ASSISTIVE TECHNOLOGY Decreasing Reliance on Paid Supports Increasing

ASSISTIVE TECHNOLOGY Decreasing Reliance on Paid Supports ~ Increasing Independence & Consumer Satisfaction! 1

PRESENTERS INFORMATION Arlene Lugo, Program Director Connecticut Tech Act 860 -424 -4881 * arlene. lugo@ct. gov * Cttechact. com Paul C. Ford, Training & Technical Assistance Money Follows the Person 860 -424 -5376 * paul. ford@ct. gov * MFP Web. Site MFP Logo 2

TODAY’S TRAINING INCLUDES: An overview of Money Follows the Person (MFP) and the CT Tech Act Project Assistive Technology – It’s more than durable medical equipment How can I… ? define, identify, assess, try, obtain, learn to use Definitions and examples of assistive technology 3

MONEY FOLLOWS THE PERSON Federal Medicaid Rebalancing Demonstration: Shifting the bias from facility to community for long-term care Transition 700 individuals from institutions to community with appropriate supports and services Increased dollars to Home and Community Based Services Increase the percent of individuals receiving long-term care in the community Decrease the number of hospital discharges to nursing facilities Increase the probability an individual admitted to a facility will return to the community within six months 4

CT TECH ACT PROJECT Mission: to increase independence and improve the lives of individuals with disabilities through increased access to Assistive Technology for work, school and community living Core Services: Information and Referral about Assistive Technology Demonstrations Recycling Financial Loan Equipment Loans 5

WHAT IS ASSISTIVE TECHNOLOGY? “Assistive Technology (AT) device is any item, piece of equipment or product system, whether acquired commercially, modified or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities. ” (AT ACT, 1998, as amended) 6

ASSISTIVE TECHNOLOGY (AT) Assistive Technology … Removes/reduces barriers Provides elders and persons with disabilities with greater control and independence of their own lives Provides elders and persons with disabilities with the ability to participate and contribute more fully in home, work, school and community 7

Lo ng Mo S t re ee er T tim pe im e t r Le e t o oi nte arni Acq uir gra ng C e te int urve or ou tin e High Tech Expensive, Complex features Often highly specialized Maintenance Issues t en itm t mm en h = co itm ec mer mm o r. T he nsu r C Hig of co vide el f Pro ev e l ls o r th ve he r Le Hig ighe H s ASSISTIVE TECHNOLOGY Moderate Tech Moderate cost, may be mechanical or electronic Moderate specialization: Low Tech Cheap, Simple, quick integration into routines Generally little or no specialization More significant disabilities may require more highly specialized technologies. 8

IN SUMMARY Assistive Technology can be any device or piece of equipment which improves or maintains a persons ability to function independently. Start Simple Get a good evaluation of the person’s needs Assistive Technology ranges from simple/inexpensive (Low Tech) to highly complex, specialized and expensive (High Tech). Try different pieces of technology Borrow equipment to see how it actually works and fits in. Lower Tech = easier to obtain and use. Higher Tech = the higher the level of commitment needed from both the consumer and the provider. For Higher Tech equipment, plan around delays related to obtaining the device and training needs. Ensure that good training and support is part of the plan Remember: Preventive maintenance! 9

NEBRASKA STUDY PREPARED FOR CMS STATE LEADERSHIP SYMPOSIUM COORDINATING AND LEVERAGING LONG TERM SUPPORTS WITH AFFORDABLE AND ACCESSIBLE HOUSING (1993) Documented the impact of an intensive approach to assistive technology service provision on functional independence, falls, and overall cost of services. 10

THE RESULTS treatment group control group relied more on assistive technology participants utilized more costly personal aide services, hospital and nursing home care expended an average of $2, 620 for assistive technology and environmental modifications. required significantly greater expenditures for institutional care. the average expenditures were $21, 846 average expenditures for institutional care for those with assistive technology and home modifications were $5, 630 11

THE CONTROL GROUP had significantly greater expenditures for nurse visits ($842 vs. $426) and case manager visits ($193 vs. $110) 12

CONCLUSION While both the treatment and control groups declined in functional status over time, the decline was greater for the control group participants. The impact of reduced decline in functional status and pain appears to be reflected in lower health care costs related to institutional care, and in-home nursing and case manager visits. Experience to date shows that the average overall cost of assistive technology and home modifications person ($3, 369) is recaptured in less than two months by preventing institutionalization of the individual. 13

COST - BENEFIT The estimated cost savings (for institutional care, and inhome nursing and case manager visits) to Nebraska for one year (1993) alone is $6, 395, 404. 14

AT SERVICES AT Services … Any service that directly assists an individual with a disability in the selection, acquisition or use of an Assistive Technology device. ” (AT ACT, 1998, as amended). 15

EXAMPLES OF AT SERVICES Evaluation of need Device Trials Designing, customizing, fitting, adapting the AT device Training & Follow up Maintenance or Repair 16

WHERE TO START… With the range of Assistive Technologies currently available, it is best to start with a functional definition of the person’s needs. Assessments can help identify the options (Don’t forget OT, PT & Speech Therapy) Trying various pieces of equipment will also help identify the right technology. Sometimes you need to be creative. 17

ADAPTION Sometimes it’s using something common and ordinary In a whole new way! Maybe it’s not the way everyone else does it, but if it works… 18

IDENTIFYING ASSISTIVE TECHNOLOGY Start with a functional description of the problem. Ask what is needed or would help. A door opening device with a remote switch Jim is able to use. Get any needed evaluations (OT, PT, SLP, etc. ) Jim needs something he can control from his wheelchair that will open the door for him. What does this tell us we need? Jim uses a power wheelchair and is unable to open the door to his apartment. Be sure the evaluator knows what problems the person encounters (unable to open the door) and ask for recommendations. If necessary: Do your research! 19

A NOTE ON EVALUATIONS OT/PT/SLP Evaluations for Assistive Technology should also include or be completed after there are recommendations for treatment and therapy. Introducing AT without exploring rehabilitation potential, may result in loss of rehabilitation potential and unnecessary reliance on assistive technology. 20

EXAMPLES: EATING Bent or built-up spoon Rocker Knife Hydration Systems Arm Supports Mechanical feeding aids (Neat Feeder) Dining Assistant – mechanical, electronic feeding system. 21

EXAMPLES: TRANSFERRING Low Tech Moderate Tech High Tech Door Grip Slide Boards Stand Pole Lift Seats Lift Chairs Multi-chair Transfer system Sera Transfer Electric Lifts Ceiling Track Lift Systems 22

EXAMPLES: TOILETING/HYGIENE Low Tech Moderate Tech High Tech Washing Aids Raised Seat Support Arms Transfer Bench Multi-Chair Transfer System Ceiling Lift Systems Door Tubs & Hydromassages 23

EXAMPLES: DRESSING Low Tech Moderate Tech High Tech Shoes w/o laces? Sox-pull Velcro Elastic Shoe laces Adapted Clothing Customized Clothing 24

EXAMPLES: MEAL PREP Low Tech Moderate Tech High Tech Puff Paint Lock Lid Pots Food Prep Boards Self Contained Grater Under Cabinet book Holder Audible Liquid Level Indicator Talking Microwave 25

EXAMPLES: MED ADMINISTRATION Low Tech Moderate Tech High Tech Pill Boxes Reminder Devices Prompting and Monitoring Devices Syringe Filling Devices Talking Glucometers Injection Devices Lock out Med Boxes 26

EXAMPLES: SAFETY & RISK Low Tech Moderate Tech High Tech Task lighting, High Contrast in environment, Cueing/Reminder notes, Glow Tape, Motion Sensor lighting, Home Automation, Life Alert Fall Alert Quiet Care Monitoring System 27

CAN ELDERS ADAPT TO ASSISTIVE TECHNOLOGY? They have been adapting to technology all of their life! 1938 – Nylon 1940 – Jeep 1942 – Atomic Reaction 1947 – Polaroid Camera 1948 – Electric Guitar 1951 – Univac I 1957 – Polio Vaccine Age 20 Today’s 70 year olds were born in 1938 Their Parents were born in 1908 -1918 Age 30 1969 – Moon Landing 1970 -- Fiber Optics 1972 -- Video Game 1974 – Bar Codes Age 40 1960 – Laser Age 10 1981 – Space Shuttle 1982 – Artificial Heart 1983 – Personal Computer Age 50 1990 – Hubble Space Telescope -- about 19 Million Debit Cards in Use 2000 Retired Age 62 2001 – About 12 Million Cell Phone Subscribers 28

ACCOMMODATING VARIOUS NEEDS Vision decrease Vision Loss Hearing decrease Brighter light, Contrasting Colors, Magnification Tactile feedback, Audio feedback, devices that talk, Amplification Visual information 29

ACCOMMODATING VARIOUS NEEDS Deafness Mental Illness Signage, Visual Notification, Animation, Speech to Text, Closed captioning. Devices to prompt or remind of tasks, appointments, medication, etc. Accommodation of symptoms or medication side effects 30

ACCOMMODATING VARIOUS NEEDS Dementia/Memory Loss Talking reminders Necklace type timers Monitoring and Alert Sensors for flooding, falls, gas, smoke, extreme temperatures, change in routines, etc. Detectors or timers to automatically turn on lights, etc. Memory or picture dial phones. Locator devices. 31

ACCOMMODATING VARIOUS NEEDS Cognitive Disabilities PDA with audio prompts Portable devices that provide step by step instruction PDAs that use pictures and audio recording Pictographs and symbol communication tools. Chinese Food 32

ACCOMMODATING VARIOUS NEEDS Staying in touch Simple E-mail Celery Simple Cell Phone Jitterbug Web Cams and Instant Messaging Virtual Dining 33

ACCOMMODATING VARIOUS NEEDS HIGH TECH, HIGHLY SPECIALIZED DEVICES Environmental Control Units aka “ECU” Augmentative Communication Devices aka “ACC Devices” Voice or Switch Controlled Phones Power Chairs with Layback, Tilt in Space, Stand and/or Leg Lift Options 34

INDEPENDENT LIVING… Environmental Control Units (ECU) Vehicle adaptations Voice input or Audio output Computer Technologies Door Openers and locks Power wheelchairs with recline, tilt in space, leg lifts, special systems for independent use/control of the chair & features. 35

HOME MODIFICATION Universal Design Visitability Ramps Lifts Bathroom Modifications • One no-step entrance • Lever handles on doors • Bathroom on main level • Outdoor lighting with motion detector • Wide doors on main level • Furniture arranges for easy mobility and access. • Grab bars • Sink with open space underneath 36

HANDOUTS & RESOURCES Please Take a Resource List for Future Reference Great AT Websites: CT Tech Act Project Get AT Stuff NEAT Marketplace Able Data The Boulevard Many National Disability or Condition Specific Organizations 37

FUNDING … Money Follows the Person – Individualized Budgets ABI Waiver – Vehicle modifications, environmental modifications, specialized medical and supplies, emergency response systems PCA Waiver – Emergency Response Systems CT Home Care for Elders Program – Home Modifications (minor), Emergency Response Systems. CT Tech Act Program – Loan Programs: Environmental Control Units (Corporation for Independent Living), Computers (Southern CT State University). Medicaid/Title XIX – When Medically necessary. More to come. 38

Case Studies Sam Mrs. Jones Alma 39 Greg Bill

SUMMARY! (WHAT WE HOPE YOU LEARNED TODAY!) Assistive Technology is any device, piece of equipment or related service that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities. Assistive Technologies range from Low to High Tech: The higher the technology, the higher the cost, time to acquire and the steeper the learning curve. Sometimes higher technology is the best option. Planning for training, support and servicing the equipment, may be as important as obtaining it. Some examples of the technologies available. 40

WAIT ---WE’RE NOT DONE YET! Please fill out evaluations and turn them in before you leave Your input will help improve future presentations Thank you! 41

PRESENTER’S INFORMATION Arlene Lugo, Program Director Connecticut Tech Act 860 -424 -4881 * arlene. lugo@ct. gov * Cttechact. com Paul C. Ford, Training & Technical Assistance Money Follows the Person 860 -424 -5376 * paul. ford@ct. gov * MFP Web. Site MFP Logo 42