Integrating Assistive Technology into Affordable Housing for Seniors and People with Disabilities

1. Integrating Assistive Technology into Affordable Housing for Seniors and People with Disabilities Gerald Stolp Tom Keating Community Housing Section Seniors and People with Disabilities, Oregon DHS New Freedom Initiative Conference March 5, 2007

2. Oregon Real Choice Systems Change 2 Problem: Assistive Technology underused in affordable housing for seniors and persons with disabilities. Service plans don�t consistently address technology implementation apart from durable medical equipment Low income housing development often doesn�t fully value and support possibilities of AT and universal design. Consumers and providers lack awareness about what�s available and how to fund it. Public and private agencies lack capacity to educate and connect consumers to innovative technology that would dramatically enhance QOL 2. e.g. network ready wiring and services, no-step entries, Even simple ceap things like touch lamps, oversized grips, large button remotes/phones, etc. What does medicaid pay for? What other state or local grant or loan programs are availablefor accessibility that could also include AT such as environmental control, etc. MAY WANT TO HAVE EXAMPLES OF RELEVBANT AT AS NEXT SLIDE GAP perhaps even moreso in care provided under 24 hr and supported living rules. Why? 6000. Total statewide billed to Medicaid for AT under waiver. WE NEED provider community to be involved in helping us figure out where AT can be better utilized, ways it�s being implemented that we may not realize. So we can come with a blueprint for systems change that is practical and useful, perhaps providing specific methods to help with billing. 2. e.g. network ready wiring and services, no-step entries, Even simple ceap things like touch lamps, oversized grips, large button remotes/phones, etc. What does medicaid pay for? What other state or local grant or loan programs are availablefor accessibility that could also include AT such as environmental control, etc. MAY WANT TO HAVE EXAMPLES OF RELEVBANT AT AS NEXT SLIDE GAP perhaps even moreso in care provided under 24 hr and supported living rules. Why? 6000. Total statewide billed to Medicaid for AT under waiver. WE NEED provider community to be involved in helping us figure out where AT can be better utilized, ways it�s being implemented that we may not realize. So we can come with a blueprint for systems change that is practical and useful, perhaps providing specific methods to help with billing.

3. Oregon Real Choice Systems Change 3 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 Services--Seniors and People with Disabilities Oregon Housing and Community Services Department Addresses priority 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.� Addresses priority 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.�

4. Oregon Real Choice Systems Change 4 Project Components Provide research-driven policy recommendations for housing and service delivery Conduct model demonstration activities to implement assistive technology in affordable housing sites throughout Oregon Develop materials and provide training for consumers, caregivers, and professionals Disseminate findings statewide and nationally 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 needs ? Creating a blueprint for systems change in SPD and OHCS ? Training consumers, service providers, case managers, housing developers, and others ? Publicizing results ? Establishing mechanisms for ongoing change 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 needs ? Creating a blueprint for systems change in SPD and OHCS ? Training consumers, service providers, case managers, housing developers, and others ? Publicizing results ? Establishing mechanisms for ongoing change

5. Oregon Real Choice Systems Change 5 www.TechnologyforHousing.org Provides detailed information on project Resource database - Assistive technology - Housing modifications - Useful links: (e.g. Abledata, Network of Care�) Communication tool - ListServ - Discussion forum/Q&A - Accessible examples/vignettes When you�re doing a web site, you start thinking, does the world really need another web site, but the goal of this site is to be locally referenced, filling a need that based on our pre-development research is unfulfilled, but at the same time providing a broader resource for others around the country. Since launch in March, we�ve gotten expressions of interest from people around the country, and some very poignant email from people in Oregon and elsewhere not only of general interest but expressing serious and touching needs for themselves or family members who are elder or who have disabilities.When you�re doing a web site, you start thinking, does the world really need another web site, but the goal of this site is to be locally referenced, filling a need that based on our pre-development research is unfulfilled, but at the same time providing a broader resource for others around the country. Since launch in March, we�ve gotten expressions of interest from people around the country, and some very poignant email from people in Oregon and elsewhere not only of general interest but expressing serious and touching needs for themselves or family members who are elder or who have disabilities.

6. Oregon Real Choice Systems Change 6 �For people without disabilities, technology makes it better; For people with disabilities, technology makes it possible�� Anonymous

7. Oregon Real Choice Systems Change 7 Environmental Control Light switch extension Remote control of household devices Computer-based remote control e.g. lights, appliances, alarms, HVAC

8. Oregon Real Choice Systems Change 8 Activities of Daily Living Reachers Sock assist Elastic shoelaces Button hooks Velcro Talking scale

9. Oregon Real Choice Systems Change 9 Alternate Computer Access

10. Oregon Real Choice Systems Change 10 �AT� Devices are Everywhere Look for everyday items with assistive value. Think curbcuts and door openers� - Voice smoke alarm (KidSmart) - Migo phone (Verizon) - Keychain voice recorder (Radio Shack) - OXO kitchen tools (BB&B) - Reach extenders (Toys �R Us) - Oversized phones and remotes (RS, Lillian Vernon) - Christmas tree light remotes (Trim-a-Tree) - Pill reminders - Item locators (Sharper Image, Brookstone) Think Lillian Vernon, Sharper Image. Brookstone

11. Oregon Real Choice Systems Change 11

12. Oregon Real Choice Systems Change 12 Technology for Remote Caregiving Support Integrating home sensor networks and web-based tools to provide data for consumers and caregivers Examples: - Providing long distance behavioral support - Helping consumers avoid victimization - Monitoring physical health and communicating information to health care providers - Monitoring environmental changes related to health and safety - Planning activity schedule with consumer-driven software Could mention examples such as icontrol, quietcare, homesight, etc. Remote caregiving Monitoring Telemedicine to track diabetes, blood pressure, medication change, compliance monitoring in less supervised arrangementsetc. Electronic data reporting and record keeping generally Channel to help support remote and family-based care: hybrid models. Could mention examples such as icontrol, quietcare, homesight, etc. Remote caregiving Monitoring Telemedicine to track diabetes, blood pressure, medication change, compliance monitoring in less supervised arrangementsetc. Electronic data reporting and record keeping generally Channel to help support remote and family-based care: hybrid models.

13. Oregon Real Choice Systems Change 13 Brief Example of Remote Monitoring in Practice Main Components Consumer-driven activity planning tool: Picture Planner� X10-based home sensor network Home automation software Consumer and caregiver monitoring computers

14. Oregon Real Choice Systems Change 14 Activity Reminder How many people out there have ever had a to do list, done something that wasn�t on the list, and after the fact, added it and crossed it out?How many people out there have ever had a to do list, done something that wasn�t on the list, and after the fact, added it and crossed it out?

15. Oregon Real Choice Systems Change 15 Some Basic X10 Modules Passive infrared motion sensor Wireless transceiver Wireless computer interface Door/window sensor

16. Oregon Real Choice Systems Change 16 Apartment Layout

17. Oregon Real Choice Systems Change 17 Activities of Daily Living Web-based Report

18. Oregon Real Choice Systems Change 18 Some Preliminary Results Improved self-management for activity and task completion Feasible cost effective remote support technology Caregiver effectiveness increased Caregiver peace of mind increased - shower - middle of the night- shower - middle of the night

19. Oregon Real Choice Systems Change 19 Questions For consumers: Equal access, better self-management, improved QOL, greater isolation? For providers: More effective use of staff, improved quality assurance systems and recordkeeping, changes in service delivery? For families: Better access to real-time info on person of concern? For developers: Greater options for less restrictive, more integrated housing solutions, or, larger community-based facilities?

20. Oregon Real Choice Systems Change 20 Systems Change Accomplishments Dedicated network wiring in all new housing projects funded by the state housing agency Inclusion of assistive technology consideration in the revised individual service plan (plan of care) process Maximizing use of provisions within Oregon�s existing waivered service options to fund innovative technology Promoting technology through Fairview Housing Grants Enhancing caregiver capability through technology in the waivered Children�s Intensive In-Home Support program 1915 C waiver Enhancing caregiver capability through technology in the waivered Children�s Intensive In-Home Support program 1915 C waiver

21. Oregon Real Choice Systems Change 21 Fairview Community Housing Trust:An Example of System Change Oregon Legislature established a Housing Trust with proceeds from sale of state institution for persons with developmental disabilities $15,000,000: 5% and all interest can be spent. Funds grants for housing modifications and equipment for persons with developmental disabilities who don�t live in licensed facilities Can be combined with waivered funds to complete larger projects Many grants for technology equipment and modifications

22. Oregon Real Choice Systems Change 22 Some Policy and Ethical Considerations Continue to develop ways to enhance access to technology for low-income consumers 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 in the name of cost-effectiveness Rather than having technology seep in a haphazard way into the lives of people supported by our systems, develop policies to progress in an intentional, strategic, and egalitarian fashion Ensure that remote support technology is deployed in a way that respects the balance between privacy and support as defined by the consumer Use Medicaid state plans and waivers to maximize funding for technology Note Medicaid emphasis on face-to-face billing vs. phone contact and what that implies for remote technology-based support (smart home, email, etc.) Viability of remote monitoring and caregiver notification technology as a billable service in relation to existing policies regarding billing for video teleconferencing, or telephone-based support? Note Medicaid emphasis on face-to-face billing vs. phone contact and what that implies for remote technology-based support (smart home, email, etc.) Viability of remote monitoring and caregiver notification technology as a billable service in relation to existing policies regarding billing for video teleconferencing, or telephone-based support?

23. Oregon Real Choice Systems Change 23 Resources Center for Assistive Technology and Environmental Access http://www.catea.org/quickrefguides/QuickRef.php Abledata http://www.abledata.com Technology For Housing http://www.technologyforhousing.org/home.php International Ctr. For Disability Resources on the Internet-wide range of AT and disability info http://www.icdri.org/Assistive%20Technology/sites_with_information_on_assist.htm Job Accommodation Network - Free consulting on individualized workplace accommodations http://jan.wvu.edu

24. Oregon Real Choice Systems Change 24 For Further Info Gerry Stolp gerald.stolp@state.or.us Tom Keating tkeating@eugeneresearch.org