Volume II, Edition IV January 2014
Central oklahoma Vital Signs Barriers to Independent Living
centra
l oklah om
a
ital Signs
This issue of Vital Signs focuses on the barriers to independent living faced by disabled individuals and or older adults in our community. Independent living refers to the ability of disabled individuals and older adults to take advantage of opportunities and to have comparable choices, control, and freedom as other citizens at home, at work, and as members of the community at large.1 Independent living does not imply that disabled or older adults be able to do everything themselves, but rather that any practical assistance they need should be available based on their own choices and aspirations. The desires of disabled or older Oklahomans should not be stifled by a lack of access to necessities which enable them to carry out their daily activities. Societal barriers which prevent disabled or older Oklahomans from living as independently as they choose and are able should be evaluated and minimized. In Oklahoma, the older adult population is predicted to increase 5.3 percent annually between now and 20302, as the older adult population increases the disabled population increases. This issue of Vital Signs focuses on the barriers particular to Central Oklahoma’s older adult and disabled population. These barriers plague many disabled individuals and older adults throughout Oklahoma and the nation. We welcome your questions and comments. Please email us at feedback@unitedwayokc.org or call 405-236-8441. Best Regards,
Robert Clements, Chair, Research and Community Initiatives Committee United Way of Central Oklahoma
1 2
J. Morris, Barriers to Independent Living: A Scoping Paper Prepared for the Disability Rights Commission, pg. 4. Oklahoma Department of Commerce, 2012 Demographics of the State of the State Report, p. 11.
1
UNITED STATES
Older Adults
Total U.S. Population (2010)
Independent Living
308,745,538
years of age
The ‘independent living movement’ challenges the social attitudes and
13%
physical barriers that stigmatize and exclude older adults and individuals with disabilities.
3,4
Disabled Citizens
A primary goal of independent living is to achieve
the capacity to live in one’s home and community in accordance with personal wishes and desires.5
of the total U.S. population
(40,267,984 people)
(56.7 million people)
OKLAHOMA Total State Population (2010)
13.5%
In discussing independent living, the barriers identified in this report should be viewed as issues related to the social conditions of individuals
of the total Oklahoma population
with disabilities, older adults, and society as a whole. There are a 6
number of barriers to independent living. Some exist at a societal level report is to identify the societal barriers disabled individuals and older
In Oklahoma, the older adult population is projected to reach 807,989 by 2030.7 An increase from 13.5 percent of the state’s population in 2010 to 18.8 percent of the state’s projected population in 2030.8
adults face in Central Oklahoma. The first barrier, lack of accessible and affordable transportation, is a theme that connects nearly all barriers to living independently. Housing
20%
Oklahoma County
encompasses the rising cost of housing and care, the role of a caregiver,
Canadian County
(576,551 people) 212,137 (36.8%) are age 65 or older
2030
13.5% 10%
2010
200,000
Older Adults Population by County
explored in the following pages. The housing and caregiver barrier
of the total Oklahoma population
18.8%
0%
and care for older and disabled Oklahomans is the second barrier
15.7%
3,751,351
(506,714 people)
and some within the legislative framework, but the main focus of this
19%
of the total U.S. population
Logan County
and the abuse, neglect, and exploitation faced by older and disabled
150,000
162,000
100,000
114,000
individuals
individuals
50,000 0
In Oklahoma, the number of adults with activities of daily living (ADL)9 difficulty is projected to increase from 114,000 individuals in 2010 to as many as 162,000 by 2030.10
Noninstitutionalized Disabled Population^ by County
Oklahomans. The third barrier in this report relates to economic matters. The economic barrier highlights poverty, employment, and government
of county’s
12% population
benefit programs, on which many disabled and older Oklahomans rely.
county’s of county’s 10.9% of population 12.6% population
(U.S. Census Bureau, Census Interactive Population Search: Oklahoma.)
^Estimate includes older Oklahomans ^^2010 American Community Survey 1 yr. estimate ^^^2010 American Community Survey 3 yr. estimate
Oklahoma County
Canadian County
Logan County
county’s of county’s of county’s 13.7% of population^^ 11.3% population ^^ 13.5% population ^^^
(U.S. Census Bureau, American FactFinder.)
Disability Resource Center of Fairfield County, Inc., What is Independent Living?. Throughout this report, Older Adult(s)/Older Oklahoman(s) is defined as age 65+. Disabled is defined as an individual having a hearing difficulty, vision difficulty, cognitive difficulty, ambulatory difficulty, self-care difficulty, and/or independent living difficulty (those who encounter challenges performing instrumental activities of daily living and self-care). 5 National Council on Disability, Living Independently and In the Community, pg. 4. 6 United Nations Human Rights, Monitoring the Convention on the Rights of Persons with Disabilities, pg. 7-8. 3 4
2
Oklahoma Department of Commerce, 2012 Demographics of the State of the State Report, p. 11. Activities of daily living (ADL) is a term used in healthcare to refer to daily self-care activities within a individual’s place of residence, outdoor environment, or both. 10 Center for Personal Assistance Services, Projections for the Population Needing Personal Assistance, 2015-2030, Oklahoma. 7-8 9
3
Transportation
“It is hereby declared to be the national policy that elderly and handicapped person Transporation Made Accessible have the same right to utilize mass transportation facilities and services; that special efforts shall be made in the planning and design of mass transportation facilities and services so that the availability to elderly and handicapped persons of mass transportation which they can effectively utilize will be assured.” Absent affordable, accessible, and reliable transportation options, disabled and older Oklahomans face isolation, a reduced quality of life, and economic hardship. Transportation allows individuals to reach medical services, go shopping, and socialize, which enables a level of independence otherwise not possible. Absent affordable and accessible transportation, older adults and disabled persons may feel isolated and dependent upon those around them.
The Need for Affordable Transportation In the United States “private dollars for transportation outnumber public dollars 5 to 1.”11 For older adults, 9 out of 10 trips are taken by private automobile, which must be purchased, insured, fueled and maintained with private resources.12 Nationally, older adults only take two percent of trips using public transportation.13 Below is an illustration of transportation costs in relation to older adults’ household budgets nationwide:
With Earned Income
Without Earned Income
(solely reliant on govt. benefit programs) 14.7%
22.1% 5.3%
Accessible transportation for disabled individuals and older adults is not limited to physical access to vehicles and transportation systems. Accessibility must be accounted for at every stage of a pedestrian’s journey. A wheelchair accessible bus holds little value if a disabled person cannot reach the bus stop. Beginning at a person’s door step and ending at his or her destination, the transportation chain must be reliable, accessible, and affordable.
33.6% 4.9%
Ben, a gentleman confined to a wheelchair who relies on the Oklahoma City metro transportation system documented his daily commutes for a Photo Voice research project at University of Central Oklahoma. His photos reveal the difficulty persons with disabilities encounter when using public transportation in the metro area.
36.4% 2.4%
2.9%
14.1%
14%
“Bench takes up half of [the] sidewalk [making it] hard [for me in my wheelchair] to maneuver around.” -Ben
11.6%
12.6%
14.5%
11%
(Source: Social Security Administration, Expenditures of the Aged Chart book, 2010, pg.11.)
Housing
Food
Out-of-Pocket Health Care
Transportation
Apparel
Entertainment
?
Other
The average cost of owning an automobile would consume 78% of an older adult’s income who lives at or below the poverty line ($10,800 for a single older adult).14
“No sidewalk [availability means that I have] to go to another stop and use the street to get there. [I] may get stuck or tip on grass; people create [their] own path [which is] unsafe [and] looks bad.” -Ben
These photographs are a part of a PhotoVoice research project carried out by students and faculty at the University of Central Oklahoma (UCO). Brie Brumfield, Community/Public Health student, was the Principal Investigator on the project. Brumfield worked under the direction of J. Sunshine Cowan, Ph.D., MPH, MCHES, and Sara L. Cole, Ph.D., MCHES, faculty in the Community/Public Health program at UCO. Haleigh Larkin, an Outdoor and Community Recreation major who is minoring in Community/Public Health also assisted with the project. Larkin begins a new project this academic year using PhotoVoice to better understand homelessness in the metropolitan area. Contact Dr. Sunshine Cowan for more information, jcowan1@uco.edu.
The average cost of owning an automobile would consume 51% of a low income older adult’s income ($15,697 for a single older adult).15
-Urban Mass Transportation Act of 1970
(Source: Transportation for America, Aging In Place, Stuck Without Options, pg.8.)
iTN America, Creating Incentives for Removing Barriers to Sustainable Senior Transportation. Poverty level defined by the Census Bureau. 15 Poverty level defined by AARP.
11-13 14
4
5
Transportation and Aging In Place
Solutions In Practice: Lovena’s Story
The typical American Adult makes 1,200 car trips per year. Therefore, as baby boomers cease driving they will need accessible and affordable transportation options.17 Only a small percentage of Americans move once they reach retirement meaning most will “age in place.” The problem is older adults “age in place” in the suburbs, and require automobiles for daily activities.18 16
58%
1 Oklahoma City’s Suburban Transit Access is the 84th worst out of the countries top 100 metropolitan cities.
Where do older Americans live?
23%
Rural
(Source: Berube, A, Missed Opportunity: Transit and Jobs in Metropolitan America, pg. 42.)
21%
Central City
Suburban
(Source: Transportation for America, Aging In Place, Stuck Without Options, pg. 8.)
100
Isolation Living away from mass transit in the suburbs can lead to social isolation, geographical isolation or both. Isolation among older adults is often defined by living arrangements. Living alone is used as a measure of isolation.19 It implies a lack of immediate support from a spouse or family member. While living alone is essential to the definition of isolation, additional factors are included in order to identify barriers that increase isolation and prevent older adults from accessing alternative sources of support.20
94,165 older Oklahomans
live in isolation.
(Source: National Center for Benefits Outreach and Enrollment, Crossing New Frontiers: Benefits Access Among Isolated Seniors.)
Lack of personal transportation results in:
15% fewer trips to the doctor 59% fewer trips to eat out 65% fewer trips to visit friends & family (Source: Transportation for America, Aging In Place, Stuck Without Options, pg. 3-4.)
Lovena L. is 90 years old, legally blind, and lives on a fixed income. She is among hundreds of seniors who use RSVP Provide-A-Ride to get to frequent medical appointments. Lovena said, “[RSVP Provide-A-Ride] is very vital to me, and hundreds of other senior citizens, to have this wonderful service. I look forward to the volunteer drivers coming because they are such wonderful people! When we go to the doctor, the drivers don’t just drop you off and promise to come back at a certain time…they stay with us and even help with the mountains of paperwork if we need the help. They stop by the pharmacy to get prescriptions and then see us safely back inside our homes. Our generation never wanted to ask for help, and I never feel less of a person when I call RSVP. God bless this wonderful program and the people that make it happen!” RSVP Mission Statement: The Retired & Senior Volunteer Program of Central Oklahoma links volunteers age 55 and older with essential community needs throughout central Oklahoma.
Transportation for America, Aging In Place, Stuck Without Options, pg. 11. Transportation for America, Aging In Place, Stuck Without Options, pg. 3. 19-20 National Center for Benefits Outreach and Enrollment, Crossing New Frontiers: Benefits Access Among Isolated Seniors, pg.1. 16-17 18
6
7
Housing, Facilities, & Caregivers Older and disabled Oklahomans face housing and care-related barriers that impact their ability to live independently. Many older adults and disabled individuals live on low or fixed incomes, which increase the financial burden of housing and care costs. Additionally, individuals in these populations are reliant upon caregivers. Reliance on caregivers can sometimes place older adults and the disabled individuals in a vulnerable position.
Housing for the Disabled In Oklahoma, 30 percent of households have at least one resident with a disability, excluding those with an independent living difficulty.22
Oklahoma Households With at Least One Resident with a Disability, 2011 (Source: AARP Public Policy Institute, Oklahoma State Housing Profile 2011, pg. 2.)
Housing, Facilities and Care Options
11.3% 7.1%
Number of Licensed Facilities Currently Operating in Central Oklahoma*
6 3 5 1
14 38 5 42 5
2 3 4
Logan County
% of 65+ only households
20.6% 13.9% 11.9% 10.7% 11.4% 6.5%
households age 18+ Any disability
Assisted Living Centers
Vision difficulty
Intermediate Care Facilities for Individuals w/ Intellectual Disability
Oklahoma County
48.1% 30.1%
Adult Day Centers Hearing difficulty
Physical difficulty
Cognitive difficulty
Self-care Independent difficulty Living difficulty
Owners
(excluding independent living difficulty)
Renters
Nationwide, more than 856,000 disabled individuals were living in homeless shelters, group homes, and other congregate facilities in 2009.
Long-term Care Facilities Canadian County
23.7% 10.6%
36% 18.9%
50.6% 30%
62% 29.8%
Residential Care Homes
(Source: Technical Assistance Collaborative, Priced Out 2012, pg. 4.)
*Numbers of facilities currently open as of October 8th, 2013 (Source: Oklahoma State Department of Health, Long Term Care Inspection Surveys.)
Oklahomans with Intellectual & Developmental Disabilities (IDD) Housing Snapshot
long-term care facilities. (Source: AARP, Across the States Profiles of Long-Term Care Services and Supports: Oklahoma, pg. 7.)
Personal & home care aides
7,870
15
Home health aides
8,810
17
aides aides
(Source: AARP, Across the States Profiles of Long-Term Services and Supports: Oklahoma, pg. 7.)
21
8
McGill, As Senior Population Grows, Aging in Place Gains Popularity: Communities Conducting Outreach.
^
2,429
ICFs - MR** Long-term Care Facilities Family Homes while Receiving Services
e Estimate *On June 30, 2011 ^2010 data **Intermediate Care Facilities for Individuals with Mental Retardation (Source: National Residential Information Systems, Residential Services for Persons with Intellectual or Developmental Disabilities: Status and Trends through 2011, pg. 39, 49, 134.)
22
7%
State
Per 1,000 People Age 65+
State Residential Settings
Persons 6,248 Total on Waiting List
2.
Home Care Based Services in Oklahoma, 2010
Non-State Residential Settings
ro M wth at R ch eq N uir ee e ds d t o
Oklahomans reside in
2,838 245 1,535 361
e
Oklahomans with IDD on a Waiting List for Residential Services, June 30, 2011
G
19,878
Where Oklahomans with IDD Live, 2011*
20
A housing option gaining popularity among older adults is the concept of aging in one’s own home, known as “aging in place.” In fact, 90 percent of older adults surveyed by AARP voiced their desire to age in their own homes.21
Residential 3,083 Total Service Recipients (Source: National Residential Information Systems, Residential Services for Persons with Intellectual or Developmental Disabilities: Status and Trends through 2011, pg. 44.)
AARP, Oklahoma State Housing Profile 2011, pg. 2.
9
The Cost of Housing
The Cost Burden of “Aging in Place”
The Cost of Long-Term Care The cost of long-term care can vary based on a host of factors, such as the type of care, the duration of care, the provider of care, the type of facility and where the individual lives.23 The cost of long-term care in Oklahoma and Oklahoma City is estimated to increase considerably by the year 2022.24
One of the most prevalent housing problems that older adults face is cost burden. Cost burden is defined as spending more than 30 percent of a household’s income on housing and utilities.25 Cost burden is an increasing housing problem for older adults, illustrated in the table below.
Prevalence of Housing Cost Burden between 1985 and 2009 Older Owner/Renter Households
2012 & 2022 Median Annual Cost of Long-Term Care in Oklahoma & Oklahoma City
Older Member Households
All other U.S. Households (without person(s) 65+)
$70,000
= 1985
$60,000
= 2009
$50,000 $40,000
= Cost in Oklahoma
$30,000
31%
= Cost in Oklahoma City
$20,000
40%
18%
39%
24%
36%
(Source: Federal Interagency Forum on Aging-Related Statistics, Older Americans 2012: Key Indicators of Well-Being, pg. 21.)
$10,000 2012
2022
Home Care Home Health Aide
2012
2022
Home Care Homemaker Services
2012
2022
Adult Day Health Care
2012
2022
Assisted Living Private One Room
2012
2022
Nursing Home Semi-Private Room
2012
2022
Housing Cost Burden for Older Oklahomans 2011
Nursing Home Private Room
(Source: U.S. Department of Health and Human Services, Cost of Care in Your State.)
30%+ of income goes toward housing Owners with mortgage
Owners free and clear
Renters
Owners with mortgage
Owners free and clear
Renters
36.5%
11.6%
55.2%
15.3%
4.1%
26.7%
2012 & 2022 Median Daily Cost of Long-Term Care in Oklahoma & Oklahoma City
(Source: AARP, Oklahoma State Housing Profile 2011, pg. 4.)
$200 $175
The Cost Burden of “Aging in Place”
$150
Disabled Oklahomans who rely heavily on Supplemental Security Income (Supp.) struggle to find affordable and functional housing.
$125 $100
= Cost in Oklahoma
$75
= Cost in Oklahoma City
$50 $25
2012
2022
2012
2022
Home Care Homemaker Services
2012
2022
Adult Day Health Care
2012
2022
Assisted Living Private One Room
(Source: U.S. Department of Health and Human Services, Cost of Care in Your State.)
10
2012 Supp. Monthly Payment and Percentage of Supp. Payment used for Housing Statistical Area
Home Care Home Health Aide
23-24
50%+ of income goes toward housing
U.S. Department of Health and Human Services, Cost of Care in Your State.
2012
2022
Nursing Home Semi-Private Room
2012
2022
Nursing Home Private Room
Oklahoma City Oklahoma
Supp. Monthly Payment
Supp. as % of Median Income
% Supp. for a one bedroom apartment
% Supp. for efficiency apartment
$739 $739
20.6% 22.7%
79% 71%
68% 62%
(Source: Technical Assistance Collaborative, Priced Out Findings, pg. 31.)
25
Federal Interagency Forum on Aging Related Statistics, Older Americans 2012: Key Indicators of Well-being, pg. 21.
11
Care Givers
In 2009, caregiver services
Who are Caregivers?
There are two types
were valued at
$450 billion per year,
an increase from
of caregivers for older adults and/or disabled:
$375 billion in 2007.
caregivers (paid
Of older adults with
informal caregivers (unpaid) and formal
service providers). (Source: Family Caregiver Alliance, Fact Sheet: Selected Caregiver Statistics.)
There are 370,000 informal caregivers in the state of Oklahoma providing
400 million hours of care each year.
(Source: Family Caregiver Alliance, Fact Sheet: Selected Caregiver Statistics.)
disabilities who received
long-term services and support in their home 66% get all of their care from family caregivers; 26% get their care from a combination of family and paid caregivers; and
9% receive their care from paid caregivers alone.
(Source: Family Caregiver Alliance, State of the States in Family Caregiver Support, State Profile: Oklahoma.)
(Source: AARP, Valuing the Invaluable: 2011 Update – The Growing Contributions and Cost of Family Caregiving, pg. 8.)
850,000 people
Older adults provide an
with IDD* live with caregivers age 60+.
*Intellectual Developmental Disability
(Source: Technical Assistance Collaborative, Priced Out in 2012, pg. 4.)
65.7 million, or 29%, of the U.S. adult population
cares for someone who is ill, disabled, or aged. (Source: Family Caregiver Alliance, Fact Sheet: Selected Caregiver Statistics.)
Solutions In Practice: Emma’s Story
average of 31 hours
per week of care while middle aged adults
provide an average of
19 hours per week. (Source: Family Caregiver Alliance, Fact Sheet: Selected Caregiver Statistics.)
33% of older adults help their care recipient
bathe and shower, while only 22% of middle aged adults help
with those activities.
From left to right: Coral Randel, Carol Rosa, Emma Monks
Emma Monks, 91, has always lived an independent life. As one of many older adults living independently in her home, Emma spends her days at Daily Living Centers where she enjoys activities and interaction with others. “It is important to stay active in order to maintain my health and stay young,” said Emma. The Daily Living Centers provide daytime social/health services to adults who need supervised care outside the home. Clients such as Emma receive cognitive and physical stimulation. The simulation enhances well-being while it delays and or prevents mental and physical deterioration which necessitates institutional setting placement. “The key is fostering self-determination and dignity through personal choice and a continuity of lifelong roles,” said Bill Weaver, Executive Director. “When coupled with support, the senior years can offer a sustained enjoyment of life.”
(Source: Family Caregiver Alliance, Fact Sheet: Selected Caregiver Statistics.)
Daily Living Centers Mission Statement: To sustain maximum independence; restore lost functioning where possible; increase or maintain present functioning levels; prevent or delay deterioration; encourage involvement in social activities regardless of disabilities; for individuals over the age of 18 who are mobile (including wheelchair, walker or other appliances) and who can benefit from the family group settings and therapeutic programming. 12
13
Long-Term Care Facility: Abuse and Neglect 8,845 vulnerable adults in the state of Oklahoma experienced abuse, neglect, exploitation, or self-neglect in 2012. (Source: Oklahoma Department of Human Services, 2012 Annual Report, pg. 11.)
More than 40 percent of all older adults will reside in long-term care facilities at some point in the course of their lives.31 Residents in long-term care facilities are at higher risk of experiencing abuse or neglect. According to the National Ombudsmen Reporting Systems Data in 2010, seven percent of all complaints made to long-term care Ombudsmen were related to abuse, neglect, and/or exploitation.32
Abuse and Neglect
In a study conducted by Ben Nathan and Lowenstien in 2010, it was found that within a year prior to the study, over 50% of nursing facility staff admitted to engaging in physical violence, mental abuse, and/or neglect of their older patients. Two thirds of those incidents reported by nursing facility staff in the study were incidents of neglect.
Older adults and the disabled are more vulnerable to abuse and neglect, defined as intentional actions that cause harm, or increase the risk of harm, to a vulnerable individual by someone, such as a caregiver or individual that is in close relations with the vulnerable individual, whether or not harm is the intended consequence of their actions.26 These actions can include failure to satisfy the vulnerable individual’s basic needs or to protect the vulnerable individual from any harm.27
(Source: Administration on Aging, National Center on Elder Abuse, Research Brief: Abuse of Residents of Long Term Care Facilities.)
Approximately 90%
of abusers are family members (Source: Administration on Aging, National Center on Elder Abuse, Data/Statistics.)
According to a recent report released by Families for Better Care, Oklahoma received a grade of F and ranked 48th out of 51 including all 50 states and the District of Columbia for long-term facility care.33
Abuse and neglect results in health and financial costs: Older adults who are abused
have a 300% higher
risk of dying while in care than older adults who are not abused. (Source: Administration on Aging, National Center on Elder Abuse, Data/Statistics.)
The direct medical cost of abuse of older adults was
estimated at $5.3 billion
of the nation’s annual
health expenditures. (Source: Administration on Aging, National Center on Elder Abuse, Data/Statistics.)
Oklahoma Long-Term Care Facility Report Card
The financial loss to
exploited older adults
Oklahoma
$2.9 billion in 2009. (Source: Administration on Aging, National Center on Elder Abuse, Data/ Statistics.)
CRITERIA
was estimated at
% Facilities With Deficiencies
91.6%
C
25
% Facilities With Severe Deficiencies
29.22%
F
43
Direct Care Staffing Above Average
37.33%
F
46
2.49
C
26
33.66%
D
36
0.47
F
51
RN Staffing Above Average
12.0%
F
47
Verified Ombudsman Complaints
66.17%
B
13
RN Hours
(Source: Families for Better Care, State Report Cards: Oklahoma.)
Administration on Aging, National Center on Elder Abuse, Research Brief: Abuse of Residents of Long Term Care Facilities. Families for Better Care, State Report Cards: Oklahoma.
31-32 33
14
RANK
Health Inspections Above Average
Professionals working with older adults and the disabled often lack proper training to detect and recognize abuse.29 Older adults and the disabled are often reluctant to report abuse out of fear, a lack of physical and/or cognitive ability to report the abuse, or they do not want to get their abuser, who is most often a family member, in trouble.30 Administration on Aging, National Center on Elder Abuse, Data/Statistics.
GRADE
Direct Care Staffing Hours
Adult Protective Services (APS) are accessible in all 50 states to provide social services to older and disabled adults who have experienced or are experiencing abuse, neglect, and/or exploitation. In addition to APS, a majority of states have mandatory reporting laws for abuse and neglect of vulnerable adults. Despite the accessibility of APS and mandatory reporting laws, a vast majority of abuse, neglect, and exploitation cases go undetected and unreported each year.28
26-30
RAW DATA
15
Abuse and Neglect of the Disabled
Solutions In Practice: Mr. John Cook
The disabled are also at risk of being abused and neglected by their caregivers. Abuse and neglect negatively impacts their health, safety, and emotional wellbeing, and in turn their ability to engage in activities of daily living, daily self-care activities.34
In a comprehensive review of literature published from 2000 to 2010, disabled individuals experienced disproportionate and higher rates of interpersonal violence (IPV) than non-disabled individuals over their lifetime. Adult disabled women had a 26 percent to 90 percent lifetime prevalence of IPV while adult disabled men had a 28.7 percent to 86.7 percent lifetime prevalence of IPV.
John Cook came to Sunbeam’s Emergency Shelter for Seniors after he escaped from his abusive daughter’s home. When John arrived at Sunbeam’s shelter he had experienced an illustrious life thus far.
(Source: Administration on Aging, National Center on Elder Abuse, Data/Statistics.)
John had traveled the country in a post office truck, while fighting lung cancer and serving as an honorary prison chaplain. Additionally, John served as a missionary in Las Vegas where he helped the homeless population by providing meals, assisting with clean up, and in general spreading hope. ‘Soup, Soap and Hope’ was John’s motto.
In a National sample of 305 adult disabled women, 68 percent reported they had experienced abuse during the previous year. Of the 68 percent reporting abuse, 30 percent had experienced sexual abuse in the previous year.
= experienced abuse during the previous year
John’s daughter brought him to Oklahoma to visit his grandson. Upon arrival, she locked him in a room and she proceeded to physically abuse him, and financially exploit him. John told Sunbeam, “My daughter would give me one egg sandwich at 4:30 PM. If I was good I might get ham on my sandwich.” One day, John saw his opportunity to escape and he ran from his daughter’s home barefoot. He explained his situation to authorities and was brought to Sunbeam’s Emergency Shelter for Seniors to begin rebuilding his life. John described Sunbeam’s Emergency Shelter for Seniors as follows, “They make you feel like you are somebody at the Shelter. It is great medicine. You feel like it is a home, not a shelter. The compassion, understanding and the attention you get is a great thing. I will be praising it for the rest of my life.”
Sunbeam’s Emergency Shelter for Seniors: The Emergency Senior Shelter, operated by Sunbeam Family Services, in partnership with DHS, Adult Protective Services, is a safe ten-bed facility working to re-establish those whom have been removed from their homes due to abuse and or neglect with the goal of safe independent living within thirty days. Sunbeam Family Services Mission Statement: Our mission is to provide people of all ages with help, hope, and the opportunity to succeed.
= experienced sexual abuse during the previous year
33% Older Owner/Renter Households
Older Member Households
All other U.S. Households
Older Owner/Renter Households
Older Member Households
All other U.S. Households
21%
(without person(s) 65+)
(without person(s) 65+)
= 1985 ==Institutionalized disabled adult women 2009 ==Institutionalized non-disabled adult women 1985
31%
40%
31%
40%
18%
39%
24%
36%
18%
39%
24%
36%
(Source: Administration on Aging, National Center on Elder Abuse, Research Brief: Abuse of Adults with a Disability.)
34
16
33 percent of institutionalized disabled adult women have experienced IPV while only 21 percent of institutionalized non-disabled adult women have experienced IPV.
= 2009 (Source: Administration on Aging, National Center on Elder Abuse, Research Brief: Abuse of Adults with a Disability.)
Administration on Aging, National Center on Elder Abuse, Data/Statistics.
17
Economic
Employment Employment opportunities are important for disabled individuals to more fully integrate into society. Persons with cognitive disabilities have shown improvement in the ability to live independently when employed in terms of both self-advocacy and self-determination.39 Self-advocacy focuses on the ability to stand up for one’s self, and self-determination is defined as the ability to both define and achieve goals for one’s self.40
Over 23 million older Americans are economically insecure35 and 28 percent of disabled individuals between the ages of 18 and 64 live in poverty.36 Each day individuals in these populations struggle with rising housing and health care costs, lack of access to transportation, diminished savings, and unemployment. Disabled individuals often struggle to find employment and are reliant on government benefit programs as their sole source of income. The same is true for older adults. The result is chronic economic instability for many older and disabled Oklahomans.
National Employment Rates, 2012 Age 16+^
Oklahoma Employment Rates, 2012 Age 16+^^
Poverty Poverty Among Disabled Oklahomans
(Source: Oklahoma Department of Rehabilitative Services, Putting it into Perspective: The Prevalence of Disability in Oklahoma.)
Older Oklahomans Poverty Levels, 2009-2011 Below 100% of poverty threshold
7%
Below 200% of poverty threshold
34%
(Source: Damico, et al., A State-by-State Snapshot of Poverty Among Seniors.)
If Social Security benefits did not exist,
nearly 50% of older Americans would live below the federal poverty level. ($10,800 per year for a single older adult) (Source: NCOA- Economic Security for Seniors.)
69.4%69.4% 17.8%17.8% 7.9% 7.9% 13.4%13.4% = Adults with a Disability
Supplemental Poverty Measure
^Unemployment data as of 2012, Annual Average (Source: Bureau of Labor Statistics, Persons with a Disability: Labor Force Characteristics 2012.)
In 2011 the Census Bureau released an alternative poverty measure known as the supplemental poverty measure.37 The supplemental poverty measure defines poverty and income differently than the official poverty measure, by using more recent patterns of expenditures on basic necessities. Adjustments are made to reflect home ownerships status and regional differences in housing prices.38
Not in labor force Employed
of people without disabilities age 16 and over have incomes below 150% of poverty
Not in labor force Employed
of Oklahomans with disabilities age 16 and over have incomes below 150% of poverty
Unemployed Employed
of persons without disabilities age 16 and over incomes fall below the federal poverty level
37.8% 25.9%
Unemployed Employed
22.8% 15.4%
of persons with disabilities age 16 and over incomes fall below the federal poverty level ($11,945 for a single person)
66.2%66.2% 24.3%24.3%
29.3%29.3% 72.3%72.3% = Adults without a Disability ^^2012 American Community Survey 1 yr. estimate (Center for Disease Control and Prevention, Oklahoma Demographic Overview.)
“Transportation is one of the most significant barriers to employment people with disabilities in Oklahoma face. Often employment opportunities for people with disabilities remain open, even with motivated people who are ready to work, because they are unable to overcome the huge barrier of reliable, affordable transportation.” -Deborah Copeland, HR/PR Administrator, Dale Rogers Training Center
(Source: Levinson, et al., A State-by State Snapshot of Poverty Among Seniors: Findings from Analysis of the Supplemental Poverty Measure.)
National Council on Aging, Economic Security for Seniors. DeNavas-Walt, et al., Income, Poverty, and Health Insurance Coverage in the United States: 2010, pg. 16. 37-38 Levinson, et al., A State-by State Snapshot of Poverty Among Seniors: Findings from Analysis of the Supplemental Poverty Measure. 35
39-40
Kutty, Sharma, Shobra, Employment Leads to Independent Living and Self-Advocacy, pg. 3-4.
36
19
Solutions In Practice: Julie’s Story
Benefits Government health and social service programs provide a necessary lifeline for older and disabled Oklahomans. The information provided below reveals the types of benefits received by older and disabled Oklahomans and the amount of money that flows into Oklahoma jurisdictions by way of benefit programs. Absent benefit programs the poverty rate among disabled and older Oklahomans would increase. Additionally, they would lack essential services that allow them to live independently.
Oklahoma Benefit Programs, 201141 Number of beneficiaries in Oklahoma
Percentage of residents receiving the benefit
Average Annual Benefit
Total Annual Benefit
Social Security
705,364
18.8%
$12,611
$8.9 billion
Medicare
585,617
15.9%
$10,105
$5.9 billion
Medicaid
799,855
21.7%
$4,923
$3.9 billion
Social Security Disability Insurance
144,566
3.8%
$815.80
$1.7 million
Program
A huge smile grows on Julie’s face and her eyes light up when asked about her new job at Dale Rogers Training Center’s Papa Murphy’s store. Julie said, “making the dough is my absolute favorite. It’s like science. I love science and you have to get the dough done just right.” The community job is a large transition from the DRTC in-house programs she has been a part of for six years. When Julie was asked why she wanted to work at Papa Murphy’s she said “to better myself, to feel like I’ve accomplished something. It’s my first real job out in the community.”
(Source: Alliance for Retired Americans, Social Security, Medicare and Medicaid Work for Oklahoma, pg.1; Social Security Administration, Annual Statistical Report on the SSDI Program, 2011, pg.47-52.)
Julie has grown confident in her work at Papa Murphy’s and learned a few lessons. Julie does the prep work in the mornings preparing the vegetables and the dough. Growing accustomed to prep charts and the fast pace of a retail establishment has taken Julie some time, but she is improving and constantly learning. Part of having a community job is transportation.
Disabilities are the most common barrier to benefits access, 6.3 million isolated42 individuals report having a disability.
Julie rides the bus to work and loves it. Her first day of work she got off at the wrong stop, but Julie was not worried, rather she thought, “I can handle this.” Julie said the “sense of freedom [she] gets riding the bus is well worth it.”
(Source: National Center for Benefits Outreach and Enrollment, Crossing New Frontiers: Benefits Access Among Isolated Seniors, pg.2-3)
With the money Julie is earning she plans to pay off her medical expenses and purchase her very own laptop and internet service. “DRTC trains you before you jump in on the big day,” said Julie. “I’m reaching my goal. I want to eventually own my own business, owning a bakery is a long term goal.” Dale Rogers Training Center Mission Statement: DRTC supports people with disabilities through paid vocational training, in-house programs and work opportunities as well as competitive community employment. 20
Please note this is not an exhaustive view of all government benefit and entitlement programs in Oklahoma, but an overview of a few larger programs. 42 Isolation among older adults is often defined by living arrangements. Living alone is used as a measure of isolation, and implies a lack of immediate support from a spouse or family member. 41
21
Medicare
Social Security and Social Security Disability Insurance
Medicare is a social insurance program that guarantees access to health insurance for Americans age 65 or older, younger persons with disabilities, and people with end stage renal disease.43
Social Security and Social Security Disability Insurance are the largest of several federal programs that provide assistance to people with disabilities.47 While the two programs are different in many ways, both are administered by the Social Security Administration, and only individuals who have a disability and meet medical criteria may qualify for benefits under the programs.48
Medicare in Oklahoma, 2009
81.4%
of Medicare beneficiaries were age 65 plus
18.6%
of Medicare beneficiaries were disabled
Medicare provided for:
24.6%
of all state healthcare spending
Oklahoma Medicare Recipients by County
109,205
(% Receiving Medicare in 2012)
Logan
Oklahoma Monthly SSDI Benefits, December 2011
Oklahomans
11.0%
Medicare and Medicaid.
Canadian
15.3%
11.5%
Cleveland
are enrollees of
(Source: Oklahoma Health Care Authority, SoonerCare Fast Facts)
(Source: Alliance for Retired Americans, Social Security, Medicare and Medicaid Work for Oklahoma, pg. 10)
(Source: Alliance for Retired Americans, Social Security, Medicare and Medicaid Work for Oklahoma, pg. 16)
Medicaid is a safety net health care payor for low-income Oklahomans who would otherwise remain uninsured.44 A person must be both low-income and eligible to qualify: such as, children, seniors, disabled adults, pregnant women, and very low-income parents with dependent children.45
disabled and older Oklahomans rely on SoonerCare.
Year
Total
Workers
Widowers
Adult Children
2011
$144,506
$133,281
$3,209
$8,209
(Source: Social Security Administration, Annual Statistical Report on the SSDI program, pg. 47)
Applying for SSDI in Oklahoma At the initial application stage, 28.6 percent of Oklahoma applicants are approved for benefits, compared with the national average of 32.1 percent.49 At the reconsideration stage, 9.6 percent of those appealing in Oklahoma are approved for benefits, while 11.3 percent are approved nationally at the appeals stage.50
Social Security
SoonerCare/Medicaid
187,000
Social Security Disability Insurance (SSDI)
70,100 older adults
&
116,600
disabled persons
(Source: Families USA, Cutting Medicaid in Oklahoma, pg.2.)
Oklahoma SSI Beneficiaries, 2010 4.3% Retired Workers 8.7% Disabled Workers
8.8% 17.0%
Widowers
61.1%
Few people have insurance that covers longterm care, the range of services and supports needed to meet personal care needs. The cost of long-term care can be financially devastating. In Oklahoma, nursing home costs average $51,500 a year.46
County
(Source: Oklahoma Health Care Authority Annual Report 2012)
End stage renal disease occurs when the kidneys stop working well enough for you to live without dialysis or a transplant. This kind of kidney failure is permanent. It cannot be fixed. (American Kidney Fund) 44-45 Richey, Medicaid 101: The SoonerCare Safety Net, pg. 1. 46 Families USA, Cutting Medicaid in Oklahoma, pg. 1.
SSI makes up 60% of low-income baby boomers’ income and 32% of high-income baby boomers’ income. (Source: Transportation for America, Aging In Place, Stuck Without Options, pg. 8)
Oklahoma SSI Beneficiaries and Benefits by County, 2010
Logan Canadian Oklahoma
43
The median social security benefit for low-income adults aged 62 plus is $6,400 per year.
Spouses
(Source: Alliance for Retired Americans, Social Security, Medicare and Medicaid Work for Oklahoma, pg. 15-16)
70% of nursing home residents have their care paid for through a Medicaid program.
(Source: AARP, Social Security: 2008 Oklahoma Quick Facts)
(Source: Transportation for America, Aging In Place, Stuck Without Options, pg. 8)
Children
SoonerCare, Long-Term Care
Almost 1/3 of older Oklahomans rely on Social Security as their only source of income.
% of population receiving benefits
Annual Total Benefits per County
17.1% 14.7% 16.2%
$91,516,000 $227,100,000 $1,506,646,000
Total Beneficiaries
Retired Workers
Disabled Workers
7,355 4,735 1,165 17,655 11,770 2,520 118,920 74,900 20,940
Widow(er)s
Spouses
Children
550 1,315 9,245
255 605 3,820
625 1,405 9,745
(Source: Alliance for Retired Americans, Social Security, Medicare and Medicaid Work for Oklahoma, pg. 15-16)
47-48 49-50
Social Security Administration, Benefits for People with Disabilities. Netter, Filing for Social Security Disability in Oklahoma.
23
Breaking Barriers CentralOK!gO The Central Oklahoma Commuter Corridors Study 51: The study will analyze transit options for three major commuter corridors: a 14-mile corridor between downtown Oklahoma City and Edmond; a 10-mile corridor between downtown Oklahoma City, Midwest City, and Tinker Air Force Base; and a 17-mile corridor between downtown Oklahoma City and Norman.
CentralOK!go Goals: 1. Enhance connections between regional activity centers and increase equitable access to transit to the entire community, 2. Maximize regional participation, 3. Promote economic development, and 4. Provide a balanced and coordinated transportation system that offers many choices.
Moore Council on Aging A transportation bus owned and operated by the Moore Council on Aging provides rides for older adults from their addressed in the Moore City limits to the Brand Senior Center.52 The service also provides older adults in the Moore city limits with transportation to banks, stores, the library, doctor’s offices, and other places within the city.
Senior Companion Program53 The Senior Companion Program pairs individuals age 55 and over with seniors and other individuals who have difficulty with daily living tasks. Through assistance and friendship Senior Companions help others live independently in their own homes rather than having to move to institutional care facilities.
2013 Legislation54 SB 272, by Sen. Kimberley David, R-18 and Rep. Doug Cox, R-5 defines “dual-eligible” as low-income seniors and younger persons with disabilities enrolled in Medicare and Medicaid. OK Health Care Authority must conduct a feasibility study of care coordination models that could be implemented and explore cost containment and delivery alternatives for the dually-eligible. SB 549, by Sen. Greg Treat, R-47 and Rep. Randy Grau, R-81, adds language to include exploitation of the elderly to the definition of racketeering. SB 587, by Rep. Wright, R- 57, Sen. Justice, R-23, provides for voluntary authorized electronic monitoring of a nursing facility resident’s room and prohibits a nursing facility from refusing to admit an individual or remove a resident because of the electronic monitoring.
http://centralokgo.org/ http://www.cityofmoore.com/locations/brand-senior-center. 53 http://www.ok.gov/health/County_Health_Departments/Rogers_County_Health_Department/Senior_Companion_Volunteer_Program/index.html 54 The legislative bills reported were passed in the 2013 Oklahoma legislative regular session and approved by the Governor. Information regarding the bills was collected from the Journal Record legislative report, http://jrlr.net/. 51 52
24
We would like to recognize all of the United Way of Central Oklahoma Partner Agencies who operate independent living programs. The work of each agency in the community is truly admirable and we could not be more proud to be a part of their efforts. Areawide Aging Agency, Inc. Arthritis Foundation, Oklahoma Chapter Coffee Creek Riding Center Daily Living Centers, Inc. Dale Rogers Training Center, Inc. D-DENT, Inc. EARC, Inc. Goodwill Industries of Central Oklahoma John W. Keys Speech and Hearing Center Latino Community Development Agency Legal Aid Services of Oklahoma, Inc. Metropolitan Better Living Center Neighborhood Services Organization NorthCare Oklahoma Foundation for the Disabled, Inc. RSVP of Central Oklahoma, Inc. Special Care, Inc. Sunbeam Family Services, Inc. The Homeless Alliance The Salvation Army Central Oklahoma Area Command YMCA of Greater Oklahoma City Catholic Charities Archdiocese of Oklahoma City
Bibliography AARP (2012). Across the states: Profiles of long term services and supports Oklahoma. Retrieved from http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ltc/2012/across-the-states-2012-oklahoma-AARP-ppi-ltc.pdf.
Research and Community Initiatives Committee Robert Clements, Chair Jane Abraham Susan Agel Nancy Anthony Cordell Brown Jim Buchanan Mike Coats Mary Jane Coffman Deborah Copeland Mark Davies Michael Davis Drew Dugan Eric Eissenstat Marti Ferretti
Neil Hann Carole Hardeman Jenny Hatton Marsha Ingersoll Christi Jernigan George Johnson Mike Joseph Craig Knutson Allison Loeffler Mary Anne McCaffree Tim O’Connor Elaine Purvis Patrick Raglow Doug Reed
Doug Rex Robert Reynolds Dave Schroeder Tracy Senat Steve Shepelwich Kent Shortridge Lonetta Smith Perry Sneed Chuck Spicer Bill Tabbernee Robert Toler Chad Wilkerson
AARP. (2008). Social Security: 2008 Oklahoma quick facts. Retrieved from http://assets.aarp.org/rgcenter/econ/ss_facts08_ok.pdf. AARP (2011). State housing profiles 2011: Oklahoma. Retrieved from http://assests.aarp.org/rgcenter/ppi/liv-com/AARP-HouProf_2011-OKs.pdf. AARP (2011). Valuing the invaluable: 2011 update – the growing contributions and costs of family care giving. Retrieved from http://assets.aarp.org/rgcenter/ppi/ltc/i51-caregiving.pdf. Administration on Aging. (2011, December 5). Comparison of age and sex of the U.S. population in the 2000 and 2010 censuses. Retrieved from http://www.aoa.gov/Aging_Statistics/Census_Population/ census2010/Index.aspx. Administration on Aging, National Center on Elder Abuse (n.d.). Data/statistics. Retrieved from http://ncea.aoa.gov/Library/Data/index.aspx. Administration on Aging, National Center on Elder Abuse (2013). Research brief: Abuse of residents of long term care facilities. Retrieved from http://www.ncea.aoa.gov/Resources /Publication/docs/NCEA_LTCF_ Research Brief_2013.pdf. Administration on Aging, National Center on Elder Abuse (2013). Research brief: Abuse of adults with a disability. Retrieved from http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_AwDisabilities_ ResearchBrief_2013.pdf. Alliance for Retired Americans. (2013). Social Security, medicare and medicaid work for Oklahoma. Retrieved from the Oklahoma Policy Institute Website: http://www.strengthensocialsecurity.org/sites/default/files/Oklahoma2012final.pdf. Berube, A., Kneebone, E., Puentes, R., Tomer, A. (2011). Missed opportunity: Transit and jobs in metropolitan America. Retrieved from the Brookings Institute Website: http://www.brookings.edu/~/media/research/files/reports/2011/5/12%20jobs%20a n%20transit/0512_jobs_transit.pdf. Bureau of Labor Statistics. (2012). Persons with a disability: Labor force characteristics 2012. Retrieved from http://www.bls.gov/news.release/disabl.htm. Cawthorne, A. (2008). Elderly poverty: The challenge before us. Retrieved from the Center for American Progress Website: http://www.americanprogress.org/issues/poverty/report/2008/07/30/4690/elderly-poverty-the-challenge-before-us/. Centers for Disease Control and Prevention, Disability and Health Data System. (2013). Oklahoma demographic overview. Retrieved, from http://dhds.cdc.gov/profiles/profile?profileId=8&geoTypeId=1&geoIds=40. Center for Personal Assistance Services. (n.d.). Projections for the population needing personal assistance, 2015-2030, Oklahoma. Retrieved from http://www.pascenter.org/state_based_stats/disability_stats/adl_projections.php?state=oklahoma. Cubanski, J., Damico, A., Levinson, Z., and Neuman, P. (2013). A state-by-state snapshot of poverty among seniors: findings from analysis of the supplemental poverty measure. Retrieved from http://kff.org/report-section/supplemental-poverty-measure-appendices/.
Volunteer Reviewers Ray Bitsche, CEO, Sunbeam Family Services, Inc. Christi Jernigan, Director, Oklahoma County Social Services Michael Joseph, Esq., Director, McAfee & Taft Lance Robertson, Director, DHS Aging Services
Degood, K., Goldber, D., Donohue, N., Shoup, L. (2011). Aging in place stuck, without options: Fixing the mobility crisis threatening the baby boom generation. Retrieved, from the Transportation for America Website: http://t4america.org/docs/SeniorsMobilityCrisis.pdf. DeNavas-Walt, C., Procots, B., Smith, J. (2011). Income, poverty, health insurance coverage in the United States: 2010. Retrieved from the US Census Bureau Website http://www.census.gov/prod/2011pubs/ p60-239.pdf. Department of Health and Human Services. Administration on Aging. (2012). Policy academy state profile, Oklahoma. Retrieved from the Administration on Aging Website:http://www.aoa.gov/AoARoot/AoA_ Programs/HPW/Behavioral/docs2/Oklahoma.pdf. Disability Resource Center of Fairfield County, Inc. (n.d.). What is independent living?. Retrieved from http://drcfc.org/whatisIL.htm. Family Caregiver Alliance (2012). Fact sheet: Selected caregiver statistics. Retrieved from http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439. Family Caregiver Alliance (2007). State of the states in family caregiver support state profile: Oklahoma. Retrieved from http://www.caregiver.org/caregiver/jsp/content/pdfs/state_profile_ok.pdf.
Staff Debby Hampton, President & CEO Randy Macon, Vice President Research, Initiative and Community Investment Laura Trent, Director of Research Susan Worden, Americorps member Kristen Griffing, Graphic Designer Karla Bradshaw, Senior Director of Marketing and Communications
Families for Better Care (2013). State report cards: Oklahoma. Retrieved from http://nursinghomereportcards.com/state/ok/. Families USA. (2011). Cutting medicaid in Oklahoma: harming seniors and people with disabilities who need long-term care. Retrieved from http://familiesusa2.org/assets/pdfs/long-term-care/cutting-medicaid/Oklahoma.pdf. Federal Interagency Forum on Aging-Related Statistics (2012). Older Americans 2012: Key indicators of well-being. Retrieved from http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2012_Documents/ Docs/EntireChartBook.pdf. Frieden, L. (2005). Living independently and in the community: implementation lessons from the United States. Retrieved, from the National Council on Disability Website: http://www.ncd.gov/publications/2005/08022005-Liv2. iTN America ( 2013). Creating incentives for removing barriers to sustainable senior transportation. Retrieved from http://publicpolicy.itnamerica.org. Kennan, T. (2010). Home and community preferences of the 45+ population. Retrieved from the AARP Website: http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf. Kutty, A.T., Sharma, R.N., Shobra, S. (2006). Employment leads to independent living and self-advocacy: a comparative study of employed and un- employed persons with cognitive disabilities, Asia Pacific Disability Rehabilitation Journal, 17, 50-52. http://www.aifo.it/english/disability/apdrj/apdrj0106/employ-cognitive.pdf. Larson, S.A., Salmi, P., Smith, D., Anderson, L. and Hewitt, A.S. (2013). Residential services for persons with intellectual or developmental disabilities: Status and trends through 2011. Retrieved from National Residential Information Systems Project Website: http://rtc3.umn.edu/risp/docs/risp2011.pdf.
McGill, N. (2013). As senior population grows, aging in place gains popularity: Communities conducting outreach. The Nation’s Health, 43 (8), 1-16. Retrieved from Nation’s Health Website: http://thenationshealth.aphapublications.org/. Morris, J. (2003). Barriers to independent living: A scoping paper prepared for the Disability Rights Commission. Retrieved from http://disability-studies.leeds.ac.uk/files/library/morris-independent-living-scoping-paper-final-edit.pdf.pdf. National Center for Benefits Outreach and Enrollment. (2011). Crossing new frontiers: Benefits access among isolated seniors. Retrieved from the National Council on Aging Website: http://www.ncoa.org/assets/files/pdf/center-for-benefits/crossing-new-frontiers.pdf. National Council on Aging. (2012, October). Economic security for seniors. Retrieved from http://www.ncoa.org/press-room/fact-sheets/economic-security-for.html. Netter, L. (n.d.). Filing for social security disability in Oklahoma. Retrieved from the Disability Secrets Website: http://www.disabilitysecrets.com/disability-resources-oklahoma.html. Oklahoma Department of Commerce. (2012). 2012 demographics of the state of the state report. Retrieved from http://www.okcommerce.gov/Libraries/Documents/Population-Projections-Report-_3648.pdf. Oklahoma Department of Human Services (2012). 2012 annual report. Retrieved from http://www.okdhs.org/NR/rdonlyres/7948D808-CDA3-45BC-8867-F5B6735ABBEE/0/S12047_2012AnnualReport_oprs_10302012.pdf. Oklahoma Department of Rehabilitative Services. (2011). Putting it into perspective the prevalence of disability in Oklahoma. Retrieved from http://www.okrehab.org/info/OK_statistics.htm. Oklahoma Health Care Authority. (2012). Oklahoma Health Care Authority annual report 2012. Retrieved from https://www.okhca.org/research.aspx?id=84. Oklahoma Health Care Authority. (2013). SooonerCare fast facts. Retrieved from http://okhca.org/research.aspx?id=87&parts=7447. Oklahoma State Department of Health (2013). Long term care inspection surveys. Retrieved from http://www.ok.gov/health/pub/wrapper/PHS-search.html. Richey, K. (2012, January). Medicaid 101: The SoonerCare safety net. Retrieved from the Oklahoma Policy Institute Website: http://okpolicy.org/medicaid-101-the-soonercare-safety-net. Rehabilitation Research and Training Center. (2011). Disability statistics & demographics. Retrieved from http://www.researchondisability.org/docs/default-document-library/annualcompendium2011.pdf. Social Security Administration. (n.d.). Benefits for people with disabilities. Retrieved from http://www.socialsecurity.gov/disability/. Social Security Administration. (2012). Disability insurance trust fund, 1975-2012. Retrieved from http://www.ssa.gov/oact/STATS/table4a2.html. Social Security Administration, Office of Retirement and Disability Policy, Office of Research, Evaluation and Statistics. (2012). Annual statistical report on the social security disability insurance program, 2011. Retrieved from http://www.ssa.gov/policy/docs/statcomps/di_asr/2011/di_asr11.pdf. Social Security Administration, Office of retirement and Disability Policy, Office of Research, Evaluation, and Statistics. (2013, March). Expenditures of the aged chartbook, 2010. Retrieved from http://www.ssa.gov/policy/docs/chartbooks/expenditures_aged/2010/exp- aged-2010.pdf. Technical Assistance Collaborative (2012). Priced out 2012. Retrieved from http://www.tacinc.org/media/33353/Introduction%20and%20Key%20Findings.pdf. Technical Assistance Collaborative (2012). Priced out findings by state. Retrieved from http://www.tacinc.org/knowledge-resources/priced-out-findings/. Trotter, M. (2013). Oklahoman faces “silver tsunami” of poor, disabled seniors. Retrieved from the Public Radio Tulsa Web Site: http://publicradiotulsa.org/post/oklahoma-faces-silver-tsunami-poor-disabled-seniors. United Nations Human Rights, Office of the High Commissioner for Human Rights. (2010). Monitoring the convention on the rights of persons with disabilities. Retrieved from http://www.ohchr.org/Documents/Publications/Disabilities_training_17EN.pdf. Ultimate Social Security Dissability Guide. (2010). Percentage of disability cases that win at application and reconsideration. Retrieved from http://www.ultimatedisabilityguide.com/ssdi_ssi _denial_rates.html. U.S. Department of Health and Human Services (2013). Cost of Care. Retrieved from http://longtermcare.gov/costs-how-to-pay/costs-of-care/. U.S. Department of Health and Human Services (2013). [Graph illustration to view cost details, to compare costs across locations and to estimate project long-term care costs]. Cost of care in your state. Retrieved from http://longtermcare.gov/costs-how-to-pay/costs-of-care-in-your-state/. U.S. Census Bureau. (2010). American Community Survey (ACS). Retrieved from http://www.census.gov/people/disability/methodology/acs.html. U.S. Census Bureau (n.d.). American FactFinder. Retrieved from http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. U.S. Census Bureau. (2012). American Community Survey (ACS). Retrieved from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_1YR_S1811&prodType=table. U.S. Census Bureau. (2012). Nearly 1 in 5 people have a disability in the U.S., Census Bureau reports. Retrieved from http://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html. U.S. Census Bureau. (2010). 2010 Census interactive population search: Oklahoma. Retrieved from http://www.census.gov/2010census/popmap/ipmtext.php?fl=40. U.S. Census Bureau. (2013, June27). State & county quick facts: USA. Retrieved from http://quickfacts.census.gov/qfd/states/00000.html.
United Way of Central Oklahoma Mission Statement To improve the health, safety, education and economic well-being of individual families in need in central Oklahoma by connecting community resources with responsive and accountable health and human services agencies.
Vital Signs is a publication of United Way of Central Oklahoma. We welcome your questions and comments. Please email us at feedback@unitedwayokc.org or call 405.236.8441. United Way of Central Oklahoma 1444 NW 28th Street Oklahoma City, Oklahoma 73106 www.unitedwayokc.org 405-236-8441
A Member of