Good day, ladies and gentlemen, and welcome to the Disability, Aging and Older Workers conference call. At this time all lines are in a listen-only mode. Later we will conduct a Question and Answer session and instructions will follow at that time. If anyone should require assistance during the conference, please press star then zero on your touch tone telephone. As a reminder this conference call is being recorded. I would now like to introduce your host for today''s conference, Mr. Peter Berg, Project Coordinator of technical support. Sir, you may begin.
Thank you very much, Operator, and welcome, everyone, to the ADA Audio Conference Series, a collaborative effort of the national network of Regional ADA Centers, also known as Disability and Business Technical Assistance Centers, DBTAC. The network of ADA Centers are funded through the National Institute on Disability and Rehabilitation Research, NIDRR, which is part of the U.S. Department of Education. As the Operator had mentioned, today''s session is being recorded. An audio archive as well as a text transcript of today''s session will be available on the ADA Audio Conference site, www.ada-audio.org, in 10 to 14 business days following today''s session. Today''s session, Disability, Aging and Older Workers, we are pleased to have with us Michael D. Williams, Ph.D. as our speaker today. Dr. Williams is a research scientist at the Atlanta VA Medical Center''s Rehabilitation and Research Center of Vision Loss and Aging. He is also assigned to the Veterans Administration''s Blind Rehabilitation Services National Program Office out of Washington, D.C. where he served as a data manager and rehab planning specialist. Dr. Williams holds an academic appointment as an instructor at Georgia State University and is also a research scientist at the Georgia Institute of Technologys Center for Assistive Technology. Dr. Williams'' current research interests include the following, and I am sure Dr. Williams will expound on this through his presentation, but has a current interest in the utilization of healthcare services and programs among older persons and how this process influences disparities in health and well-being. Also is interested in outcomes and program evaluations of VA sponsored blind rehabilitation services and also processes and issues surrounding family and care-giving for elderly disabled care recipients, so with that I will turn the session over to Dr. Williams, and following his presentation we will open it up to all of you for questions, so without any more ado, Dr. Williams.
Thanks a lot Peter, I appreciate that and I appreciate the elaborate and extensive overview of my background there. My task here today is really to discuss I think in some fairly significant detail issues that we are facing here in the United States with respect to aging, the demographic realities of that, and how that really intersects with a lot of I think very important social and policy issues that are very germane to this particular audience. I understand we have a lot of folks here who are involved in the provision of service delivery, vocational rehabilitation, and various and sundry aspects related to employment, and I guess with DBTAC''s involvement here and ADA, this is I think a very relevant issue. So I am going to go into some pretty deep discussion on a wide-ranging areas of aging, and I am sort of approaching this in a way that I am assuming that a lot of folks on this call while probably very much steeped in understanding ADA and issues related to individuals with disabling conditions, perhaps not as familiar with the reality of aging in our society, currently what is going to happen in the next 15 to 20 years. So with that being said, let me give my proper tip of the hat to some various folks. Peter mentioned my current appointment with the VA, and I have been working with the VA in various capacities for many years, and I have also had an appointment with Georgia Tech at the Center for Assisted Technology and Environmental Access for about three or four years, and the information I am going to be sharing with you folks today really is in part a pre-conference seminar I gave at CSUN last year in Los Angeles on this very topic, and I think it is interesting that Robin Jones and the folks at the DBTAC contacted me about this because we have had a lot of work and effort trying to get the message out on this particular issue, so I do want to give a shout out to CATEA out there at Georgia Tech and acknowledge that in part some of the information provided to you here has been funded through NIDRR, National Institute on Disability and Rehabilitation Research, obviously affiliated with the U.S. Department of Education, and that grant number is H133E20720, and I would encourage anyone who is interested to please visit the Work RERC, for a wide range of information that is available there. Of course the Work Place Rehabilitation Engineering and Resource Center at Georgia Tech has recently been renewed for an additional five years, and we are very excited about that. You can contact them directly over the internet at www.workrerc.org. So please check that out. Okay. I am going to probably spend about 35 or 40 minutes here going through as I said a fairly rigorous overview of aging, demographics, and a myriad of I think issues that are very germane to this topic, and then we will have some time at the end of this call to make some comments and do some Q&A. I will acknowledge on the front end here that I don''t have all the answers. Clearly there are a lot of very, very knowledgeable folks on the phone with respect to ADA, work place accommodation and various sundry issues related to employment and disability, and so I think I look forward to collaborative Q&A at the end of this presentation. Okay. Let''s talk about the footprint of aging here in the United States. Those of you who have an outline that was sent ahead of time, please just refer to that. If anyone needs any of the materials, please contact Peter Berg, anyone with DBTAC after this call and we will be glad to get that information out to you. Most recent data that we were able to pull up from the U.S. Census Bureau from July of 2003 estimated that some 36 million people were currently residing in the United States who were 65 years of age or older which represents roughly about 12%, maybe 13% of the U.S. population. And just for the sake of argument, let''s say we have roughly 300 million people in the United States right now, maybe a little bit more than that, but for today''s purposes that will suffice. So 36 million people, that''s a -- not an insignificant number of folks, and when we really talk about people who are 65 years of age or older, what we typically do in gerontology and folks who deal with issues related to aging is to try to really categorize this group, this sort of homogenous group of folks who are 65 years of age or older into really three different categories. We refer to the 65 to 74 year age group as what''s often referred to as the young-old cohort. And for today''s purposes, this is likely to be the most relevant group that we are talking about in terms of folks who may actively be engaged in gainful employment and/or pursuing work, maybe needing work for various and sundry reasons, et cetera, and among the folks who would be from 75 to 84 years of age, we refer to those folks as our old cohort, and anyone 85 years of age or older we refer to as our oldest-old cohort. And what is really amazing here for me as a gerontologist and a person who has been involved in policy for many years is that, this generation that we find ourselves in, we are witnessing unheralded growth in elderly persons in our society that is absolutely without precedent. By 2030 it is conservatively forecast that we are going to double the numbers of folks who are 65 years of age or older to perhaps more than 70 million people by 2030 which would represent roughly 20%, 25%, maybe even 30% of the U.S. population by 2030. I mean that is just a jaw-dropping staggering statistic and has obviously a huge implications in a constellation of issues related to society, policy, et cetera. One clear issue here is the exploding health care costs as a result of this doubling of people who are 65 years of age or older is something that is absolutely unavoidable. And coinciding with this is the tax supported expenditures that target elderly folks such as Social Security, Medicare, Medicaid, other types of federal programs and state programs that target elderly persons and particularly when we are talking about healthcare expenditures will be dramatically impacted by this as well. One other I think really clear issue that we are going to be dealing with and grappling with is the explosion in the need for formal as well as informal care giving throughout our society. Obviously those of you not steeped in this sort of language of care giving, formal care giving would refer to skilled nursing, assisted living, perhaps you know 24/7 nursing home type care or perhaps at-home types of nursing assistance that would come in to help with the care-giving responsibilities, informal care-giving of course refers to typically family or other nonprofessionals who are providing care giving needs to elderly folks. If we are going to double the size of people who are 65 years of age or older, with the linear relationship between disability and aging, it certainly goes without saying that we are going to have a huge increase in the demand and need for care giving. And of course I think the really salient issue today here is the economic issue facing elderly persons as we double the size of a person 65 years of age or older while simultaneously dealing with loss of retirement benefits and programs, entitlement programs that are shrinking or just disappearing. Fortune 200, 500, Fortune 1,000 companies who are restructuring retirement benefit packages or programs, and perhaps absolutely just releasing or disavowing retirement programs is a very alarming trend and certainly something that indicates that vast numbers of elderly persons will be forced as an economic reality into situations where they will have to be participating in gainful employment. This is a phenomenal this reality that we are dealing with, and many of us are very fortunate that we are going to if we you know keep, stay healthy and stay in the game here, we are going to be able to witness this first hand. And so it is really an exciting time. The U.S. senior population really has grown rapidly throughout the 20th century, and it is remarkable in fact how fast and how profound the growth of persons 65 years of age or older has really been. In 1900 there were approximately 3 million persons who were 65 years of age or older or roughly 4% of the overall population, we had about 75 million people living in the U.S. in 1900. By 2003 there was some as I pointed out 36 million folks, about 12% of the population which is a remarkable increase in overall numbers of people at 65 years of age or older. And in fact the growth of older persons in the population here in the United States has outpaced the growth of the total U.S. population over the past century in every age group, and it is forecasted that this will continue to do so and even at an accelerated pace over the next 30 to 50 years, so this is a very, very relevant topic and something that I am pleased to always be able to have an opportunity to get this message out there. There is a good friend of ours who we have done a lot of presentations with over at Georgia Tech at CATEA who works with Provident Unum, and Ken always refers to the growth of older persons in society as literally as a tsunami, and I think that this is a very apropos way to phrase this. We are going to see a doubling in total numbers of people who are 65 years of age or older. This is just fantastic, this is a very unusual situation. And this is really a direct result of the unique demographics bubble if you will of Baby Boomers that entered into U.S. population post World War II. Of course this Baby Boomer era, this 18-year interval if you will from 1946 to 1964 represents this incredible influx of persons into the U.S. population, and ever since really Baby Boomers started to make their appearance in 1946, we have dealt with interesting demographics realities: not enough schools, elementary schools, middle schools, high schools, just huge issues in terms of getting these people into society, into the work place, colleges, et cetera, and so this is a continuing on throughout as they move into the senior phase of their trajectory, and something that I think that we have dealt with over and over again. This is clearly something that is new, novel, and something that we have never really dealt with before. And perhaps among this remarkable growth of older persons in society, the most significant footprint among these elderly persons is the unheralded growth of person who are actually the oldest-old, if you recall I referred to that cohort a minute ago, those persons 85 years of age or older. In 1900 persons 85 years of age or older were virtually unheard of, less than 1/10 of 1% of the total U.S. population, maybe roughly 100,000 people. By the year 2000 this had increased a dizzying 42 fold to some 4.2 million people who were 85 years of age or older. It is just remarkable, and to go even further, if we look at people who are actually 100 years of age or older, or what we commonly refer to as centenarians, this number has increased dramatically as well. Of course once we start really getting to the very edge of the stratosphere in terms of our population footprint of elderly persons, we kind of run into the issue of sketchy or dodgy local vital statistics information, birth records, et cetera, but nevertheless we have a pretty good handle on folks who are 100 years of age or old in the United States, and we have roughly 50,000 or so centenarians currently alive which is really remarkable, and represent a particularly fascinating area in terms of looking at factors related to health, longevity, activity, engagement, what were the perhaps benchmarks in the indicators that seemed to really set these persons in a particular category of long life and successful aging as compared to their counterparts, and it is just a remarkable area. I have to tell you gerontology is just, this is a really hot area right now. There are very few sure things in life. One sure thing is policy or any type of activity involving elderly persons in the next 15 or 20 years, I am telling you. Let''s talk a little about some theory here because I can throw statistics at you guys all day long, but I think having some theoretical framework to try to understand where we are going with this kind of helps us I think grapple with some of these social and policy issues that we are going to talk about. Biologically obviously we can look at a lot of different issues related to aging and how we explain this whole process of how we move forward, Program Theory suggest that cells replicate a specific number of times, and that is basically it. There has been a lot of work looking at this, looking at, and various sundry issues in terms of extending the overall life of replication within cellular activity. Error Theory of course would be that the structure of DNA is altered as people age, this is a process of transcription and translation malfunction and that this ongoing error is demonstrated and foisted upon our systems through manifest indications of aging, illness, disabling conditions, et cetera. Free Radical Theory, of course, cell membranes are exposed to radiations or free radicals, and this has a negative impact on cell membrane and cell structure. You know these biological theories, I think all of them have some real validity here. But of course that is drilling into the well so far that you can''t really pull the lens back and see what the actual issues of aging have perhaps in a larger social sort of perspective. I am a social scientist and a gerontologist by training, and I think it helps perhaps look at it in more of a social level rather than drilling in so hard into the cell. One of the perhaps standard theories that were put out there for many years and has really been I think widely has been discredited at this point but still has I think a lot of sway for a lot of folks is this idea of Disengagement Theory, that aging is an inevitable universal process that we all go through, and that our identities and our roles in society change in a profound way from middle age and middle adulthood to when we become seniors, and that we as elderly persons of society are expected to essentially make way for younger members of society, to withdraw from our active engagement in activities, gainful employment, et cetera, and basically quietly step to the side as the younger generations come up. This sort of slow process of disengagement suggests that we willingly acquiesce and go quietly to our rocking chairs and then eventually to our graves. Obviously, Disengagement Theory is a very structural sort of concept and what I would suggest to you very immutable, almost deterministic and easy to discredit. Nevertheless, a lot of folks still claim that Disengagement Theory is really the way to explain this whole process of aging from a social and policy perspective. Another theory that has often been put forth and I think has a lot of merit, Age Stratification Theory suggests that where you are born into, the location and position within society, and the strata or the stratification of society, based on many different benchmarks, racial or ethnic affiliation, gender, your access to social economic means, educational attainment, where you live, if you live in a rural or live in an urban area, access to healthcare, are all vitally important throughout the life course, and so your ability to access opportunities structure, to have adequate healthcare, to engage in education and acquire the training necessary to be involved in professional types of activities or vice versa, not to have that opportunity, directly shapes and influences a person''s life and indeed influences large numbers and groups of persons. So what we are talking about here, I guess, an example would be a person who perhaps does not have access to graduate training or perhaps did not even get through high school, once they get through to the later years in life where they are a person 65 years of age or older and does not have a great deal of perhaps experience in professional types of gainful employment or has worked in perhaps sort of the lower end sector of the economy, is likely going to have a much more difficult time locating and participating in gainful employment as a result of their job prep, their job training, experience, et cetera, and a lot of this has to do with directly with what they were exposed to as they went through the process of their life trajectory. So perhaps more even Marxist perspective which follows on this Age Stratification Theory which is really put forth by Carol Estes and a lot of folks who subscribe to this political economy of aging say that the means of production and particularly if you are a member of an at-risk group that has historically has been marginalized economically or on the periphery of society, functions as a profound social force that can combine to marginalize and restrict particularly minority and particularly women to access of societal resources. And so what we are talking about here is discontinuous work patterns, limited occupational structure and opportunity that was available for particularly for females, particularly for females of color historically who are now retired and find themselves without any retirement benefits perhaps not paying into Social Security, perhaps living in economic marginality for a large portion of their lives, find themselves now really behind the 8 ball in terms of access to resources, et cetera. Political Economy of Aging Theory a very interesting theory. Along that same line is what we refer to as double jeopardy or the notion that the interlocking nature of various issues that marginalize people, particularly combined with minority racial membership puts elders at further risk of economic marginalization, so a person who may be minority and also a female and a person who likewise lives in a rural community where opportunity structures, health care, resources, et cetera, are very limited or just simply not available may find themselves at double or triple multiple jeopardy for negative social or personal health outcomes. So these are just some of the highlights of some of the various social theories that I think are out there, and I think that they all can really kind of help serve or help us couch this discussion of aging in an interesting way. One last theory I would like to point out. Robert Atchley suggested with this idea of Continuity Theory: that persons who are best able to adapt and modify their lives as the inevitable change in life happens and as we go through role transitions as a process of the adult experience that we go through typically will demonstrate a higher degree of ability to deal with change and come through that process of redefining role and identity, much better than those folks who have not had to deal with that, so it almost says that persons who have dealt with adversity, people who have had to deal with sort of a lot of change in their lives and have successfully managed that are often better suited for dealing with life and issues that will impact you as an elderly person than those persons who perhaps have not had that and had a much more static experience throughout their life course. I dont know, I think that is an interesting theory as well. Okay, so enough for theory right now. I don''t want to blow your circuits completely today but I think it does helps to kind of couch this in a theoretical model. People in the U.S. are living longer, and for a lot of folks living without as much co-morbidity or disability than ever before, but of course there are some I think countervailing themes going on here. Remember in 1900, the life expectancy was roughly 47.3 for those persons who were born in the year 1900. For persons who were born in the year 2000, eight years ago, the life expectancy is 77.1. I mean that is remarkable increase in life expectancy. Now of course part of what is driving that the lower life expectancy in the year 1900 which is 47.3 was elevated infant mortality rates, but nevertheless we have really seen a remarkable expansion not just in the numbers of older persons in society but how long they are living. So this suggests that there are a lot of issues that directly impact these people''s lives that go very, very long into the distance here. So one I think issue though that we have not been able to really avoid or that we have to grapple when we talk about life expectancy are differences in life expectancy across racial or ethnic lines as well as between sexes. In the year 1900 the life expectancy was 47.6, and females would typically live two years longer than males, 48, about 48, males would have a life expectancy of 46. But if we were to look at that across racial groups here, there are great disparities in the year 1900 between males and females and between race, white and black, and in fact there was a life expectancy deficit of some 14.6 years between whites and blacks in the year 1900. The life expectancy rate for whites was 47.6 in the year 1900. The life expectancy rate for African-Americans in 1900 was 33, 14.6 year difference. This is a remarkable and very troubling historic difference between these two racial groups. Now if we look at the year 2000, we have really closed the gap quite a bit in terms of racial differences and life expectancy, but we still see a very troubling life expectancy deficit. If we look at for both sexes among white persons born in the year 2000, the average life expectancy is 77.6. Among African-Americans born in the year 2000, the life expectancy is 71.9, so we still have a life expectancy deficit of 5.7 years. Now, what does this mean for today''s conversation? Well, simply that the reality embedded in aging and in our society is that we have some fairly significant differences in terms of poverty rates, educational attainment, participation in occupational structure, and indeed certain very basic vital statistics benchmarks such as life expectancy, so this is something that suggests that we really do need to attend to this and pay attention to that. One other issue here with respect to gender and life expectancy that I wanted to point out, and I think is very germane to todays discussion, is the fact that women outlive men by an average of 5.4 years, this is of course based on the latest 2000 U.S. census data, and by the year 2000, the way this works out is, it is a very asymmetrical distribution of males and females. In the year 2000 there are 81 males to every 100 females who are 55 years of age. In this asymmetrical structure of male to female ratio becomes far more pronounced at advancing age at persons who are in the oldest-old cohort, 85 years of age or older, the ratio is 49 males to every 100 females. So what does this mean? Well this means a lot of things I think that negatively or potentially negatively impact older females and the experience of aging because men are generally older than their spouses at the time of marriage, and the fact that women have higher life expectancy, it is clear that a much higher proportion of elderly women are widows and thus find themselves living alone. And this has a direct influence in terms of issues that impact aging females, higher tendency for institutionalization, because there is no spousal caregiver to provide care for that female, experiencing reduced income because the husband has passed away, reduction in perhaps pension benefits, retirement benefits, et cetera, and thus older females are much more likely to likewise live in poverty as a result of this reality of how they will outlive males. So this likewise suggests that older females may find themselves in situations where they are forced into gainful employment as a last recourse to avoid the reality of poverty or lack of resources. Very significant issue there. Okay, we are going to jump over mortality. I know I got some of that information provided to you folks, but for the sake of time we are going to jump ahead a little bit on our outline. And we are going to talk a little bit about primary and secondary aging, so please refer to the paragraph on primary aging. And this one refers to the normal process, the physiological changes that are typically associated with aging. And we know that there is demonstrable decrease in functional cell mass in every organ that begins to become measurable and pronounced by the age of 30. This is an inevitable process of our bodies going through the physiological changes of aging. And it has been suggested that a gradual and steady decline in cell and organ function is a very normative experience that we go through and that by age 75, physiological structures have lost approximately 50% of their original functional capacity. Now of course if there are any biologists on here or physicians, I certainly know that this is subject for debate. But I think it is widely accepted that organ function does decline in a very steady process that is considered to be a normative process of aging. So what we are really dealing with here is this idea of diminishing functional reserve potential. In other words, as we lose functional capacity when we do have an injury, when we do have a trauma to the system, at what point do we lose capacity to compensate for that and start to experience perhaps less satisfactory health outcomes and disabling types of processes as a result of this process of aging. So that''s what we refer to as primary aging. Secondary aging would be defined as an accelerated process of aging that occurs from perhaps preventable or otherwise modifiable circumstances, right, cardiovascular and cerebrovascular disease, diabetes, smoking, poor nutrition, risk factors in lack of exercise all can contribute in this process of secondary aging to expedite or facilitate primary aging in a very negative way, so obviously preventative healthcare and behavior modifications are clear mechanisms that we deal with this. Now one reality of aging that we haven''t really gotten to yet is this issue of chronic illness and impairment. Chronic illness and impairment are among the leading causes of disability among older persons, and when we talk about the ADA, and when we talk about voc rehab and placing people into gainful employment and work place accommodations, often times we make distinctions between people who are perhaps born with a disabling condition or have onset of a disabling condition that occurs some point earlier in life where vocational needs are clear and appropriate modifications and strategies can be utilized to help compensate with that. But when we are talking about adventitious onset of disabling conditions, primarily as a result of aging, what we are really talking about here are perhaps a group of people who have not had disabling conditions throughout the majority of their life as an adult but rather as an onset later on in life, and so are thrust into the situation without perhaps the skill, the knowledge, the understanding, and indeed the identity of themselves as an individual who has a disabling condition, and perhaps doesnt have the intuitive understanding of voc rehabilitation, the various and sundry elements that we have out there in society to provide help and assistance to navigate through the system, and so it becomes a real issue here. Obviously, chronic illness can negatively impact the quality of life, can compromise independent living and community dwelling status, and likewise imposes or represents significant economic burden on people, individuals and families. It has been estimated that 80% of people 65 years of age or older have at least one chronic health condition and some 50% report two or more. So this is significant related issues. Arthritis being one of the most common areas of chronic illnesses reported by persons 65 years of age or older and represents literally a constellation of potential issues that negatively impact a person''s ability to perform daily activities or to be involved in gainful employment, from fine motor related issues to overall mobility, et cetera, arthritis represents a significant problem. Another chronic illness that is absolutely just epidemic out there is hypertension, often accompanied with circulatory disease, et cetera, and is literally one of the real big issues facing a lot of elderly persons in our society. Unfortunately referred to as a silent killer, not often readily noticeable until perhaps a long-term duration of this disease process has been in place, significant issue. Obviously heart disease and cardiovascular issues are commonly seen as chronic illnesses as well, and can clearly impact overall health and well-being, morbidity, et cetera. It is a huge issue. Diabetes is another huge problem, I can tell you from the VA side of the house, we have millions of folks who are at risk for diabetes or who have been diagnosed with a diabetic condition and represents significant potential for disruption of function and overall health in a lot of different areas, so chronic illness is a very, very significant issue, obviously osteoporosis, et cetera, so we really have to face the fact that we are dealing really with a lot of chronic illnesses among elderly persons. One area in particular of chronic illness and impairment that I think is particularly relevant for today''s discussion among elderly persons is the proliferation of sensory impairment including vision and hearing loss, and this is a very commonly experienced sensory loss among elderly persons. While persons who are 65 years of age are only about 12% of our population, roughly 36 million people, over 37% of these folks are hearing impaired, and some 30% of persons 65 years of age or older are visually impaired. This represents a significant issue. And in fact, hold on one second here, I have got a little power point issue. Vision impairment is really considered to be primarily an age-related problem. The prevalence rates by age are just stunning. Persons from 0 to 54 years of age, 6/10 of 1% are 20/50 acuity or worse, but person who are 85 years of age or older, some nearly 22% of these folks are what we refer to as low vision or folks who have acuity at 20/50 or worse. In most states, if you have acuity of 20/50 or worse you are no longer eligible to drive your car, so it is a very significant issue. And historically we know particularly persons who are visually impaired have found it difficult to obtain employment. And according to statistics from the American Foundation for the Blind, 46% of visually impaired adults aged 18 to 69 are employed along with 32% of legally blind adults in that same age group, and this is significantly less than what we would see among even disability groups, so persons with vision impairment represent a particularly underemployed or unemployed group of persons with disabilities, so it is a significant issue. Let''s get to the slide. I only got a few more minutes here for this portion of the discussion. Let''s get to the slide or the area of this discussion labeled Aging Into Disability because I think it is another issue that is important for a lot of the folks on this call today. As I have said several times here, with the increase in life expectancy, the amount of time an older person is likely to live with a disability is very likely going to increase. So one of the things that was really in vogue some years back and pushed really hard by geriatrics and folks in gerontology was this concept of compression of morbidity, that is with appropriate healthcare, better nutritional awareness, and behavior, risk behavior modification, people would continue to age, and we would be able to manage this onset of disability as a function of a chronic illness in aging and that people would live to advanced old age and only experience perhaps morbidity or illness, chronic illness at the very last stage of life, in other words, compress morbidity or illness to the very end of life, and perhaps maybe 18 months or so hopefully even less, of really significant chronic illness before we get to the end of our lifespan. But unfortunately this compression of morbidity concept really does not appear to be happening. In fact, data suggest that beyond a certain age, many people living longer does not necessarily mean that they live healthier, or more active, but that we do have a lengthy period of chronic illness and disabling condition that we live through. In fact, the longer we live the greater likelihood that we will spend an increasing percentage of our older years living dependently rather than independently. Not that is a rather sobering comment. And given the fact that we have this explosion this enormous tsunami of elderly persons in the next 20 or 30 years, I think really resonates with a lot of people. This is a significant issue. So we really sort of moved from this concept of compression of morbidity to a sort of a newer kind of idea or understanding of aging into disability, and that is this idea of successful aging, and so what we are saying here is that successful aging is a term that is best described as the ideal physiological and psychological aging outside of the impact or the intersection of disease. And so you know that it is a process where we try to separate out what is statistically normal from what is a group of people who seem to really, really do well and successfully navigate this process of aging without really succumbing to illness and what is it in terms of their life, their exposure, their behaviors, their genetic predisposition that seems to benefit them and allow them to enjoy the fruits of this successful aging as compared to their colleagues who perhaps do have chronic illness, et cetera. And so this is really sort of where we are going in terms of trying to understand reduction in disability among certain groups of elderly persons, so it is an exciting area, and I got to tell you that the next 15 or 20 years is just a remarkable time for persons who are involved in aging and in gerontology related areas. Let see now, we got just a couple more issues that I wanted to talk about. One final issue is the social implications of aging. Now, the reality is that poverty rates among persons who are older in our society have actually declined over the past 50 years as a function of the Social Security Act and various sundry legislation that has been put in place, policies, et cetera, that have helped to reduce overall poverty rates for older persons in society. In 1959, 35% of persons 65 years of age or older lived below the poverty line. In 2003, this has decreased to some 10%. That is a remarkable decline in the overall amount of poverty being experienced by elderly persons in society. However, older women and particularly older women of color are far more likely to live in poverty than their male peers for many of the reasons that I have already discussed. Older white women living alone experience poverty at 17%, older black and Hispanic women living alone experience poverty rates as high as 41%. Now that is a remarkable distinction in terms of racial affiliation and the prevalence of poverty. It is remarkable and troubling finding. Future implications of aging in the U.S., well, this is just a rehash of what I said at the top of my lecture here, this unheralded phenomenal growth in older persons of society really represent a lot of areas that we are going to have to deal with. As I said from the beginning of this discussion, huge and absolutely exploding healthcare costs as a result of this much larger group of elderly persons of society is absolutely inevitable. Tax supported expenditures that target elderly will dramatically increase, and the demand for that will be profound and clearly with concerns and respect to the solvency of Social Security as well as available funding from Medicare and Medicaid will be significantly taxed and stretched. So we are obviously very concerned about this, and what this really means for society at large. Formal and informal care-giving needs once again will be very significant. And to make one final point about this informal care-giving issue, one can certainly imagine a situation where we have a dyad, a married couple where perhaps one person is requiring a great deal of care-giving being provided by the spouse, informal care giving, and perhaps there is economic marginality or the need for employment. What often happens is that, the person who is having to provide that informal care giving, that family member or that spouse often times is indeed forced out of gainful employment because they have to spend time at home providing care to the care recipient. This can obviously have a cascading impact in terms of the economic wherewithal of that particular situation. And obviously as I said several times, the reduction of retirement and pension benefits, that seems to be a very troubling and all too common trend that we are experiencing in the United States here. Likely is going to continue, and thus forcing many older persons back into the workplace as a result of just the economic reality they find themselves in. The linear association with aging in chronic illness and disability is very clear, so, and likewise the advantageous nature of illness and disability among older persons suggests that for many people who are aging into a disability as a function of this aging process are going to be very naive and novice in terms of understanding how voc rehab works, how to facilitate that, how to negotiate that, and persons who may be 65 years of age or older may be up against institutional barriers and bias from the support structures we have in place just because these policies perhaps focus only on what we have historically referred to as persons of working age or gainful employment age, employable age. So there is a huge amount of issues I think surrounding aging, disability, and employment, and hopefully some of the stuff that I have hit on has resonated with you folks and has kind of got the creative juices flowing. Obviously I have a lot of references and material that I have begged, borrowed and stolen from here, and as indicated in my reference list and would be delighted to provide anyone a copy of these, the outline notes if you are so interested. With that I think I will kick it back to Peter Berg for Q&A.
Alright, thank you, Dr. Williams. At this point I would ask the Operator to rejoin us so he can give folks instructions on how to ask questions.
Thank you. Ladies and gentlemen, if you would like to ask a question at this time, please press the one key on your touch-tone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the pound key.
Dr. Williams, while we are waiting for questions to come in there, one thing that just popped in my head when you were talking about some of the barriers that older individuals may face in terms of accessing rehab services and so forth, relates to identity. I know that as my parents got older, you know, they viewed themselves with a loss of vision and loss of hearing, and their mobility not being what it was when they were you know 20 and 30, just viewed that as part of the aging process and getting older, and in terms of you talking about older workers or individuals needing to stay in the work place, stay in the workforce longer because of financial needs you know in terms of identity, you know what sort of impact for employers, where these individuals with this current generation that is getting older, are they going to be individuals who identify themselves as having a quote unquote disability and seek out accommodations or what sort of impact in that area?
Yes, that is a great question and certainly something that we have to speculate on, but one issue here that I think is really important to keep in mind here, is that 18 year interval, that Baby Boomers generation, 1946 to 1964, that really comprises who we are talking about in the next 20 years, and this has historically been an unusual group of people who have been very loud and very clear about their needs for their generation and for their cohort historically. So this is not going to be our parents or our grandparents generation of elderly persons that we will see here, and so I would suggest to you that in terms of understanding and embracing this idea of identity as an elderly person, particularly a person who maybe aging into a disabling set of realities or chronic illnesses, this is going to be different. I think the idea of a more active robust vocationally-involved elderly person is much more likely going to become a thing that is not an unusual event but rather something that becomes a normative structure in society just by the sheer fact that Baby Boomers have always approached things I think differently and more independently, so I don''t know, but I would -- I am optimistic that we will see I think a redefining of what appropriate behaviors and activities engagement elderly persons are involved in. And in 25 years if we were to have this phone call, I would hope that we would agree that, yes, we have seen some profound changes in terms of what is expected, what is anticipated, and what people actually are engaged in, so we will see, but that is just actually a very, very good question.
Very good. Operator, could we have our first question, please.
Yes, sir. Our first question.
I think that would be me, then?
Go ahead with your question.
Hi, I am here in Springfield, Illinois. I have a general question and kind of a specific question. I am very new to this type of meeting. I have never dealt with ADA before except for the fact that I am physically disabled. I am a totally blind person. I am 51-year-old and I work for the State of Illinois as a microfilm operator. My general question is, I have heard that the Americans with Disabilities Act has been watered down so to speak in the last few years and that there is evidently some legislation out there that is supposed to be a restorative for the ADA. I was wondering if that is the truth, if those things are true. And then my specific question is, with the influx of veterans, a lot of veterans, they are not getting killed but they are becoming highly disabled, I wonder if the influx of veterans is going to have an effect on how the elderly are going to be dealt with when it comes to ADA because as you said with populations exploding, the last thing elderly people, I mean, this is just my logic, the last thing that elderly people would want to see is a bunch of young soldiers coming in with super disabilities because then the money is going to be harder to divide up and be tighter. And those are my questions, if they made any sense.
Okay, I appreciate that. What I would like to if you could put your phone on mute, I appreciate that. The first question obviously, Peter, you are going to have one of your experts field.
Sure. The first question, you know there have been Supreme Court rulings over the past five to ten years which have refined and the definition of disability and who is covered by the ADA, and there is a current legislation in Congress, an ADA Restoration Act that is proposed to reflect the original intent of Congress as to who is a qualified individual with a disability under the ADA. I would suggest for purposes of today''s conference getting information on that we do have an archive of a past session, specifically on the topic of the ADA Restoration Act, and you can listen to that audio archive by visiting the www.ada-audio.org website to get a good perspective on that piece of legislation and where it currently resides.
As far as the second question with respect to returning service members who have been injured in the global war on terror, and I guess with respect to the two active theaters in Iraq and Afghanistan, I think it is clear we have had service members who have been injured and have returned back state side and have required rehabilitation, et cetera. I would suggest to you that, A, the Veterans Health Administration and the Veterans Benefit Administration are working very hard, tirelessly to provide appropriate services and opportunities both through our rehab programs, our very extensive poly-trauma network of care and other rehab entities as well as our basic healthcare service delivery mechanisms and through our internally through our own veterans vocational rehabilitation program and benefits program to meet the needs of those service members who require assistance. Clearly a very significant concern that we have here, but I can tell you that I don''t anticipate the influx of folks who have been injured in this current global war on terror represent any type of a significant concern in terms of having resources diverted from other folks who represent individuals with disabilities in the civilian population. I heard that concern expressed in the past, and I don''t really feel that is something that is really something that has a lot of credibility, and rest assured we are spending a great deal of time and effort trying to meet the needs of our brave men and women who have come back from overseas with an injury and the VA is doing everything that we can with the collaboration of the Department of Defense to meet the needs of these folks. So, I am not sure if that answers your question completely, but that is the way that we see it.
Sure. In the archive of the ADA Restoration Act was from May 15 of 2007. So you can visit the Audio Conference Archive Section to get information on that. Operator, may we have our next question, please.
Yes, sir. Our next question.
Go ahead with your question. If you are on a speakerphone, if you could pull the phone closer to you or pick up a handset so you could hear more clearly.
Yes, I am in Ohio here, I would like to ask if Dr. Williams would expand a little for us on some of the exciting developments we hear in the field of gerontology that comes from research in stem cells. Whether this be biological improvements, we hear things like the elimination of diseases like diabetes, there are just infinite possibilities and it seems to be an uplifting topic in the potential and I would be interested in your background if you have any perspectives on that.
That is a great question and I got to tell you that it is not really my area of expertise and I don''t feel qualified to really address that directly. I would, I do have colleagues who I could direct you to contact directly for that level of information, but I feel that I would do this call a disservice if I launch into a sort of discussion of that given my somewhat modest knowledge in that area. I will say this however, that indications are that stem cell research perhaps will be getting increasing amounts of energy and shall we say inertia behind it in coming months and years. And so we can certainly look forward to that, but I just don''t feel comfortable going into any lengthy discussion with respect to that, sir.
And we have one question that was submitted electronically. This individual wants to know if you are aware of any employers or industries that are looking to address the increased accommodation needs of older workers who are going to remain in the workforce longer because of financial needs.
Well, I don''t know about employers per se. I know that there are numerous organizations and advocacy groups who are looking at this, clearly AARP being one of the sort of arbiters of the advocacy for older persons in society. But I think that some of our more classic groups that are advocates for individuals with disabilities likewise American Foundation for the Blind, et cetera, see this as a very germane issue that needs to be dealt with. I know that there are certain companies out there who have addressed this as a legitimate issue that needs to be really addressed, and particularly when we are talking about access to computer technology and ability to perhaps have magnification or perhaps speech text types of screens, et cetera, to help facilitate persons who have perhaps vision issues, particularly. There is a low of work in that area, but there are I think a lot of advocacy groups that work with older person who have addressed this as a very significant issue.
Great. Operator, may we have our next question, please.
Thank you. Our next question.
This is the Captioner. This is a question coming from the ADA in Indiana. Has there been any talk of increasing funding for older worker programs for low-income folks and are those programs working collaboratively with the VA and other groups to learn how to provide accommodations and things of that sort?
Yes, I am going to have to refer to Peter on some of that because, Peter, you will probably going to have your finger on some legislation particularly through your vast network of folks with respect to any new funding opportunities.
Right, yeah. At this point I am not aware of any new or pending legislation that would provide additional funding for older workers or older individuals.
With respect to the VA, the VA clearly recognizes the vocational needs of our group that we work with, our veteran population who -- that we work to serve. And there has been continuous effort to try to address the vocational and rehabilitation needs of persons that we serve, particularly elderly folks, and it has been acknowledged that vocational needs and employment needs requirements are out there for person who do have disabling conditions, and the VA does spend a lot of time and quite frankly a lot of resources trying to meet the needs of these folks. Unfortunately I really can''t address the state vocational rehab issues here. If there are any folks who represent state vocational rehabilitation entities who have pilot programs or any new areas of activity that do specifically target older individuals with disabilities, please jump in on this conversation and this particular question.
Alright, great. Operator, may we have our next question, please?
Our next question.
Yes, I would like how to know just in terms of, Michael, how you are looking at models. If you are drawing from any models that are international such as the Scandinavian countries or China, and how they are setting up or dealing with their own tsunamis, where are we drawing from to create policy and programs and directions other than the United States?
Right, that is a fantastic question and clearly you have zeroed in on probably a very significant Achilles heel of this particular set of data that I have pulled together and policy thrust throughout my lecture. There are models, European models out there that deal with this, and indeed the tsunami if you will of older persons of society is not something that is solely being shouldered or experienced here in the U.S. This is a global phenomenon in many countries around the world, in Asia, and in Europe, elsewhere. That is a great question. And we know that there are differences, clear differences in terms of the homogenous nature of certain societies in terms of issues that impact them, that really are not easily translated to the unique aspect of aging and the composition and demographic reality of aging here in the United States. However, you raise really, really good points. Largely a lot of the policy thrusts and emphasis here in the United States has really been driven from a domestic perspective, and we don''t really borrow from lessons learned or policies perhaps that are in play in Scandinavian countries or Asian countries, and I think we would be very -- we can learn a lot from that process because there are I think strategies in place that are novel. Of course, part and parcel of this is the way that we have structured our healthcare systems, our systems of support and care that are in place to facilitate persons who may have needs that are or organized in different ways than what we have here in the United States. But you raised a great, great point, and I think that we can all as folks looking at this issue of aging and policy benefit from expanding the petri dish, if you will, of policy experiences from beyond the borders of the United States.
Great. We have another question that was submitted electronically, and it touched on this at the end of your presentation. This individual wants to know what are the most prevalent impairments that present barriers for older individuals remaining in the workforce?
Okay, that is a very good question and I intentionally sort of avoided going into that at great length because I was running out of time, but I would certainly be happy to revisit that. It will take me a few minutes. Do you want me to go there, Peter?
Okay, obviously as I mentioned earlier, arthritis represents a very significant issue in terms of chronic or degenerative type of impairment that has a direct impact with respect to participating in daily activities, perhaps mobility, fine motor skills, et cetera. Often times with arthritis it is more commonly experienced obviously in among elderly and clearly seen more often in women. Damage to the cartilage and surrounding areas can lead to joint weakness and instability, and depending on the location of joint involvement can interfere with a significant myriad of daily activities and tasks. That is a very significant issue. Let''s see here. And in fact the most common chronic conditions that people age 65 years of age or older experience would be arthritis, hypertension, cerebrovascular or stroke-related CVA types of situations, neoplasms or cancers, diabetes, and of course coronary heart disease is another very significant footprint. And any and all of these can have significant impact in terms of daily function, participation in gainful employment, et cetera. So there is really just a kind of a litany of chronic illnesses and conditions that older persons are much more likely to experience and deal with on a daily basis that can clearly have significant impact in terms of daily functioning, independence, and participation in gainful employment. And as I said before, another really significant issue here is this issue of folks who have sensory loss such as vision loss or hearing loss or the dual sensory types of situations where we see a situation with people having vision difficulties as well as hearing limitations and that intersects to create an even higher level of disability or impairment for folks. One area and if I got a couple of minutes here since we are on the topic that I really did not I think adequately deal with was persons who have a disabling condition who then on top of that disabling condition are also going through this process of aging. So rather than aging into disability, you are aging with disability, and that is really an interesting area. Until recently individuals with disability seldom had or experienced life expectancy as their peers who did not have disabling conditions, and so persons who do have, perhaps persons who have mobility limitations or perhaps use a chair or various sort of functional limitations along that track often have secondary medical conditions such as respiratory illness, renal failure, we note a higher level of depression among this group. And the issue of general lack of adequate overall primary medical care, but we have seen really significant advances in terms of expansion of life expectancy and decline in overall secondary medical conditions that are relevant to the experience of folks who are aging with a disability, and this is really I think been a very positive situation that we are dealing with. So I don''t know if that answers your questions directly, but I think that those are sort of the highlights there.
Sure, alright thanks. I think that you talked about the sensory impairments, obviously a barrier there is access to information and technology which is widely used in business.
Well, let me say this, Peter, the ubiquitous nature of written information and the way that we use communication in such a vast and ever-present sort of daily activity represents a remarkable barrier for people who do succumb to vision impairment, particularly folks who don''t have experience with negotiating or dealing with this loss of vision and have not had appropriate rehabilitation or training to augment what existing vision they have. And so particularly for people who are aging into this disabling condition, the sensory loss, where they don''t have perhaps the knowledge or the wherewithal to get a computer that has a text screen reader or scanner with an OCR attached to it, really are behind the curve here in a very dramatic way and are often forced out of gainful employment as a result of that. And once again it is this folks who are aging with a disability who perhaps have had a great deal of knowledge and experience negotiating in navigating through voc rehab and understand that process of reasonable accommodation and understand what the ADA is all about, really have an advantage over their colleagues or their contemporaries who are aging into a disabling condition who really have not experienced that. So once again, there is a great need here for disseminating that information, making that information widely available, for persons who find themselves now thrust into a situation where they do have a disabling condition. And once again to get to the gentlemen''s point earlier, I think it was from Springfield, we do have an interesting situation with these Baby Boomers who we are talking about now for the next 20 or 30 years who represent this elder population. I think that we do have a different group of people who are going to be much more vocal, much more willing to be advocates for themselves and pursue strategies that available for them, and we can certainly only hope for that. I think most of us on this call are in that camp already, and so we will see. Anyway, great question.
Excellent. Operator, may we have our next question, please.
Our next question.
Hi. Just like to go back to the person who asked about do you know of any employers that are providing accommodation or planning to. Under Title I of the ADA, a Title I entity which is employer is obligated to provide accommodations. In fact, here in Raleigh our center for independent living is working with a consumer who works for a large hospital, and they caught the vis, of the hospital that is, in providing the accommodation for a screen reader but also they are going to - they are looking towards the future in terms of providing it throughout their system so that their base of employment, our employees, can grow from the communities. So that people who are aging with disability and becoming low vision, for example, and in this particular, they are beginning to see that they are going to have to address this issue and provide an accommodation and if they want an employee base, and this is the particular one that they are looking at right now, so they have a future vision, but as a Title I entity, all employers are required to provide an accommodation to their employee.
I just wanted to, but also, people are -- businesses seem to be catching on, and the hospital is also working with a manufacturer, a company that creates the screen reader, the Jaws, and to make sure that it works effectively with their system and so forth, so businesses are working with the technology out there and the companies that create it.
Okay. Great. Thanks for that point. Operator, do we have another question?
Our next question.
Go ahead with your question.
Your line is open.
I am listening to this, and it is all really fascinating. I guess my question is, can you talk a little bit about the new -- I see it as there being a need out there somewhat for marketing and education and for policy related issues to deal with some of the more societal issues around aging into a disability and aging with a disability because you are right when you say that people are less likely to have a job when they have a disability or that there are going to be certain functional limitations. An awful lot of this happens, you know, happens because no matter what kind of you know, technology the person knows is out there, when you walk into an employer and they look at you and they say blind people can''t do this job, or when they look at you and say, oh, my gosh, this person is you know 70 years old, and they are never going to stick around at this job, I can''t hire them, you know, that is not going to, whatever technology you have is not going to overcome that. As a blind person with a job, I know I am an anomaly. And you know likewise you got a lot of, it is that same attitudinal issue about disability that makes it so that a lot of people who are aging into a disability would sooner you know turn green and spit lobsters than identify as having a disability. And so you are not necessarily you know, there is a certain way of marketing the information about the services out there to people that is going to have to be a little different than the way you -you know it has been done for people who have had a disability all along. I dont like it, particularly. I think people should be able to wrap their brain around the idea of disability, but that is the way people are, and so I guess my question is there is a lot of talk about you know the functional issues around aging and what needs to be done about the fact that people get chronic conditions and, I understand that kind of research is really important, but could you address what needs to be done in terms of you know the problem that is not the disability because really when I, you know a lot of people with disabilities and a lot of older people when they go around in the world, it is not the disability that is the issue. It is the policy issues and the attitudinal issues and you know some of the education and marketing of ideas that needs to be out there for people that isn''t always being done.
I couldn''t agree with you more, and you know what you are talking about here is really sort of a multiple thrust or areas that we need to talk about. One is clearly an educational piece or dissemination piece, that this is not some sort of unusual event or occurrence, this is a very normal process. And so my one hope, my optimistic hope here, and I do have sort of a glass is half full approach here is that with the huge increase in the numbers of older persons who as a result of this process of aging are going to be experiencing disabling conditions in far greater numbers than we have seen before, this in and of itself will help to push the dialog if you will, the narrative much more front and center than it is currently. Secondly, with we certainly hope this new generation of Baby Boomers who are moving into these, this position of older persons in society, just the prima facea evidence alone of their advocacy for themselves and their very determined sort of way that they have lived their lives thus far suggests that many Baby Boomers are not going to go into retirement or go into this process of disabling conditions and impairment without kicking and screaming and demanding that accommodation be met and that needs be addressed. We certainly hope that is the case, but I agree we are up against a significant issue, and that is the issue that all of us I think deal with every day, and that is the inherent bias that many employers bring to the table in terms of lack of knowledge, lack of understanding, lack of willingness to hire or to work with persons who may require perhaps assistive technology to perform their job, perform their job as well or better than other folks. And so are we talking about do we need a bigger 2x4 here to effect some sort of policy a la ADA that specifically addresses older persons who may have specific issues in place or that need to be addressed? I really don''t know, and I agree with you though there are numerous question that are salient here and need to be addressed, but I really think that this Baby Boomers generation, not to denigrate or cast a negative light on older persons who perhaps represent groups that perhaps precede the Baby Boomers generation but in particular this Baby Boomers generation I think will be instrumental in really redefining the narrative and the myriad of issues that we will inevitably be facing here with older persons, and I am very optimistic about that. I would welcome any other comments, though, and Peter, if you have any thoughts on that, please.
Sure. No, no, I think that with her question and comments addressed that as well as you did. We have a few more minutes here. Lets see if we can get some more questions in before we get to the bottom of the hour. Operator, may we have the next question, please.
The next question is from the caption line.
This is the ADA in Indiana - speaking to "saving" Social Security, the good news is that average age at retirement has been going up pretty significantly (albeit due to changes in policy and to the need to work as much as the desire to work). For every extra year in the workforce, there is a 7% savings in the total cost of Social Security for individuals. Hence, public policy that supports retention and re-entry is a no-brainer. This would include better workplace accommodations and a shift from health care reimbursement policy from a disease focus (as in Medicare) to a focus on "function" - the case of hearing aids is a great example. Would you agree?
Absolutely. I think that is very well stated. And I think that once again would indicate a shift in policy from more of a healthcare mindset to more of one of maintaining position in employment and of providing incentives to encourage and augment that, so I would certainly agree with that.
Very good. Operator, our next question, please.
Our next question.
Go ahead with your question.
Okay. I would like to ask what kind of enforcement is being considered for employers that generally do not have the resources to provide reasonable accommodations. Is there a major education effort being conducted to parallel what happened when the ADA was passed?
Peter, I am going to have to punt the ball to you on this. I think you are far better suited to address that.
Right, right. In terms of enforcement, the federal agencies, the EEOC, Equal Employment Opportunity Commission, and state civil rights commissions that enforce employment laws; as far as education, you know you have the U.S. Department of Labor, Office of Disability Employment Policy that is out there you know working with employers and educating employers. You have the federally funded national network of ADA Centers that, who have a primary focus on employment and working with employers and educating employers regarding rights and responsibilities under the ADA, so there are definitely efforts out there. I am not aware of efforts going forward to begin to educate additional employers as this Baby Boom generation you know ages. There may be more accommodation needs in the work place than there have been at any other point. Operator, could we squeeze one more question in before we hit the bottom of the hour.
Again, if you have a question, please press the 1 key at this time.
Well, if we have gone through our questions, probably a good point to wrap up and let Dr. Williams, I want to thank you. Two things that I have popped in my head as we have gone through the session and in terms of the aging of the Baby Boom generation, and an employment, you know one is obviously increased accommodation needs that are going to be present, but also is the possibility of underemployed individuals with disabilities outside the Baby Boom generation who may be able to step in and fill some of the void as the Baby Boom generation begins to retire.
Absolutely. I think that those are two very germane areas that we will anticipate will be very important, particularly the issue of increased need for assistive technology and devices and use of strategies, et cetera, to help compensate for impairment and chronic disability. I just want to thank you guys for giving me the opportunity to get on my soap box and talk about this area. It is obviously an area that I am very passionate about and would welcome any additional questions or thoughts from anybody who has been out there in our audience today and also want to compliment all the folks who called in with or came in with questions today. They were all very, very good and solid questions, so, Peter, Robin, thank you very much, and do appreciate your time.
Absolutely. Dr. Williams, we appreciate your time. For everyone out there, again, in 10 to 14 business days from today we will have the audio archive and text transcript of today''s session available on the ADA Audio website. Please plan to join us in March on the 18th when we will look at The Nature and Scope of Discrimination in Hiring under the ADA. Once again, we will have Dr. Brian McMahon from Virginia Commonwealth University joining us. Brian is a Professor at VCU. He is also Director of the Center for Outreach and Research Coordination, the CORC, which works along with the Disability and Business Technical Assistance Centers, the national network of ADA Centers. You can get information on that by going to the www.ada-audio.org website. If you have any questions regarding the ADA or if you had questions that you did not have a chance to ask to Dr. Williams today, I would encourage to you contact your regional ADA Center by calling 800-949-4232, and we can forward any questions onto Dr. Williams. I thank all of you for joining us today. I hope where you are it is warm and dry and we look forward to seeing all of you joining us in March. Thank you.