A Profile of Disability Among Families on AFDC – Report
Profile Of Disability Among Families On AFDC
Prepared by Pamela Loprest and Gregory Acs of the Urban Intitute
Prepared for The Henry J. Kaiser Family Foundation
August 1996
- Executive Summary
- Introduction
- What is Disability?
- Disability Among Women Receiving AFDC
- Disability Among Children Receiving AFDC
- Disability Among Families Receiving AFDC
- Disability and Work
- Conclusions
- Data Appendix
The current contentious debate over how to restructure our social welfare system belies a remarkable consensus over a fundamental belief held by both political parties, endorsed by President Clinton, and echoed by most of the American public: all adults who can work, should work. But not all adult welfare recipients can work, either because they themselves are disabled or they have a disabled child who requires special care. While some disabled persons receive cash assistance under the Supplemental Security Income (SSI) program, a program specifically designed to provide benefits to the disabled, many persons with disabilities do not qualify for SSI benefits. Poor families with children not qualifying for SSI will, more than likely, qualify to receive Aid to Families with Dependent Children (AFDC), the largest cash assistance program in our social safety net.
Knowing the extent to which current recipients of AFDC can work is the first step for policy makers aiming to move women off of welfare and into work. Yet little is known about the profile of disability among women and children receiving AFDC. This study uses data from three national surveys to fill this important void.
In the debate around reforming AFDC, it is not clear what will happen to recipients with disabilities. Currently, states are conducting a variety of “experiments” with welfare programs, including time-limiting benefits anywhere from 2 to 5 years, increasing work requirements, and increasing sanctions for those who do not meet these requirements. Many of these reforms, including programs in Wisconsin, Utah, and Michigan, require some work or work-like activity from all recipients. For example, Wisconsin’s program allows for different types of activities, such as supervised work at a sheltered workshop, but all recipients must perform some work. It is not clear what wiill happen to those who canno work at all.
Many other recipients with disabilities need certain accommodations to be able to work or may have limited ability to work in the jobs available to them. The presence of children with disabilities in families on welfare, particularly single-parent families, can also inhibit work because of special child care needs. While the goal may be for all recipients to work, access to necessary resources, ranging from special equipment or training to mental health or substance abuse treatment to specialized child care, varies substantially across states and localities. And providing these resources often means increased program costs.
To examine the profile of disability among families receiving AFDC, we analyze data from the 1990 Survey of Income and Program Participation (SIPP), the National Health Interview Survey (NHIS), and the National Longitudinal Survey of Youth (NLSY). The major findings of our study are as follows:
- About 18 percent of women receiving AFDC have some disability that limits work.
- At least half of the women with a disability who receive AFDC have a serious disability. Serious disability includes women who have difficulty with basic day-to-day functions such as dressing, eating, or getting around inside the house.
- Almost 30 percent of families receiving AFDC include either a disabled mother or child. Two-thirds of these families (about 20 percent of all AFDC families) include either a disabled mother or a severely disabled child.
- These findings are remarkably consistent across the three data sets used. The narrow range of results across a variety of sources suggests these results are highly reliable.
In addition, since the data used do not fully capture limitations due to mental or emotional disorders or substance abuse, these findings probably understate the true level of disability among the AFDC population.
Thus, while work may be a reasonable goal for some or even most AFDC recipients, a significant part of the targeted population (at least 20 percent) have special needs or face specific obstacles because of disability. In fact, these barriers to work may have led families to apply for welfare in the first place.
This does not necessarily mean that all women with disabilities should be exempt from work requirements, although for some families this may be the best solution. As more employers comply with the Americans with Disabilities Act, for example, accommodations for disability may make work more accessible for AFDC recipients with disabilities. But policy makers also need to consider how to structure welfare reforms to give women with disabilities access to resources that can help overcome these barriers. In light of the relatively large number of AFDC recipients with disabilities, the potential negative effects of requiring work without access to these resources could be substantial.
The contentious debate over how to restructure our social welfare system belies a remarkable consensus over a fundamental belief held by both political parties and most of the American public: all adults who can work, should work. Most adults receiving cash assistance from the federal government receive support through the Aid to Families with Dependent Children Program (AFDC) and most of the adults on AFDC are single mothers. Thus, if the goal of welfare reform is to put adult welfare recipients to work, we must understand the extent to which single mothers receiving AFDC “can” work.
While most participants in the current debate have acknowledged that there are some people on welfare that will have more difficulty working than others, there is no general agreement on who these groups are or their size. In this report, we focus on recipients with disability as an important group that may experience difficulty in moving to work. We examine the extent to which women receiving AFDC have limited ability to work due to their own disabilities or disabilities of their children.
Knowing the profile of disability among families on welfare is particularly important for policy makers reforming welfare programs. Currently, states are conducting a variety of “experiments” with welfare programs, including time-limiting benefits anywhere from 12 months to 5 years, increasing work requirements, and increasing sanctions for those who do not meet these requirements. Women with disabilities may have limited ability to work in the jobs available to them or may need certain accomodations to be able to work. In addition, the presence of children with disabilities in families on welfare, particularly single-parent families, may also inhibit work because of special child care needs.
Although some previous studies have included a measure of disability in trying to understand AFDC families’ movements off the caseload and into work, they have not focused on this issue and only used limited measures of disability. This study provides a more complete profile of disability among women and children receiving AFDC, both the extent and the severity. Knowing the extent to which women on AFDC have disabilities will help us to understand the impact of these changes on their families. It will also help policy makers understand the potential importance of exemptions or accommodations in program requirements for these families.
To obtain the most complete picture possible, we use information from three data sets: the 1990 Survey of Income and Program Participation (SIPP), the 1990 National Health Interview Survey (NHIS), and 1992 data from the National Longitudinal Survey of Youth (NLSY). The SIPP and the NLSY are often used to study welfare issues and the NHIS is primarily used for studying health issues.
Each of these data sets has different strengths important for this study. The SIPP contains information on the ability to perform a long list of functions for adult women. The NLSY contains more extensive information on the limitations and conditions of children. The NHIS contains information on functioning, conditions, and health care utilization. All three contain information on AFDC receipt. Each data set does differ somewhat in the sample of AFDC recipients it reflects. The SIPP data include all women who received AFDC at any time over a 32 month period. The NLSY sample includes all women ages 27 to 34 who received AFDC over the course of a year. The NHIS includes all women receiving AFDC in one month.
The next section of this report discusses briefly what is meant by disability and defines some of the terms we will use. We then profile disability among women receiving AFDC and then disability among children receiving AFDC. We also examine the extent to which families have either an adult or child with a disability. We then briefly discuss the relationship between the profile of disability and work behavior and conclude with a discussion of the implications of our findings for policy.
In discussing health and disability, a number of different concepts are used, including the terms impairment, condition, functional limitation, and disability. Condition is a general term that includes any specific illness, injury, or impairment. Chronic conditions or impairments refer to long-term or permanent illnesses or defects resulting in the loss or abnormality of mental or physical functioning of a body system. Examples of impairments include the absence of a limb or body part or blindness. Examples of chronic conditions include diabetes, heart conditions, or arthritis. Functional limitations exist when a person is limited in their ability to perform certain activities or tasks. Examples include walking, dressing, bathing, or lifting objects. A given functional limitation can be caused by a variety of conditions or impairments, and the same condition or impairment may or may not result in a given functional limitation, depending on severity and other factors. For example, diabetes or highblood pressure if treated may not result in any functional limitation.
The concept most important for this study is disability. Disability results from chronic conditions, impairments, or limitations resulting in the inability to perform expected social roles. This definition focuses on the outcome of the interaction between impairments, conditions, and functional limitations and the social context. For example, a limitation in the ability to lift objects of a certain weight is only a disability if that individual is expected to do that task for work or as a regular activity. Therefore, disability can vary across time and across situations. Because our expected social roles change with age, how we measure disability also varies with age. Limitations relevant for understanding disability in a three-year old differ from those relevant for adults. In addition, the same impairments and functional limitations do not always lead to disabilities. For example, an inability to perform a certain function such as walking may cease to be disabling if accommodations are made to the environment, such as wheelchair access to buildings.
Measuring the interaction of mental and physical limitations and the social context is difficult. It depends on the expectations for the group being studied. Whether a woman receiving AFDC “can” work depends on the woman, her family situation, opportunities, and the interpretations and assumptions of those assessing whether or not she is disabled: herself, policy makers, researchers, or program administrators. Conceptually, measuring chronic conditions, impairments, and functional limitations is more straightforward, although individual empirical measures will have limitations. For this reason, in this study, we mainly use measures of functional limitations and, in some cases, chronic conditions and impairments. To obtain measures of disability, we focus on functional limitations, impairments, or conditions that would most likely reduce the ability of a woman to work or care for basic needs.
Because children with disabilities may require additional care from mothers, we also report measures for children in families receiving AFDC. Mothers of children with disabilities, particularly single mothers, may be less able to work because their children have special care needs and the potential difficulty and cost of finding alternate caretakers. Measures for children differ from those used for adult women, but are chosen to be age appropriate and reflect varying levels of disability.
Finally, it is important to note that disability encompasses mental or emotional disorders, including substance abuse, that impair an individual’s ability to carry out his or her regular activities. However, there is little data available on these conditions. Although some of the measures of disability we report will reflect limitations due to mental illness, none of the data we use fully capture these types of conditions. Since conditions such as mental illness and substance abuse can restrict the ability of welfare recipients to work, our estimates likely understate the extent of disability among families receiving AFDC.
Disability Among Women Receiving AFDC
The most commonly used measure of whether health affects the ability to work is the direct question “Do (you) have a physical, mental, or other health problem that limits the kind or amount of work you can do?” Table 1 shows the results of this question from all the data sets we use.
| Table 1: Women Receiving AFDC Who Have a Work Limitation | |||
| Data Source | Percent of Single Mothers |
Percent of All Mothers |
Sample Size* |
| SIPP | 16.5 | 16.6 | 1,409 |
| NHIS | 17.9 | 17.8 | 1,082 |
| NLSY | 18.0 | 19.2 | 506 |
Source: Urban Institute tabulations.
* Sample size indicates the number of families receiving AFDC included in each survey sample.
The percentage of all women on AFDC reporting a work limitation ranges from 16.6 percent to 19.2 percent, across these data. Although the samples differ somewhat (see previous section), the range of these estimates is fairly small. These rates are considerably higher than the percent of all adult women reporting work limitations. In the NHIS, 13 percent of all women ages 18 to 64 report a comparable limitation, and, in the NLSY, 9 percent of women report a work limitation. This supports the conclusion that women receiving AFDC are more likely to have a disability that limits work than women in the general population.
Some two-parent families receive AFDC under the AFDC-UP (unemployed parent) program where one of the parents is unemployed. Because this program has traditionally been small (the AFDC-UP program was only about 10 percent of the total AFDC caseload in 1990) and because the impact of disability on the family may differ in a two-parent family than in a one-parent family, we separately report work limitations for single-parent families receiving AFDC. For the most part, the difference between the percentage of single mothers with work limitations compared to all mothers with work limitations is small, the largest difference being 1.2 percent in the NLSY data. This is not surprising since there is no clear reason to think single women would be more or less likely to be disabled than married women receiving AFDC.
| Table 2: Severity of Overall Limitations Among Women Receiving AFDC | ||
| Disability Measure | Percent | |
| Severity of work limitation | ||
| Unable to work | 10.1 | |
| Limited in kind or amount of work | 4.1 | |
| Limited in other activity | 3.7 | |
| Severity of limitation in major activity of the past 12 months | ||
| Unable to perform major activity | 6.1 | |
| Limited in kind or amount of major activity | 6.2 | |
| Limited in other activity | 5.6 | |
Source: Urban Institute tabulations of 1990 National Health Interview Survey.
Beyond this general measure of limitations, additional measures can give us information on the severity and type of these limitations. The severity of a woman’s reported limitations in her ability to work or perform her “major activity” is shown in Table 2. A fairly large group of women receiving AFDC, 10.1 percent, report they are unable to work, indicating a fairly severe disability. Another 4.1 percent report a potentially less severe disability of being limited in the kind or amount of work they can perform. In addition, another 3.7 percent of women receiving AFDC say they are not limited in work, but in some other activity. Without knowing the activity, it is difficult to assess the severity of these limitations, although they are presumably less severe than limitations that render a woman unable to work.
Because not all women have worked or are working, women receiving AFDC were also asked about current limitations in the ability to perform the activity the woman was engaged in for most of the previous year. Options for this activity include working, keeping house, going to school, or something else. Again, women responded whether they were currently unable to perform this activity or were limited in the kind or amount of this activity. Because these women are all referring to their major activity in the past year, this measure reflects the recentness of disability as well as the severity. For example, women who reported their major activity was going to school, but who are now unable to perform this activity have experienced this change recently, probably sometime in the last six months (since this activity was their major activity over the past year.) In 1990, 6.1 percent of women receiving AFDC reported they were unable to perform their major activity of the past year. An additional 6.2 percent reported they were limited in the kind or amount of this activity. Another 5.6 percent were not limited in their major activity, but were limited in some other activity. This group could include those who are unable to work and have, therefore, not done so in the past year.
Another measure of disability is the ability to perform specific functions. Because individuals may have very different ideas about work, saying one is limited in the ability to work may mean different things to different people. For example, a woman who has always held jobs where she has to stand for long periods may report a work limitation when she has foot problems, while a woman who works sitting down may not report this same problem as a work limitation. Asking about specific functional limitations allows us to create measures of severity of disability based on less subjective answers.
To obtain a clearer idea of the severity of these functional limitations, we examine the number of and degree of difficulty in performing these functions. Women can report having one of two levels of difficulty for each limitation: they have some difficulty with the function or they either cannot perform the activity or need the help of another person. Table 3 reports these different measures of the severity of functional limitations among women receiving AFDC.
| Table 3: Severity of Limitations in Specific Functions Among Women Receiving AFDC | |||
| Disability Measure | Percent | ||
| Has some functional limitation | 20.1 | ||
| Degree of Difficulty with functional limitations | |||
| Needs help/unable to perform | 8.4 | ||
| Some difficulty | 11.7 | ||
| Number of functional limitations | |||
| Needs help/unable to perform | |||
| 1 activity | 4.5 | ||
| 2+ activities | 3.9 | ||
| Some difficulty | |||
| 1 activity | 7.4 | ||
| 2+ activities | 4.3 | ||
Source: Urban Institute tabulations from 1990 Survey of Income and Program Participation.
Slightly more than one-fifth of these women report some difficulty with at least one of the functions. More than 8 percent needs help or is unable to perform at least one function, indicating a relatively severe disability. Almost 12 percent report some difficulty with at least one function.
Having a limitation in one function may not be terribly disabling, depending on the function. However, being limited in several functions indicates a higher level of severity. Of women receiving AFDC, 8.2 percent have more than one functional limitation. In addition, almost 4 percent report more than one activity they are unable to perform or with which they need help. This measure captures more severe disability.
In addition to degree of difficulty, the extent of disability leading from functional limitations depends on the type of function being discussed. It is difficult to generalize about the ability to work from limitations in specific functions because of the differences in requirements across jobs. However, we can make some inferences about the difficulty of working and the severity of the disability from the type of function. Table 4 separates functional limitations into difficulties with basic needs, referred to as Activities of Daily Living (ADLs) and routine needs, referred to as Instrumental Activities of Daily Living (IADLs). We include sensory limitations in the category of ADLs.
| Table 4: Type of Limitations in Specific Functions Among Women Receiving AFDC | |||
| Disability Measure | Percent | ||
| Type of functional limitations | |||
| One or more ADLs | |||
| 1 activity* | 7.3 | ||
| 2+ activities* | 3.3 | ||
| One or more IADLs | |||
| 1 activity* | 4.8 | ||
| 2+ activities* | 4.6 | ||
| Type of functional limitations | |||
| Needs help with personal care** | 1.2 | ||
| Limited in routine activities** | 13.6 | ||
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (**) 1990 National Health Interview Survey.
Of all women receiving AFDC, 10.6 percent report some difficulty with at least one ADL. Of these, a third (3.3 percent) report difficulty with more than one ADL, indicating more substantial limitations. In addition to those reporting difficulty with one or more ADL, 9.4 percent of women receiving AFDC have difficulty with an IADL. This indicates that about half of the women reporting functional limitations are having trouble attending to these basic needs.
Another measure distinguishing the type of functions with which a person has difficulty comes from the NHIS and is also shown in Table 4. This question directly bundles functions into “basic” and “routine” by asking whether a person “needs help with personal care needs, such as eating, bathing, dressing, or getting around the house” (basic needs) or is “limited in routine needs including everyday household chores, necessary business, shopping, or getting around for other purposes” (routine needs). Only 1.2 percent of women on AFDC report needing help with personal care. This percentage is likely smaller than those with trouble with an ADL because it reflects a combination of the type of function, the level of difficulty, and even the number of functions.
The share of women who are limited in routine activities is 13.6 percent. This percentage is somewhat higher than the percentage of women with some level of difficulty with an IADL (over 9 percent). However, this question is broader, allowing inclusion of functions that may not be in the list of specific functions asked about in the SIPP.
In addition to limitations in performing certain functions, certain measures of health status provide information about disability. Table 5 includes measures of days stayed in bed for at least half the day, health care utilization (number of days admitted to hospital not counting child birth and number of outpatient visits to a doctor), and self-reported health status. There are concerns with each of these as a measure of disability. The number of bed days reflects illnesses that may not be chronic, and thus, may only be temporarily disabling. Measures of health care utilization reflect health status as well as access to health services which varies with income and health insurance coverage. This problem is mitigated here because all AFDC recipients are eligible for Medicaid and are in a similar income class. However, to limit these problems, we concentrate on the percentage of women with relatively large numbers of bed days, hospital days, and doctor visits, believing that these are more likely to reflect serious problems.
About 7 percent of women on AFDC report they had over 30 days in the past year where they were confined to bed for health reasons. Almost 4 percent of women were in the hospital for more than five days, and 8.7 percent had 16 or more visits to a doctor. This indicates that there is a small but significant portion of the AFDC population that has significant health problems over the course of a year. Even if these problems are not chronic, for this subset of women, health issues can be an impediment to work.
The measure of self-reported health status only reflects health at the time of the interview. However, previous research finds this is a good proxy for general health when compared with more sophisticated measures. Four and one-half percent of women on AFDC report that their health is poor, and another 17.5 percent say they are in fair health. This means that over one-fifth of this group feels they are in less than good health. This is far higher than what is reported by all women ages 18 to 64: 2 percent are in poor health and 6 percent fair are in fair health.
| Table 5: Measures of Health and Health Care Use Among Women Receiving AFDC | ||
| Disability Measure | Percent | |
| Number of Bed Days in past 12 months | ||
| 0 to 15 | 86.9 | |
| 16 to 30 | 6.1 | |
| 31 or more | 6.9 | |
| Number of Hospital Days in past 12 months | ||
| None | 90.0 | |
| 1 to 5 | 6.2 | |
| 6 or more | 3.8 | |
| Number of Doctor Visits in past 12 months | ||
| None | 15.4 | |
| 1 to 15 | 75.9 | |
| 16 or more | 8.7 | |
| Self-Reported Health Status | ||
| Excellent | 24.5 | |
| Very Good | 23.2 | |
| Good | 30.0 | |
| Fair | 17.5 | |
| Poor | 4.5 | |
Source: Urban Institute tabulations from the 1990 National Health Interview Survey.
Table 6 summarizes the extent to which women receiving AFDC have some disabling limitation and the extent to which they have serious disabilities. The percent of women on AFDC with some limitation ranges from 16.5 to 20.1 percent. Using several different measures, the percent of women with a serious disability ranges from 8.4 percent to 10.6 percent.
| Table 6: Summary of Disability Among Women Receiving AFDC | ||
| Disability Measure | Percent | |
| Any Limitation | ||
| Has a work limitation *12 | 16.6-19.2 | |
| Has any functional limitation* | 20.1 | |
| Serious Disability | ||
| Unable to work1 | 10.1 | |
| Unable to perform at least one function* | 8.4 | |
| Difficulty with at least one basic function* | 10.6 | |
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (1) 1990 National Health Interview Survey and (2) 1992 National Longitudinal Survey of Youth.
Disability Among Children Receiving AFDC
In addition to their own disabilities, women who have children with disabilities may have limitations on their ability to work. Caring for children with disabilities can involve more time, call for specialized day care, and lead to additional expenses. The extent to which any of these occur depends on the nature of the disability, the family situation, and the community in terms of available services and jobs. How having a child with a disability restricts a parent’s ability to work depends on all of these same factors and the type of jobs available to the parent. We examine the disabilities of children in AFDC families because having a child with a disability may affect a recipient’s ability to work.
We measure the disability of children receiving AFDC by examining limitations in their ability to carry out certain functions. While some of the measures are broad enough to apply to all children, others are appropriate for only certain age groups. Because children of different ages are at varying stages of development, the functions they are expected to carry out vary as well. For example, attending school is an expected activity for children over five but not for toddlers. Therefore, some of the measures of disability we use reflect age-appropriate functions.
Table 7 shows the extent of functional limitations among children receiving AFDC. All statistics represent the number of families receiving AFDC with at least one child having that limitation. The first measure, limitation in major activity, is similar to that used for women on AFDC. For children under age 6, major activity involves regular play, while for children 6 to 17, the major activity is attending school. In almost 2 percent of families on AFDC, a child is unable to perform his or her major activity; this represents the most severe type of limitation. In 10 percent of families, children are limited in the kind or amount of their activity, and in an additional 4 percent of families, children are limited in some other non-major activity. Overall, almost 16 percent of families have a child with some functional limitation.
Other measures of more specific functional limitations are also shown. Only 1.7 percent of families on AFDC have young children who are limited in usual activities. This is partly due to the difficulty in diagnosing some disabilities, for example learning disabilities, in young children. In addition, 2.4 percent of families on AFDC have children between the ages of 3 and 14 with a “long-lasting” condition that limits their ability to walk, run, or use stairs.
| Table 7: Functional Limitations Among Children Receiving AFDC | ||
| Disability Measure | Percent | |
| Limitation in major activity | ||
| Unable to perform major activity** | 1.8 | |
| Limited in kind or amount of major activity** | 10.1 | |
| Limited in other activity** | 4.0 | |
| Condition that limits physical activity** | ||
| 9.4 | ||
| Limitation in usual activities* | ||
| (for children ages less than 6) | 1.7 | |
| Limitation in ability to walk, run, or use stairs* | ||
| (for children ages 3 to 14) | 2.4 | |
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (**) 1990 National Health Interview Survey.
For school-age children, the type or severity of disability can be measured in relation to the ability to carry out school-related activities. Table 8 shows several measures of the type and severity of limitations in these activities.
| Table 8: Limitations Related to Schooling Among School-Age Children Receiving AFDC | ||
| Disability Measure | Percent | |
| Limitation in school activity (ages 5 to 17) | ||
| Unable to attend school** | 1.7 | |
| Attends special school or classes** | 7.3 | |
| Needs to attend special school or classes** | 1.9 | |
| Limited in school attendance** | 3.3 | |
| Received special education services* | 5.4 | |
| (ages 6 to 21) | ||
| Limited in school work* | 6.3 | |
| (ages 6 to 21) | ||
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (**) 1990 National Health Interview Survey.
Of families receiving AFDC, 1.7 percent have children who are unable to attend school because of an impairment or health problem. Another 7.3 percent have children that attend a special school or classes with an additional 2 percent needing this schooling. Another 3.3 percent of families report having a child that has limited school attendance because of health. Altogether this set of measures indicates that over 14 percent of families receiving AFDC have school-age children that have some limitation in school activities. Other related measures of limitations show that 5.4 percent of families have children receiving special education services and 6.3 percent report the child has a limitation in his or her ability to do regular school work.
In addition to functional limitations, a child’s use of, or need for, certain health care services can reflect disability. Table 9 reports a variety of these measures for children in families receiving AFDC. First, 4.6 percent of families require use of special equipment, from wheelchair to special clothing, reflecting a range of disabilities. Also, 2.6 percent of families have children under 6 who have received therapy or diagnostic services designed to meet their “developmental needs.” This too is open to the parent’s interpretation and can reflect a variety of services. About 4 percent of families have a child that has spent more than 5 days in the hospital in the last year and 6.3 percent of families have a child that has had more than 15 visits to the hospital. While both of these are likely to reflect relatively severe impairments or conditions, they include both chronic conditions and short-term acute conditions.
| Table 9: Health Care Service Use and Needs Among Children Receiving AFDC | ||
| Disability Measure | Percent | |
| Requires use of special equipment2 | 4.6 | |
| Received therapy or diagnostic services* | 2.6 | |
| (asked for children less than 6) | ||
| Hospital days in past 12 months1 | ||
| None | 90.8 | |
| 1 to 5 | 5.0 | |
| 6 or more | 4.2 | |
| Doctor visits in past 12 months1 | ||
| None | 8.6 | |
| 1 to 15 | 85.1 | |
| 16 or more | 6.3 | |
| Child in family receiving SSI1 | 2.6 | |
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (1) 1990 National Health Interview Survey and (2) 1992 National Longitudinal Survey of Youth.
Of families receiving AFDC, 2.6 percent have at least one child participating in the Supplemental Security Income (SSI) program. This program provides benefits for low-income persons with severe disabilities. Although individuals cannot receive both SSI and AFDC, families can have different members receiving both. The SSI program has a complex process for determining disability that is generally considered as measuring fairly severe disabilities.
| Table 10: Serious Health Conditions Among Children Receiving AFDC | |
| Serious Hearing Difficulty | 0.9 |
| Serious Difficulty in Seeing | 0.2 |
| Emotional Disturbance | 1.2 |
| Orthopedic Condition | 1.6 |
| Mentally Retarded | 0.7 |
| Blood Disorder | 1.1 |
| Epilepsy/Seizures | 1.3 |
| 1 or more of above conditions | 3.8 |
Source: Urban Institute tabulations from the 1992 National Longitudinal Survey of Youth.
Finally, specific conditions that are generally chronic and severe can be used as measures of disability among children. Table 10 shows that the percent of children in families receiving AFDC with any of the listed conditions ranges from less than half a percent with serious difficulty seeing to 1.6 percent with a crippling orthopedic condition. Overall, as another measure of serious disability, 3.8 percent of families receiving AFDC have a child with 1 or more of these conditions.
Using the measures presented, we can create overall measures of some limitation among children and measures reflecting more serious disability. The measures of serious disability represent a lower bound on the share of mothers receiving AFDC whose children’s disabilities likely affect their ability to work. In these measures we do not include overall limitations in school activity because it is unclear whether some of the learning disabilities that are included in these numbers would affect mothers’ work. Table 11 provides a summary of the extent of disability and serious disability among children receiving AFDC.
The percentage of families that have at least one child with some limitation ranges from 11.1 to 15.9 percent across the data sets used. While each measure captures slightly different functional abilities, the range is fairly narrow. The measures of more serious disability among children, although more varied, range from 1.8 percent to 3.8 percent of families.
| Table 11: Summary Measures of Disability Among Children Receiving AFDC | ||
| Disability Measure | Percent | |
| Some level of limitation | ||
| In major activity1 | 15.9 | |
| In school or physical activity2 | 15.1 | |
| In school, usual activities, or movement* | 11.1 | |
| Serious disability | ||
| Unable to perform major activity1 | 1.8 | |
| 1 or more chronic conditions2 | 3.8 | |
| Receiving SSI1 | 2.6 | |
| Unable to walk, run, or use stairs (ages 3-14)* | 2.4 | |
Source: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (1) 1990 National Health Interview Survey and (2) 1992 National Longitudinal Survey of Youth.
Disability Among Families Receiving AFDC
To understand the extent to which women receiving AFDC are likely to have some limitation on their ability to work due to disability, we need to know the combined rate of disability among mothers and children. Table 12 reports the percentage of families receiving AFDC where either the mother or the child has some limitation due to impairments or health conditions. As we have shown, there are many ways to define and describe disability for women and children. We use three different definitions from the three data sets used in this study. Almost thirty percent of families receiving AFDC have either a women or child with some level of disability. Despite the slightly different measures from these data, the range of results is relatively narrow, varying from 27.4 to 29.5 percent.
Because children with severe disabilities are more likely than children with less severe disabilities to require additional time, specialized care, or greater costs that could limit a women’s ability to work, we also consider the extent to which families receiving AFDC have a mother with any limitations or a child with a serious disability. Again, there are many ways to measure severe disability among children. Table 12 uses three different measures of severe disability among children from the three data sets. About one-fifth of families receiving AFDC have a mother with some disability or a child with a severe disability; the figures range from 18.4 percent to 21.3 percent. Although these measures for children’s serious disability differ more substantially than the measures for mother’s limitation, the range of results is still relatively narrow.
| Table 12: Families Receiving AFDC where Mother or Child has a Disability | ||
| Percent of Families Where… | Percent | |
| Mother or child has some limitation | ||
| Limitation in major activity1 | 29.5 | |
| Some functional limitation* | 27.4 | |
| Work, school, or physical limitation2 | 28.9 | |
| Mother has some limitation or child has serious disability | ||
| Child is unable to perform major activity1 | 18.4 | |
| Child is unable to walk, run, climb stairs* | 21.3 | |
| Child has at least one chronic condition2 | 20.7 | |
Sources: Urban Institute tabulations from (*) 1990 Survey of Income and Program Participation and (1) 1990 National Health Interview Survey and (2) 1992 National Longitudinal Survey of Youth. (See text for functions and chronic conditions included.)
The three data sets indicate that either the mother or a child in an AFDC unit suffers from some type of disability in a substantial minority of AFDC cases. But the extent to which these disabilities preclude adult welfare recipients from working is unclear. After all, many disabled individuals have successful careers, and many long-term AFDC recipients have no limitations on ordinary activities.
In previous research, we examine the extent to which disabilities limit AFDC recipients in their attempts to move from welfare to work. For that analysis, we use data from the 1990 SIPP and examine if, after taking other important differences into account, women who have functional limitations or children with functional limitations take longer to leave AFDC for work than other AFDC recipients. Since the amount of time a woman spends on AFDC may affect her chances of leaving the program, our sample consists of only cases for which we observe the start of a spell of AFDC receipt. We then review their work/welfare status at four month intervals.
We find that, on average, a woman with no disabilities and whose children have no disabilities has a 7 percent chance of leaving AFDC for work in any given wave. If she herself has a functional limitation, the chance of leaving AFDC falls to 3.8 percent. The severity and number of the limitations matter considerably. Women who report needing help or being unable to perform the activities we consider have, on average, only a 2.5 percent chance of leaving AFDC for work. And women who report having multiple limitations have only a 2.4 percent chance of moving from welfare to a job in a given four month period. Women who report having less severe or only a single limitation are not significantly less likely to leave welfare for work than non-disabled women. Similarly, we find that having a disabled child does not inhibit AFDC exits for work. However, this finding might differ if measures that better reflected severe disability among children were available in the SIPP.
Thus, our results indicate that while disabilities are not uncommon among women and children on AFDC, women with multiple and/or severe physical limitations are more likely to be significantly inhibited in their attempts to move from welfare to work.
Welfare programs are currently undergoing changes in many states, as programs begin to time-limit benefits and move more recipients into work. Although programs such as Supplemental Security Income (SSI) provide cash assistance to those with severe disabilities, many poor persons with disabilities that limit their ability to work do not qualify. This profile of disability among recipients of AFDC, the largest federal cash assistance program, shows that the rate of disability among this group is large.
We find that in 17 to 19 percent of families receiving AFDC, the mother has a health condition or impairment that limits her ability to work or perform other routine functions. Between two and four percent of families receiving AFDC have a child with a seriousdisability that is likely to effect a mother’s ability to work. Altogether we find that in slightly more than one-fifth of families receiving AFDC, between 18 and 21 percent, the mother has a disability or a child has a serious disability. These findings are consistent across the three different data sources used, the SIPP, the NHIS, the NLSY. In addition, since the data used do not fully capture limitations due to mental or emotional disorders or substance abuse, we probably understate the true level of disability among the AFDC population.
The large extent of disabilities among families with AFDC has serious implications for welfare reform. Reforms that place time limits on receipt of benefits and introduce stricter requirements for work need to take into consideration the recipients’ ability to work. Under some of the current reforms being implemented by states, the goal is for all recipients to eventually be required to work. The ability of a woman to work depends, in part, on whether she or her child has a disability, the nature and severity of that disability, and the requirements of the jobs available to her. For women with severe disabilities, policy makers may want to consider exemptions from work requirements altogether. For women with less severe disabilities, accommodations in work places, alternate types of work arrangements, and specialized child care services, may make work more feasible. Increasing implementation of the Americans with Disabilities Act prohibiting discrimination against individuals with disabilities may lead to increasing numbers of employers making such workplace accommodations.
Thus, given the extent of disability in families receiving AFDC, our results suggest that putting the entire AFDC caseload to work is an unrealistic goal without further consideration of possible accommodations for these families. Policy makers reforming AFDC need to consider the impact of reforms on the large number of women and children with disabilities receiving these benefits.
Survey of Income and Program Participation
The 1990 Survey of Income and Program Participation (SIPP) provides detailed information on individuals’ labor market activity, welfare program participation, and health. The SIPP is a longitudinal survey, and the 1990 panel contains information on over 20,000 households who were re-interviewed at 4 month intervals (known as waves) over a 32 month period. During the third wave, the SIPP administered a special topical module asking detailed questions about individuals’ functional limitations.
Our sample consists of women who responded to the questions in the disability topical module in wave 3 and received AFDC or General Assistance at some time over the 32 month period. To guard against spurious responses, a woman had to report receiving welfare in at least two months, and the two months must not be separated by more than a single month. Thus, we view a woman who reports receiving welfare in months 5 and 30, for example, as reporting bad data and do not include her in the sample. Women who report receiving welfare in consecutive months or in two out of three consecutive months are included.
Our sample consists of 1,409 women who received AFDC at any time over the 32 month period; 798 of these women began receiving AFDC after the first month of the survey.
National Longitudinal Survey of Youth
The National Longitudinal Survey of Youth (NLSY) began in 1979 with a cohort of over 12,000 young men and women between the ages of 14 and 21. It reinterviewed them annually, obtaining detailed information about their labor market activity, welfare program participation, and living arrangements. In 1986, the NLSY began collecting supplemental information on the children born to female respondents. During the 1986, 1988, 1990, and 1992 surveys, a battery of child physical and psychological tests were administered to NLSY mothers and their children. These mother-child data include detailed information on conditions that limit children’s activities.
Our sample consists of NLSY mothers who report receiving AFDC for at least two months during 1991 and who responded to the general mother’s disability questions and the child disability questions in the 1992 survey. We have 506 families in our sample; the mothers range in age from 27 to 34.
National Health Interview Survey
The National Health Interview Survey (NHIS) each year collects information on health characteristics, conditions, injuries, activity limitations and use of medical services from a nationally reprentative sample of the noninstitutionalized population. In 1990, data was collected from 46,476 households. Information about receipt of AFDC is not regularly collected, but a supplement on sources of income was included in the 1990 survey.
Our sample consists of women over age 16 who have children and report receiving AFDC in the past month. The sample includes 1082 families.
This research was sponsored by a grant from the Henry J. Kaiser Family Foundation. The authors would like to acknowledge David Dickenson, Eric Meier, Cori Uccello, and Keith Watson for their helpful comments and research assistance. Any opinions expressed herein are those of the authors’ and do not necessarily reflect the views of the Urban Institute or its funders. The authors claim full responsibility for all errors.
