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.
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:
- 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.
- 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.
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.
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