance service plan,
- Determine the feasibility of implementing a
national personal assistance service plan, and
- Determine the ultimate implications for the
Federal budget by evaluating potential savings through reduced
institutional costs and enhanced income from increased taxes as
personal assistance services enable severely disabled persons
to become employed or to live outside of institutions.
These demonstration projects should be carefully designed
and evaluated since they would help establish the parameters of
a national attendant services program.
Coordination
As Federal programs seek to promote independence and
equal opportunities for people with disabilities, there is an important
need that services and programs be coordinated. "Coordinated services"
describes the ideal results of a wide range of interactions among
persons active in policy and program development. Although these
interactions take place every day, their purpose, frequency, and
effectiveness vary greatly from community to community, State to
State, and from program to program. In the Forums conducted in 1984
and 1985 as part of the Council's background activities leading
to this report, disabled people around the country declared that
many programs do not mesh well with other available services, and
that too often the service delivery system exhibits gaps, inconsistencies,
and inequities. It is clear, however, that there is no single or
simple solution to the need for better coordinated services. The
Council believes that mechanisms should be in place throughout the
service delivery system that consistently and purposefully attempt
to improve the linkages among the policy makers and programs that
serve disabled people.
The Council advocates frequent and purposeful interaction
at the national level of all parties involved in policy decisions
that affect services to people with disabilities. To that end, the
Council pledges to maintain its information base with consumer organizations
around the country while strengthening interaction on coordination
issues with State, local and national policy actors, private organizations,
the Congress, and the Administration. This process will continually
identify coordination issues which can best be resolved through
specific legislative or administrative actions. In addition to these
national level activities, state and local planning by recipients
of Federal funding should be fostered in every community.
Recommendations
1. Congress should require State and local agencies
that receive Federal funds for services for people with disabilities
to participate in the development of coordinated service delivery
plans.
A State planning requirement is in place for citizens
with developmental disabilities. The Council recommends that a similar
planning process should address the needs of all citizens with disabilities
and that it should occur at the local as well as the State level.
The planning process should seek the involvement and participation
of existing planning mechanisms in each State and community. For
this reason, lead agency responsibility and a detailed schedule
for the creation of such plans should be assigned by the appropriate
governor or mayor.
At a minimum, State and local agencies that receive
or administer Federal funds for the following benefits and services
should participate in the planning process: Veterans benefits and
services; Social Security Disability Insurance, health services,
long-term care and medical insurance programs; education; mental
health, mental retardation, rehabilitation and independent living
services; Title XX; Worker's Compensation; employment and training
(Job Training Partnership Act); housing and transportation; developmental
disabilities planning and services.
In addition, the process should, by requirement and
design, substantively involve people with disabilities in the planning
process. The planning process should specifically address methods
of improving service delivery. Particular attention should be paid
to the needs of individuals with disabilities who do not fit neatly
into established service categories. For instance, careful planning
should prevent persons with disabilities who are declared ineligible
for SSDI from being denied vocational rehabilitation services. It
should assure that appropriate services are delivered to people
with multiple handicaps, such as the estimated 15-20 % of mentally
retarded individuals who also have emotional problems. In States
and local communities, the planning process should lead to improved
communications, more integrated services, and better informed policy
discussion. No additional Federal costs are associated with this
recommendation; if implemented in good faith at the State and local
levels, the planning process should lead to improved services at
equal or reduced costs. Such cooperative planning will help to engender
a Federal, State, local, and private sector partnership in rendering
effective and nonduplicative services to enhance the opportunities
for equality and independence for persons with disabilities.
List
of Federal Programs Affecting Persons with Disabilities in Order of
Expenditure
Federal programs directly
benefiting disabled persons are listed below in descending order
of program size. Program size was determined by review of the 1986
estimates for each program as presented in the 1985 Catalog of Federal
Domestic Assistance. If significant differences were reflected between
1985 estimates and 1986 estimates as presented in the 1985 CFDA,
additional references were sought and noted accordingly.
Programs included on the list are those for which
spending on disabled persons could be identified or reasonably estimated
and/or rationalized.
Programs were not included if:
- They were small in dollars (usually less than one
million dollars).
- They provided funding only for administrative or
enforcement action.
- They primarily served to train professionals rather
than disabled persons.
- They were not administered by an Executive Branch
Agency (i.e., Gallaudet, NTID).
There are several large programs which were not included
on the list because the specific amount of monies spent on disabled
persons cannot be determined nor can the actual number of disabled
persons served by the program be determined. These programs include:
- Alcohol, Drug Abuse and Mental Health Services
Block Grants
- Food Stamps
- Title XX Social Services Block Grants
- Maternal and Child Health
A forthcoming recommendation of the National Council
on the Handicapped will be that agencies administering such programs
develop and implement methods for monitoring their respective programs
relative to their impact on persons with disabilities.
Four programs were included on the list because they
reflect Federal efforts on behalf of policy setting and advisory
functions as well as standard setting and enforcement functions.
These programs are:
- President's Committee on Employment of the Handicapped
- Architectural and Transportation Barriers Compliance
Board
- President's Committee on Mental Retardation
- National Council on the Handicapped
For purposes of this listing, disabled persons includes
both disabled and blind recipients combined for those programs which
list each separately.
Spending totals and beneficiaries are estimates for
disabled persons only.
1. Social Security Disability Insurance (SSDI)
Authorization: 42 U.S.C. 420-425
CFDA: 13,802
Agency: Social Security Administration
FY 1986 Est.: $19,566,567,000
Disabled Persons Benefiting: 3,900,000
The SSDI program is intended to replace part of the
earnings lost because of a physical or mental impairment severe
enough to prevent a person from working. It serves about 2.8 million
disabled persons and 1.1 million dependents. All disabled recipients
are under 65 years of age. Monthly cash payments range to a maximum
of $909 for an individual and $1,364 for an individual with eligible
dependents. The average monthly benefit in January 1985 was $454
for an individual and $885 for an individual with dependents. [CFDA,
Social Security Bulletin]
2. Medicare
Authorization: 42 U.S.C. 1395 et seq.
42 U.S.C. 1305 Note
CFDA: 13.773 (Hospital Insurance)
13.774 (Supplementary Insurance)
Agency: Health Care Financing Administration
FY 1986 Est.: $9,000,000,000
Disabled Persons Benefiting: 2,750,000
The Medicare program provides hospital and medical
insurance protection for disabled individuals under 65 years of
age who have qualified for SSDI coverage for 24 months or for railroad
retirement benefits based on disability for 29 consecutive months;
in addition, many under-65 persons with chronic kidney disease are
eligible. Disabled beneficiaries represent about 9% of the estimated
30,870,000 persons receiving Medicare assistance. Medicare spending
on disabled persons comprises about 13.5 % of the $75 billion annual
Federal outlays on both parts of Medicare. [CFDA; Social Security
Bulletin; Rutgers Univ.; Committee on Ways & Means, 2/22/85,
page 1231
3. Medicaid
Authorization: 42 U.S.C. 1396 et seq.
CFDA: 13,714
Agency: Health Care Financing Administration
FY 1986 Est.: $8,820,000,000
Disabled Persons Benefiting: 3,150,000
Medicaid is a means-tested assistance to states program
for persons who are poor. Disabled individuals may qualify if they
demonstrate eligibility for Supplemental Security Income (SSI).
Disabled beneficiaries represent about 14% of the 22,500,000 persons
receiving Medicaid. Spending on these persons accounts for approximately
36% of the $24,500,000,000 spent by the Federal government on Medicaid.
[CFDA, Social Security Bulletin, Rutgers Univ.]
4. Veterans Compensation fo Service-Connected Disabilities
Authorization: 38 U.S.C. 310,331
CFDA: 64,109
Agency: Veterans Administration
FY 1986 Est.: $8,210,732,000
Disabled Persons Benefiting: 2,220,000
This veterans' compensation program provides direct
payments to veterans having service-connected disabilities, to a
maximum of $3,697/month. All recipients are disabled. [CFDA]
5. Supplemental Security Income (SSI)
Authorization: 42 U.S.C. 1381-1383c
CFDA: 13,807
Agency: Social Security Administration
FY 1986 Est.: $6,400,000,000
Disabled Persons Benefiting: 1,927,000
SSI provides a minimum guaranteed income for under-65
disabled individuals who meet a means test and who are unable to
engage in substantial gainful activity. Monthly payments range to
a maximum of $325; $488 for an eligible person with a spouse. The
average monthly benefit in 1984 was $186; the average monthly payment
in 1986 is estimated to be $199. Disabled beneficiaries represent
about 47 % of the 4,100,000 persons receiving payments. Benefits
paid to disabled recipients comprise approximately 70% of the $9,200,000
FY 1986 estimated Federal outlays for SSI. Many states provide supplementary
benefits. [CFDA; Rutgers Univ.; Office of Supplemental Security
Income, SSA, Interview, Michael Staren, Dec., 1985]
6. Pension for Non-Service Connected Disabilities
Authorization: 38 U.S.C. 511,512,521
CFDA: 64,104
Agency: Veterans Administration
FY 1986 Est.: $2,550,000,000
Disabled Persons Benefiting: 676,000
This program provides an annual pension of approximately
$5,700, reduced by countable income, for an individual; $4,780 for
a veteran with one dependent; and $968 for each additional dependent.
If the veteran is in need of personal attendant care, the pension
may increase to $9,132 for an individual and $10,902 for a veteran
with one dependent. All participants are disabled and are veterans
of wartime service. [CFDA]
7. Education of Handicapped Children
Authorization: 20 U.S.C. 1401-1419
CFDA: 84,027
Agency: Department of Education
FY 1986 Est.: $1,164,000,000
Disabled Persons Benefiting: 4,200,000
This program provides grants to states to assist them
in providing a "free, appropriate, public education" for handicapped
children, including preschool students. The per-student payment
by the Federal Government averages about $265; the Federal share
of each $16 spent in special education is $1. All program participants
are disabled. [CFDA, Dept. of Education]
8. Vocational Rehabilitation
Authorization: 29 U.S.C. 701
CFDA: 84.126
Agency: Department of Education
FY 1986 Est.: $1,100,000,000
Disabled Persons Benefiting: 931,800 (1985 est.)
This program provides grants to states to enable them
to deliver counseling and related services to disabled persons.
Approximately 226,000 persons are "rehabilitated" to gainful employment
annually. The Federal outlay per person served per year is about
$1,200. The Federal share of each dollar spent on rehabilitation
is about eighty cents. [CFDA, Dept. of Education]
9. Special Benefits for Disabled Coal Miners
Authorization: 30 U.S.C. 901-945
CFDA: 13,806
Agency: Social Security Administration
FY 1986 Est.: $979,000,000
Disabled Persons Benefiting: 300,000
This "black lung" program makes direct payments to
coal miners who become disabled with pneumoconiosis or other chronic
lung disease and to their widows. No new applications have been
accepted since 1973, except for survivors' benefits. The basic monthly
payment is $328, with a maximum of $656 as of January 1985. All
beneficiaries are disabled. [CFDA]
10. Social Insurance for Railroad Workers
Authorization: 45 U.S.C. 351-367; 45 U.S.C. 231-23lu
CFDA: 57,001
Agency: Railroad Retirement Board
FY 1986 Est.: $775,000,000
Disabled Persons Benefiting: 104,500
This insurance program includes disability benefits
for railroad workers who retire due to disability or who are sick
or injured and unable to work and for their dependents, pursuant
to the Railroad Retirement Act and the Railroad Unemployment Insurance
Act. The maximum monthly benefit for disabled retired beneficiaries
is about $1,283, with the average being $612; for disabled unemployed
and sick workers, the maximum is $500 per month and the average
also is $500 per month. Payments to disabled persons comprised about
12.5 % of the program's $6,200,000,000 outlays for FY 1986. Approximately
11% of the program's 950,000 beneficiaries are disabled. [CFDA;
Marla Huddlston, staff, Railroad Retirement Board, interview, December,
19851
11. Coal Mine Workers Compensation
Authorization: PL 97-119
CFDA: 17,307
Agency: Department of Labor
FY 1986 Est.: $632,868,000
Disabled Persons Benefiting: 190,200
Direct payments are made to coal miners disabled by
black lung disease and their dependents. The basic monthly rate
is $328, with a maximum for the claimant with three dependents being
$656. The average as of January 1985 was $415 per month exclusive
of medical benefits for treatment of black lung disease. All beneficiaries
are disabled. [CFDA]
12. Lower Income Housing Assistance (Section 8)
Authorization: 42 U.S.C. 1401-1435, 1437
CFDA: 14,156
Agency: Department of Housing and Urban Development
FY 1986 Est.: $400,000,000
Disabled Persons Benefiting: 100,000
Section 8 rent subsidies are paid to building owners
to help defray rental costs; the beneficiaries pay 30% of adjusted
income for rent. Disabled beneficiaries are estimated at about 5
% of the program's $8,000,000,000 outlays. [CFDA, Social Security
Bulletin, Rutgers Univ.]
13. Education of Handicapped Children in State-Operated
or-Supported Schools
Authorization: PL 98-211
CFDA: 84,009
Agency: Department of Education
FY 1986 Est.: $150,170,000
Disabled Persons Benefiting: 247,000
This program helps states to improve services for
handicapped students in state-operated or -supported schools and
institutions. Handicapped children through age 20 whose education
is the state's responsibility may be served. The average per-student
Federal payment is about $592/year. [CFDA, Dept. of Education]
14. Vocational Rehabilitation for Disabled Veterans
Authorization: 38 U.S.C. 1502
CFDA: 64,116
Agency: Veterans Administration
FY 1986 Est.: $116,000,000
Disabled Persons Benefiting: 35,000
This program provides payment for education expenses,
including full tuition, books, and fees and supplies, as well as
monthly allowances. The monthly payment ranges to a maximum of $310
for a single veteran and $452 for a veteran with two dependents.
Non-interest-bearing loans are also available, for up to $620 per
enrollment period. In FY 1986, an estimated 28,400 trainees will
be helped and some 6,495 veterans will receive loans. All recipients
are disabled or hospitalized. [CFDA)
15. Veterans Prosthetic Appliances
Authorization: 38 U.S.C. 362 et al.
CFDA: 64,013
Agency: Veterans Administration
FY 1986 Est.: $100,869,000
Disabled Persons Benefiting: 1,000,000
This program purchases aids and devices for disabled
veterans. Medical equipment, hearing aids, orthopedic shoes, prosthetic
devices and other appliances are provided. The range of purchase
and/or repair expenditures is from about $ 10 to $25,000, with an
average per aid of $67. In FY 1986, the VA expects to purchase or
repair some two million aids. [CFDA]
16. Housing for the Elderly or Handicapped (Section
202)
Authorization: 12 U.S.C. 1701q; 73 Stat. 654, 667
CFDA: 14.157
Agency: Department of Housing and Urban Development
FY 1986 Est.: $110,000,000
Disabled Persons Benefiting: Information Unavailable
The HUD section 202 program allocated some $109 million
of $557 million in FY 1985 in direct loans for construction of 2,700
units for handicapped persons. Residents also received section 8
rental assistance. The section 202 program has $631 million available
in FY 86. [CFDA, ARC-US]
17. Vocational Education On-Basic Grants to States
Authorization: 20 U.S.C. 2331-2342
CFDA: 84,048 Agency: Department of Education
FY 1986 Est.: $72,000,000
Disabled Persons Benefiting: 490,000
This program, most recently reauthorized by Carl D.
Perkins Vocational Education Act, offers vocational education to
handicapped students, most at the secondary level. Estimated Federal
expenditures on the Perkins program for FY 1986 are $723,141,000.
About 490,000 of the 13,000,000 students assisted are handicapped.
Of these persons, 290,000 are served using the mandatory 10% setaside
of Federal funds while 200,000 are mainstreamed into ongoing vocational
education programs at no extra cost to the Federal Government. Enrollment
by handicapped students benefiting from the 10% setaside in vocational
education programs represents 3 % of all students in these programs.
[CFDA]
18. Developmental Disabilities-Basic Support and Advocacy
Authorization: PL 98-527
CFDA: 13.630
Agency: Department of Health and Human Services
FY 1986 Est.: $64,000,000
Disabled Persons Benefiting: Information Unavailable
This program assists states to provide cross-cutting
services and protection-and-advocacy assistance to persons with
severe disabilities occurring prior to age 22. All beneficiaries
are disabled. Most funds are used for advocacy activities benefiting
numerous persons, rather than for direct services. [CFDA]
19. National Institute of Handicapped Research
Authorization: PL 98-221
CFDA: 84.133
Agency: Department of Education
FY 1986 Est.: $39,000,000
Disabled Persons Benefiting: Information Unavailable
NIHR conducts research and demonstration projects
and programs and disseminates research findings. Most funds are
allocated to research/training or rehabilitation engineering centers.
[CFDA]
20. Books for the Blind and Physically Handicapped
Authorization: 2 U.S.C. 135
CFDA: 42,001
Agency: Library of Congress
FY 1986 Est.: $38,402,000
Disabled Persons Benefiting: 630,000
This program provides books on cassette, disc and
in Braille as well as machines to read them. A total of 56 regional
and 102 subregional libraries are supported. [CFDA]
21. Rehabilitation Services-Service Projects
Authorization: 29 U.S.C. 701
CFDA: 84.128
Agency: Department of Education
FY 1986 Est.: $29,300,000
Disabled Persons Benefiting: Information Unavailable
This program provides demonstration grant monies to
states and public nonprofit organizations to improve rehabilitation
services to disabled persons. Funds provide for about 50 projects
per year, of which about half are continuation grants from a prior
year. [CFDA]
22. Centers for Independent Living
Authorization: 29 U.S.C. 796e
CFDA: 84,132
Agency: Department of Education
FY 1986 Est.: $27,000,000
Disabled Persons Benefiting: 26,000
This program provides for grants to states or nonprofit
organizations to establish and operate independent living centers
serving severely disabled individuals. The average grant per 160
centers funded is about $175,000. Total includes $5 million for
Part A independent living services. [CFDA, Dept. of Education]
23. URBAN MASS TRANSPORTATION
CAPITAL IMPROVEMENT GRANTS
Authorization: 49 U.S.C. 1601 et seq.
CFDA: 20.500
Agency: Department of Transportation
FY 1986 Est.: $3,500,000
Disabled Persons Benefiting: Information Unavailable
This program includes a I % setaside of Federal gasoline
tax revenues to be used to support transportation projects and programs
benefiting disabled persons. Funding in FY 1985 for the entire program
was about one billion dollars. For FY 1986 the Administration proposed
a reduction to about thirty-five million; such a reduction would
lower the 1% setaside drastically. [CFDA]
24. HANDICAPPED EARLY
CHILDHOOD EDUCATION
Authorization: 20 U.S.C. 1423
CFDA: 84.024
Agency: Department of Education
FY 1986 Est.: $22,500,000
Disabled Persons Benefiting: 18,000 (1984 est.; FY 84 $21,000,000)
This program supports demonstration and dissemination
projects for handicapped children below six years of age (in some
cases, below eight years). About 170 projects are supported, many
for parental training, and home-based instruction. [CFDA]
25. HANDICAPPED MEDIA
SERVICES AND CAPTIONED FILMS
Authorization: 20 U.S.C. 1451-1453
CFDA: 84.026
Agency: Department of Education
FY 1986 Est.: $16,500,000
Disabled Persons Benefiting: Information Unavailable
This program supports grants demonstrating innovative
ways of using technology to assist disabled persons, captioning
of films and of television programs, and training of teachers. [CFDA]
26. HANDICAPPED-INNOVATION
AND DEVELOPMENT
Authorization: 20 U.S.C. 1441-1442
CFDA: 84.023
Agency: Department of Education
FY 1986 Est.: $16,000,000
Disabled Persons Benefiting: Information Unavailable
This program supports research and demonstration projects
to improve education for handicapped children and youth. Emphasis
is upon model programs and instructional interventions. [CFDA]
27. DEAF-BLIND CENTERS
Authorization: 20 U.S.C. 1422
CFDA: 84.025
Agency: Department of Education
FY 1986 Est.: $12,000,000
Disabled Persons Benefiting: 6,100 (1984 est.; FY 84 $15,000,000)
This program serves some six thousand deaf-blind children
and youth as well as 4,000 parents; 1,900 teachers; and 2,000 professionals
who also work with deaf-blind persons. Grants, usually for one year,
are offered to schools and other education agencies. [CFDA]
28. SPECIALLY ADAPTED HOUSING FOR DISABLED VETERANS
Authorization: 38 U.S.C. 801-806
CFDA: 64.106
Agency: Veterans Administration
FY 1986 Est.: $12,000,000
Disabled Persons Benefiting: 405 (84 est.; FY 84 $13,000,000)
This program provides up to 50% of the cost of housing,
land, and other allowable expenses, to a maximum of $35,000, for
disabled veterans and up to $6,000 for adaptations to the veteran's
residence. [CFDA]
29. AUTOMOBILES AND ADAPTIVE
EQUIPMENT FOR CERTAIN DISABLED VETERANS AND MEMBERS OF THE ARMED
FORCES
Authorization: 39 U.S.C. Chapter 39
CFDA: 64,100
Agency: Veterans Administration
FY 1986 Est.: $12,000,000
Disabled Persons Benefiting: 650
This program provides financial assistance toward
the purchase price of an automobile and additional funds for adaptive
equipment such as lifts or hand controls. Service-connected disabilities
affecting upper or lower limbs or producing blindness are covered.
Up to $5,000 may be provided for an automobile or van. [CFDA]
30. VETERANS HOUSING-DIRECT
LOANS TO DISABLED VETERANS
Authorization: 38 U.S.C. 1811
CFDA: 64,118
Agency: Veterans Administration
FY 1986 Est.: $9,238,000
Disabled Persons Benefiting: 30,000
This program provides loans averaging $32,000. [CFDA]
31. DEVELOPMENTAL DISABILITIES-UNIVERSITY
AFFILIATED FACILITIES
Authorization: PL 98-527
CFDA: 13.632
Agency: Department of Health and Human Services
FY 1986 Est.: $9,000,000
Disabled Persons Benefiting: Information Unavailable
Some 35 demonstration and dissemination projects are
funded. [CFDA]
32. BLIND VETERANS REHABILITATION
CENTERS
Authorization: 38 U.S.C. 601, 3021
CFDA: 64,007
Agency: Veterans Administration
FY 1986 Est.: $8,205,000
Disabled Persons Benefiting: 734
This program supports VA hospital programs serving
blinded veterans. [CFDA]
33. SECONDARY EDUCATION
AND TRANSITIONAL SERVICES FOR HANDICAPPED YOUTH
Authorization: PL 98-199
CFDA: 84.158
Agency: Department of Education
FY 1986 Est.: $6,330,000
Disabled Persons Benefiting: Information Unavailable
This program made 34 grants in FY 1984 for projects
on secondary and postsecondary education of handicapped youth. [CFDA]
34. CLIENT ASSISTANCE
PROGRAM FOR HANDICAPPED INDIVIDUALS
Authorization: 29 U.S.C. 732
CFDA: 84.161
Agency: Department of Education
FY 1986 Est.: $6,300,000
Disabled Persons Benefiting: Information Unavailable
This program supports State agency assistance for
clients of State rehabilitation agencies. By law, the State governor
selects the agency to administer the CAP program. [CFDA]
35. HANDICAPPED-REGIONAL
RESOURCE CENTERS
Authorization: 20 U.S.C. 1421
CFDA: 84.028
Agency: Department of Education
FY 1986 Est.: $6,000,000
Disabled Persons Benefiting: Information Unavailable
Provides grants to establish and operate resource
centers assisting school districts and teachers. [CFDA]
36. POSTSECONDARY EDUCATION
PROGRAMS FOR HANDICAPPED PERSONS
Authorization: PL 98-199
CFDA: 84.078
Agency: Department of Education
FY 1986 Est.: $5,300,000
Disabled Persons Benefiting: Information Unavailable
This program provides demonstration grant monies to
support interpreting, reading, notetaking, tutoring, counseling
and related services for postsecondary students who are handicapped.
A total of 21 projects were supported in FY 1984, including four
continuation grants. Priority is given to four regional programs
serving deaf students. [CFDA]
37. LONGSHORE AND HARBOR
WORKERS' COMPENSATION
Authorization: 36 U.S.C. 501; 42 U.S.C. 1651, 1701;
43 U.S.C. 1333; and 5 U.S.C. 8171
CFDA: 17.302
Agency: Department of Labor
FY 1986 Est.: $4,500,000
Disabled Persons Benefiting: 14,250
This program makes direct payments to longshore workers,
harbor workers, and certain other employees to compensate for total
or partial disability. About two-thirds of base pay is provided.
[CFDA]
38. INNOVATIVE PROGRAMS
FOR SEVERELY HANDICAPPED CHILDREN
Authorization: 20 U.S.C. 1424
CFDA: 84,086
Agency: Department of Education
FY 1986 Est.: $4,300,000
Disabled Persons Benefiting: 4,730
This program offers contracts to improve educational
or training services for severely handicapped children and youth.
In addition to the students served, some 2,000 professionals benefit
from-n training on independent living and parental involvement.
[CFDA]
39. HANDICAPPED-SPECIAL
STUDIES
Authorization: PL 98-199
CFDA: 84.159
Agency: Department of Education
FY 1986 Est.: $2,000,000
Disabled Persons Benefiting: Information Unavailable
This program supports data collection and impact studies
of program effectiveness in the area of education for disabled persons.
[CFDA]
40. PRESIDENT'S COMMITTEE
ON EMPLOYMENT OF THE HANDICAPPED
Authorization: Executive Order 11480
CFDA: 53.001
Agency: PCEH
FY 1986 Est.: $2,000,000
Disabled Persons Benefiting: Information Unavailable
PCEH sponsors an Annual Meeting and selected other
conferences and issues several publications, to enhance employment
of disabled youths and adults. [CFDA]
41. ARCHITECTURAL AND
TRANSPORTATION BARRIERS COMPLIANCE BOARD
Authorization: 42 U.S.C. 4151 et seq.
CFDA: 88.001
Agency: ATBCB
FY 1986 Est.: $1,930,000
Disabled Persons Benefiting: Information Unavailable
The Board enforces the Architectural Barriers Act
of 1968, issues minimum requirements for four standardsetting Federal
agencies, and provides technical assistance on removal of barriers
facing physically disabled persons. [CFDA]
42. PRESIDENT'S COMMITTEE
ON MENTAL RETARDATION
Authorization: Executive Order 121 10
CFDA: 13.613
Agency: Department of Health and Human Services
FY 1986 Est.: $800,000
Disabled Persons Benefiting: Information Unavailable
PCMR conducts public information and advisory activities.
[CFDA]
43. NATIONAL COUNCIL ON
THE HANDICAPPED
Authorization: 29 U.S.C. 780-785
CFDA:
Agency: NCH
FY 1986 Est.: $750,000
Disabled Persons Benefiting: Information Unavailable
The Council advises the Congress and the President
on Federal policies toward disabled persons and sets policies for
the National Institute for Handicapped Research. [NCH]
44. HANDICAPPED ASSISTANCE
LOANS
Authorization: PL 97-35; Small Business Act of 1953
CFDA: 59.021
Agency: Small Business Administration
FY 1986 Est.: -O-; FY 85 Est.: $30,000,000
Disabled Persons Benefiting: 164
The Administration proposed to eliminate the SBA in
FY 1986. Loans are made to individuals or to organizations for working
capital, construction, and other business expenses. Loans in FY
1984 ranged from about $500 to about $350,000; with the average
being $88,900. [CFDA]
45.
DEVELOPMENTAL DISABILITIES-SPECIAL PROJECTS
Authorization: PL 98-527
CFDA: 13.631
Agency: Department of Health and Human Services
FY 1986 Est.: -O-; FY 85 Est.: $ 2,700,000
Disabled Persons Benefiting: Information Unavailable
This program, which was recommended for elimination
by the Administration in FY 1986, provides grants to support innovative
work in integrating developmentally disabled persons into the community.
About 30 projects were supported in FY 1985. [CFDA]
Notes to the Listing
1. Sources. Most information
derives from the Catalog of Federal Domestic Assistance-1985
(Office of Management and Budget [OMB]; Government Printing
Office, 1985). In some instances, as with the number of persons
participating in independent living programs or in state-operated
or -supported schools, program officials in the U.S. Department
of Education were consulted. In a few instances, as with the number
of disabled persons benefiting from Medicare or from section 8 housing
assistance, program officials were not able to provide the needed
information but publications such as Social Security Bulletin
or university researchers, notably at the Bureau of Economic Research,
Rutgers University (Professors Berkowitz, David, and Worrall) were
able to provide estimates.
2. Excluded. Not included
in this priority listing are the "special institutions" Gallaudet
College, National Technical Institute for the Deaf, Helen Keller
National Center, American Printing House for the Blind-each of which
has funding set by the Congress and none of which is administered
by an executive branch agency. These programs do not appear in the
CFDA. Also excluded from this priority listing are a few programs
designed to train special educators or rehabilitation personnel;
the basis for exclusion is that these programs do not benefit disabled
persons so much as professionals in human service fields.
3. See also: Berkowitz, Monroe. Disability Expenditures
1970-1982. New Brunswick, NJ: Rutgers University, 1985.
Biographies of Members of
the National Council on the Handicapped
Sandra S. Parrino
Sandra S. Parrino, of Briarcliff Manor, New York,
was appointed Chairperson of the National Council on the Handicapped
in 1983 by President Reagan. She has been actively involved in issues
concerning disabled people for many years. Her 20 year old son,
Paul, has been severely physically disabled for most of his life.
She is best known as a spokesperson for parents of disabled children,
as a panelist, lecturer, lobbyist, and organization official.
Mrs. Parrino serves on numerous boards and councils.
She has been director for the Office of the Disabled in Ossining
and Briarcliff Manor, New York; she has served on the board of Westchester
County Homes for the Retarded; and she has been a member of the
New York State Assembly Task Force on the Disabled, which reviews
pending legislation in the State of New York. Through her efforts,
many local advances have been made to improve accessibility for
disabled people, such as setting up transportation services and
installing voting machines for disabled persons, fundraising to
provide interpreter services for deaf people, and supervision of
the school district's compliance with Federal regulations. Her major
interest since becoming a member of the Council has been promoting
independence and equality for people with disabilities.
Mrs. Parrino is also a member of the board of Parent
Chain, and has served as an American representative to the United
Nations and UNICEF for the International Year of Disabled Persons.
She is currently the North American Vice President of Rehabilitation
International, a worldwide service, information, and advisory organization.
H. Latham Breunig, Ph.D.
H. Latham Breunig, Ph.D., resides in Arlington, Virginia.
He is retired from Eli Lilly and Company, Indianapolis, Indiana.
At age three, Dr. Breunig had a 25 percent hearing loss, and at
age seven his loss of hearing was 95 percent. He attended Wabash
College, Indiana; earned his Ph.D. in Chemistry from Johns Hopkins
University; and also studied at Purdue University, Indiana, in the
field of Statistics and Quality Control.
Among the many organizations where Dr. Breunig has
been active are the President's Committee on Employment of the Handicapped;
the American Statistical Association; the Clarke School for the
Deaf; and the Alexander Graham Bell Association for the Deaf, where
he has served on the Board of Directors for the past twenty-four
years, two of them as President. He founded Telecommunications for
the Deaf in 1968, and was Chief Executive Officer until 1978. He
has been active in the development of oral interpreters for deaf
people.
Special awards presented to Dr. Breunig have included
the President's Committee on Employment of the Handicapped Commendation
by President Johnson in 1967; Sertoma International, Midwest Region,
Service to Mankind in 1968; Sagamore of the Wabash (Governor Branigin
of Indiana) in 1969; and Telephone Pioneers, Honorary Member, in
1973. In 1977, Teletypewriters for the Deaf, Inc. made him the first
recipient of its H. Latham Breunig Award. Dr. Breunig was honored
by Wabash College in 1984 with its Alumni Award of Merit.
Robert V. Bush, C.P.O.
Robert V. Bush, Certified Prosthetist and Orthotist,
resides in Albuquerque, New Mexico, and is a Clinical Associate
with the New Mexico Medical School. He is presently chairperson
of the University of New Mexico Medical Center Board of Trustees,
and is a member of both the Heights General Hospital Board of Trustees,
and the New Mexico Multiple Sclerosis Society Board of Directors.
He has been active with the VA prosthetic/orthotic programs, as
well as the Division of Vocational Rehabilitation. He is past chairperson
of the Bernalillo County Mental Health, Mental Retardation Board
of Trustees. He has also served as President of the American Orthotic/Prosthetic
Association.
As a Prosthetic/Orthotic technician for Walter Reed
Hospital, Mr. Bush did research on upper extremity prosthetics,
particularly at Northrup Aircraft, setting up the plastic shops
in five Army Amputee Centers. Later he was manager of A. J. Hosmer
Corp., doing research, and was a leading manufacturer of upper extremity
prosthetic components.
Justin W. Dart, Jr.
Justin W. Dart, Jr. resides in Fort Davis, Texas,
and Washington, D.C. A wheelchair user since 1948, he has been active
as an advocate for the rights of disabled and disadvantaged persons
for more than 30 years. He has served as Chairman and as a member
of the Texas Governor's Committee for Persons with Disabilities
(1980-85), as Chairman of the Governor's Long Range Planning Group
for Texans with Disabilities (1982-83), and as Vice Chairperson
of the National Council on the Handicapped (1982-85). He continues
to serve as a member of the Texas Council on Disabilities.
Mr. Dart founded Japan Tupperware (a division of Dart
Industries, now Dart and Kraft) in 1963, and served as its President
until 1965. From 1968 to the present, he and Mrs. Dart have operated
a private independent living program; more than 70 disabled and
nondisabled persons have spent from six months to four years in
their home, before moving on to successful programs of education
and employment.
Mr. Dart received his B.S. and M.A. degrees from the
University of Houston in 1953-54, and attended the University of
Texas Law School 1955-56. He has edited two books of poetry, and
has authored papers on the philosophy and administration of independent
living programs. He served as coordinator and lead editor of the
Long Range Plan for Texans with Disabilities, and of the National
Policy for Persons with Disabilities.
Joe S. Dusenbury
Joe S. Dusenbury lives in Columbia, South Carolina.
He is past Chairperson of the National Council on the Handicapped.
He has been with the South Carolina Vocational Rehabilitation Department
since 1960, and has been Commissioner since 1976. He oversees a
wide range of services necessary to rehabilitate physically and
mentally handicapped individuals in the statewide network of more
than one hundred offices and programs.
Mr. Dusenbury has had ten years experience as the
principal of both elementary and junior high schools. While principal
of a junior high school, he organized the first "ability groups"
in the area, thus recognizing the special educational class for
educable mentally retarded students on a secondary level.
As an active member of the National Rehabilitation
Association (NRA), he has been both, Program Chairperson of the
Regional NRA and President of the Regional and National NRA. He
has also been President of the South Carolina Vocational Education
Association. He currently serves as Vice-Chairperson of the South
Carolina Occupational Information Coordinating Committee and as
Chairperson of the South Carolina Governor's Committee on Employment
of the Handicapped.
Among his most notable awards for public service are:
the Distinguished Public Service Award from the American Legion
Department of South Carolina in recognition of outstanding contributions
to his community, state, and nation; the National Rehabilitation
Association President's Award for outstanding achievements on behalf
of disabled persons; and the Mary E. Switzer Award for excellence
in performance of rehabilitation leadership from the National Association
of Rehabilitation Administrators. He is the only recipient of the
Region IV RSA Commissioner's Award in recognition of his constant
outstanding leadership in programs having a positive impact on the
lives of disabled persons. In 1984 he was honored by having the
new State Office Building, which houses the Vocational Rehabilitation
Department, named the Joe S. Dusenbury Building in recognition of
his determined efforts to improve opportunities for the state's
disabled citizens.
John S. Erthein
John S. Erthein lives in Los Angeles, California,
where he is currently the President of John S. Erthein, Inc., a
public relations firm with offices in Los Angeles and Washington,
D.C., and producer of the upcoming motion picture, Monimbo, from
the book of the same title by Robert Moss and Amaud de Borchgrave.
Mr. Erthein previously served as Vice President of Marketing for
a major specialty greeting card publisher, Nu-Art, Inc., in Chicago,
Illinois. Earlier, as a management consultant, Mr. Erthein successfully
completed marketing assignments for numerous major clients in a
variety of fields.
He is on the Board of Directors for the American Paralysis
Association, an organization that has as its primary objective funding
research for the nation's 500,000 spinal cord injured individuals
and their families.
Mr. Erthein, a graduate in Marketing from Columbia
University, served as an officer in the United States Coast Guard,
and was Security Officer and Public Information Officer for his
unit in New York.
He was Assistant for Finance for Citizens for the
Republic, when Ronald Reagan chaired that organization. Subsequently,
he assisted in setting up the fundraising organization for the 1980
Reagan Presidential campaign.
He is currently producing a number of programs for
release on video cassette.
R. Budd Gould
R. Budd Gould was born in Pasadena, California and
lives in Missoula, Montana. He has been blind since age 33. He attended
the University of Montana in Missoula in the area of Business Administration.
Mr. Gould was elected to the Montana State House of
Representatives in 1974 and is currently serving his fifth term.
In 1975, 1977, 1979, and 1981, he served on the Public Health Committee
and was chairman of that committee in 1981.
He has been active in human service and rehabilitative
endeavors. Mr. Gould serves on the Montana State Library Advisory
Council, to which he was first appointed in 1972. He was Chairman
for Region Five of Montana on the White House Conference on Handicapped
Individuals, and served on the Rehabilitation Services Advisory
Council in 1976, the Visual Services Advisory Council in 1977, and
on the Board of Directors of the Western Montana Radio Reading Service
in 1979.
Mr. Gould has received numerous awards for his outstanding
service, including the Man of the Year Award in 1977 from the Montana
Association of the Blind.
Hunt Hamill
Hunt Hamill lives in Winnetka, Illinois. From 1975
to 1983 he served as President of the Rehabilitation Institute of
Chicago, affiliated with the McGraw Medical Center, Northwestern
University. From 1968 to 1975, subsequent to his retirement as President
of the National Sugar Refining Company (Jack Frost), he was President
and Director of the Brain Research Foundation, an affiliate of the
University of Chicago. He has had extensive experience in highly
responsible positions in business and technical fields, serving
on Boards of Directors of several technologically-oriented corporations.
As Chief Executive Officer of the Rehabilitation Institute
of Chicago, a comprehensive medically-oriented center which has
aided disabled persons in employment, accessibility, transportation,
housing issues, public education programs, etc., he was influential
in changing community attitudes and increasing the acceptance of
disabled individuals.
Mr. Hamill's efforts through the Institute have had
national impact on the lives of thousands of people with disabilities.
He served as Chairperson of the Chicago Hospital Council in FY 1982-1983.
Marian North Koonce
Marian North Koonce of Santa Barbara, California,
is the mother of six children. Two are physically handicapped from
birth and a third contracted Multiple Sclerosis as a young adult.
Along with the great amount of time and attention she gives to her
family, she has held many administrative and leadership positions
in business, most recently as Chairman of the Board of a Santa Barbara
independent bank.
She is involved in numerous local and national organizations.
She was Chairman of the Santa Barbara County Reagan-Bush '84 Committee.
She has served as delegate to the Republican National Conventions
of 1976, 1980 and 1984.
From 1980 to 1981, Mrs. Koonce was Vice-President
of Recording for the Blind Auxiliary. She serves on the Board of
the Santa Barbara Symphony Association; the Las Positas Park Board;
the Board of Trustees of the University of California, Santa Barbara;
and is Chairman of the Channel Islands Chapter of the National Multiple
Sclerosis Society.
Nanette Fabray MacDougall
Nanette Fabray MacDougall, a resident of Pacific Palisades,
California, is a renowned actress who developed a progressive hearing
disability. Following four operations, the difficulty, which threatened
her with total deafness, was cured. She has continued to be active
in organizations benefiting hearing-impaired and other disabled
persons.
Mrs. MacDougall was Regional Chairperson of the National
Easter Seal Society for Crippled Children, and the National Mental
Health Association. She is past Chairperson of the National Advisory
Committee for Education of the Deaf. She currently serves on the
Board of the National Captioning Institute, the Better Hearing Institute
in Washington, D.C., as well as the House Ear Institute and the
Museum of Science and Industry.
Among the many awards she has received are the President's
Distinguished Service Award (1971) and the Eleanor Roosevelt Humanitarian
Award (1964). Mrs. MacDougall and Helen Keller are the only two
women ever to have received the annual Public Service Award of the
American Academy of Ophthalmology and Otolaryngology. She has two
honorary doctoral degrees, one from Gallaudet College and one from
Western Maryland College. She was one of the original members of
the National Council on the Handicapped, and was reappointed by
President Reagan.
Michael Marge, Ed.D.
Michael Marge, Ed.D., of Syracuse, New York, has been
Professor of Special Education and Rehabilitation (Communicative
Disorders) and Professor of Child and Family Studies, Syracuse University,
since 1974. He was Dean of the College for Human Development from
1974-1979. He has been active in special education and rehabilitation
for more than thirty years. He began his career as Director of the
Upstate New York Speech and Hearing Therapy Project for the Easter
Seal Society. He developed the Glens Falls, NY Cerebral Palsy Clinic
and the Northeastern New York Cleft Palate Center; was Director
of Speech Therapy Services for the Mount Carmel Guild Programs for
the Handicapped, Newark, NJ, which provided services for more than
200 elementary and secondary schools; and he founded and served
as Co-Chairman of the Department of Communicative Disorders at Seton
Hall University from 1960-1964.
In 1964 he served at the U.S. Office for Education
as Program Coordinator for Speech and Hearing Services in the Division
of Handicapped Children and Youth, later becoming Director of Program
Planning and Evaluation for the Bureau of Education for the Handicapped.
He was Deputy Commissioner of Education for Planning Research and
Evaluation (1969-1971), and Deputy Director of the Bureau of International
Studies (1971-1974).
He is a member of numerous professional organizations,
serving as an officer and chairperson of selected committees. Currently,
he is Chairman of the ASHA Committee on Prevention of Communicative
Disorders and the Central New York Committee on Disability Prevention.
In 1980 he received a Mary E. Switzer Fellowship Award for his contributions
to disability prevention. He is the author of a textbook on language
disability in children and more than thirty publications on communicative
disorders, special education and rehabilitation.
Jeremiah Milbank, Jr.
Jeremiah Milbank, Jr. of Greenwich, Connecticut, graduated
from Yale University in 1942, and Harvard Business School in 1948,
after which he worked in the private investment business in New
York.
Mr. Milbank has held a leadership position in both
community and national organizations, including President of the
J. M. Foundation, Boys Clubs of America, and the International Center
for the Disabled. He has been Chairman of the Republican National
Finance Committee, 1969-72 and 1975-77; he is on the Board of Governors
of the Ronald Reagan Presidential Foundation; and is a Trustee of
the Taft Institute for Two Party Government. A recipient of the
President's Award for Voluntary Action, 1983, he also holds three
honorary degrees.
Alvis Kent Waldrep, Jr.
Alvis Kent Waldrep, Jr. of Plano, Texas, is the President
and Chief Executive Officer of the Kent Waldrep National Paralysis
Foundation, a non-profit organization dedicated to finding a treatment
and cure for paralysis caused by spinal cord injury. He is responsible
for all phases of daily operations which include fundraising, budgeting
and public awareness through its national office in Dallas. From
September 1982 to June 1985, Mr. Waldrep was President of the American
Paralysis Association.
From June 19179 to December 1981, Mr. Waldrep founded
and served as Chief Executive Officer of the Kent Waldrep International
Spinal Cord Research Foundation, Inc., a non-profit organization
which became the American Paralysis Association. He was responsible
for planning and implementing all programs designed to meet the
objectives and goals of the Foundation.
Mr. Waldrep served as Assistant Sports Information
Director for Texas Christian University from April 1977 to June
1979. There, he assisted the Sports Information Director with all
sports promotion programs, including media communication, brochure
preparation, compilation of statistics and advertising sales. This
followed on three years of intensive physical therapy following
paralysis caused by a cervical spinal cord injury from football
in 1974 which left him a quadriplegic with paralysis from the neck
down.
He is a member of several community and professional
groups including the Board of the Dallas Rehabilitation Institute
and The National Society for Fundraising Executives. He has been
the recipient of many awards honoring him for his achievements in
the area of disability. Mr. Waldrep was selected by the United States
Jaycees as one of the ten outstanding young men in America for 1985.
Roxanne S. Vierra
Roxanne S. Vierra of Littleton, Colorado has been
actively involved in business as well as in community and political
affairs. Her son, Steven, had brain damage from birth. His handicap
gave her insight into the needs of mentally retarded individuals.
This insight caused her to develop Retarded Unlimited, Inc., an
organization designed to establish business ventures owned and operated
by mentally retarded persons. Her objective is to make mentally
retarded people more self-sufficient and less dependent on government
funds. Steven is an example of what a mentally retarded individual
can do: He lives in his own townhouse, works as a courtesy clerk
at a grocery store and is relatively independent.
Mrs. Vierra serves as an officer of the Children's
Diabetes Foundation, which is dedicated to research in finding a
permanent cure for children's diabetes. She is on the Board of Directors
of the American Lung Association, and is President of the Board
of Childhelp USA, a national organization to prevent child abuse.
She has campaigned and organized numerous activities in national
elections including fundraising in President Reagan's campaign.
In the business world, Mrs. Vierra has been a Broker Associate for
the Devonshire Company selling residential property for the past
six years.
Henry Viscardi, Jr.
Henry Viscardi, Jr., L.L.D. (Hon.) of Long Island,
New York is highly respected in the fields of rehabilitation and
education. Born without legs and confined to a public ward in a
hospital for the first seven years of his life, Dr. Viscardi has
devoted his life to insuring that severely disabled individuals
have the opportunity to achieve their fullest potential.
Dr. Viscardi has been an adviser to Presidents and
has been awarded over a dozen honorary degrees including doctorates
in law, science, humane letters and literature. He has written numerous
books, and the National Rehabilitation Association presented him
with its highest honor, The President's Award Medal. His international
activities include missions to India, Egypt, the Scandinavian countries,
Australia and Western Europe.
In 1952 Dr. Viscardi founded the internationally famed
Human Resources Center in Albertson, New York. Through this Center,
he has shown that disabled people can be fully integrated into every
phase of American life from infant education to professional accomplishments.
Someone has said, "Standing on artificial limbs, he is a giant among
the great Americans of our time. "
References
American Public Transit Association. (1985).
Fact Sheet: Public Transportation for the Disabled. Washington,
DC.
Dole Foundation & President's Committee on Employment
of the Handicapped. (1985). Disabled Americans at Work. Washington,
DC.
DuPont de Nemours and Company, E. 1. (1982). Equal
to the Task: 1981 du Pont Survey of the Handicapped. Wilmington,
DE.
EMC Institute. (1979). Program Issue Review: Characteristics
of the Developmentally Disabled. Washington, DC: Office of
Human Development, U.S. Department of Health, Education, and Welfare.
Gatty, B. (1981, August). Business finds profit in
hiring the disabled. Nation X Business. pp. 30-35.
General Accounting Office. (1982). Status of Special
Efforts to Meet Transportation Needs of the Elderly and Handicapped.
Washington, DC.
Goldman, H. H., Gattozzi, A. A., & Taube, C. A.
(1981). Defining and counting the chronically mentally ill. Hospital
and Community Psychiatry, 32(1), 21-27.
Hood, L., & Downs, J. (1985). Return to Work:
A Literature Review. Topeka, KS: The Menninger Foundation.
Mathematica Policy Research, Inc. (1984). Digest
of Data on Persons with Disabilities. Washington, DC: Congressional
Research Service, The Library of Congress.
National Council on the Handicapped. (1983). National
Policy for Persons with Disabilities. Washington, DC.
National Institute of Mental Health. (1985). Mental
Health, United States 1985. (DHHS Publication (ADM) 85-1378).
Washington, DC.
National Study Group on State Medical Strategies.
(1983). Restructuring Medicaid: An Agenda for Change: Background
Papers. Washington, DC: Center for the Study of Social Policy.
Reagan, R. (1983). Fair Housing Legislation: Message
to Congress transmitting the proposed legislation, July 12, 1983.
Presidential Documents, 19, 991-992.
Reagan, R. (1983). National Decade of Disabled Persons:
Proclamation 5131. Presidential Documents, 19, 1621-1622.
Reagan, R. (1983). National Decade of Disabled Persons:
Remarks on Signing Proclamation 5131, November 28, 1983. Presidential
Documents, 19, 1620-1621.
Report of the United Nations Expert Group Meeting
on Barrier-Free Design (1975). International Rehabilitation
Review, 26, 3.
Smith, M. F. (1984). S. 2053 and the Transfer of
Mentally Retarded Persons from Large Institutions to small Community
Living Arrangements. Washington, DC: Congressional Research
Service, The Library of Congress.
Sirrocco, A. (1983). An overview of the 1980 national
master facility inventory survey of nursing and related care homes.
Advanced Data From Vital and Health Statistics (NO91, DHHS
Publication (PHS) 83-1250). Washington, DC.
U.S. Department of Housing and Urban Development.
(1984). The President's National Urban Policy Report: 1984. Washington,
DC: U.S. Government Printing Office. |