Brown poll says 1 in 5 people in R.I. disabled
The state's 20.2 percent disability rate is higher than the national average of 19.3 percent and the New England average of 18.3 percent.

12/28/2002

BY FELICE J. FREYER
Journal Medical Writer


One in five Rhode Islanders is considered disabled, the highest rate in New England and slightly more than the national average, according to a Brown University analysis of data from the 2000 U.S. Census.

And those with disabilities tend to cluster in certain communities, with Central Falls having the highest concentration and Narragansett the lowest.

Brown's Taubman Center for Public Policy examined recently released information from the Census Bureau, which asked people whether they had long-lasting physical, mental or emotional conditions that make it difficult to do such things as walk, climb stairs, dress, bathe, learn or remember.

"Rhode Island is poorer, has more immigrants and has one of the highest percentages of senior citizens of any state in the country," said Darrell M. West, Taubman Center director. "All the types of people who are likely to have disabilities, we have in large numbers, even compared to the rest of New England."

The data, West said, have broad implications for public policy because the people who consider themselves disabled -- an estimated 196,000 -- are more likely to need public assistance and publicly financed health care.

Among people who have disabilities and are of working age (21 to 64), only 6 out of 10 were employed, the lowest rate in New England. Forty-four percent listed more than one disability.

Indeed, people with disabilities consume a third of the state Medicaid budget, and officials at the state Department of Human Services are already struggling to find ways to contain costs while better meeting their needs.

Rhode Island ranks 16th in the nation in the percentage of civilians age 5 or older who consider themselves disabled but are not living in an institution, the Brown study found. The census uses a broad definition of disability that encompasses limitations ranging from deafness to dyslexia, and it relies on individuals' own assessment of their condition. West said that these self-reports are considered accurate.

The state's 20.2 percent disability rate is higher than the national average of 19.3 percent and the New England average of 18.3 percent.

The rates for the other New England states are: Maine, 20 percent; Massachusetts, 18.5 percent; Connecticut, 17.5 percent; Vermont, 17.1 percent; and New Hampshire, 16.9 percent.

The state with the highest rate of disabled people is West Virginia (24.4 percent). Alaska and Utah tied for the lowest rate, 14.9 percent.

Rhode Islanders with disabilities are more likely to be poor: 17.3 percent had incomes below the poverty level in 1999, compared with 10 percent of the nondisabled population.

West said the relationship between poverty and disability "cuts in both directions." Disability can promote poverty by making it harder to earn a living. According to the census data, 41.6 percent of Rhode Island's disabled people are unemployed.

At the same time, West said, "If you are poor you lack access to medical treatment. That can aggravate a disability or prevent you from getting the help that you might need to overcome the disability."

Jane Hayward, director of the state Department of Human Services, said that some of the high rate of disability may stem from failures of the health-care system, rather than lack of access. People who have disabilities and are on Medicaid, the state health-care program for the poor, use a lot of health-care services, but not always in the best way, she said.

"I really wonder about our service-delivery system for those folks," Hayward said. "You have to wonder if their care was coordinated whether they wouldn't be getting better outcomes in terms of functional ability."

For example, she said, proper management of certain heart or respiratory problems could prevent disability altogether. Instead, Medicaid recipients with disabilities in the 19-to-64 age group require hospitalization an average of nine times a year.

Additionally, Hayward noted, many of the people who are classified as disabled suffer from behavioral disorders such as addiction or mental illness -- and some of them could become fully functional with more or better treatment.

Hayward speculated on other possible factors. She said that Rhode Island has a high rate of children classified as having "special needs." The state also has a rapidly growing population of people older than 85, who are naturally more likely to have disabilities.

Rhode Island has high rates of heart disease and cancer, which can cause disability, she noted. And, Hayward added, "We have one of the highest consumption rates of alcohol per capita in the country" -- a habit that contributes to illness and injury.

The census looked at six categories of disability: sensory (such as blindness or deafness), physical (such as difficulty walking or lifting), mental (learning, remembering or concentrating), self-care (dressing, bathing or getting around the home), going outside the home (for people 16 or older), and employment.

Employment and physical disabilities are the two largest groups: More than 84,000 had an employment disability and more than 75,000 had a physical disability. There is probably considerable overlap between these two groups, the study said.

In Rhode Island, every minority group except for Asians had a higher rate of disability than the statewide average. One-quarter of blacks and Hispanics considered themselves disabled, compared with one-fifth of whites. West attributed this disparity to economic factors.

Demographics determined the disparities among cities and towns, West said. Central Falls, with 30 percent, had the highest rate of people with disabilities, followed by Block Island (27.7 percent), Woonsocket (26.3 percent) and Pawtucket (25.9 percent). In contrast, Narragansett has only 12.7 percent disabled.

Barrington (13.8 percent), Richmond (13.4 percent) and West Greenwich (13.1 percent) also had low disability rates.

"Central Falls has a lot of senior citizens and immigrants. They have a lot of poor people," West said. "Those are all categories of people more likely to report various kinds of disability."

Central Falls also had the highest percent of people over 65 with disabilities: 56.8 percent. The Brown report called that number "striking" when you consider that it does not include anyone in a nursing home.

(As for Block Island, West said the high rate is probably a statistical fluke resulting from the island's small population.)

The study found high rates of disability within each age group. Among those age 5 to 20, 9.3 percent were listed as disabled -- the third highest in the nation.

Among working-age people, those 21 to 64, a startling 19 percent reported at least one disability. More than 40 percent of those 65 and older said they were disabled.

Similar information about disability was not collected in 1990, so the census data does not reveal whether the disabled population has grown or changed.

Hayward, the human resources director, cautioned against making "a big deal" about the census numbers. She noted that Rhode Island's disability rate is less than 1 percentage point above the national average, and that the New England states are all within 3 percentage points of each other.

"It looks a little on the alarming side," she said. "But we're kind of right in the ballpark."

But Hayward also said that the number of Rhode Islanders considered too impaired to work (a smaller group than those counted in the census data) had increased by about 3 percent a year since 1990 and that the state now has 29,400 people with disabilities on Medicaid.

The Rhode Island Public Expenditure Council, a private watchdog group, has estimated that Medicaid costs for adults who are under 65 and who have disabilities will amount to $477.2 million in the current fiscal year.

The full report, including breakdowns for each city and town as well as regional and national comparisons, can be found online at www.brown.edu/Departments/TaubmanCenter.
--------------------------------------------------------------------------------
Online at: http://www.projo.com/news/content/pr...led.956aa.html