Connecting Through Technology

Connecting through technology banner with background of abstract expressionist painting in pink, blue, and white

Assistive Technology for communication and community integration

Not everyone communicates the same way. For some individuals, expressing thoughts, feelings, and emotions is made more challenging by certain disabilities. For non-verbal individuals, assistive technology supports offer additional ways to make connections, be heard, and join in. This is especially true for Dan.

Dan is a highly energetic and personable 67 year old man with cerebral palsy. He enjoys good company, good jokes, and a good beer. Throughout his lifetime, Dan has seen his fair share of technology advances—in his memoir, written with the assistance of his communication device, he recalls a time before he got his first wheelchair when he was pulled around in a red wagon. Now utilizing a power wheelchair to get around on his own, he has since added additional technology supports to further his independence.

Though he is able to communicate by vocalizing a ‘yes’ or ‘no’ (which he prefers in direct conversations) or by motioning when a choice is involved, he utilizes technology supports to express himself in greater detail. For the past several years, Dan has used the Essence Language System communication device, acquired using waiver funding. Resembling a large tablet, the device helps him to communicate via text-to-speech or through email using tab-based navigation and head mouse technology. The built in software, which includes spelling and word prediction for quicker and more efficient thought expression, also provides Internet access for Dan to perform Google searches or get to YouTube to listen to his favorite music—country.

“He expresses himself very well even though he’s not verbal, but through his communication device he gets the words out.”

Sam Subah, Assistant Program Manager at Living Well Disability Services

 

Communicating isn’t done through words alone. Art can be a powerful outlet for individuals of all abilities to capture their emotions and express themselves. After the passing of his wife, Sally, in May 2017, art became a great outlet for him to express his grief.Through the Creative Arts program at his day program (Midwest Special Services, Inc), Dan showed interest and skill in painting. To help him paint independently, staff members worked with him to create assistive technology tools made from basic objects. An adaptive head apparatus was created using the inside framing of a construction hat and a metal rod to hold his paint brushes directly in front of his eye, which is his preferred placement while working. Using this device, along with an adapted easel and palette, Dan is able to spend his time creating large paintings that have been displayed in local galleries and exhibitions—like his recent live painting installation at a Minnesota Wild Game.

Because of his patience and motivation for increased independence, Dan and his support team were able to explore different technologies that worked for him and met his goals. He is not only able to connect further with individuals through his communication device, but engage the broader community as well through his art—showing others what is possible.

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In addition to taking advantage of assistive technology to express himself, Dan also utilizes various assistive devices around his home, supported by Living Well Disability Services, to maintain his independence which will be documented in an upcoming TRC case study—stay tuned!

Banner Image Credit: Dan Stallsworth

View more of Dan’s artwork on his website


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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 or learn more about how to start the conversation.

Creating Organizational Buy-In Part 3 | Becoming a Champion for Technology

Being a part of an organization that utilizes all available resources to assist not only those you help support, but the staff and overall operations of the company sounds like a win win for all involved. But how is your organization able to get to that point? It could all start with YOU!

If you’ve missed the first two posts in the series, read up on creating organizational buy-in with The Basics, which covers the main steps to follow to help gain buy-in, and Breaking Barriers, which walks through common sticking points and offers solutions to get everyone on board.

The experts:

sean henderson headshot Sean Henderson, Information Systems Analytics Manager Hammer Residences
kathy larson headshot Kathy Larson, Director of Brain Injury and Specialty Support Services REM Minnesota
kit piltingsrud headshot Kit Piltingsrud, Program Manager and Assistive Technology Professional Living Well Disability Services

Put Yourself out There

To become the go-to-tech-person in your organization, you have to first let people know what you’re trying to accomplish and why it’s important—for them and for the organization.

  • Be everywhere. Literally. Attend all staff meetings, workshops, and team huddles to discuss the benefits of technology and share examples. Five minutes at the beginning of each meeting for a few months running is a great way to provide valuable information in a quick and digestible format to get individuals comfortable with the addition of technology in care plans.
  • Create opportunities to get in front of people by thinking outside the box. You could host tech talks like Sean or even create tech experience nights. The main point is to utilize your resources and creativity to meet individuals where they are—both physically and by interest level.

Share the Technology

Seeing is believing. Putting technology support options and devices in front of people is key to getting them on board.

  • Bring the technology to them. Demonstrations are a great way to show individuals what tech is available, and may also help get them comfortable with the idea of technology use by being able to see it (and test it out) themselves. Starting with lower tech/lower cost options is a great first step to get people comfortable with utilizing tech supports.
  • Share success stories and resources to get the latest and greatest technology in front of them. Seeing what others are doing helps get people thinking about possible uses, and about other individuals that could benefit from like technology. Subscribing/forwarding on the TRC monthly newsletter is a great start to share success stories and technology news from around the web.

Continue Training

Training. Training. Training. If you’ve read through The Basics and Breaking Barriers, you may have noticed a theme. Without proper training and check-ins to ensure the technology is always meeting the current needs of the individual, technology implementations may stall out, and frustration levels may rise.

  • Cultivate shared learning experiences and model behavior. Being present during implementations and having staff, individuals, and family members be a part of setting up the technology supports (no matter how simple) helps create a “learning together” atmosphere and gets everyone familiar with the technology and on the same page.
  • Create training documents for the team and for future hires. Include notes about the initial implementation, why you chose the tech you chose, and any tweaks you made along the way to give new staff background and get them up to speed.
  • Build on the momentum. Once people begin to realize the benefits of technology use, take the training a step further by spreading the word through experienced staff.

Ready to bring technology supports to your organization but have a few follow-up questions before you get started? Ask the Mentors! TRC Mentors are available to help answer any remaining questions you have and to help you get started. Learn more about the TRC Mentors.


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New Technology Means New Options for People Needing Supports: A Minnesota Story

Technology options for people needing supports

Sandy Henry, Technology Advocate and former community residential services provider
Reprinted with permission from Impact, a newsletter published by the Institute on Community Integration (UCEDD), and the Research and Training Center on Community Living and Employment (RTC-CL), University of Minnesota.

Until recently “supervision,” as used in regulatory language, had often been synonymous with having a caregiver physically present, whether the caregiver is family or Direct Support Professionals (DSPs). This fact has been one of the greatest barriers to individuals with intellectual or developmental disabilities (IDD) living more independent lives. But, what if there was a way for caregivers to know when they are needed and when the person is doing fine on his or her own? What if a caregiver could be assured a vulnerable person got home from work on time, didn’t let anyone else in the apartment, never left the stove on unattended, took medications on time, and could check-in for a chat or a question even with the caregiver miles away? And, what if the tools it took to do all these things were affordable? Remote supervision and support offers those possibilities.

Overview

Remote support and the technology it requires is not new, but spreading the word and adapting regulatory and funding rules to take advantage of it has been a slow process. Because “supervision” required the presence of a DSP, funders felt safe tying payment to DSP physical presence, and regulatory language often used “supervision” and “staff ” interchangeably. It all worked, for better or worse, until supervision no longer required the physical presence of a DSP. Minnesota has found a way to adapt funding and regulation to use the new technology tools, and it is starting to catch on.

Minnesota identified two ways of funding remote support through the HCBS Waiver:

  1. Individuals living in their own home (non-provider controlled) where services are offered via a menu of options. In this situation, remote support technology and services are covered under Environmental Accessibility Adaptations. Since the technology is of no use without DSPs or natural supports receiving and responding to information from the technology, DSP 24-hour remote supervision and response is covered under 24-Hour Emergency Assistance in a daily rate.
  2. Individuals living in licensed provider-controlled housing with services paid for via an inclusive daily rate. In this case a rate calculation system called the Rate Management System (RMS) is used to determine the daily rate. The RMS calculation is based on the person’s needs, including on-site awake staff, on-site overnight sleep staff, and remote monitoring hours of supervision.
    Two organizations using remote support technology in Minnesota are Dungarvin and CCRI.

Dungarvin: Alternative Overnight Supervision

Dungarvin is a national organization of privately-owned companies that are dedicated to providing high quality, community-based supports to people with varying support needs. In Minnesota, it first piloted the use of technology for remote support in 2006, and now uses remote monitoring technology in a number of locations. It took a few years of work with regulators and other stakeholders to receive approval for remote supervision as an alternative to on-site overnight staff, as required by regulation. Dungarvin now uses two active staff overnight to provide scheduled cares and respond to call devices in five homes in Minnesota. Staff can get to each house from another within the times specified in each person’s support plan.

Dungarvin currently uses bed, motion, and contact sensors, and a variety of call devices to match each person’s physical abilities. If a person can’t use a traditional call pendant, a button activated by the light touch of a knee, elbow or head will do. Adapted call devices are mounted to beds, wheelchairs, and walls in bathrooms and anywhere else a person might want to let DSPs know they want help. Dungarvin also uses sensors on individuals’ medication cabinets and sensors to prompt DSPs when critical cares are due, helping the busy staff stay on top of things.

The sensors and call devices are connected to robust software managed by Sengistix, a national remote support vendor. Each person’s support team decides the areas of vulnerabilities for which a DSP needs to be notified and respond in person. Individuals at risk of falls or wandering might require a DSP to respond as soon as a person is out of bed, or out of bed and not moving around in his or her room. Each person served decides how and when to use the call device to request DSP attention. All notifications to staff are private, going to a phone DSPs carry to receive and accept responsibility for responding to notifications. The various sensors also track the care actions of DSPs to help verify how quickly notifications are responded to and timing of critical cares, such as medication administration and repositioning.

CCRI: Independent Housing Options

CCRI, in Clay County of western Minnesota, developed the Independent by Design (IBD) program partnering with Sengistix as the technology vendor. For CCRI and Clay County this program is an alternative to traditional 3-4 person homes. By using the same type of technology Dungarvin uses, CCRI staff support a variety of people with a range of needs, each living in his or her own community apartment/home. Each person, with help from the support team, identifies what situations indicate a need for IBD staff to respond and what the expected response is. It might be a phone call to discuss an issue and offer direction, or a DSP going to the person’s home to provide face-to-face support. When appropriate, the technology keeps staff informed of when individuals come and go, take medications, are in or out of bed, have an activated smoke detector, and so forth. The technology is also used to provide reminders and prompts directly to the person, only involving staff if the matter isn’t resolved. For example, if a vulnerability for one person is getting up and off to work on time, a bed sensor can prompt a phone call to the person if not out of bed by 6:30, again at 6:35 and again at 6:40, if not out of bed. If by 6:45 the person is still not out of bed, the system will call the assigned DSP to intervene per the person’s plan. The same can apply to taking medications, leaving for work on time, or any number of activities and behaviors. When someone needs more intense support and education in certain areas, additional hourly supports can be added and adjusted as the need indicates.

The individuals supported by IBD are not restricted to living in group settings to share staff support. They get the interactive support they need when they need it, while living in the place of their choice. When they don’t need direct staff interaction, they are independent and on their own, knowing support is available at the push of a button. The IBD staff are mobile and can be anywhere in a 20 minute radius, helping someone prepare a meal, talking a person through a tough day at work, checking on a person with diabetes whose refrigerator hasn’t opened all day, being where they’re needed when they’re needed instead of sitting around a group living setting waiting to be needed.

Results

Both uses of technology profiled here:

  • Allow individuals greater privacy, dignity, independence, and control.
  • Extend the reach of DSPs by helping them know when, where, and how to be of greatest assistance.
  • Maximize the efficiency of taxpayer resources by reducing wasted DSP time when they are not needed.
  • Improve accountability of the services, as a collateral benefit.

To enable these uses of technology the Minnesota Department of Human Services allowed innovation to occur, then worked with providers and advocates to find ways to responsibly adapt funding and regulation to support it (see the department’s policy page titled Monitoring Technology Usage). Regulations that don’t overly restrict providers or teams enable ongoing innovation, and funding that allows flexibility and adequate resources while still incurring overall savings sets up the system for success.

 

Learn more about Dungarvin’s remote support implementation
Learn more about CCRI’s remote support implementation

Impact is a newsletter published by the Institute on Community Integration (UCEDD), and the Research and Training Center on Community Living and Employment (RTC-CL), University of Minnesota. Articles cover useful and practical information, research, and case studies related to persons with intellectual, developmental, and other disabilities.

Learn more about Impact


 

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Regaining Confidence Through Remote Support

Expert contributor: Tamara Twite, CCRI

 

Going from having caregiver support 24 hours a day to just nine hours per week seems unimaginable, right? Who is making sure the individual is safe? Who is making sure they are getting to work on time or taking their medications?

A 159 hour per week drop in caregiver hours seems dramatic. That’s because it is—but in a good way. Ryan Sebelius was able to achieve greater independence while decreasing his need for in-person support through the use of remote support technology. Though not “traditionally” supported 24 hours a day as he was before the addition of technology, he is certainly not without support during the times a caregiver isn’t physically present in his home.

The Move to Remote Supports

Living on his own was always Ryan’s goal. He chose CCRI’s Supported Living Services program in 2006 to first develop critical skills for living more independently, such as stable medication management. At the time, he received 24 hour care and received help in managing his medications to make him less “hyper”, as he would say. Once his medication was on track, his next move was to CCRI’s Independent by Design program (IBD) where he uses remote monitoring in conjunction with direct caregiver hours to provide increased independence while matching his support needs.

Ryan is very independent and does an outstanding job at the day-to-day tasks of life. Reassurance that he is doing a good job is what he needs most. Technology provided that reassurance and helped create a smooth transition to independent living.

The Technology

Remote supports consist of sensors that are placed around a home that alert staff to a need. Alerts from sensors trigger a phone call to the assigned caregiver. In IBD, there is a caregiver in a nearby office 24 hours a day, 365 days a year, to help individuals when a need arises. Caregivers respond to technology alerts, maintain the tech, and help with any other issues that come up.

At Ryan’s apartment, a front door sensor details comings and goings, and, because Ryan loves to cook (he is very proud of his pumpkin sloppy joes), a stove sensor was placed in a drawer next to the stove which notifies staff and Ryan if the temperature exceeds a certain level. On a weekly basis, Ryan, now independently, sets up his medications. In the beginning, a sensor was placed on his medication cabinet which let staff know when he was accessing his medication (by tracking when the cabinet opens and closes). With the consistency of the technology reminders, Ryan gained the independent routine to take his medications without the need for reminders.

How it works for Ryan

“Since beginning in IBD Ryan has become more outgoing and will stretch himself by trying new things—he just seems to beam.” Said Eric Hilber, SLS Director. Using remote support technology, Ryan is able to live safely in his own home—independently.

Since implementing the technology, Ryan’s in-person caregiver hours have gone from 24 hours a day to just nine hours per week. He no longer needs the sensors on his medication dispenser, he fills his automatic medication manager independently, and reorders his medications as needed. With his newfound independence, he is able to relax more, sleep in when able, and enjoys quieter mornings which he appreciates.

Technology can fulfill the desire for independence, while still maintaining the safety of the individual by instilling confidence and the assurance needed to achieve life goals. Often times following a technology implementation, it is found that certain supports are able to be removed as individuals become more confident and routines are solidified. Technology is there when needed, provides reassurance, and is easily modified as needs change.

 


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 or learn more about how to start the conversation.

Creating a strong base

Scott Wiyninger, SUCCESS Computer Consulting, Inc.

Investing in technology infrastructure for data security and independence

About seven years ago, The Phoenix Residence made the decision to invest heavily in new technology when they transitioned from paper records to electronic processing for items like medication, payroll, and scheduling.

Their new technology investments not only freed up resources to assist in handling some workforce issues that are common in the disability services industry, but also had the added benefit of allowing their residents to utilize assistive technology devices powered through Wi-Fi to increase independence.

Securing the data

In moving from paper to electronic medical records, The Phoenix Residence knew certain precautions would need to be put in place to protect individuals’ privacy. “Certainly, our exposure has increased, because we’re now doing so much of our work through an electronic mechanism,” noted Alan Berner, VP of Community Services.  

For facilities that process electronic medical records, certain measures need to be accounted for to ensure only the proper people have access to this sensitive data. How is this done? For The Phoenix Residence, they beefed up their data security infrastructure to ensure the proper level of security. They worked with our team to deploy firewalls throughout their 19 Minneapolis care facilities that were further reinforced by an additional layer of security services that stop malicious software (Malware) from gaining access to their system.

Adding access

As with most organizations, a stable and strong Wi-Fi network was very important to The Phoenix Residence as their staff utilize mobile devices for documenting care needs and medications. To help with this, additional Wi-Fi access points were installed to ensure a strong signal. These additional access points also allowed The Phoenix Residence to provide more extensive wireless coverage for the people they support—opening the door for greater independence through technology use.

“With the wireless access points, though we added them for business operations, there was a side benefit of being able to provide more extensive wireless coverage for the people we support where there wasn’t before – there’s a huge space for growth in this. For example, one person uses Alexa (Amazon’s digital assistant) for quality of life purposes. She controls her lights with it and even has it read her stories. Without being able to use that device, she could not do those things independently. We’ve been discussing integrating more of these devices in other areas of the residence so that when she’s not in her room, she can still have those functions, and some of the other people in the home would be able to utilize them as well,” said Alan.

Read the full case study prepared by SUCCESS Computer Software for full technology details.

SUCCESS provides managed network support, cloud services, project services, security solutions, CIO services, HIPAA consulting and Microsoft Office 365 migrations. We work with business leaders to ensure technology delivers the best value and is utilized in the most effective way for the success of their business today and in the future.

As a full-service provider of managed IT services, we are a part of your team, using technology as a tool to solve your business challenges, and integrating with your business as if we were a full-time employee. It is our purpose to revitalize the promise of technology — to empower businesses with the best and most appropriate technical infrastructure that enables them to succeed. 

 

Has your organization gone through a similar transition? If so, how has technology changed your daily processes or access to additional technology assistance for residents? Let us know about your tech experiences

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.

Watch the video to see how the staff at Dungarvin managed the funding process to implement remote monitoring and the impact it had on residents like Jamie and Lauren.

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

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.  

 

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

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.

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.