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AbstractIn most developed countries, disability income support caseloads are on the rise. Little empirical knowledge exists, however, about how policy‐makers design these programmes, contributing to caseload growth. This article specifically explores how the boundary between who is eligible and who is not for disability income support is drawn in Australia and Canada. Forty‐five interviews were conducted between March 2012 and September 2013 with informants who were or are currently involved in designing disability income support in these jurisdictions. Analysis followed the fundamental steps of grounded theory. Findings revealed that the informants describe this process as "gatekeeping," which can be subdivided into two stages: (a) establishing the gate (definition of disability) and (b) operating the gate (who interprets the definition and how). I present the results using a conceptual model I developed, deconstructing each stage of the process of gatekeeping into discrete units of analysis. The model is useful for future comparative studies, providing a historical perspective and allows policy researchers to concentrate on specific aspects of the process in detail, which could lead to finding solutions to the challenges related to disability income support.

AbstractThe Disability Support Pension (DSP) provides financial support to more than 750,000 Australians with permanent physical, intellectual or psychiatric impairments that prevent them from engaging in employment. We sought to characterise the information, compliance and psychological costs of applying for the DSP. A cohort of 518 DSP applicants and recipients completed a questionnaire capturing medical, disability, benefit and demographic data. The questionnaire also included an Administrative Burden (AB) scale that was co‐developed with disability advocates and people with lived experience of DSP processes. Most respondents reported high or very high scores on three sub‐scales assessing information, compliance and psychological costs. In logistic regression models, DSP applicants reported greater costs than DSP recipients across all three scales. People with poorer health‐related quality of life, younger age and less education reported higher costs, consistent with the observation of an inequitable distribution of administrative burden in AB theory. All three scales had acceptable reliability. Study findings suggest that DSP applicants find the application process challenging and stressful. These effects are more pronounced in people who have applied for the DSP than those currently receiving the DSP, and in those with lower human capital.

Abstract
People with disability are an at-risk group in the COVID-19 pandemic for a range of clinical and socioeconomic reasons. In recognition of this, Australians with disability and those who work with them were prioritized in access to vaccination, but the vaccination targets were not met. In this paper, we analyze qualitative data generated from a survey with 368 disability support workers to identify drivers of COVID-19 vaccination hesitancy and why the implementation of this policy may have experienced challenges. We identify a range of themes within these data but ultimately argue that a major driver of vaccine hesitancy in this group is a mistrust of government and an erosion of employment terms and conditions. Drawing on the policy capacity literature, we argue that the "Achilles' heel" for the Australian government in this case is the critical policy capacity of political legitimacy. This finding has important implications for where the government needs to increase/build policy capacity, strengthening its efforts and better relating to organizations that can be helpful in terms of developing public health messaging for disability support workers.

Objectives: Describe perceptions of COVID‐19, COVID‐19 vaccines, information sources, and levels and reasons for vaccine hesitancy among disability support workers (DSWs). Methods: Cross‐sectional survey of 252 DSWs from across Australia, between early March and early April 2021. Perceptions of risk of COVID‐19; government and media representations; vaccination status (Y/N); vaccine intentions (when offered, delayed vaccinators, vaccine refusers); reasons for hesitancy; confidence in safety and efficacy of vaccine; and information sources. Results: At the time of the survey, fewer than 1% of DSWs had been vaccinated and 17% had been offered vaccination. Of those who had not had the vaccine, 47% said they would get it as soon as it was offered; 19% would not get the vaccine; 12% would have if required; 13% hadn't decided; and 8% would wait until it was available for a while. Reasons for hesitancy included inadequate safety data (70% delayed vaccinators, 79% vaccine refusers), side effects (63% delayed vaccinators, 58% refusers), and distrust in the government (17% delayed vaccinators, 52% refusers). DSWs most trusted sources of information were their own doctor, Chief Medical Officers, and governments. 61% believed that COVID‐19 will only stop if most of the community is vaccinated and 53% agreed the chances of them or their clients getting COVID‐19 would be reduced if they were vaccinated. Conclusions: Tailored information is needed to reduce vaccine hesitancy and increase confidence in COVID‐19 vaccines among DSWs. The importance of getting vaccinated to prevent COVID‐19 among people with disability should be emphasised.

AbstractPeople with disability are an 'at‐risk' group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID‐19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter‐organisational issues during the second wave of the COVID‐19 pandemic in disability residential settings gathered from senior managers, team leaders, and disability support workers. We use Victoria as a case study since several Victorian disability residential settings were in mid‐transition from state provision to non‐profit organisations. We argue that residential settings in mid‐transition had clearer lines of organisational accountability and communication, which was thought to reduce the impact of outbreaks compared to residential settings in other States and Territories with multiple lines of communication and blurred accountability. The paper contributes to the literature on inter‐organisational collaboration by reinforcing the necessity of clear lines of accountability and leadership in collaborative governance during emergencies. The evidence suggests how government and disability residential settings could better support residents and staff in future COVID‐19 outbreaks or other pandemics.Points for practitioners
People with disability, particularly those living in congregate settings, are often at heightened risk during public health emergencies.
Clearer lines of responsibility, administrative, and communication arrangements across organisations and governments, alongside tailored responses within residential settings, are required to keep 'at‐risk' individuals safe.
Emergency management block funding could be designed to alleviate the financial pressures identified in this study for residential disability services in future pandemic responses.

AbstractUtilisation of budgets provides important insights into the effectiveness of individualised funding schemes. Significant under‐utilisation by certain cohorts may indicate schemes are not working as intended. People with psychosocial disability have been identified as one such cohort experiencing barriers to effective budget utilisation within Australia's National Disability Insurance Scheme. Our mixed‐methods research confirms that while this cohort receive sufficient budgets, their spending is lower in comparison to other participants. Addressing under‐utilisation drivers arising from complex interactions between individual, systems, and contextual‐level factors, requires intervention within individualised funding schemes and the broader policy environment.

BACKGROUND: In most developed countries, governments are implementing policies encouraging older persons to work past 65 years to reduce the burden on societies related to disability benefits and pension payments. Despite this push to extend working lives, we know little about who already works past this age and any inequalities that may exist. Our study investigates the employment rates of those aged 65-75 years of age by educational level, health status and sex in Canada (CAN), Denmark (DK), Sweden (SE) and the United Kingdom (UK). Secondly, we aim to relate findings on employment rates to prevailing policies in the different countries, to increase the understanding on how to further extend working lives. METHODS: We used nationally representative cross-sectional survey data from the 2012-2013 Canadian Community Health Survey, 2013/14 Survey of Health, Ageing and Retirement in Europe for Denmark and Sweden and the 2013 English Longitudinal Study of Ageing to examine employment rates for those aged 65-75 years by sex, educational level and health status (having limiting longstanding illness (LLI) or not). RESULTS: Employment rates decline by age, but we see a linear decline in CAN and the UK compared to an initial decline then a plateau of employment rates from 66 to 68 years in DK and SE. Employment rates among persons aged 65-75 years were lower in the UK than in CAN, DK and SE. Among women, employment rates were highest in SE. Women with low education and a LLI had considerably lower employment rates than men with low education and a LLI (employment rates for men ranged from 27% to 12% compared with employment rates for women which ranged from 12% to 0%). CONCLUSIONS: Our results suggest that educational level, sex and health all play a role in extending working lives. The variation in employment rates between the four countries implies that policies do matter, but that social differentials show that policies cannot be 'one size fits all'. Policy-makers must consider different groups (i.e. low-educated women with a LLI) when designing policies to extend working lives.