Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are state and federally funded income programs that can provide steady health insurance, increasing access to healthcare and other needed services. It has been previously demonstrated that approval for social security disability benefits can lead to better access to housing and long-term subsidies, reduce emergency department usage and recidivism rates, and address systemic problems within the community. However, it has previously been shown that individuals experiencing homelessness are more likely to receive an unfavorable award decision, despite having more severe healthcare treatment needs compared to the general population. In Massachusetts, the state award rate for homeless applicants has averaged 22-33% over the past 2 years, compared to 45% for non-homeless cases awarded. The primary objective of this research study was to investigate applicant and application characteristics associated with disability outcomes among patients at the Boston Health Care for the Homeless Program (BHCHP) Barbara McInnis House (BMH) Medical Respite Unit and to explore the effect of advocacy in increasing access to benefits for those who qualify. The target population for this study was individuals experiencing homelessness who were admitted to the BHCHP BMH Medical Respite Unit and received assistance with an application or maintenance of Social Security benefits between the fiscal years of 2013 and 2018. The variables of interest included age, gender, race/ethnicity, preferred language, primary diagnosis, and housing status of the applicant. Presence or absence of medical advocacy letter and request of DDS mandated consultative examination were application characteristics of interest. The outcome variables were determination time and application decision. This chart review was retrospective and no patients were engaged with directly. All data of interest was pulled from the BHCHP electronic health record or the Microsoft Access database used for tracking application characteristics and outcomes of disability applications. It was shown that advocacy and assistance with the application process for SSI and SSDI produced an allowance rate for people experiencing or at risk of homelessness considered in this study that was almost twice the allowance rate for the homeless population in the state of Massachusetts and was significantly higher than the state general population. Despite the increase in allowance rate, the application determination times were significantly longer for the population of interest in this study as compared to the general population. The median age of applicant population decreased over the timeline of the study, but the median age of those approved did not change at the same rate. Under the age of 40 and mental health diagnosis, as opposed to over the age of 40 and non-mental health diagnosis, were associated with statistically significant lower odds of approval for disability benefits. Medical advocacy letters were found to aid in access to benefits for those with mental health primary diagnoses. Common denial reasons included inability of the Social Security Administration (SSA) to contact the applicant, missed DDS mandated consultative exam by the applicant, and inadequate documentation to demonstrate severity of the disability. Barriers included severe mental illness, cognitive disorders, chronic physical health conditions, substance use disorders, and lack of accurate record keeping of when, where, and why an individual was treated at a facility. Individuals experiencing or at risk of homelessness face many systemic and institutionalized barriers to obtaining disability benefits that they qualify for and deserve. Analysis of current gaps in access to disability benefits could help illustrate how the current system harbors barriers to deter and deny people benefits, especially those who have low literacy, are poor, and have no access to advocates who could potentially help to garner attention to areas in need of intervention. Advocacy can help increase access to benefits and can help individuals achieve better health outcomes by offering a means of preventative care.

Nearly a quarter of a century after the passage of the Americans with Disabilities Act (ADA), people with disabilities remain severely under-employed. All the while, they command a disproportionate share of public monies through Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). This report seeks to contribute to the conversation on current disability policy, as well as offer short-, mid-, and long-term solutions. The document opens with a history of the Social Security Administration (SSA), the federal agency responsible for setting national disability policy. This is followed by a discussion of SSA’s primary categories of client support: health care and employment initiatives. The health section details the medical coverage attached to both SSDI and SSI, with a particular focus on the Affordable Care Act (ACA). Next is a review of work incentives offered to SSDI/SSI beneficiaries. Concluding this chapter is an investigation of the causes of under-employment that continue to plague the disabled circle, in spite of these many interventions. The study continues by exploring various issues affecting today’s U.S. disability policy. These include both exogenous and endogenous factors, including the growth of SSDI and SSI; the structural issues inherent to the current paradigm, as well as a number of disincentives to employment. The analysis then turns to disability policy in the international community. Of particular interest are the experiences of Sweden and the Netherlands as they established fiscally sound policy while assisting the nation’s disabled. From these case studies emerge several lessons pertinent to the U.S. This chapter closes with a thorough analysis of these European nations’ responses to their ever-growing disability programs, and the implications for disability policy makers and advocates. Concluding the report are several recommendations that can guide policy makers and advocates as they strive to place the disability community on the path to self-sufficiency. Most relevant and promising to the U.S. are the passage of the ABLE Act, instituting a national Medicaid Buy-In, and establishing a central disability agency. With successful implementation of these reforms, American with disabilities can potentially finally realize what the ADA promised 25 years ago. / text

Thesis advisor: Mathis Wagner / The essays that comprise my dissertation analyze the interactions among old age labor supply, health, and Social Security system in the United States. In the first chapter of my dissertation, I provide estimate of the causal effect of Social Security Disability Insurance (SSDI) application on employment of denied applicants. Using exogenous variations of SSDI application decision, I find that the employment rate is 36 percentage points lower for the denied applicants than that of comparable non-applicants in the short-run. In the second chapter (with Matthew Rutledge and April Wu) we explore the relationship between individuals’ expectation on longevity and their plans for retirement in a quasi-experimental setting. The estimates in this paper suggest a large and statistically significant relationship between subjective life expectancy and retirement expectations: an individual who is one standard deviation more optimistic about living to age 75 has a greater probability of planning to work fulltime at 62 and 65 by 10 percent and 21 percent, respectively. In the third chapter of my dissertation (with Norma Coe and Matthew Rutledge) we identify the contribution of Medicare in explaining the retirement behavior of workers. We find individuals without access to retiree health insurance from work are 7.5 percentage points more likely to retire soon after their 65th birthdays and are 5.8 percentage points less likely to delay retirement until the Full Retirement Age (FRA) than those with that insurance. We interpret this finding as evidence that Medicare eligibility persuades more people to retire, because they can begin receiving federal health coverage. The findings of the research in my dissertation provide important insights in making the Social Security system more welfare enhancing for the older workers and the disabled as well as keeping it sustainable in the long-run. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

The following project is a compilation of three separate articles all utilizing a database extracted from the UNUM/Provident Life Insurance Company, including all consecutive short-term disability (STD) claims filed with UNUM from January 1, 1994 to December 31, 1996 from claimants who were also insured for long-term disability (LTD) by UNUM. The resulting sample includes 77,297 claims.The results of these studies are part of a larger investigation that documented the Progression of Disability Benefits (PODB) phenomenon. PODB refers to the migration of workers with work-limiting disabilities through a system of economic benefits resulting in their placement onto Social Security Disability Insurance (SSDI). Claimant and employer demographics were found to influence the PODB. The following articles study three unique ways in which the PODB measure can be informative.The first of the articles tracts the experience of 400 individuals with neurological impairments through the PODB, and compares them with a general disability population on key demographic characteristics. In general, it is found that persons with neurological conditions have greater progression on to advanced disability levels than other types of disabilities. Individual claimants are also younger and male.The second article explores the relationship of integrated disability management(IDM) practices with PODB. It proposes that while the efficacy of IDM programs has been measured by the bottom line, that PODB can be used as an additional tool to assess effectiveness of DM programs. It finds that employers with higher levels of IDM activity will experience a reduced PODB rating.The third and final article examines one industry, Healthcare. It studies how demographics can be used to predict claimant industry as well as PODB performance. Findings reveal that men were more likely to move on to advanced disability benefits while workers in the Healthcare industry were less likely to move on to advanced statuses than employees in other industries. Furthermore, disability type is the greatest predictor of PODB, followed by age for all but one category in which employment sector was the next predictor of PODB. This finding leads to questions regarding how the workplace may contribute to disability and the PODB.

Afin de réduire les vibrations d'une structure, on utilise des éléments piézoélectriques connectés à des circuits électriques passifs. L'objectif est de se rapprocher de l'efficacité du contrôle actif sans en supporter la complexité et la consommation. On considère d'abord l'association d'une résistance (qui a un effet similaire à un amortissement visqueux) et éventuellement d'une inductance (permettant de réaliser un oscillateur accordé) aux éléments piézoélectriques. Ces systèmes ont des propriétés intéressantes, mais sont peu efficaces à moins d'un accord très précis de l'inductance. Afin d'obtenir des performances élevées sans accord précis, on étudie un circuit à commutation, qui se ferme et s'ouvre à des instants bien précis. L'effet de la charge, qui freine la structure, s'apparente à un frottement sec. En synchronisant les commutations sur les vibrations, le système est auto-adaptatif et peut être auto-alimenté. Les fortes non-linéarités entraînent une excitation haute fréquence de la structure qui peut rendre la synchronisation problématique. Deux modèles électromécaniques (analytique et éléments finis) réduits sont proposés, permettant de décrire la dynamique du système complet de manière précise et de mettre en valeur le couplage entre un mode de vibration et le circuit électrique. Ce couplage est déterminant pour la réduction de vibrations. Une étude de l'influence de divers paramètres permet d'optimiser les éléments piézoélectriques, les circuits, et les instants de commutation. Ces résultats sont vérifiés expérimentalement. On constate un bon accord avec la théorie ; la difficulté de synchroniser correctement la commutation est aussi constatée. / In order to reduce the vibrations of a mechanical structure, one can use piezoelectric elements connected to passive electrical circuits. The goal is to achieve the same efficiency as active vibration control without the associated complexity and energy consumption. First the use of a resistor (with an effect similar to viscous damping) and eventually of an inductor (allowing the creation of a tuned resonator) for the circuit is considered. These systems have interesting properties, but are not very efficient, except in the case of a finely tuned inductor. In order to obtain good performance without requiring a precise tuning, a switching circuit is considered. The switching process is synchronized on the vibrations, and the effect of the free electric charge (similar to a dry damping) reduces the vibrations. This system is self-adaptive and can be self-powered. However, the strong non-linearities create a high frequency excitation which may disturb the switch timing. Two different reduced electromechanical models (analytical and finite element) are proposed, allowing a description of the whole system dynamics with accuracy and to emphasize the coupling between one vibration mode and the circuit. This coupling is found to be decisive for the performance in vibration reduction. A study of the influence of various parameters allow the optimisation of the piezoelectric elements, electric circuits and switch timing. These results are experimentally tested and a good agreement with the predictions is obtained ; the difficulty of switch timing is also noticed.

Afin de réduire les vibrations d'une structure, on utilise des éléments piézoélectriques connectés à des circuits électriques passifs. L'objectif est de se rapprocher de l'efficacité du contrôle actif sans en supporter la complexité et la consommation. On considère d'abord l'association d'une résistance (qui a un effet similaire à un amortissement visqueux) et éventuellement d'une inductance (permettant de réaliser un oscillateur accordé) aux éléments piézoélectriques. Ces systèmes ont des propriétés intéressantes, mais sont peu efficaces à moins d'un accord très précis de l'inductance. Afin d'obtenir des performances élevées sans accord précis, on étudie un circuit à commutation, qui se ferme et s'ouvre à des instants bien précis. L'effet de la charge, qui freine la structure, s'apparente à un frottement sec. En synchronisant les commutations sur les vibrations, le système est auto-adaptatif et peut être auto-alimenté. Les fortes non-linéarités entraînent une excitation haute fréquence de la structure qui peut rendre la synchronisation problématique. Deux modèles électromécaniques (analytique et éléments finis) réduits sont proposés, permettant de décrire la dynamique du système complet de manière précise et de mettre en valeur le couplage entre un mode de vibration et le circuit électrique. Ce couplage est déterminant pour la réduction de vibrations. Une étude de l'influence de divers paramètres permet d'optimiser les éléments piézoélectriques, les circuits, et les instants de commutation. Ces résultats sont vérifiés expérimentalement. On constate un bon accord avec la théorie ; la difficulté de synchroniser correctement la commutation est aussi constatée.

New materials and new fabrication techniques in turbomachinery lead to monolithic<p>structures with extremely low damping which may be responsible for severe vibrations<p>and possible high-cycle fatigue problems. To solve this, various techniques<p>of damping enhancement are under investigation. The present work is focused on<p>piezoelectric shunt damping.<p>This thesis considers the RL shunt damping of rotationally periodic structures using<p>an array of piezoelectric patches, with an application to a bladed drum representative<p>of those used in turbomachinery. Due to the periodicity and the cyclic symmetry of<p>the structure, the blade modes occur by families with very close resonance frequencies,<p>and harmonic shape in the circumferential direction; the proposed RL shunt<p>approaches take advantage of these two features.<p>When a family of modes is targeted for damping, the piezoelectric patches are<p>shunted independently on identical RL circuits, and tuned roughly on the average<p>value of the resonance frequencies of the targeted modes. This independent<p>configuration offers a damping solution effective on the whole family of modes, but<p>it requires the use of synthetic inductors, which is a serious drawback for rotating<p>machines.<p>When a specific mode with n nodal diameters has been identified as critical and<p>is targeted for damping, one can take advantage of its harmonic shape to organize<p>the piezoelectric patches in two parallel loops. This parallel approach reduces considerably<p>the demand on the inductors of the tuned inductive shunt, as compared<p>to independent loops, and offers a practical solution for a fully passive integration<p>of the inductive shunt in a rotating structure.<p>Various methods are investigated numerically and experimentally on a cantilever<p>beam, a bladed rail, a circular plate, and a bladed drum. The influence of blade<p>mistuning is also investigated. / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished