AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON), SETH KELLER, MD, MICHAEL E. WALDMAN, MD AND MISHA GAREY, DDS
Instead of lobbying “just” for the three million children with disabilities, with “only” 7.7 percent of the total population with disabilities, unquestionably we would carry greater momentum by joining forces with the other estimated 36 million younger and older adults to make the case for legislative support.
We were wrong when we wrote the article, “Population projections: overwhelming the number of children with disabilities,” that appeared in the March 2013 issue of Exceptional Parent magazine.1 The perception that we
chose was to emphasize the dramatic, striking, remarkable (and any number of other synonyms) increasing numbers of elderly with disabilities which would overwhelm societal collective attention to the needs of children with disabilities. The fact is that seniors tend to vote and children don’t; politicians are more apt to respond to their voting constituents. We highlighted the fact that by 2030, there will be an estimated less than 3.5 million children with disabilities and 25.7 million seniors with disabilities.
In a later manuscript for EP magazine, “Why are there increasing numbers of children and adults with disabilities?,”2 we continued to emphasize the dramatic rise in the number of older individuals with disabilities, (based upon projected general population growth through 2050) but with added emphasis on the question of
whether there would be sufficient numbers of trained practitioners who would be willing to provide the needed services.
ELDERLY WITH DISABILITIES
Our attention to the dilemma of numbers of individuals with disabilities and needed providers was rekindled after reviewing the December 2014 Census Bureau report, “Older Americans with a disability: 2008-2012.”3 The publication detailed the reality that in 2008–2012, there were:
• “40.7 million people aged 65 and over in the United States, representing 13.2% of the total population. Among this older population, about 15.7 million, or 38.7% reported having one or more disabilities.
• The older population with a disability was disproportionately concentrated among the oldest old – those aged 85 and older representing 13.6% of the total older population, but accounted for 25.4% of the older population with disabilities.
• Women composed 59.0% of the older population experiencing disabilities. 3
In addition, among the older population:
• 15.9% reported having only one type of disability.
• 8.0% reported two types of disabilities.
• 14.5% reported three or more types of disabilities.3 (Figure 1)
About half (50.5%) of older Americans with a disability resided in nine states. Each of three states had more than one million older people with a disability: California (1.6 million), Florida (1.2 million), and Texas (1.1 million). Each of six states had 500,000 or more older residents with disabilities: New York (976,000), Pennsylvania (753,000), Ohio (634,000), Illinois (614,000), Michigan (529,000), and North Carolina (502,000).3
CHILDREN WITH DISABILITIES
In 2013, the Census Bureau reported that there were slightly more than three million children with severe disabilities. However, the Census Bureau reported only hearing and vision difficulties for the less than five years age group. (Table 1) Based upon Census Bureau estimates, the reality is that the three million children with disabilities represent 7.7% of the total population (39.1 million) with severe disabilities (including 20.3 million individuals between 18 & 54 years and 15.7 million individuals 65 years and over).4
AGING OUT
In time, the less than five years of age 160,686 youngsters with disabilities (remember, the Census Bureau only recorded youngsters with hearing and vision difficulties) will join the 2,879,661 children between five and 17 years with a range of severe disabilities who, in turn, will reach their young adult years. (Table 1) Surely, these youngsters will not be aging out of needed health care, social support, education, employment opportunities and any numbers of other required services. Unfortunately much of the attention and government support for youngsters slips away
during the early adult years.
For example, while the provision of dental services is required under the Medicaid Early and Periodic Screening and Diagnostic Program for youngsters, most states either provide little to no Medicaid dental services for adults. Similarly the Affordable Care Act allows young adults to stay on their parents’ health care plan until age 26. Before this landmark legislation, many health plans and insurers could and did in fact remove young adults from their
parents’ policies because of their age, leaving many college graduates and others with no insurance. After 26 years of age, options include, returning to their parents’ insurance (probably for an added premium), applying for Medicaid, obtaining coverage under an employer policy (if employed) and securing coverage through a health insurance exchange.
Indeed, the competition for added support is not just between children and the elderly population. It is ongoing difficulties for all ages, in particular, for individuals with disabilities of all ages.
WHAT IF INSTEAD OF COMPETING WE HELPED EACH OTHER ACHIEVE OUR GOALS?
“Harry S Truman was once quoted as saying ‘there is no limit to what can be accomplished if it doesn’t matter who gets the credit.’”5
“So often in life our jobs use competition to determine who is going to get the next raise or promotion. We fight to bring each other down rather than bring each other up. I know that sounds right. We are taught from the time we are children that life is a survival of the fittest. That only the strong survive, and that it’s a dog eat dog world. Now I agree that all these things are true. At least in today’s view of the world and business. But I think we can change that. I think that we can take a new view on business … (and caring for those in need).”6
“There’s nothing inherently wrong with competition, but I would argue that there’s nothing wrong with doing something every now and then where trying to beat your fellow players isn’t at the heart of the activity.”7
Instead of lobbying “just” for the three million children with disabilities, with “only” 7.7 percent of the total population with disabilities, unquestionably we would carry greater momentum by joining forces with the other
estimated 36 million younger and older adults to make the case for legislative support, the host of needed programs and trained personnel to meet the needs of this increasing population of youngsters and the not so young with disabilities. Let’s not make our motto the aphorism, “It is not whether you win or lose in a competition, but how you place the blame!” •
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail:h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) – Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Seth M. Keller, MD is Past President AADMD, Co-Chair National Task Group on ID and Dementia Advocare Neurology of South Jersey
Michael E. Waldman, MD is a Nuclear Radiologist based in Brookfield, CT
Misha Garey, DDS is Director of Dental Services at the Orange Grove Center.
References
1. Waldman HB, Perlman SP. Population projections: overwhelming the number of children with disabilities.
EP Magazine, 2013; 44(3):14-16.
2. Waldman HB, Garey M, Perlman SP. Why are there increasing numbers of children and adults with
disabilities? EP Magazine, in press.
3. He W, Larsen LJ. U.S. Census Bureau, American Community Survey Reports, ACS-29, Older Americans With a Disability: 2008-2012. Web site: http://www.census.gov/content/dam/Census/library/publications/2014/acs/acs-29.pdf Accessed March 25, 2015.
4. Census Bureau. American Community Survey. Web site: factfinder2.censusbureau. Accessed March 25, 2015.
5. Linkedin.com. Importance of collaborating instead of competing. Web site:https://www.linkedin.com/pulse/importance-collaborating-instead-competing-ken-robinson?trk=pulsedet-nav_art Accessed March 26, 2015.
6. TED Conversations Archives. Web site:http://www.ted.com/conversations /8917/what_if_instead_of_competing_f.html Accessed March 26, 2015.
7. The Dad Game: Cooperating instead of competing. Web site: http://www.news-sentinel.com/articl/2014140339956 Accessed March 26, 2015.
