There is growing awareness that the design of many nursing homes and residential care facilities for elderly people and people with disabilities can be improved. A growing body of knowledge supports the notion that improved design of living space has the potential to promote improved functioning among elderly people and persons with disabilities with physical and cognitive limitations and greater cost effectiveness in facility operation. With an increasingly aging population, and with greater protection now available for people with disabilities, the need for technology to create new and enhanced residential housing for these populations will increase.
Innovative residential care facility design, however, is frequently deterred by multiple competing laws and regulations at the federal, state, and local levels. Many existing design codes and regulations focus on the physical building, often ignoring the environmental impacts on residents, staff, and families. These codes and policies cause nursing homes and residential care facilities to waste money trying to get approval for, and often abandoning, design innovations that would benefit their residents.
This assessment would build upon OTA's report on "Special Care Units," which analyzed the competing regulations and interpretations of standards involved in constructing nursing homes and special care units (SCUs) for people with dementia. This assessment will: 1) examine literature on environmental features that foster adaptation and independent living; 2) discuss advances in housing design and technology (e.g., "Smart House" technology, computers as aids to independent living, speech activation systems); and 3) analyze government policies that promote or impede appropriate uses of design technology. The assessment will expand the population of interest beyond nursing home residents with dementia to include older people with a range of functional limitations and younger people with disabilities.
Project Director: Paula Bruening 228-6692.
Estimated publication date: Spring 1996.
Requested by: Senate Committee on Small Business, Subcommittee on Innovation, Manufacturing and Technology
Senate Special Committee on Aging
Concern about the preparation for work and careers of youth who do not go on to four-year colleges has been growing for some time. In the United States, we have primarily relied upon schools to provide this preparation. The assumptions have been that schools will motivate them to learn and provide them with the skills and education they need to be successful in the job market and in life. The large numbers of youth who do not gain skills and do not find stable employment until they are in their thirties seriously challenge these assumptions.
One major difficulty may be that youth do not see much connection between doing well in school and in careers. One way of making this connection could be to combine work and learning directly, in programs of apprenticeship and work-based learning that lead to good jobs and skilled careers. We know that young people entering today's labor market can expect to change jobs and careers several times, and that skills of thinking, problem-solving and cooperation are increasingly valued by employers. We also know that the success of strategies of work-based learning will ultimately depend upon the involvement of employers; this would be especially true if substantial components of learning were expected to occur on the job. We need to know what factors will affect the decisions of employers to expand good opportunities for work-based learning.
The School to Work Opportunities Act recently passed by the Congress and signed by the President has launched the nation on an experiment in school to work. States will receive major grants to rethink and redesign their strategies for preparing youth for work and careers. One of the major priorities of the legislation is to significantly expand opportunities for work-based learning. Proposals may be eventually advanced to develop large-scale systems of work-based learning through youth apprenticeships and other means.
The OTA study will assess alternative approaches to work-based learning, and issues of the feasibility of expanding opportunities for youth apprenticeships, tech prep (programs that combine high school, community college, and work-based learning), and other alternatives in the U.S. The issues will include:
Project Director: John Wirt 228-6786.
Estimated publication date: Spring 1996.
Associated publication: "Vocational Education: Good Jobs and the Economy" (BP), Spring 1995.
Requested by: Senate Committee on Labor and Human Resources
As the 21st century approaches, Congress and the executive branch have committed to fund research to determine the location of all human genese.g., as has been done for sickle cell anemia, cystic fibrosis, and muscular dystrophy. The Human Genome Project, estimated to be a 15-year, $3 billion project, has been undertaken with the expectation that it will improve genetic diagnoses and advance therapies.
In 1991, the National Institutes of Health (NIH) applied for patents on thousands of human DNA sequences of uncharacterized function, representing approximately 5 percent of all human genes. The move set off a storm of controversy in the United States and abroad, although the issues raised extend beyond the NIH applications. Who can "own" human DNA sequences and what must be known about a DNA sequence beyond the order of bases to permit patentability, if it should be permitted at all?
This assessment will 1) examine the arguments for and against patenting human DNA sequences of the type encompassed by the NIH filing, as well as an analysis of the degree to which "found" DNA sequences can be incorporated into patents; 2) discuss the social and ethical issues of ownership of human DNA sequences; 3) examine the effect of the trend to file early patents on research conduct, and whether the effect is different for U.S. scientists, universities, industry, national laboratories, the Federal Government, and international research collaboration; and 4) assess the legal and economic impacts of existing technology transfer laws on human genome research.
Project Director: Robyn Nishimi 228-6690.
Estimated publication date: Winter 1995.
Requested by: Senate Committee on Labor and Human Resources
Senate Committee on Appropriations
Senate Committee on the Judiciary, Subcommittee on Patents, Copyrights, and Trademarks
Publicly-funded long-term care services for people with chronic disabilities are currently provided by numerous Federal, State, and local government programs with diverse eligibility criteria. The eligibility criteria often pertain to a person's age, a particular disease or physical or mental condition, or the person's need for a particular treatment. These criteria define categories of people, each of which includes some people who do not need long-term care services. Other people who do need long-term care services are not included in the categories. Still others who have multiple physical and mental disabilities could be included in several of the categories but do not fit well in any of them.
Several recent proposals for long-term care reform are intended to provide services for people of all ages with severe, chronic disabilities. The proposals generally base eligibility on functional criteria, that is, criteria that measure an individual's ability to perform certain functions or activities. The most commonly used functional criteria are impairments in activities of daily living (ADLs), but advocates for some types of people with severe, chronic disabilities, including people with chronic mental illnesses, people with developmental disabilities, and technology-dependent children, point out that ADL criteria do not necessarily reflect the problems that result in a need for long-term care services for these people.
This assessment will identify the problems with ADL-based eligibility criteria for various client populations, review the eligibility criteria and assessment technologies currently used in Federal, State, and local programs that provide long-term care services, and analyze the pros and cons of various eligibility criteria and assessment technologies for identifying people with severe, chronic disabilities who need long-term care. The assessment will provide options to assist Congress in defining eligibility criteria for a Federally-mandated long-term care program to serve people with such disabilities.
Project Director: Katie Maslow 228-6688. Estimated publication date: Summer 1995. Requested by: Senate Labor and Human Resources Committee