A New Way of Doing Business

Increasing independence while maximizing staff resources

Utilizing technology supports in care plans is not a new phenomenon – but is an option that is becoming more mainstream as the independence benefits for persons-served and staffing constraints for organizations are realized.

The Story

Eight years ago, Dungarvin began implementing alternative overnight supervision when they realized the workforce was becoming more and more limited.  As people served were expressing a stronger desire to be more independent, Dungarvin staff thought through scenarios on how to navigate both the independence desire and how they would provide services in the future. Technology was their answer.

The Outcome

Through the implementation of alternative overnight supervision, Dungarvin was able to reduce on-site full-time overnight staff for eleven homes while maintaining the same level of care and supervision. What once took 15 staff to accomplish is now able to be covered by four.  This allowed for previous overnight sleep staff to be more actively engaged in helping people at other times of the day.

How did they do it? Prior to implementation, Dungarvin staff spent several months documenting the needs that arose at night so they could get a better understanding of scenarios that would come up as well as needs of residents during the night shifts. Residents now have silent call buttons that they press when they need assistance instead of loud buzzers that their housemates might hear, which helps increase privacy. The call buttons alert awake float staff that they want or need assistance. Sensors placed throughout homes also help to notify staff if there may be a problem, as well as track care activity throughout the evening.

Not only did investing in the technology help Dungarvin maintain their staffing needs, but gave residents, like Jamie Jensen and Lauren Ireland, the independence and privacy they appreciate. “It’s 100 percent worth it” was Jamie Jensen’s reply when asked his opinion on the transition to technology supports.

Download the Case Study One-Pager or Explore funding options for technology supports

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Alternate Overnight Supervision – what it is and how to get it

Anna MacIntyre and Deb Amman
Minnesota Department of Human Services

What it is

Legislation, introduced in 2009, made it possible to use monitoring technology in Adult Foster Care (AFC) and Community Residential (CRS) settings in place of on-site overnight staff during normal (overnight) sleep hours.

A proven way to increase both independence and privacy of the person served, this newer monitoring practice is called Alternate Overnight Supervision and can be utilized following a formal assessment of the individual and once informed consent has been given by the person served. Along with obtaining an AOST (Alternate Overnight Supervision Technology) License, defined policies and procedures must be in place.

The person served should:

  • Be reasonably independent and have the ability to request assistance or direction.  
  • Be able to have their needs met within a reasonable timeframe for health and safety by using the least intrusive technology option.

How to get it

Once the technology has been found to match the needs of the individual, the AOST License can be applied for. DHS Licensing provides an AOST Licensing Checklist which identifies all licensing requirements.

Following the submission, barring any open investigations relating to supervision, the Licensing Consultant will review the file within 60 days. If any deficiencies are found within the application, the applicant will have 45 days to correct.

Read the full article on what AOST is (and isn’t) and further explanation on how to obtain and maintain AOST Licensing >

Anna MacIntyre is the policy lead for the Minnesota Department of Human Services, Disability Services Division. She can be reached at anna.macintyre (at) state.mn.us

Deb Amman is a licensing consultant  with the Minnesota Department of Human Services, Office of Inspector General Licensing Division. She can be reached deborah.g.amman (at) state.mn.us

A Case for Provider Investment

Alan Berner, Vice President of Community Services – The Phoenix Residence, Inc.

 

While the state of Minnesota boasts one of the richest, most comprehensive funding structures for technology, there continue to be areas in which funding is not available. Lack of formal funding should not deter providers from considering to invest their own dollars in certain solutions which make sense to help improve an organization’s ability to encourage independence of the people we support as well as helping an organization become more effective.

The Phoenix Residence, Inc. has invested heavily in back-end solutions aimed at helping us complete our work in the most efficient manner possible. This has helped us continue to grow in our ability to support people with their technology. It has also led to solutions which have great benefits for the people we support as well as our organization.

The first solution I’d like to highlight is our support of a highly mobile individual who has a history of falling and is living in an ICF/DD home where we provide support. We had several instances where bruising or other injuries occurred and were unable to be explained by staff as they hadn’t witnessed any causal events. As a result, the relationship between our staff and family members, who expected answers, grew strained; so at the request of the family members, we installed a camera system in the common areas of the home. For a cost of less than $2,000, staff have not only been able to identify more fall instances, but they are also better able to evaluate care needs such as whether a neuro evaluation is needed, and demonstrate to family members the proper supervision as detailed in the care plan is being provided. Those benefits alone were worth the investment. Financially—installing cameras has saved time in resources that would have gone into investigating issues and providing unnecessary supports.  As an organization, we continue to only implement this type of solution at the request and consent of the people living in the homes, as we feel it is their place to say whether they would want cameras in their home.

Another solution in which we invested is an assistive voice activated remote for an individual who spends considerable time in his room watching TV and movies. Like many of us, he wants to change channels frequently, but he needs help in order to do so. He would frequently call out to the staff members on site to come and change his channel causing them to either alter what they were doing or he would have to wait for a task to be completed before they could come and support him. By adding the device, he was able to change the channels on his own. With the investment we made in this device, it is not only improving his independence, but freeing up our staff to focus on alternative tasks for significant periods of time. The device itself, along with the training to make it useful, cost nearly $5,000.  While the investment in the remote was significant, even if it saved 15 minutes of our staff time a day, it would result in a savings of nearly $2,000 a year.  Over the five years he effectively was able to use this remote, we easily recouped our investment.

These two solutions were focused on creating better outcomes for specific individuals and funding was not available due to the ICF/DD homes where they live.  Our investment in both locations not only created the better outcomes we were hoping for, but also allowed us the significant savings in our staffing resources that outweighed the resources we dedicated to getting the technologies implemented.  

 

•  •  •

Visit the Resource Library to review additional tools that may be used to help find and evaluate funding options.

Funding 101 – Disability Waiver Rate System

Download Funding 101 – PDF Handout

Key Points

    • There are numerous funding streams that providers and service recipients can use to support
      technology use.
    • Minnesota has one of the strongest models for funding the use of technology.
    • Providers, technology suppliers, and individuals should work together to determine the right mixture
      of services and funding supports.
    • Remote support for residential services under the Disability Waiver Rate System is recognized as a
      form of supervision on the 6790 and rolled into the service provider daily rate.
    • 24-hour emergency assistance, paid to a service provider, and environmental accessibility adaptations,
      paid to the technology vendor, are available for people living in their own home.
    • Funding for technology is also available under the CDCS waiver and some items through State Plan
      services.

FundingDiagram

*Monitoring technology: 3 supervision/support options. 1) Awake on-site staff 2) Sleep on-site staff 3) Remote monitoring supervision

 

Download Funding 101 – PDF Handout, or visit the Technology Resource Center and learn more about Funding.

Putting a Plan Together for Independent Living

The Story

Though experiencing health issues that would ultimately require her to need more intensive care, including possible round-the-clock assistance, Angie wanted to maintain her independence and continue to live on her own without being reliant on a staff person constantly in her home.

Following conversations about her needs and wishes, a support and response plan was created with her team that not only made her feel supported, but maintained her desired level of independence as well.

The Outcome

Angie moved into her own apartment supported by CCRI’s Independent by Design program which helped to identify, implement, and monitor technology solutions to meet her medical and quality of life needs. Along with hourly staff services to assist with household tasks, technology supports provide monitoring and assistance for needs such as waking up on time and medication management.

Putting a plan together that considered Angie’s needs and desired living situation resulted in an overall improvement in her independence and reduced her reliance on assistance. She is healthier and continues to remain very active in the community—just the way she likes it.

Watch the video to learn how Angie and her team began the planning process:

Begin Planning or visit the ARRM Technology Resource Center to learn about more success stories and case studies showing how technology is changing the lives of those living with disabilities.

Required Technology Discussions

New legislation requires technology supports be discussed at all 45-day planning meetings.

New legislation goes into effect on August 1, 2017, requiring technology supports be discussed as part of all 45-day planning meetings for people with disabilities. These meetings establish the needs of the individual receiving services, their personal goals, and the supportive services necessary to meet these objectives.

It starts with a conversation

Technology supports are becoming a core option for more and more people. These supports are increasing independence while reducing the overall reliance on in-person staff time. Due to the variety of technologies and systems available—from remote monitoring to assistive devices— some form of technology support can be a part of almost anyone’s care plan. It all starts with a conversation between the person receiving services, their family, their provider, and their case manager to determine what options might be a good fit based on their person-centered plans.

Because this type of support marks a change in the look and feel of supportive services, questions and reluctance to even begin the conversation keep hundreds from having real discussions about technology as an option. That’s why Minnesota Statute 245D was revised this session to require teams to include a discussion about technology in all 45-day planning meetings. While the statute does not require that technology be used, the required discussion will open the opportunity for teams or team members who might have questions about initiating the use of technology.

A new source of information

As a key player in developing and passing the legislation, ARRM committed to ensuring resources are available to support conversations—including key information about technology supports and examples of successful implementations. ARRM’s new Technology Resource Center will house an ever-growing body of the latest information and tools related to utilizing technology to support people living more independent lives.

Get Started

Download ARRM’s one-page summary of what’s required under the new legislation and check out the rest of the Technology Resource Center for guidance as conversations begin.


 

Asking the right questions

Utilizing assessment tools to help identify goals and begin conversations surrounding technology.

Assessments for remote monitoring—and technology in general—help teams ask the right questions to identify goals and outcomes technology may assist with. Most technology service vendors and many service providers have their own assessment process to help fine tune outcomes and recommend specific tool options. The following basic questions are a good place to start the conversation:

  1. What is/are the thing(s) the person wants to do with less caregiver intervention?
    Do they want to live in their own home with less staff; be in their own room without staff checking in all the time; get to work; take medications; choose and make their own food; etc.
  2. What are the risks/vulnerabilities if the person did this without or with reduced caregiver intervention?
    What would the caregiver need to know to be comfortable NOT being physically present?
  3. What prompts, tools, or support would the person need to help him/her manage this without having a caregiver physically present all the time?
    Identify only what you want the tool to do at this point; not the technology solution. For example, prompt to take meds, if hasn’t done so; prompt if not out of bed by 7:00 and notify caregiver if not out by 7:30; identify possible falls; prompt or turn off stove, if left unattended.

Assessment templates are included in the Technology Resource Library as examples. The Ohio Remote Monitoring Assessment and Instructions was developed and has been used in Ohio to help teams consider and discuss when remote supervision for a person or group might be appropriate and what the needs are. The Hammer Residences’ Person Centered Technology Support Addendum is used to consider assistive technology on a broader scale. Ohio and Hammer Residences’, Inc. have given their permission for others to use and adapt these tools to meet individual needs.

Visit the Resource Library to review additional tools that may be used to help begin the conversation.

 

Technology On The Job

Dylan Dreifke provides outstanding customer service at The Home Depot by utilizing his iPad, a free Home Depot app, and his amazing memory (prior to being hired, he memorized all product and product category locations throughout the entire store!).

Dylan greets people who enter The Home Depot by using his iPad along with customized sentence software which he purchased on his own. Paired with a speaker bought by Opportunity Partners, Dylan is able to greet and communicate with customers to provide excellent service by asking customers what they are looking for and then leading them in his wheelchair to the appropriate location.

Check out Dylan’s story in the news:

Visit the ARRM Technology Resource Center to learn about more success stories and case studies showing how technology is changing the lives of those living with disabilities.

Remote monitoring starts with a conversation

The Story:

An exploration of technology support options began when a group of men with developmental disabilities expressed their desires for increased privacy and independence. These men had been supported by staff 24/7 and wanted to reduce the amount of time caregivers spent in their home. A conversation began with the group of men, regulators, guardians, and providers to find a solution everyone was comfortable with.

The Outcome:

After extensive research assessing normal habits, safety concerns, and abilities to respond to emergency situations, a plan was implemented utilizing remote monitoring technology.  Following the implementation, the men’s home became almost exclusively staffed remotely during nights and evenings. All parties were pleased with the dedication to safety and the care taken in working through all ‘what-if’ scenarios.

And what do the men think of their increased independence? “Awesome” sums up one man’s feelings towards what it’s like living with the new plan in place.

Watch the video to learn more about the process:

 

Start the Conversation or visit the ARRM Technology Resource Center to learn about more success stories and case studies showing how technology is changing the lives of those living with disabilities.