THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by Contract No. SS00-13-60048-0005 with the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-39257-0
International Standard Book Number-10: 0-309-39257-8
Digital Object Identifier: 10.17226/21922

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

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COMMITTEE TO EVALUATE THE SOCIAL SECURITY ADMINISTRATION’S CAPABILITY DETERMINATION PROCESS FOR ADULT BENEFICIARIES

PAUL S. APPELBAUM (Chair), Elizabeth Dollard Professor of Psychiatry, Medicine and Law, and Director, Division of Law, Ethics and Psychiatry, Department of Psychiatry, Columbia University

KAREN E. ANDERSON, Director, Huntington Disease Care, Education and Research Center, and Associate Professor of Psychiatry and Neurology, Georgetown University Medical Center and MedStar Georgetown University Hospital

MARÍA P. ARANDA, Associate Professor, University of Southern California School of Social Work

NANCY BAGATELL, Associate Professor, Division of Occupational Science and Occupational Therapy, University of North Carolina at Chapel Hill

JULIE BIRKENMAIER, Professor, Saint Louis University School of Social Work

NANCY N. DUBLER, Professor Emerita, Albert Einstein College of Medicine; Consultant for Ethics, New York City Health and Hospital Corporation; and Adjunct Professor, Division of Medical Ethics, New York University Langone Medical Center

LAURA B. DUNN, Director, Geriatric Psychiatry Fellowship Training Program and Professor, Department of Psychiatry and Behavioral Sciences, Stanford University

ALAN M. JETTE, Professor of Health Policy & Management, Boston University School of Public Health

DAVID A. LOEWENSTEIN, Director and Professor of Neuropsychology, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine

MARC A. NORMAN, Professor, Medical Neuropsychology, and Director, Neuropsychiatry/Epilepsy Clinical Evaluation Program, University of California, San Diego

ELDAR SHAFIR, William Stewart Tod Professor of Psychology and Public Affairs, Department of Psychology and the Woodrow Wilson School of Public and International Affairs, Princeton University

KELLY A. THOMPSON, Thompson Wildhack PLC, Arlington, Virginia

Consultant

ALLEN W. HEINEMANN, Director, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago

IOM Fellow

KENDALL M. CAMPBELL, Co-Director, Center for Underrepresented Minorities in Academic Medicine, and Associate Professor, Family Medicine and Rural Health, Florida State University College of Medicine

IOM Project Staff

CAROL MASON SPICER, Study Director

FRANK R. VALLIERE, Associate Program Officer

JENNIFER FLAUBERT, Associate Program Officer (since December 2015)

NICOLE GORMLEY, Senior Program Assistant

PAMELA RAMEY-McCRAY, Administrative Assistant

FREDERICK ERDTMANN, Director, Board on the Health of Select Populations

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Henry Aaron, The Brookings Institution

Sara S. Bachman, Boston University School of Social Work

Denise Burnette, Columbia University School of Social Work

Lisa Dixon, Columbia University Medical Center

Kathryn Edin, Johns Hopkins University

Eric B. Elbogen, University of North Carolina at Chapel Hill School of Medicine

Jason Karlawish, University of Pennsylvania

Kristi L. Kirschner, University of Illinois at Chicago

Daniel C. Marson, The University of Alabama at Birmingham

Barton W. Palmer, University of California, San Diego

Elizabeth K. Rasch, National Institutes of Health

Marc I. Rosen, Yale University School of Medicine

Elyn Saks, University of Southern California Gould School of Law

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Georges Benjamin, American Public Health Association, and Bradford H. Gray, The Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Preface

With support from SSA, the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering, and Medicine convened a committee to evaluate SSA’s capability determination process. In pursuit of that goal, the committee reviewed the relevant professional literatures in several languages, heard testimony from researchers who study the capability determination process and from persons directly involved with it, considered existing assessment tools and their applicability to this process, looked at comparable programs in the public and private sectors in Canada and the United States, and obtained background information and data from SSA on the operation of its system.

Drawing on all of these sources, the committee formulated a number of conclusions and recommendations that it believes can inform and guide efforts to improve the current capability determination process. Most notably, the committee concluded that basing capability determinations on evidence of beneficiaries’ actual performance in meeting their basic needs is superior to office-based assessment of individuals’ financial competence. In such a performance-based process, priority is given to information from persons who are in direct contact with beneficiaries and are in a position to know about their financial performance.

On behalf of the committee, I want to thank all of the individuals who shared their time and expertise during the committee’s information-gathering sessions. Special thanks go to Winthrop Cashdollar at America’s Health Insurance Plans for collecting and compiling information from a number of private companies that provide disability income protection coverage about their procedures for determining when a claimant is not competent to handle disability income benefits. I also extend thanks to the IOM staff members who played a key role in the production of this report, including Rick Erdtmann (board director), Carol Mason Spicer (study director), Frank Valliere (associate program officer), Nicole Gormley (senior program assistant), and Julie Wiltshire (financial associate). Research assistance was provided by Daniel Bearss and Rebecca Morgan. Rona Briere and Alisa Decatur are to be credited for the superb editorial assistance they provided in preparing the final report.

Finally, as committee chair, I want to express my appreciation for the hard work and collegial approaches of all the committee members. I know they share my hope that this report can have a positive impact on the lives of persons with disabilities who may need assistance in managing their benefits.

Paul S. Appelbaum, Chair
Committee to Evaluate the Social Security
Administration’s Capability Determination
Process for Adult Beneficiaries

Contents

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Boxes, Figures, and Tables

BOXES

TABLES

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