The Social Security Administration and Abbott Laboratories are about to embark on an experiment to determine whether people with severe intestinal disorders, who can survive only through regular intravenous feeding, can be returned to productive jobs -- and thus can be removed from the Social Security disability rolls.
It is estimated that at least 200,000 Americans have such serious digestive problems that at some time during the year they must be fed through a process called total parenteral nutrition (TPN) to live. Some people need the intravenous feeding constantly, while others are fed that way for shorter periods when they have a spell of the illness.
Until recently, victims of digestive disease had to be hospitalized to receive TPN treatment, at a cost of thousands of dollars a month. Now treatment is available at home for half the cost, although it still can run up to $6,000 a month.
Social Security Administration officials say that the new home treatment methods open up the possibility that some patients now on the disability rolls could switch to home treatment at night and continue to work during the day.
But so far this hasn't happened much, primarily because of patients' concerns that their benefits could be jeopardized once they returned to work. The Abbott experiment is designed to respond to those fears.
In home treatment, a permanent catheter is inserted into a major blood vessel of the patient. When the patient feeds himself, he prepares a solution of the necessary nutrients and then inserts it through the catheter with an electronic pump. The procedure can even be performed overnight while the person sleeps.
Many people who require TPN treatments are of working age, but because of the complications of hospital treatment they cannot work. Some are retired on Social Security disability payments, which also entitles them to Medicare benefits that cover most of their treatment costs. Health and Human Services Department officials estimate that Medicare pays the TPN treatment costs of several thousand people.
Under existing law, if patients go back to work for five years and 10 months but then prove they cannot work, they would have to wait at least five months to qualify for disability payments and 24 months to qualify for Medicare again. The cost of treatment is so high that many fear they could not afford to pay for it if they were unemployed, and would die while waiting to get back on the Medicare rolls.
To explore the employment possibilities for some of these people, Abbott, a major manufacturer of TPN equipment headquartered in North Chicago, Ill., has agreed to hire up to 20 people now on the disability rolls, pay them regular wages, provide them with free home TPN services and equipment, and cover their other medical needs under the company's group health plan.
Social Security, in turn, has agreed to waive the waiting period for these people to get back on the disability and Medicare rolls if it turns out they can't work.
Social Security officials reason that this will encourage them to try working, because they won't have to worry about how they would pay for their benefits if they eventually lose their jobs.
HHS Secretary Margaret M. Heckler said, "This unique rehabilitation project demonstrates that the private sector can join hands with the federal government to overcome obstacles and return disabled persons to full-time participation in the work force.
"It is an innovative and challenging concept that we hope to use as a model for more public-private partnership efforts."
Experiments such as the one involving Abbott Laboratories were authorized by 1980 amendments to the disability benefit program. The amendment, sponsored by Sens. Robert J. Dole (R-Kan.) and David F. Durenberger (R-Minn.), directed the SSA to study ways to encourage disabled beneficiaries to return to work.