The Americans With Disabilities Act (ADA) of 1990 is "An Act to establish a clear and comprehensive prohibition of discrimination on the basis of disability" (Preamble, ADA, 1990). One definition of disability discrimination given in the law is the failure to provide accommodation (ADA, 1990). The Equal Employment Opportunity Commission (EEOC; 1999) called the accommodation request process a fundamental feature of the ADA. The ADA does not mandate employment, it prohibits discrimination.

Research into the employment goals of the law makes the assumption that the ADA accommodation request process is viable (DeLeire, 2000; Moon, Chung, & Yang, 2003; Stapleton & Burkhauser, 2003, Wells, 2001). These studies, some using the same data sources, generate opposing answers on the ADA's impact on employment all the while ignoring the fundamental request process of the ADA. Other research looks into the behaviors of entities covered by the law, but these may not be relevant to the ADA's goals. For example, Bruyere (1999) surveyed 1,402 human resource departments on their preparedness to accommodate and reported that most said they were making changes. However, there was no way of knowing from that study whether the changes were initiated by, or even affected employees and/or job seekers with disabilities. Hernandez, Keys, and Balcazar's (2000; 2004) indicated that employers and representatives of the private and public sector express positive attitudes about the employment and access rights of workers with disabilities, but their behaviors may not match their attitudes. Relevant ADA behaviors have not been researched.

The meaning of the attitudes and opinions of people with disabilities in terms of their actual behaviors and the effect of ADA is also unclear. People with disabilities know about the law and are in favor of it (NOD/Harris, 2000; 2002), and some think it has not accomplished much (Hinton, 2003; NOD/Harris, 2004). The National Council On Disability's (NCD) (1995) collection of testimonies from people with disabilities affirmed the well known benefit of receiving accommodations. However, the NCD study did not describe the ADA request process in light of disability discrimination, that is, the refusal to accommodate. The functional impact of the law--the behaviors of the people who could make ADA requests and those who receive ADA requests is not known.

When the ADA complaint processes are used they are not effectual means of acquiring accommodation. In a comprehensive study of all ADA EEOC employment discrimination charges (N = 149,143) between July, 1992 and September, 2000, Moss, Burris, Ullman, Johnsen, and Swanson (2001) found that most complaints were rejected and that when a complaint was accepted, the person with the disability lost most of the time. Furthermore, Moss et al. found that the result of a fully processed EEOC complaint, win or lose, was most often simply a letter to the complainant. The authors concluded that the EEOC complaint process is ineffectual, and noted, "Aside from a chance to tell their stories, most claimants will not benefit from filing a claim." Colker (2000) reviewed ADA litigation and concluded that covered entities knew it was highly unlikely that they would ever face any enforcement action for noncompliance.

Sullivan (2001) found the major reason people charging disability discrimination lost their litigation was because of a breakdown in the negotiation process whereby an employee and an employer discuss what accommodation is needed. He noted the ways employees were blamed for contributing to that breakdown but wrote that the ways employers affected that breakdown were too varied to list. In contrast, Harlan, and Robert (1998) listed some of the ways employers effect the request for accommodation process. They labeled these tactics "employer resistance strategies." These included generating fear of reprisal, giving misinformation, pejorative labeling of requesters as "lazy" or "trouble makers," and telling requesters accommodations would take a long time to arrive and would be of poor quality. Informants in the Harlan and Robert study said they did not request accommodation because they feared reprisals such as being fired, or passed over for promotion. Intimidation, rather than outright refusal followed by a redress process is a means some employers use to avoid fulfilling ADA requests.

Harlan and Robert (1998) found that professionals and managers with disabilities did not negotiate for accommodations. At that level, accommodations were a perquisite of the position. At the entrance level, Hauser, Maxwell-McCaw, Leigh, and Gutman (2000) found a blanket refusal to accommodate or hire Ph.D. clinical psychology interns who are deaf or hard of hearing. Some of McNeal, Somerville, and Wilson's (1999) informants with post polio syndrome did not make requests out of fear of being fired.

Despite changes in the nature of supported accommodation services for people with learning disabilities, little progress was made during the '70s, '80s and '90s in addressing the extent of unmet need. While the advent of Supporting People has more recently led to an increase in the volume of provision, unmet need continues to be a major concern to people with learning disabilities and their families. There is good reason to believe that, as a result of changes in the demographic profile of people with learning disabilities, changes in expectations and changes in the pattern of informal care, this issue will become substantially more pressing over the coming two decades. This paper attempts to estimate the nature and extent of increased need.

The last four decades have witnessed dramatic changes in the way we have provided supported accommodation for people with learning disabilities. In 1976, more than 50,000 people with learning disabilities were living in large-scale NHS long-term institutional provision. In effect, institutionalisation was the only option for people with learning disabilities who could not live relatively independently and who, for whatever reason, no longer lived with their family. In 2006 the last of these NHS institutions will close. In their place we now have an array of smaller, more community-orientated provision (Emerson, 2004).

There is little doubt that these changes have, overall, been to the benefit of people with learning disabilities and informal carers (Emerson & Hatton, 1994; Hatton & Emerson, 1996). There is also little doubt that the gains made are still far from sufficient to afford many people with learning disabilities an acceptable quality of life (Emerson et al, 2005).

Improving the quality of supported accommodation is, however, only part of the problem we are currently facing. The other key part relates to increasing the supply of supported accommodation services in order to meet current and future need and demand. The 1971 White Paper Better Services identified a significant shortfall in the volume of provision, and set specific targets for increasing volume by 1991. The best estimate is that no progress at all was made towards these targets over the following three decades (Emerson & Hatton, 1998), and that unmet need for supported accommodation for people with learning disabilities continued to constitute a major problem (Watson, 1996).

In this paper I will address three questions that are relevant to estimating current and future need and demand for supported accommodation services for people with learning disabilities.

* How many adults with learning disabilities are there in England?

* Do the numbers of adults with learning disabilities vary by area?

* How might the need and demand for supported accommodation change in the future?

How many people with learning disabilities are there in England?

There are two quite different answers to this question. Our best estimate (derived from analysis of learning disability registers) is that 0.46% of the adult population of England are users (if only on an occasional basis) of services for people with learning disabilities (Emerson & Hatton, 2004b). This is equivalent to approximately 170,000 adults aged over 20 in England.

We know from epidemiological studies (Leonard ft Wen, 2002), however, that the 'true' prevalence of learning disabilities is much closer to two per cent of the adult population (equivalent to approximately 800,000 adults aged 20 or more). The discrepancy between these two figures is due to a combination of factors, including the use of eligibility criteria to exclude people with lower support needs from services, and the reluctance of some people with learning disabilities to identify themselves as such during their interactions with service providers.

Table 1, below, gives estimated age-specific prevalence rates for the 'administrative' and 'true' populations of people with learning disabilities in England. These estimates can be used to predict the number of adults with learning disabilities who, on average, would be expected to be eligible for services in any given area.

J. Pierpont Morgan was a ruthless financial wizard with superb taste, whose monument--the library designed by McKim, Mead & White in 1906--was a surprisingly restrained product of America's first gilded age. Still more astonishing in that country's latest era of obscene excess, the Morgan has been doubled in size without losing its distinctive personality. The Renzo Piano Building Workshop has wrought its customary magic in weaving together old and new, strengthening the sense of place, and opening up the new central court to views of the street on three sides. Visitors walking into this serene, light-filled atrium, or looking down from two upper-level balconies can savour the sensation of floating within a transparent bubble at the heart of the metropolis.

Nearly all museums have a compulsion to expand, to display more of their holdings and find room for new acquisitions, but also to accommodate ever-greater crowds and boost revenue. A happy few, like the Frick, stay small and are cherished for doing so. In contrast, the Museum of Modern Art abandoned its early role as a tightly focused shrine of the avant garde, and turned itself into an overpoweringly vast emporium with all the appeal of a convention centre. By choosing Piano, who cares as much for the sacred (contemplating art) as the profane (socialising, shopping and eating) and manages to keep the two kinds of space distinct, the Morgan avoided that fate.

The development of obesity is the result of an imbalance between food intake and energy expenditure. The mechanisms that control food intake or energy expenditure are not fully understood. Signals that arise from the GI tract contribute to meal termination and, hence, determine meal size. One of the modulations of upper GI secretion, sensation, and motility is the neurotransmitter, somatostatin. Octreotide, the cyclized analog octapeptide, binds preferentially to type 2 somatostatin receptors. Some studies have shown the effects of somatostatin or the synthetic analog, octreotide, on human GI motor functions in health and disease states. To further this research area, a group of researchers from the Mayo Clinic compared the effects of octreotide and a placebo on postprandial symptoms, satiation, and gastric volumes in obese patients.

In a randomized, parallel-group, double-blind, placebo-controlled study, 26 obese but otherwise healthy subjects received 100 micrograms of octreotide or placebo simultaneously 30 minutes before each study. Studies were performed on two separate days and included validated noninvasive techniques: 99mTc-single photon emission computed tomography imaging to measure fasting stomach volume and gastric volume changes after 90 mL of water, 240 mL of Ensure, and a standardized nutrient drink test to measure the maximum tolerated volume and postprandial symptoms.

Relative to placebo, octreotide increased gastric volume after 90 mL of water, but fasting and gastric volume change post-Ensure and maximum tolerated volume of Ensure were not different. Octreotide decreased sensations of fullness and bloating and tended to reduce aggregate symptoms after the fully satiating meal.

In obese individuals, somatostatin analog significantly reduced postprandial sensations after a satiating meal without altering maximum tolerated meal volume or post-nutrient gastric volume, suggesting an effect on upper gut sensation. The data also suggest that different mechanisms come into play in the presence of nonnutrient or nutrient loads to the stomach. The role of somatostatin as a permissive factor in the development of obesity by reducing postprandial sensations deserves further study.

WHEN 30 Dell temporary employees walked off the job in February, saying they weren't allowed to conduct sunset prayers, it brought attention to Muslim prayer accommodation in the workplace.

Globally, there are an estimated 2 billion Muslims, with 7 million living in the United States. "Islam is one of the fastest-growing religions in the world," says Rabiah Ahmed of the Council on American-Islamic Relations, a Washington, DC, advocacy group for the American Muslim community.

According to CAIR's annual civil rights report, religious accommodation is consistently one of the top three concerns for Muslim Americans. Muslims, Ahmed says, are "dealing with issues other minorities and religious groups have dealt with in trying to accommodate a religion as well as other responsibilities." A Muslim's responsibilities include praying five times a day, ideally in a certain time frame.

And unlike in other faiths, Muslims need to step away from work to pray, Ahmed says.

Employers must accommodate workers who ask for that time unless accommodation creates an undue hardship on the business, says Lori Carr, an employment partner with law firm Gardere Wynne Sewell in Dallas. An undue hardship can be financial or nonfinancial, such as the impact on morale or scheduling. "It's really [determined] on a case-by-case basis," Carr says. Ahmed believes entrepreneurs must be aware and flexible. "[Muslims' responsibilities] can be accommodated if both parties are willing to work at it," she says. CAIR offers a booklet that helps companies implement Islamic religious practice policies that work for both sides.

Employers could soon find it harder to claim undue hardship, no matter what the religion: In March, the Workplace Religious Freedom Act-which would update Title VII rules to require employers to accommodate employees' religious needs unless they would create "significant difficulty or expense"--re-emerged in Congress for the seventh consecutive session, co-sponsored by Sens. Rick Santorum (R-PA) and John Kerry (DMA). With bipartisan support, it might not take a wing and a prayer to pass this time.

Accommodating a longtime employee's medical impairments does not establish that an employer regarded the employee as disabled under the Americans with Disabilities Act (ADA), according to the 7th U.S. Circuit Court of Appeals.

In June 2003, Connie Cigan, a 30-year employee of the Chippewa Falls School District, retired from her position as physical education instructor. According to Cigan, the school district forced her to retire because of her medical impairments, which included arthritis, bursitis and degenerating spinal discs.

Before her retirement, the school permitted Cigan to take time off work and to ask other teachers to cover some of her duties or to adjust their own teaching periods to provide her with additional rest time.

In January 2003, the school superintendent informed Cigan that he would not recommend renewing her contract for the 2003-2004 school year. Cigan decided to retire at the end of the school year.

Cigan then filed a lawsuit, alleging violation of the ADA based upon her "forced" retirement, which she characterized as a constructive discharge. The lower court dismissed her claims, and the 7th Circuit agreed, holding that constructive discharge must include "unendurable working conditions." Cigan's argument that working conditions are irrelevant when the prospect of discharge lurks in the background was unfounded in law. The prospect of being fired at the conclusion of an extended process is not itself a constructive discharge, the court said.

Accommodating a longtime employee's medical impairments does not establish that an employer regarded the employee as disabled under the Americans with Disabilities Act (ADA), according to the 7th U.S. Circuit Court of Appeals.

In June 2003, Connie Cigan, a 30-year employee of the Chippewa Falls School District, retired from her position as physical education instructor. According to Cigan, the school district forced her to retire because of her medical impairments, which included arthritis, bursitis and degenerating spinal discs.

Before her retirement, the school permitted Cigan to take time off work and to ask other teachers to cover some of her duties or to adjust their own teaching periods to provide her with additional rest time.

In January 2003, the school superintendent informed Cigan that he would not recommend renewing her contract for the 2003-2004 school year. Cigan decided to retire at the end of the school year.

Cigan then filed a lawsuit, alleging violation of the ADA based upon her "forced" retirement, which she characterized as a constructive discharge. The lower court dismissed her claims, and the 7th Circuit agreed, holding that constructive discharge must include "unendurable working conditions." Cigan's argument that working conditions are irrelevant when the prospect of discharge lurks in the background was unfounded in law. The prospect of being fired at the conclusion of an extended process is not itself a constructive discharge, the court said.

The appeals court also held that Cigan was not "disabled" under the ADA because she did not show she was substantially limited in any major life activity. Instead, Cigan asserted that the school district had "regarded" her as disabled, based primarily on the district's efforts to accommodate her impairments.

The ADA requires employers to provide certain accommodations to qualified individuals with disabilities, and to engage in an interactive process to determine the applicability and reasonableness of the accommodations. For most purposes, a person "regarded as" disabled by an employer has the same rights as a person who actually is disabled. An individual is regarded as disabled when the employer believes that an impairment substantially limits one or more of the employee's major life activities.

The 7th Circuit, however, was unwilling to accept the premise that an employer offers accommodations only if it thinks an employee suffers from a substantial limitation in a major life activity. Instead, the court specifically found that "decent managers" try to help employees cope with declining health without knowing or caring whether an employee fits the description in the federal statute. Similarly, managers can respond to state and local laws, regulations, and collective bargaining agreements without implicitly concluding that an employee is disabled.

Adult smoking prevalence has been falling in the United States, down from 42.4 percent in 1965 to 24.1 percent in 1998, a 43 percent reduction. The percentage of adults who never smoked increased from 44 percent in the mid-1960s to 55 percent in 1997.1 It is not surprising then that owners of restaurants have responded to changing customer preferences by changing how they allocate their air space between smoking and non-smoking use. Restaurants without non-smoking seating sections have become exceptions. These provisions are not isolated to locations where state or local laws restrict or ban smoking and indicate an active private market in accommodation.

It has been shown that areas with lower adult smoking rates have more smoking laws and bans. It is important to note, however, that such laws have been introduced without much benefit of research on how the private market has dealt with the issue of accommodation of both smokers and non-smokers. Proponents of smoking restrictions often argue that smoking exerts a negative externality on non-smokers and that governments should control smoking through laws and bans. [Campaign for Tobacco Free Kids, 2002] Even if such externalities exist, it would appear to be useful first to ask whether, in the absence of laws, private markets work toward internalizing the externalities. An active market in accommodation might indicate that laws and bans are simply overturning, partially or totally, actions of owners that had successfully dealt with smoking-related externalities.

This paper examines the diversity of private market accommodations in roughly 1,000 restaurants and bars in Wisconsin. We develop a model that predicts which factors determine the share of seating devoted to non-smoking use within the setting of profit-maximization. While it is important to note that the data are limited to Wisconsin, this is likely a reasonable case study for a number of reasons. First, the state has few stringent smoking laws, providing a rich data set to explore how voluntary choices of owners are related to various factors. This analysis examines laws each owner may be subject to and considers this information in the model. Wisconsin is also not an outlier because it does not ban smoking everywhere, as does California, nor does it fail to control its use in restaurants, as does Nevada. Finally, the adult smoking rate in Wisconsin is 23.4 percent, which is well within two standard deviations from the median smoking rate of 22.9 percent of all states. [Cook, 1999]

The paper begins with a literature review summarizing previous studies that address smoking policies. This is followed by a description of the data. An economic model then indicates which factors underlie smoking policies chosen by owners, and determines which factors are important to smoking policies in the absence of government restrictions and which factors are no longer important following the imposition of smoking laws. The conclusion discusses implications about the private market in accommodation and the effects of smoking bans and restrictions on individual owners.

LITERATURE REVIEW

Only limited research has been conducted on the private market in accommodation. Two studies directly examine seating allocations within restaurants and bars. Boyes and Marlow [1996] examine survey data in San Luis Obispo, one of the first cities to institute a ban on smoking in restaurants and bars. Sixty-four restaurants and bars were surveyed-roughly 65 percent of all affected businesses. The authors suggest that an active market in private accommodation existed prior to the ban because 62 percent of owners had non-smoking sections.

Logit models of support for bans in San Luis Obispo were estimated using data from a random survey of 764 individuals, 84 percent of whom were non-smokers. The empirical evidence indicates that the odds of supporting the smoking ban are significantly lower for respondents who smoke and are male. Age, education, and whether or not a respondent resided in the local community did not significantly influence odds of supporting the ban. Despite widespread support for the bans a significant percentage of the non-smokers (62 percent) also believed that smoking/non-smoking sections dealt effectively with smoking prior to the ban. Apparently, while a majority of non-smokers believed that the private market in accommodation was effective, they nonetheless favored outright bans.

Dunham and Marlow [2000a] also study private market accommodation. They examine national survey data drawn in 1996 from owners/managers of 1,300 randomly selected restaurants (650) and bars/taverns (650) across the United States. Samples were drawn in a statistically random manner and were applicable to all such establishments with a maximum sampling error of approximately plus or minus 4 percentage points. The survey found that, for restaurants, on average, 54 percent of seating was allocated to non-smoking, and for bars/taverns 5 percent was thus allocated. Both restaurants and bars/taverns exhibited cases where smoking was entirely prohibited as well as allowed throughout establishments. The authors conclude that state smoking laws do not influence allocations of non-smoking seating and suggest that laws are passed in states with relatively few smokers and therefore owners had already allocated relatively many seats to non-smoking use prior to the passage of laws. This hypothesis is supported by their finding that states with relatively many people involved in the tobacco manufacturing industry are significantly less likely to pass smoking laws than those states with relatively few workers. They also find that the percentage of seating allocated to non-smoking is negatively related to the percentage of smokers in the population, is significantly higher for owners affiliated with chains, and is significantly lower for older businesses and for bars.