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Integrating Assistive Technology into Affordable Housing for People with Developmental Disabilities:


Oregon Real Choice Systems Change. 2 2006. PROBLEM: Assistive Technology ... CMS Real Choice Grants. Part of the New Freedom Initiative ... Further Morsels ... – PowerPoint PPT presentation

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Title: Integrating Assistive Technology into Affordable Housing for People with Developmental Disabilities:

Integrating Assistive Technology into Affordable
Housing for People with Developmental
Disabilities Supporting Consumers and Caregivers
in Residential Services
  • Gerald Stolp, Manager
  • Community Housing Section
  • Seniors and People with Disabilities, Oregon DHS
  • Tom Keating, Ph.D., Director
  • Eugene Research Institute
  • NASDDDS May 2006
  • Project funded in part by U.S. Centers for
    Medicare and Medicaid Services, Award 92512/0

PROBLEM Assistive Technology is a largely
untapped resource in residential services for
persons with developmental disabilities.
  • Not systematically addressed by service plans.
  • Possibilities not adequately addressed in low
    income housing development.
  • Disconnect between availability of assistive
    technology and consumer awareness about what it
    is and how to get it.
  • Gap between availability and utilization
  • Lack of clarity about funding avenues.

CMS Real Choice Grants
  • Part of the New Freedom Initiative
  • Response to the Olmstead v. L.C. Supreme Court
  • Support infrastructure changes that will result
    in effective and enduring improvements in
    community long-term support systems.

CMS Real Choice Grants
  • Address 9 different funding areas, one of which
    is Integrating Long Term Supports with Affordable
    Housing, in order to
  • remove barriers that prevent Medicaid-eligible
    individuals with disabilities of all ages from
    residing in the community or in the housing
    arrangement of their choice.
  • Open to any state agency that provides supportive
    services to individuals with disabilities.

Purpose of Oregon Real Choice Grant
  • Increase awareness and use of Assistive
    Technology in affordable housing for persons with
    disabilities of all ages
  • Collaboration for system change by two
    Departments of Oregon State Government
  • ? Department of Human ServicesSeniors and People
    with Disabilities
  • ? Oregon Housing and Community Services

Amount of Grant Funding
Note Grant award is shared between Seniors and
People with Disabilities focus on assistive
technology with Mental Health and Addiction
Services focus on improving payment mechanisms
for mental health providers.
What We Are Doing
  • ? Gathering information to determine the scope of
    the problem Needs, Barriers, Awareness
  • ? Analyzing Housing Department and DD/Seniors
    Services for policy and rule changes to ensure
    more systematic assessment and funding of AT
  • ? Creating a blueprint for systems change in SPD
    and OHCS
  • ? Training consumers, caregivers and housing
    developers and other professionals
  • ? Publicizing results
  • ? Establishing mechanisms for ongoing change

Three Phases
Unifying Project Components
  • ? Quarterly Stakeholder group input (Consumers,
    families, human service professionals, technology
    specialist, housing professionals)
  • Technology for Housing web site vehicle for
    internal and external communication
  • Model demonstration projects drive development
    of materials and policies

  • Project information
  • Resource database
  • - Assistive technology
  • - Housing modifications
  • - Useful links (e.g. Abledata, Network of
  • Communication tool
  • - ListServ
  • - Discussion forum/QA
  • - Accessible examples/vignettes

So what do we mean by Assistive Technology?
  • To be successful at home, school, work, and in
    other environments, to achieve our hopes and
    dreams, and to simply get through each day,
    everyone needs assistive technology,
    accommodations, and supports.
  • -Kathie Snow (2006)

Home Modifications as Assistive Technology
  • Some standard home modifications for
  • -Ramp/no-step entry roll-in shower accessible
    sinks/counters, code doorways door handles low
    profile thresholds, no-slip carpets, door
    openers, etc.
  • More Creative?
  • - bathtub with door in it keyless entry (RF
    and RFID)
  • - Home automation features, motion controlled
  • appliances (fans, HVAC, media)
  • Behavioral support?
  • - hardened walls and windows, enclosures,
    unique fixtures

Assistive Technology Sampler
  • Low Tech
  • Eyeglasses
  • Hearing aids
  • Reach extenders
  • Openers (bottles, jars)
  • Oversized grips
  • Big button phones
  • Big button remotes
  • Wheelchairs
  • Switched toys/devices
  • Hi Tech
  • Aug comm devices
  • Digital reminders
  • Voice recognition
  • Handsfree access
  • FM Loops
  • Switch access
  • Wheelchairs
  • Screen readers/magnifiers
  • Software applications
  • Smart home tech

Model Demonstration
  • 5 sites, Seniors and DD, some dispersed, range of
  • ? Pre-wired for shared LAN and Internet
  • ? Architectural plan review to assess optimal
    locations for network ports and server computer
  • ? Identify potential location for personal
    information kiosk
  • - accessible activity calendar
  • - community events
  • - weather
  • - reminders
  • - activity and task prompts

Sample Demonstration Site
  • 2 story complex
  • Eight 1 bdr. Units
  • Community room/shared laundry
  • Parent driven development with Housing Authority
    under HUD 811 program

User Driven Focus
  • Participants 8 people with mild cognitive
  • Individualized assessments
  • Computers, email, security, monitoring, social

Applications of Integrated Technology-Based
Approach to Residential Support
  • New service element offers semi-supervised
    supported living to young woman, but hinges on
    detection of seizures
  • Individual capable of non-24 hour supported
    living, but makes poor friendship choices that
    result in victimization
  • Health and behavior monitoring toward better
    communication with health care providers

Working Example of Remote Monitoring in Practice
  • Main Components
  • Consumer-driven activity planning tool Picture
  • X10-based home sensor network
  • Home automation software
  • Consumer and caregiver monitoring computers
  • Expert systems software

Activity Planning
Activity Reminder
Apartment Layout
Some Basic X10 Modules
  • Passive infrared motion sensor
  • Wireless transceiver
  • Wireless computer interface
  • Door/window sensor

Remote Desktop View
Ubiquitous Web-Based Access
Fr. dr.
Some Preliminary Results
  • Improved self-management for activity and task
  • Feasible ubiquitously accessible remote support
  • Caregiver effectiveness increased
  • Caregiver peace of mind increased

Project Sustainability
  • System change activities
  • Web site self-generated support
  • Funding strategies

Funding Questions
  • Direct Medicaid some AT directly (wheelchairs,
    aug comm)
  • Medicaid Waivers
  • - Brokerage?
  • - Comprehensive Services/ 24 hour?
  • Does waiver funding support AT purchase and
    support and what are limits?
  • Note Medicaid emphasis on face-to-face billing
    vs. phone contact and what that implies for
    remote technology-based support (smart home,
    email, etc.)
  • How to promote strategic use of remote care
    systems that facilitate better consumer
    self-management and let caregivers focus efforts
    on community-inclusion, etc., without supplanting
    personal contact.

Further Morsels
  • Fact tech innovation will continue its march,
    especially through senior services channel.
  • Question Will it seep in a reactive way into the
    lives of people supported by our systems, or
    evolve in an intentional, planful, strategic and
    egalitarian fashion?
  • If I knew what was going to happen as a
    result of my theories, I would have been a
    locksmith. -Albert Einstein

Food for Thought
  • 1. Not a question of if, but when
  • - technology is there or soon will be
  • - considerable evidence of looming market
  • - considerable evidence of corporate investment
    for elder care (Siemens, GE, Honeywell, Philips,
    Intel, MS, ADT)
  • 2. Privacy concerns
  • 3. Unclear funding mechanisms
  • - how to tap existing funding to increase
    implementation of AT (Medicaid medical expenses,
    waivered services?)
  • - difference between services or devices used by
    consumer vs. caregiver to provide support more
  • - viability of remote monitoring and caregiver
    notification technology as a billable service in
    relation to existing policies regarding billing
    for telephone-based support?

Final Questions
  • For consumers equal access, better
    self-management, improved QOL, greater isolation?
  • For administrators New quality assurance systems
    and standards, cost cutting?
  • For families Better access to real-time info on
    person of concern?
  • Greater options for less restrictive, more
    integrated housing solutions? Or larger
    community-based facilities.

For Further Info
  • Gerry Stolp
  • Tom Keating