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Diabetes and Vocational Rehabilitation Employment Services and Outcomes

Research to Practice 38

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Originally published: 6/2005

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The Vocational Rehabilitation (VR) system provides employment supports to a range of people with various disabilities. This brief report is part of a series examining select populations that fall under the rubric of the National Institute on Disability Rehabilitation and Research's concept of "emerging disability." Certain populations are exhibiting high or changing rates of disability, including people in poverty, single mothers receiving welfare, underserved communities of recent immigrants, and specific cultural and racial groups. Particular chronic health conditions are rising rapidly and differentially among cultural and racial groups. Diabetes is one of those conditions, with about 1.3 million people newly diagnosed each year (American Diabetes Association, 2005).

According to the American Diabetes Association, approximately 18 million people in the U.S. have diabetes (see www.diabetes.org/diabetes-statistics/national-diabetes-fact-sheet.jsp). The prevalence is higher among African-Americans, Latinos, and American Indians and Alaskan Natives, and among subpopulations, particularly Mexicans, Puerto Ricans, and American Indians in the southeastern United States (American Diabetes Association, 2005). Having diabetes in and of itself does not necessarily qualify any given individual for disability services. However, for some individuals, diabetes can be serious enough or can lead to secondary conditions that would qualify a person for VR services. The leading complications of diabetes are heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease, and amputations (ADA, 2005). The American Diabetes Association reports that the cost of diabetes is approximately $132 billion per year, with about $40 billion of that amount related to disability, work loss, and premature death.

This report uses the Rehabilitation Services Administration case closure data to provide a picture of people with diabetes using the VR system. It compares individuals with diabetes mellitus listed as the cause of primary impairment closed in year 2003 to those without diabetes listed as the cause of primary impairment.

Demographics: Who Are People with Diabetes Using the VR System?

About 2% of people using VR services have diabetes as the cause of their primary impairment. Demographic differences between people with diabetes and those without are provided in Table 1. People with diabetes tend to be about nine years older on average and have higher rates of college attendance than the general population of VR consumers. About one-quarter of both groups are African-American, but the percentage is slightly higher for people with diabetes. Although the majority in both groups are men, a higher percentage of people with diabetes are women.

Table 1: Demographics

General population (N=607,738)People with diabetes (N=10,023)
Race (%)
Non-Hispanic Black22.525.7
Non-Hispanic White65.559.7
Hispanic9.511.8
Native American1.21.6
Asian/Pacific Islander1.31.2
Gender (%)
% Female45.348.4
Age
Mean age36.045.5
Education (%)
Less than high school31.929.5
HS diploma or equivalency48.345.1
Some college13.918.1
College degree or more5.97.4

Primary Impairments

The top five most frequently occurring primary impairments are shown in Table 2. The most frequent impairments in the general population are cognitive, psychosocial, and mental impairments. For people with diabetes, the impairments listed the most often are physical or sensory in nature. The top five impairments are known to be secondary conditions related to diabetes. Cognitive and psychosocial impairments did not register in the top five for people with diabetes.

Table 2: Top Five Primary Impairments Listed

Rank order General population (N=607,738) People with diabetes (N=10,023)
Primary impairment % Primary impairment %
1Cognitive impairments23.0Other physical impairments49.9
2Psychosocial impairments20.6Blindness or other visual impairments23.8
3Other mental impairments11.6General physical disability18.7
4Other orthopedic impairments6.7Orthopedic/neurological impairments3.2
5Orthopedic/neurological impairments6.4Mobility and manipulation impairments1.6

Economic Indicators

People with diabetes are less likely to receive Supplemental Security Income (SSI), either at application or at closure, and more likely to receive Social Security Disability Insurance (SSDI). People with diabetes are also more likely to receive Medicare than the general group but receive Medicaid somewhat less frequently. Very few people in either group receive either general assistance (GA) or welfare (TANF) benefits.

Table 3: Economic Indicators at Application and Closure (2003)

General population (N=607,738)People with diabetes (N=10,023)
Social Security (%)
SSI at application16.611.2
SSI at closure16.310.9
SSDI at application12.515.0
SSDI at closure13.417.0
Insurance (%)
Medicare at application8.612.6
Medicare at closure9.313.7
Medicaid at application23.519.7
Medicaid at closure22.519.5
Other public assistance
TANF at application3.94.2
TANF at closure2.63.0
GA at application4.34.4
GA at closure2.63.3
College degree or more5.97.4

VR Services Received

The cost of services is about equal between the two groups. However, patterns of use differ by specific types of services funded. People with diabetes receive the following services more frequently than the non-diabetic population: diagnosis and treatment, disability-related training, and rehabilitation technology. People with diabetes receive vocational training, on-the-job training, job readiness training, job search service, and on-the-job supports less frequently than the non-diabetic population.

Table 4: Services Received (2003)

General population (N=607,738)People with diabetes (N=10,023)
Cost of purchased services
Mean (standard deviation)$2,160 ($5,552)$2,220 ($5,232)
Services provided (%)
Assessment59.959.2
Rehabilitation counseling and guidance47.049.6
Diagnosis and treatment29.037.3
Transportation18.017.0
Other services15.115.9
Job placement services17.615.4
Job search services17.014.0
Information and referral10.212.1
College/university8.69.9
Disability-related training2.49.6
Miscellaneous training7.49.1
Maintenance9.19.0
Rehabilitation technology4.78.7
Occupational/vocational training8.77.4
On-the-job supports9.65.0
Job readiness training7.14.6
On-the-job training2.61.5

VR Closure Type

Type of closure rates are about identical across the two groups. About one-sixth are closed prior to eligibility determination, and another quarter closed prior to the development of an Individual Plan for Employment. About 40% of all individuals who approach the VR system reach an employment outcome.

Table 5: Distribution of Closure Type (2003)

Type of closure(%)General population (N=607,738)People with diabetes (N=10,023)
Employment outcome35.139.5
Services initiated, no employment outcome25.124.2
After eligibility determination, before Individual Plan for Employment22.820.8
Before eligibility determination13.912.9
Other3.42.6

Employment Outcomes: Type of Employment, Mean Weekly Wages, and Mean Weekly Hours

The most striking difference between people with diabetes and those without is in the rate of closure to homemaker or unpaid family worker status. About one-fifth of people with diabetes are closed into this status. Upon further analysis, those closed into homemaker or unpaid family worker status are blind or visually impaired (87%); are women (68%); have an average age of 57; and were not working at the time of application (95%).

People with diabetes are closed into integrated employment less often than people without diabetes (74% vs. 85%). Even so, people with diabetes closed into integrated employment earn more. Mean weekly wages are higher for people with diabetes (close to $20), although mean weekly hours are about the same. People with diabetes are much less frequently closed into supported employment than the general population of people receiving VR services (1.6% vs. 8.4% respectively).

Table 6: Employment Outcomes (2003)

Employment outcomes General population (N=213,616) People with diabetes (N=3,958)
% Mean weekly earnings ($) Mean weekly hours % Mean weekly earnings ($) Mean weekly hours
Integrated employment85.0332.83474.3355.734
Self-employment (except BEP)2.3301.8284.7228.626
Supported employment8.4170.8241.6236.827
Other employment outcomes.1N/AN/A.3N/AN/A
Homemaker and unpaid family worker4.1N/AN/A19.2N/AN/A

Summary

Some of the differences in outcomes and services may be related to the characteristics of the population of people with diabetes receiving VR services. People with diabetes on average tend to be older. More have a college education and a work history. These differences may explain both the higher weekly earnings for some and the greater frequency of homemaker status closures for others. In addition, the higher rates of closure into homemaker status, along with the use of disability-related training, may indicate that about one-fifth of people with diabetes use VR services for independent living goals rather than employment.

Points for further consideration:

References and Sources for More Information

American Diabetes Association. (2005). National Diabetes Fact Sheet. http://www.diabetes.org/diabetes-statistics/national-diabetes-fact-sheet.jsp

National Institute on Disability Rehabilitation and Research. (2005). Brochure on Mission, Goals, and Activities. http://www.ncddr.org/new/announcements/nidrr_brochure.html

Centers for Disease Control and Prevention. (2005). Racial and Ethnic Approaches to Community Health (REACH 2010). http://www.cdc.gov/reach2010

For further information on this publication, please contact the lead author (Mr. Woodring) at 617/287-4367 or jonathan.woodring@umb.edu.

This is a publication of the Emerging Disabilities, Employment Outcomes, and Systems Change Project (H133A021503) funded by the National Institute on Disability Rehabilitation and Research at the U.S. Department of Education.

Third author: Lauren Miller

ICI: promoting inclusion for people with disabilities