10 states where workers went to hell

The Census Bureau has put a sobering message for the health care and long-term care (LTC) planning communities in its latest batch of Current Population Survey (CPS) results: U.S. adults look shaky.

The percentage of U.S. adults ages 16 to 65 who said they had a severe disability increased to 6 percent in the 2014 data released in September 2015, up from 5.5 percent in the data released in 2010.

In theory, the increase in the percentage of working-age adults who identified themselves as being disabled could be the result of the aging of the baby boomers, but, in reality, the indicators also moved in the wrong direction for people in just about every other age group. For adults ages 25 to 35, for example, the percentage who reported having a severe work disability increased to 5 percent, from 4.5 percent.

For purposes of the CPS, the Census Bureau defines an adult as having a severe disability if the adult uses a wheelchair, cane, crutches or walker; needs help to perform activities such as seeing, speaking or grasping small objects; is unable to perform at least one activity of daily living (ADL), such as getting out of bed, without help; is unable to perform at least one instrumental activity of daily instrumental living (IADL), such as keeping track of bills, without help; or has a mental or emotional condition that seriously interferes with everyday activities.

Policymakers in the United States and other rich countries are wondering how they will provide medical care and a minimal level of income support for growing number of residents who have reached the normal retirement age, and long-term care (LTC) for residents who have reached their “oldest old” years.

If today’s working-age adults stay healthier longer than the working-age adults of the past did, that could help hold down future health care and LTC costs.

If today’s working-age adults are able to participate in the workforce at a high rate, that could also help, by increasing the amount of income the workers can use to pay taxes, and to support older loved ones with payments out of their own pockets.

Some sources of health data suggest show that U.S. residents really are staying healthier longer. The Census Bureau notes that the disability numbers in the CPS economic supplements come from participants’ answers to screening questions, not carefully validated disability measures. But, even if an increase in the CPS disability rate has more to do with perceptions, or with malingering, than with people’s actual ability to function, the increase could still be bad news: People who think they are more disabled than they really are, or who are pretending to be disabled, may develop ways of thinking and acting that lead to real limitations on the ability to function.

CPS disability rate increases at the state-level may reflect random statistical fluctuations, the rate of aging of the population, or the success of programs, such as special schools or work programs, that help people with potentially disabling conditions function. Making modest changes in parameters, such as the exact age group considered, leads to big changes in the disability rate rankings.

But state-level increases could also be early warning signs. In some states with big increases in CPS disability rates, the ability of working-age adults to function may really be going to hell.

We came up with an increase indicator by finding the difference between a state’s 2010 disability rate and the state’s 2015 disability rate in percentage points, then dividing that number by the 2010 disability rate to come up with the percentage increase in the disability rate.

We think looking at the percentage change in the disability rate, rather than just the 2015 disability rate, may help show where the disability rate is really getting worse, instead of simply singling out states in which longstanding health status problems or disability aid program rules have traditionally led to high disability rates.

In the United States as a whole, for example, the disability rate increased 0.5 percentage points between 2010 and 2015: to 6 percent, from 5.5 percent. The 2015 disability rate is 9.1 percent higher than the 2010 disability rate.

We found that the severe work disability rate improved in nine states and the District of Columbia. In the District of Columbia, the jurisdiction with the best performance, the severe work disability fell to 7.6 percent, from 9.6 percent. The disability rate fell 21 percent between 2010 and 2015.

For a list of the 10 states with the biggest increases in the severe work disability rate for adults ages 16 to 65 between 2010 and 2015, read on.