Although the Americans with Disabilities Act (ADA) has helped increase awareness of barriers faced by people with disabilities, and advances in science and engineering have led to better assistive technologies that make it easier for individuals to lead productive, independent lives, outdated regulations too often impede access to health care coverage and assistive devices for many who need them, says a new report by the Institute of Medicine.
The report calls on Congress and appropriate federal agencies to improve decision making about what and who Medicare and Medicaid will cover and to eliminate waiting periods for qualified individuals to receive Medicare coverage. The federal government should find ways to ease restrictions that prevent people from getting effective assistive services and technologies to help them live as independently as possible and participate in work and other activities outside the home.
"The number of Americans who have disabilities will grow significantly in the next 30 years as the baby boom generation enters late life. If one considers people who now are disabled, those likely to develop a future disability, and people who are or will be affected by the disabilities of family members or others close to them, it becomes clear that disability will eventually affect the lives of most Americans," said Alan M. Jette, director, Health and Disability Research Institute, Boston University School of Public Health, Boston, and chair of the committee that wrote the report. "Increasingly, scientific evidence reveals that disability results, in large part, from actions society and individuals take. The sobering reality, however, is that over the past two decades, far too little progress has been made in adopting major public policy and practice advances to reduce disability in America."
Currently, more than 40 million Americans , at least one in seven , have physical mobility, sensory, or other impairments or limitations. Since IOM's previous reports in 1991 and 1997 that highlighted disability as a pressing public health issue, there has been growing recognition that disability is not inherent in individuals, but rather is the result of interactions between people and their physical and social environments. Many aspects of the environment contribute to limitations associated with disability -- for example, inaccessible transportation systems and workplaces, restrictive health insurance policies, and telecommunications and computer technologies that do not consider people with vision, hearing, or other disabilities.
The ADA -- and other policies aimed at reducing barriers for people with disabilities -- has helped to increase recognition of environmental obstacles, but its implementation and enforcement have often been disappointing, the committee said. Ironically, even within health care facilities, people with disabilities encounter equipment and surroundings that are not designed to accommodate their needs -- for example, examination tables and weight scales that are difficult for people in wheelchairs to use. Information materials for people with vision or hearing loss are frequently limited, as well.
The committee said it was encouraging to find that in older adults, the chances of having certain kinds of activity-limiting disabilities have declined during the last two decades. However, data for younger and middle-aged adults suggest an increasing risk for disability and for conditions that contribute to disability , notably, physical inactivity, diabetes, and obesity. These trends raise concerns that the next generation of people entering late life may experience more disability than the current population of seniors.