Academic journal article The Journal of Rehabilitation

The Relationship between Housing Accessibility Variables and Employment Status among Adults with Multiple Sclerosis

Academic journal article The Journal of Rehabilitation

The Relationship between Housing Accessibility Variables and Employment Status among Adults with Multiple Sclerosis

Article excerpt

The rate of unemployment among people with multiple sclerosis (MS) is consistently found to be much higher than that seen in the general population. Although over 90% of Americans diagnosed with MS have employment histories and most were working at the time of their diagnosis, only an estimated 20% to 30% of Americans with MS are employed 15 years after diagnosis (Fraser, Clemmons, & Bennett, 2002; Roessler, Neath, McMahon, & Rumrill, 2007). Data from recent large population-based studies support these estimates, indicating that over 55% of working-aged Americans with MS are not engaged in the labor force (Julian, Vella, Vollmer, Hadjimichael, & Mohr, 2008; Minden et al., 2006).

Multiple sclerosis is a chronic immune-mediated disease of the central nervous system that affects over 400,000 people in the United States, or approximately 1 in 750 Americans at any one time (Fraser, Kraft, Ehde, & Johnson, 2006; National Multiple Sclerosis Society [NMSS], 2012). Typically diagnosed among adults between the ages of 20 and 40 years, MS is one of the most commonly diagnosed neurological conditions and the leading non-traumatic cause of nervous system disabilities in young adults (Myhr, 2008). The clinical course of MS is characterized by episodes of neurological symptoms, frequently followed by fixed neurological deficits resulting in increasing disability, mobility limitation, and physical decline (Buchanan, Wang, Martin, Ju, 2006).

Although the clinical sequelae of MS certainly contribute to the relatively high unemployment rate among people with MS, research also suggests that the "wholesale disengagement from work" that characterizes this population cannot be fully explained by the medical accompaniments of MS (Rumrill, Hennessey, & Nissen, 2008, p. 21). For example, it has been established that, among people with MS who are unemployed, 75% left their jobs voluntarily, often before their symptoms made them incapable of working (Roessler, Rumrill, & Hennessey, 2002). Furthermore, 80% of people who became unemployed following their diagnosis with MS believed that they retained the ability to work (Sumner, 1997), and between 40% and 75% reported that they would like to return to work (Gordon, Feldman, Shipley, & Weiss, 1997; Julian et al., 2008; Rumrill, 2006).

A considerable amount of research has been committed to understanding the reasons for the high rate of unemployment among people with MS and to exploring the predictors and correlates of employment. This research has incorporated a broad range of demographic, functional, environmental, and employment policy variables and, in the aggregate, has contributed to improved understanding of this complex situation. Given the continuing high rates of unemployment seen in this population, however, it is clear that continued exploration of the factors that affect employment retention is necessary for understanding this complex and multifaceted situation.

In an effort to clarify employment barriers faced by persons with MS, the present study evaluated the relationship between employment status and several variables related to housing accessibility. Although the relationship between housing and employment among people with MS has not previously been examined, we propose that consideration of the many issues involved in housing accessibility suggests a variety of potential direct and indirect relationships. Broadly considered, housing accessibility incorporates such issues as (a) the ability to access the broader community through public or private transportation; (b) the ability to enter and exit the residence; (c) the ability to safely and fully use all rooms and functional areas of the residence, with or without assistance or accommodation; and (d) the ability to accomplish various activities of daily living. Limitation in any one or all of these areas may inhibit one's ability to seek, obtain, and maintain employment. …

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