Search

This article examines the impact of algorithmic systems on disabled people's interactions with social services, focusing on a case study of algorithmic decision-making in Australia's National Disability Insurance Scheme (NDIS). Through interviews and document analysis, we explore future visions and concerns related to increased automation in NDIS planning and eligibility determinations. We show that while individuals may not fully comprehend the inner workings of algorithmic systems, they develop their own understandings and judgments, shedding light on how power operates through the datafication of disability. The article highlights the significance of addressing epistemic justice concerns, urging a reevaluation of dominant modes of understanding and assessing disability through algorithmic categorisation, while advocating for more nuanced approaches that acknowledge disability's embeddedness in social relations. The findings have implications for the future use of algorithmic decision-making in the NDIS and disability welfare provision more broadly. Points of Interest: Computer-based tools, or algorithms, are increasingly being used to assess who is eligible for public disability programs. This research investigates disabled people's concerns about the use of these tools. It uses a case study from Australia, where algorithmic assessments were recently proposed and trialled by the government. Concerns about technology's impact on resource allocation in disability support regimes include insensitivity to individual lived realities and reduction of disability to a score of bodily functionality. To avoid harm to disabled people, the research recommends an approach to assessment that better addresses contextual factors and lived experiences of disability. [ABSTRACT FROM AUTHOR]

While the National Disability Insurance Scheme (NDIS) has been operating in Australia for 10 years, numerous eligible people with disability have not accessed the scheme, many of whom are in prison. The South Australian Government, in partnership with the National Disability Insurance Agency (NDIA), implemented a pilot programme to assist people in prison to access the NDIS as having NDIS supports on release may reduce the risk of returning to custody. This qualitative study, drawing on interviews with 20 stakeholders, explores the enablers and barriers of assisting people with disability in prison access the NDIS. Our findings show that while custodial settings provide opportunities to assist people with disability to have their eligibility for the NDIS assessed, prisons are difficult settings in which to undertake subsequent assessment and planning processes to determine the supports available on release. People with disability exiting prison also face significant challenges accessing suitable accommodation and support services, particularly when their needs are complex. Further work is required to ensure planning and assessment processes meet the needs of this group. The findings provide useful insights to both justice and other institutional settings and respond to many of the questions raised by recent public inquiries and reviews. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the COVID-19 pandemic on disability insurance grants and related costs for workerswith cancer. Methods: This ecological time series study uses the inflection point regression model and the federal government's open-access dataset. We analyze the annual grant and cost rates of cancer-related disability insurance in Brazil (2010-2021). Results: In 2020, the number of disability insurance grants due to malignant neoplasms decreased by 62.26%, and the total annual cost decreased by 62.94% compared to those in 2019. All illnesses and injuries were reduced by 2.56% and 20.02%, respectively. Between 2010 and 2021, the COVID-19 pandemic has reversed the increasing trend in annual disability insurance granted due to cancer and its associated expenses to a stable trend. Conclusion: The COVID-19 pandemic has harmed the provision of disability insurance for workers with cancer. [ABSTRACT FROM AUTHOR]

While a growing body of evidence has highlighted the psychological distress experienced by individuals dealing with the UK benefits system, there has been little research into that system from the perspective of Trauma Informed Care (TIC). This study explored to what extent people's experiences of benefits assessment fitted with TIC principles, using a framework produced by NHS Education for Scotland. Secondary aims were to understand experiences that were not captured by the framework, and to explore the limitations of the framework in context. Participants were 12 people receiving NHS therapy for trauma-related difficulties, who had attended an assessment for the Personal Independence Payment (PIP), a UK financial benefit designed to help with long-term illness or disability. Semi-structured interviews were carried out, and a framework analysis conducted. Results suggested that PIP assessments were severely re-traumatising, with a prolonged adverse effect on mental health. Participants' experiences contrasted so greatly with the principles of TIC that an alternative framework was constructed, comprising five key themes: harm, distrust, rigidity, intimidation, and powerlessness. Recommendations are made for further research, including an understanding of assessors' perspectives, and how TIC principles might be introduced into the assessment process. [ABSTRACT FROM AUTHOR]

The degree to which disability benefit programs provide an adequate standard of living to those with work-limiting disabilities has long been overlooked in social policy research. This paper presents a framework for assessing disability-related decommodification and then applies that framework to an analysis of the Social Security Disability (SSD) programs in the United States. The paper draws on survey data from the Health and Retirement Study linked to administrative records from the Social Security Administration, and further compares the U.S. estimates to those from 27 other countries. The results indicate that more than 50 percent of older adults of working-age with work-disabilities in the U.S. do not receive SSD benefits, though rates of benefit receipt are higher than the average across other high-income countries. Those that receive SSD benefits, moreover, experience greater difficulty achieving an adequate standard of living, as measured by an index of financial security, than those with similar characteristics in the U.S. who do not receive disability benefits. The paper thus provides a framework for future policy research on benefit adequacy, while evaluating the availability and generosity of disability benefits in the U.S. [ABSTRACT FROM AUTHOR]

BACKGROUND: A substantial gap in employment rates has been documented between people with and without visual impairments, but most employment-related research for people with visual impairments has focused on employment at one time point. OBJECTIVE: The purpose of this study was to examine longitudinal employment trajectories by visual impairment and investigate factors associated with trajectories for people with visual impairments. METHODS: The data source was the 2014 Panel of the Survey of Income and Program Participation. Participants were 816 adults with visual impairments and a matched comparison group of 816 adults without visual impairments. We used group-based trajectory modeling to estimate employment trajectories, identify predictors of trajectory group membership, and explore the impact of health on employment trajectories. RESULTS: Visual impairment was associated with a lower probability of membership in the Rising, Declining, and High employment trajectory groups compared to the Low group. Predictors of trajectory group membership included disability benefit receipt, non-visual disabilities, gender, race, age, and education. Fair or poor health was associated with decreases in all four trajectories over time. CONCLUSION: Visual impairment is a risk factor for not working across multiple years. Disability benefit receipt was the strongest predictor of trajectory group membership for this population. [ABSTRACT FROM AUTHOR]

This study examines the administrative burden imposed by two federal disability assistance programs, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). We consider how communities in two distinct regions of the United States—and their respective institutions—serve as mediators between citizens and the state. We draw on 68 interviews from Clay County, Kentucky, and Humphreys County, Mississippi—two rural counties with high rates of disability assistance but differing racial compositions. Predominately white Clay County recipients described an institutionally supported route to claiming disability assistance. In majority-Black Humphreys County, most recipients described an institutionally neglected route to claiming disability assistance. The rejection rate and average wait times were significantly higher for applicants in Humphreys County than in Clay County. Our results highlight how disparities in access to and treatment by local institutions can create uneven implementation of federal programs. [ABSTRACT FROM AUTHOR]

Purpose: As the effect evaluation of our randomized controlled trial the "Comprehensive Approach of Reintegration for clients with Multiple problems" (CARm) showed no superior effect on re-integration into paid employment of the clients when compared with clients of the care as usual, we conducted this process evaluation to gain insight into whether the intervention was conducted according to protocol. Methods: Using questionnaires on recruitment, reach, dose delivered, dose received, fidelity, context, and satisfaction we collected data from 40 labour experts of the Public Employment Service of the Dutch Social Security Institute, and from 166 disability benefit recipients dealing with multiple problems. Results: Only few of the labour experts provided the key elements of the intervention to their clients. Between the clients of both groups were no significant differences in the dose received. More than half of the labour experts of the intervention group reported organizational changes. Conclusion: The lack of effect of the CARm intervention was almost certainly caused by implementation failure. Once again this study showed the importance of involving all stakeholders in developing and the conduct of the intervention, and of clarifying the consequences for the organization, to ensure that it can be conducted according to protocol. IMPLICATIONS FOR REHABILITATION: A Strength based intervention was developed to improve re-integration into paid employment of disability benefit recipients facing multiple problems and a process evaluation was carried out. Organizations should provide sufficient time to support their professionals by implementing this intervention into practice. Protocol adherence is crucial to value intervention results in practice. [ABSTRACT FROM AUTHOR]

The text discusses labor force nonparticipation rates among different age groups and genders from 1999 to 2022. It highlights that school attendance was the main reason for nonparticipation among teenagers and young adults, with an increase in nonparticipation due to factors such as increased summer school attendance and parental emphasis on education. Among men aged 25 to 54, illness or disability was the main reason for nonparticipation, while women cited home responsibilities as their main reason. The text also mentions that nonparticipation due to illness or disability increased for both men and women during this period. The COVID-19 pandemic had a significant impact on the U.S. labor force, with the overall nonparticipation rate rising from 34.0 percent in 2019 to 35.5 percent in 2022. Retirement was the main reason for the increase in nonparticipation during the pandemic. The article also discusses trends in retirement patterns, including the impact of recessions and the COVID-19 pandemic on retirement rates. [Extracted from the article]

We examine the targeting effects of stricter screening in the Dutch disability insurance (DI) program induced by a nationwide reform. The drastic "gatekeeper protocol" increased application costs and revealed more information about individuals' ability to work. Discontinuity-in-time regressions on administrative data show substantial declines in DI application rates (40 percent in one year) following the reform, particularly among those with difficult-to-verify impairments and less severe health disorders. Individuals who were deterred from applying had worse health and worked less than never-applicants. Changes in average health conditions of awardees were almost fully driven by self-screening and work resumption during the DI sick-pay period. [ABSTRACT FROM AUTHOR]

The Netherlands reformed its disability insurance (DI) scheme in 2006. Reintegration incentives for employers became stronger, access to DI benefits became more difficult, and benefits became less generous. Using administrative data on all individuals who fell sick shortly before and after the reform, we study the impact of the reform on labor participation of individuals who fell sick and their spouses. Difference-in-differences estimates show, among other things, that the reform led to an increase of labor participation of the individuals who fell sick only if these individuals had a permanent job, whereas spouses responded to the DI reform in other cases, where the individuals reporting sick had a temporary job or were unemployed. More generally, the spouses respond when the sick individual's labor market position is weak and the individual him- or herself has trouble finding or retaining employment. The effects are persistent during the 10 years after the reform. The effect on the spouse can be seen as an "added worker effect," where additional earnings of the spouse compensate for the sick individual's income loss so that both partners share the burden of a more stringent DI scheme. Comparing individuals reporting sick with and without partner provides further support for the notion that the responses of couples to the reform are joint decisions of the two partners. [ABSTRACT FROM AUTHOR]

In this paper, we critically reflect on the methodological challenges encountered during a qualitative research project that examined the effectiveness of the Australian National Disability Insurance Scheme (NDIS). We draw on Lewis and Mehmet's (2021) approach that combines aspects of autoethnography and reflexivity to focus on three key areas, inclusive research, informed consent, and recruitment, which we have considered in terms of mistrust and the roles of the gatekeeper. This paper contributes to our understanding of researching vulnerable and marginalised populations and highlights learnings for marketers as they seek to identify how to adequately capture the voices of the often voiceless. Key implications include acknowledging vulnerability as a multi-dimensional concept, adopting a continual reflective approach, selecting appropriate channels of communication, and considering team dynamics before and during research implementation. By showcasing our learning experiences, we guide other market researchers who are interested in exploring similarly marginalised or vulnerable groups. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThe purpose of this study was to explore the experiences of human service workers (HSWs) in engaging with Aboriginal participants of the National Disability Insurance Scheme (NDIS).Semi-structured interviews were undertaken with HSWs engaging with Aboriginal participants of the NDIS on Kaurna Country (Adelaide, South Australia). Data were analyzed using thematic analysis.In total, n = 10 HSWs participated in the study. Three themes impacting upon HSWs ability to effectively engage with Aboriginal participants were identified: (1) lack of access to training, support and supervision, (2) difficulties in navigating assessment and intervention, and (3) limited availability of culturally specific services.This study contributes to Australian disability policy and practice with insights gained from the experiences of human service workers engaging with aboriginal participants of the NDIS. Systemic changes are required within policy and funding arrangements to create a system flexible enough to respond to the needs of Aboriginal Peoples with disability. Aboriginal peoples with disability are underrepresented within the National Disability Insurance SchemeConcerns exist over the adequacy of the knowledge and skills of the disability workforce associated with the National Disability Insurance SchemeThis study highlights three key barriers human service workers face in effectively engaging with Aboriginal participants of the National Disability Insurance SchemeThese barriers reflect both organizational and policy constraints and highlight the need for systemic changes to the way disability services are delivered to Aboriginal PeoplesAboriginal peoples with disability are underrepresented within the National Disability Insurance SchemeConcerns exist over the adequacy of the knowledge and skills of the disability workforce associated with the National Disability Insurance SchemeThis study highlights three key barriers human service workers face in effectively engaging with Aboriginal participants of the National Disability Insurance SchemeThese barriers reflect both organizational and policy constraints and highlight the need for systemic changes to the way disability services are delivered to Aboriginal Peoples [ABSTRACT FROM AUTHOR]

Australians with a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan may at times require emergency care due to the fluctuating nature of their physical and mental health conditions or when their supports have become insufficient. This nationwide study investigated the experiences of people presenting to an emergency department (ED) who have a PSD and an NDIS plan. The objective was to understand current care and communication practices and to provide recommendations for service integration. Twenty‐four interviews were conducted with people who had a PSD and an NDIS plan. Participants were asked semi‐structured questions about their experiences when engaging with NDIS processes and when engaging with the ED as an NDIS recipient and how communication practices could be improved between the two services. A qualitative, descriptive thematic analysis approach was used. A lived experience advisory group participated in the research and provided commentary. The findings of this study indicate that the NDIS, as a personalised budget scheme, presents challenges for people with complex PSD and physical needs. ED clinicians appear to be unclear about what the NDIS provides and communication between the two systems is fragmented and inconsistent. The themes identified from the analysed transcripts are: (a) People with PSD experience distress when dealing with the NDIS; (b) There's a blame game between the ED and the NDIS; and (c) Inadequate service integration between the ED and NDIS. Recommendations to assist with service integration include building service capacity, providing overlapping care and bridging the diverse biomedical, psychosocial and disability care services. [ABSTRACT FROM AUTHOR]

This case commentary considers unique features of medical-legal partnerships (MLPs) in the Veterans Health Administration that may potentially mediate and minimize ethical tensions that may arise in MLP collaborations involving diagnosing and documenting disability. [ABSTRACT FROM AUTHOR]

Aim: The inclusion of production losses in health care priority setting is extensively debated. However, few studies allow for a comparison of these losses across relevant clinical and demographic categories. Our objective was to provide comprehensive estimates of Norwegian production losses from morbidity and mortality by age, sex and disease category. Methods: National registries, tax records, labour force surveys, household and population statistics and data from the Global Burden of Disease were combined to estimate production losses for 12 disease categories, 38 age and sex groups and four causes of production loss. The production losses were estimated via lost wages in accordance with a human capital approach for 2019. Results: The main causes of production losses in 2019 were mental and substance use disorders, totalling NOK121.6bn (32.7% of total production losses). This was followed by musculoskeletal disorders, neurological disorders, injuries, and neoplasms, which accounted for 25.2%, 7.4%, 7.4% and 6.5% of total production losses, respectively. Production losses due to sick leave, disability insurance and work assessment allowance were higher for females than for males, whereas production losses due to premature mortality were higher for males. The latter was related to neoplasms, cardiovascular disease and injuries. Across age categories, non-fatal conditions with a high prevalence among working populations caused the largest production losses. Conclusions: The inclusion of production losses in health care priority debates in Norway could result in an emphasis on chronic diseases that occur among younger populations at the expense of fatal diseases among older age groups. [ABSTRACT FROM AUTHOR]

In the Netherlands, access to disability insurance has become gradually more limited and demanding. The same holds for sheltered work. This puts disabled workers, and especially those with no working history, in disadvantaged competition with the non-disabled segment of the working population. In this study, we employ a Lotka–Volterra competition model based on differential equations to investigate how government expenditures for disability and other social benefits interacted in the period between 2010 and 2018. We contribute to the literature by showing that public expenditure for disability is not autonomous and that its competitive power in the social protection ecosystem changes both in type and over time. Our findings suggest that government expenditure for disability benefits in the Netherlands behaved both as prey in favour and predator at the cost of social exclusion and unemployment benefits. Reforms that took place in the ecosystem of interest are used to interpret such behaviour. [ABSTRACT FROM AUTHOR]

The article is a personal testimony by Georgia Vrakas, a psychologist and professor who lives with a mental illness. Vrakas argues against including mental illness as the sole medical condition for accessing medical assistance in dying. She shares her own experience of misdiagnosis and suicidal thoughts, emphasizing the importance of mental health services and suicide prevention. Vrakas believes that allowing medical assistance in dying for mental illness sends a message of hopelessness and disposability, and instead advocates for increased investment in mental health promotion, prevention programs, services, research, and education to combat stigma and support recovery. [Extracted from the article]

Background: The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families. Method: A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis. Results: The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families. Conclusion: Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised. [ABSTRACT FROM AUTHOR]

Within growing marketisation of publicly funded services, the internet has provided new opportunities for marketing, delivery, and coordination of those services. Using web scraping and hyperlink network analysis techniques, this paper examines the ways in which organisations operating in Australia's evolving National Disability Insurance Scheme (NDIS) system inter-connect online. Social media plays the most important role in the online network. Government agencies also play a central role, with many disability service organisations linking their web users to them. Government agency websites do not hyperlink to disability service providers, suggesting that governments do not see their role as assisting access to such services. Advocacy and peak disability organisations are important in online connections between the websites of government and service organisations. Innovative uses of the internet for online brokerage of disability services are evident. The implications of these findings for service delivery are discussed. [ABSTRACT FROM AUTHOR]

Medicare Part D expanded public prescription drug insurance coverage to millions of Social Security Disability Insurance (SSDI) Medicare beneficiaries. Using difference-in-differences estimation and data from the Medical Expenditure Panel Survey, I estimate the effect of Medicare Part D on the prescription drug coverage, utilization, and expenditures of this understudied group. I estimate that the policy increased prescription drug coverage by 18 percentage points and decreased annual out-of-pocket prescription drug expenditure by $526 (a decrease of 42 percent from the pre-reform mean). Additionally, the estimates suggest modest substitution away from private prescription drug coverage (decrease of 5.7 percentage points) and little decrease in annual private insurance prescription drug expenditure ($31). This would suggest large welfare gains from the policy for the Part D eligible SSDI population. [ABSTRACT FROM AUTHOR]

The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working‐age adults not yet age‐eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working‐age adults with a history of cancer and compare them with estimates among working‐age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019–2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer. [ABSTRACT FROM AUTHOR]

Research suggests that sexual minority individuals are at increased risk of suicide compared with the general population. As technology continues to develop in sophistication and accessibility, a growing number of research and therapeutic interventions utilize web-based assessments. To facilitate future research on assessing and responding to suicidal thoughts and behaviors, we describe the implementation of procedures for doing so in the context of a limited-interaction, remote cohort study. We describe factors associated with suicidal thoughts and behaviors among sexual minority men (SMM) that can guide risk/benefit assessments in future studies. Descriptive statistics were used to characterize the sample in terms of self-injury/suicidality. Bivariate χ2 tests were conducted to explore differences in these indicators by age, race and ethnicity, sexual orientation, health insurance, region, education, and self-ranked socioeconomic status. Additionally, logistic regressions were used to examine associations between demographic characteristics, various psychosocial syndemic factors, and the four measures of self-injury/suicidality. In addition, we describe the experiences completing the suicidality follow-up protocol within the study. We conducted a nationwide study of 10,607 participants and found that 27.8% had a history of self-injury, 5.6% in the past year, 21.0% had attempted suicide, 18.2% experienced suicidal ideation, and 9.4% had thoughts of killing themselves. Logistic regressions revealed that depression, everyday discrimination based on sexual orientation, childhood sexual assault, and intimate partner violence were the strongest predictors of self-injury and suicidality. Study participants experienced high rates of self-injury and suicidality. Effective protocols can be developed to assess and respond to suicide risk in web-based SMM studies. [ABSTRACT FROM AUTHOR]

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi‐structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person‐centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person‐centred care approach are provided. Alternative support options for this group of people need to be explored. [ABSTRACT FROM AUTHOR]

This study investigated the extent to which behaviour support services are accessible under Australia's National Disability Insurance Scheme (NDIS). We conducted semi-structured interviews with families who support a member with an intellectual disability and challenging behaviour. We analysed this data with a supply and demand access framework initially designed for health care and described the lived experiences of participants and their families accessing behaviour supports. Results show that while the NDIS has improved participants' ability to pay for behaviour (and other) supports, this financial capacity represents only one of six other important aspects of access. Families compensate for the shortcomings of the marketised environment which has arisen under the NDIS. This raises questions about the responsibilities of support provision, which is obscured in the new NDIS system and places responsibility for successfully accessing behaviour supports onto the family of the person with an intellectual disability. [ABSTRACT FROM AUTHOR]

The delivery of a dementia diagnosis, the information provided, and the practical advice and support arranged can have a long‐lasting impact on patients and their families and deserves attention equal to that given to the assessment and investigation process. Patients and their families need a constructive yet sensitive conversation about the nature and cause of their difficulties, communicated in plain language, and tailored to their main concerns and needs. This conversation should lead to the provision of high‐quality, easily accessible information. Following this, clinicians may wish to consider broaching the following dementia topics: (1) pharmacological and non‐pharmacological interventions, (2) connection and integration with relevant organisations, (3, 4) application for formal support services and engagement with support teams, (5) safety in the home, (6, 7) financial planning, guardianship and legal matters, (8) driving eligibility, (9) support and education resources to family carers and (10) research initiatives and genetic information. Addressing these topics will contribute to improved disease management, which is likely to improve the dementia journey for the patient, their carer(s), and family. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about depression treatment for transgender and gender diverse (TGD) older adults or TGD people with disabilities. The purpose of this study was to characterize receipt of minimally recommended depression treatment and outcomes for TGD Medicare beneficiaries. Methods: Using Medicare claims data from 2009 to 2016, we identified potential TGD beneficiaries with depression (n=2223 TGD older adult beneficiaries and n=8752 TGD beneficiaries with a disability) and compared their rates of minimally recommended mental health treatment, inpatient mental health hospitalizations, psychotropic medication fills, and suicide attempt to a group of Comparison beneficiaries with depression (n=499,888 adults aged 65+ years and n=287,583 who qualified due to disability). We estimated disparities in outcomes between TGD and non-TGD beneficiaries (separately by original reason for Medicare eligibility: age 65+ years vs. a disability) using a rank-and-replace method to adjust for health needs. Results: After adjustment, rates of minimally recommended mental health treatment and psychotropic medication fills were higher among TGD versus Comparison beneficiaries, as were rates of inpatient mental health visits and suicide attempts (predicted mean of disparities estimates for older adult subgroup: 0.092, 0.096, 0.006, and 0.002, respectively, all p<0.01; and in subgroup with disability: 0.091, 0.115, 0.015, and 0.003, respectively, all p<0.001). Conclusion: Despite higher mental health treatment rates, TGD beneficiaries with depression in this study had more adverse mental health outcomes. Minimum recommended treatment definitions derived in general population samples may not capture complex mental health needs of specific marginalized populations. [ABSTRACT FROM AUTHOR]

Internationally, community healthcare is provided by personal health budgets or personalised schemes as part of a consumer-directed care emphasis. Although the introduction of a personalised scheme in Australia has improved the lives of many, people with psychosocial disability (PSD) and their families have experienced many challenges with service integration. Six focus groups with 17 National Disability Insurance Scheme (NDIS) support workers were conducted between June and November 2022. Participants were asked semistructured questions about their engagement with emergency department (ED) clinicians when presenting with a person with PSD and NDIS plan. They were also asked how they contribute to service integration to improve communication practices between the two services. A qualitative, descriptive thematic analysis approach was used. Results indicate there is a need for improved service integration pathways between the ED and NDIS services. The thematic analyses identified five main themes: the ED is harmful and not safe, but nowhere else to go; make the ED safe; further training for ED staff; improving communication across services; and alternatives to the ED. This study reports NDIS support worker's experience when supporting a person they are caring for in the ED. NDIS support workers have an understanding of the needs of the people they care for;their wisdom can contribute greatly to ED clinical responses in crisis care. Recommendations are offered to assist with service integration between the two systems. [ABSTRACT FROM AUTHOR]

Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal. We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal. Eighty-seven appeals addressed an endometriosis-related issue. Three themes—evidence, treatment, and time—were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences. Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Studies on the societal burden of patients with biopsy-confirmed non-alcoholic fatty liver disease (NAFLD) are sparse. This study examined this question, comparing NAFLD with matched reference groups. Materials and Methods: Nationwide Danish healthcare registers were used to include all patients (≥18 years) diagnosed with biopsy-verified NAFLD (1997-2021). Patients were classified as having simple steatosis or non-alcoholic steatohepatitis (NASH) with or without cirrhosis, and all matched with liver-disease free reference groups. Healthcare costs and labour market outcomes were compared from 5 years before to 11 years after diagnosis. Patients were followed for 25 years to analyse risk of disability insurance and death. Results: 3,712 patients with biopsy-verified NASH (n = 1,030), simple steatosis (n = 1,540) or cirrhosis (n = 1,142) were identified. The average total costs in the year leading up to diagnosis was 4.1-fold higher for NASH patients than the reference group (EUR 6,318), 6.2-fold higher for cirrhosis patients and 3.1-fold higher for simple steatosis patients. In NASH, outpatient hospital contacts were responsible for 49 % of the excess costs (EUR 3,121). NASH patients had statistically significantly lower income than their reference group as early as five years before diagnosis until nine years after diagnosis, and markedly higher risk of becoming disability insurance recipients (HR: 4.37; 95 % CI: 3.17-6.02) and of death (HR: 2.42; 95 % CI: 1.80-3.25). Conclusions: NASH, simple steatosis and cirrhosis are all associated with substantial costs for the individual and the society with excess healthcare costs and poorer labour market outcomes. [ABSTRACT FROM AUTHOR]

Research Question: This study investigates gender differences in job satisfaction among employees in Serbia. Motivation: The main goal of the research is examine and providing evidence the existence and scope of the paradox of gender job satisfaction. In his paper, Clark (1997) proves that women have greater job satisfaction than men. The author suggests that, in general, the higher satisfaction of women at work may be a consequence of lower job expectations as a result of the worse position in the labor market that women have had in the past. Idea: The starting point of this research is the assumption that employed women are on average more satisfied than men, despite the inferior position they occupy in the labor market. Data: The research was conducted among 468 employees in six privately owned IT and publishing companies and one state-owned company (The Pension and Disability Insurance Fund of the Republic of Serbia). The structured questionnaire was used and distributed during January 2021. Tools: The questionnaire has two parts. The first part pertains to the respondents' demographic information such as gender, age, level of education, the sectoral structure of the company in which they are employed, management positions and years of work experience. The second part of the questionnaire referred to questions related to job satisfaction, i.e. it contained 8 questions in accordance with the Job Satisfaction Questionnaire (Clark, 1997), which measured the degree of satisfaction with aspects of job including general satisfaction with current job. Findings: The results research show the women are more dissatisfied with their job compared to men, despite the fact that the distinction in job satisfaction between women and men is statistically insignificant. Finding that women on the average more dissatisfaction with their jobs than man appears to be contradictory to the most of studies report that women more satisfaction with their jobs than men. Accordingly, the idea of the gender-job satisfaction paradox in conditions of high levels of gender inequality that characterizes the labor market in Serbia cannot be confirmed and accepted as a universal phenomenon. Contribution: The paper adds existing knowledge about the job-gender paradox. Evidence that there are no differences in job satisfaction between female and male employees suggests that gender discrepancies is becoming less significant. [ABSTRACT FROM AUTHOR]

Social enterprises play an increasing role in providing employment opportunities for disabled people. This paper examines the implications of social enterprises' market-based approach to disability inclusion, which is characterized by viewing disability as an asset rather than a limitation. Taking our inspiration from critical disability scholars who have pointed out that inclusion agendas produce disability as a distinct social reality, we use a performative lens to examine how social enterprises variously "do disability," for instance, by defining where the potentials of disabled people lie and how best to promote them. Drawing on an ethnographic study of Magic Fingers, a Nepal-based enterprise that employs blind people as massage therapists, we identify entrepreneurial "doings" of disability that were guided by ideals of empowerment but that ultimately produced new and subtle forms of exclusion. By closely examining the case organization's founding phase, as well as its practices of advertising, recruitment, and day-to-day management, we show how Magic Fingers commodified disability in novel ways, reinforced the notion of disability as a negative condition that must be "overcome" through work, and introduced new market-oriented evaluative distinctions between "more able" and "less able" disabled individuals. By exploring and evaluating these effects, this paper draws attention to the ways in which social enterprises, while challenging deficit-oriented representations of disability, can paradoxically solidify disability as something profoundly "other." [ABSTRACT FROM AUTHOR]

The article examines the implementation of the 2016 revised disability benefit claims regulation made by the U.S. Department of Labor (DOL) under the Employee Retirement Income Security Act of 1974 (ERISA) as of April 2024. The amendment aims to increase ERISA fiduciary standards and enhance procedural safeguards in claims processing. Also cited is the recommended use of the Chevron doctrine when interpreting ERISA claims procedure regulations.

Background: Poor self-rated health (SRH) is a well-established risk factor for premature employment exit through unemployment, work disability, and early retirement. However, it is unclear whether the premature employment exit risk associated with underlying cardio-metabolic health conditions is fully captured by poor SRH. This study examines the metabolic syndrome (MetS), an early-stage risk factor for cardiovascular disease and type two diabetes mellitus, as a risk factor for premature employment exit while controlling for poor SRH. Methods: We analyzed data from N=55 016 Dutch workers (40-64 years) from five waves of the Lifelines Cohort Study and Biobank. MetS components were based on physical measures, blood markers, and medication use. SRH and employment states were self-reported. The associations between MetS, SRH, and premature employment exit types were analyzed using competing risk regression analysis. Results: During 4.3 years of follow-up, MetS remained an independent risk factor for unemployment [adjusted subdistribution hazard ratio (SHR): 1.14, 95% CI: 1.03, 1.25] and work disability (adjusted SHR: 1.33, 95% CI: 1.11, 1.58) when adjusted for poor SRH, common chronic diseases related to labor market participation (i.e., cancer, musculoskeletal-, pulmonary-, and psychiatric diseases), and sociodemographic factors. MetS was not associated with early retirement. Conclusions: Poor SRH did not fully capture the risk for unemployment and work disability associated with MetS. More awareness about MetS as a 'hidden' cardio-metabolic risk factor for premature employment exit is needed among workers, employers, and occupational health professionals. Regular health check-ups including MetS assessment and MetS prevention might help to prolong healthy working lives. [ABSTRACT FROM AUTHOR]

This is a study of decision problems under two-dimensional risk. We use an existing index of absolute correlation aversion to conveniently classify bivariate preferences, with respect to attitudes toward this risk. This classification seems to be more important than whether decision makers are correlation-averse or correlation-seeking for the study of insurance demand when a loss has a multidimensional impact. On this note, we also re-examine Mossin's theorem under bivariate preferences, where full insurance is preferred with a fair premium, while less than full coverage is preferred with a proportional premium loading. Furthermore, based on the comparative statics of this two-dimensional insurance model for changes in correlation aversion, we derive testable implications about the classification of bivariate utility functions. For the particular case when the two-dimensional risk can be interpreted as risk on income and health, we identify the form of separable utility functions depending on health status and income that is consistent with household disability insurance decisions. [ABSTRACT FROM AUTHOR]

The article provides an overview of the Australian insurance industry's efforts to address customer disputes and enhance their products and services. The Australian Financial Complaints Authority (AFCA) has observed a 24% decrease in life insurance complaints in the 2022-23 period, although challenges such as premium changes and claim delays persist. The industry has made substantial investments to adhere to the new Life Insurance Code of Practice, resulting in a reduction in complaints. However, general insurance complaints have increased by 50%, primarily due to claim delays. The article also emphasizes the difficulties faced by insurers in responding to natural disasters and the ongoing need for improvements in claims handling and customer service. The leading sources of complaints in the life insurance sector, according to the Australian Financial Complaints Authority, are income protection policies, funeral plans, term life policies, and total and permanent disability policies. The most common issue raised by complainants is misleading information about products or services. While insurers may be receptive to complaints, they are crucial for customers and can help ensure accountability within the industry. [Extracted from the article]

The rollout of the National Disability Insurance Scheme (NDIS) has transformed the Australian funding landscape for individuals with disability and their families. This study examined whether the profiles of autistic children and their families accessing an early intervention (EI) setting have changed following its introduction. The cognition and behavioural profiles of children funded under the NDIS (n = 58) were compared to children who had received block government funding (n = 58). Parental mental health and quality of life (QoL) outcomes were compared. Children presented with similar baseline cognition, functional abilities and autism behaviours at intake into EI irrespective of funding type. While parental QoL was similar across groups, parents funded by the NDIS reported significantly higher stress and depression levels. The current findings suggest that modifications to the NDIS framework may be necessary to extend benefits beyond the individual living with disability to foster the health and wellbeing of their primary carers. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate occupational health (OH) primary-care patients' use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). Methods: Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014–2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. Results: Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. Conclusions: OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits – either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support. [ABSTRACT FROM AUTHOR]

We study the costs associated with domestic violence (DV) in Norway by comparing outcomes before and after a DV report, using those who will be victimized in the future as controls. A DV report is associated with increased mental health diagnoses for both victims and their children and reduced financial resources. Victims experience marital dissolution, more doctor visits, lower employment, reduced earnings, and higher use of disability insurance. Their children are more likely to receive child protective services and commit a crime. Using a complementary regression discontinuity (RD) design, we find declines in children's test scores and grade completion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. OBJECTIVE: Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. METHODS: Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher's Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. RESULTS: Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. CONCLUSION: About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable. [ABSTRACT FROM AUTHOR]