AT for Independent Living Utilization of Assistive Technology under CT Money Follows the Person

1. AT for Independent LivingUtilization of Assistive Technology under CT Money Follows the Person April 1, 2014 1:45 - 3:15 PM

2. Presenter Paul C. Ford Training & Technical Assistance Money Follows the Person Department of Social Services 25 Sigourney Street – 11th Floor Hartford, CT 06106 (V) 860-424-5376 (Fax) 860-951-9544 E-mail: paul.ford@ct.gov • Background • CT Tech Act Project Counselor – Independence Northwest • Nursing Facility Transition Project – CT Association of Centers for Independent Living • State of CT – Money Follows the Person

3. Presentation Summary • This session will focus on the utilization of assistive technologies for individuals transitioning out of nursing facilities to community under Money Follows the Person (MFP): • creative approaches, • challenges encountered, • lessons learned and • success stories. • Analysis of data collected by MFP and funding streams utilized relative to assistive technology will be discussed.

4. My Place CT • My Place to find the information and resources I need to live Independently. • http://www.myplacect.org/ • My Place to find the information and resources I need about working as a care giver. • http://www.myplacect.org/careers-and-training

5. Money Follows the Person • Federal Medicaid Rebalancing Demonstration: Shifting the bias from facility to community for long-term care • Transition 5200 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

6. Federal Definition of 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)

7. ADA Definition of Disability • The Americans with Disabilities Act ( ADA) has a three-part definition of disability. Under ADA, an individual with a disability is a person who: • (1) has a physical or mental impairment that substantially limits one or more major life activities; OR • (2) has a record of such an impairment; OR • (3) is regarded as having such an impairment.

8. Importance of these two definitions… • Elders and persons with disabilities tend to see themselves as separate groups • By the ADA definition elders who need assistance to remain independent meet the definition of person with disability. • This can be important when seeking justification or funding for AT for Elders.

9. AT for Independent Living- We’ve come a long way! Today Few options High Cost Specialized or dedicated technology Limited availability Many common types of equipment have accommodations ‘built-in’ Costs decreasing –especially as applications for general population become popular More readily available In the past

10. And we have a long way to go… • Information and resources about AT for independent living • Training for the general public and professionals including PT & OT, SLPs

11. Low, Moderate & High Tech Moderate High Inexpensive Simple Little or no specialization Quick intergradation into routines More costly Mechanical or electronic Moderate specialization Some training needed Low • Costly • Complex • Often highly specialized

12. Reality Check: Understanding the reality of low, moderate and high tech • The more high tech a device is the: • longer it may take to acquire • steeper the learning curve • greater the need for training & support • more time before successful integration into routines • higher the level of commitment needed by • the person who will use it and • the people who support them • Greater the need for preventative maintenance and a back-up plan

13. Where to start • Define the need in a simple and functional way • Consider an evaluation • Do some research • Try different pieces of equipment to see what works best • Be creative!

14. Problem Solving! • Think of solutions not products • Check out You Tube and other on-line resources! • Be creative – what could make this work?

15. Tip! • Before exploring higher tech solutions for common equipment: Look for accessibility features built-in to many products. • This is especially true with telecommunications equipment, electronic deices and media devices.

16. Evaluations and Rehab Considerations • With PT, OT, SLP – always ask about rehab potential • For AT Evaluations look for someone who is: • Experienced and familiar with a wide variety of devices, manufacturers and methods of access. • Creativity! • Willingness to commit to or recommend resources for training, for the consumer and their supporters. • Able to see the big picture: How the device fits into the consumer’s overall Person Centered Plan, life and lifestyle. • Absent of a vested interest in the device selected.

17. Evaluator Qualifications • In terms of certification – there isn’t a ‘required’ certification to do AT Evaluations • Having the AT Practitioner (ATP), offered by Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) does show that one has a certain level of knowledge and skills to perform AT Evaluations • CAP – Certified Aging in Place is a certification offered by the National Association of Home Builders (NAHB) • In addition to ATP and CAP specialists, evaluations can be done by a whole host of individuals: • Occupational Therapists (OT), • Physical Therapist (PT), • Speech Language Pathologist Therapist (SLP), • Rehab Engineers and others.

18. Creative Approaches We’ve learned that sometimes the answer is pretty simple…

19. Should we rip up the carpet? • Marie’s stand-pivot device doesn’t work on thick carpet • Aids were unable to turn the device to complete a transfer • Second Aid about $15 – 20 per transfer • Solution: Office Chair Mat • Onetime cost – about $30.00

20. Just hope no one bad comes in • John couldn’t keep up with replacing keys for his aids and was fearful that in case of emergency, help couldn’t get in – so he never locked the door • His family worried • Solution: Realtor's Lock box for keys • About $30.00

21. Stick with finger food? • Bruce has use of only one hand and couldn’t cut his own food • Aid at mealtimes to cut food $15-20 per meal • Solution: One-hand cutlery • One-time cost $76.00

22. Can’t afford any other care despite need • Joan needed a nurse three a day to do her eye drops • $94 per visit – • $282 per day • $1,974 per week • $7,896 per month • Solution – Auto drop Eye Drop Guide • One time cost of $5.45 plus a couple of nursing visits for training – Total less than $300

23. The mail must go through • Karen couldn’t get to the mail box on her own, so if the aid who helped couldn’t come – her Aids time sheets were late and aids didn’t get paid. • Some aids threatened to quit • Solution – Fax Machine • One-time cost – less than $100

24. Sometimes you just have to make something that works • Home made accessible chop sticks:

25. Challenges • Lack of knowledge about AT • Not considering AT as an option to a paid helper • Terminology • The way we have always done it vs thinking outside the box • Justification • Funding challenges

26. Lessons Learned • AT works best when you work in a person centered approach and the AT makes sense to the person. • Importance of not assuming and asking questions • Asking for a solution vs. a piece of equipment, • Importance of thinking functionally • Importance of trying to see the big or whole picture

27. Success stories • Just like any other kid • An iPad helped a teen, to communicate and even send e-mail and use face book, now she says she is just like every other kid in her class • ECU saves the day • Parents having to get up at night to adjust heat, turn on/off fan now Fred can do this and his parents can sleep

28. Success Stories • Computer and Peapod • Marie managed pretty well, but getting groceries was a problem – relying on neighbors was a hassle and she couldn’t afford to pay and aid. Now she orders what she needs and it delivered right to her door! • Adaptive kitchen • After a stroke and loss of the use of one arm – Joan’s passion for cooking was at an end until she worked with the local trade school to make her kitchen accessible – She is happily back to baking and making soups of every kind!

29. And yet one more… • Splash-top • An inexpensive ap for the iPad and iPhone allows a paralyzed architect to once again design – Splash-top allows full use of CAD on his desk top to be accessed and operated through iPad!

30. MFP Data • Money Follows the Person (MFP) contracts with the University of CT to study and analyze the work of transition. Information is collected through federally required surveys of people who transition under MFP. • The following two slides captures part of the data – the full reports are available on the UConn COA Website at: • http://www.uconn-aging.uchc.edu/money_follows_the_person_demonstation_evaluation_reports.html

31. Assistive Technology

32. Happiness

33. Resources CT Tech Act Project – Arlene Lugo, Program Director: Arlene.lugo@ct.gov Department of Rehabilitation Services (V) (860) 424-4881 (Fax) (860) 424-4850 http://www.cttechact.com/index.php Get AT Stuff http://www.getatstuff.com/home.php

34. Resources Center for Assistive Technology and Environmental Access (CATE) Georgia Institute of Technology National Public Website on Assistive Technology (V) (404) 894-4960 (Fax) (404) 894-9320 http://www.assistivetech.net/ This website provides a guided search to help identify appropriate assistive technologies

35. Resources NEAT Market – New England Assistive Technology Resource Center 120 Holcomb Street: Hartford, CT (V) (860) 243-2869 Toll Free (866) 526-4492http://www.neatmarketplace.org/index.asp Online Catalog of Used Assistive Technology available through NEAT http://www.neatmarketplace.org/store/index.asp NEAT Satellite at Disability Resource Center of Fairfield County 80 Ferry Blvd., Stratford, CT (V) (860) 378-6977 (Fax) (860) 357-2748 http://www.drcfc.org/neat.htm

36. Resources - Evaluations Use the links below to find local ATP and CAP Evaluators AT Practitioner (ATP), through the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) (http://www.resna.org/ ) does show that one has a certain level of knowledge and skills to perform AT Evaluations. CAP – Certified Aging in Place is a certification offered by the National Association of Home Builders (NAHB). (http://www.nahb.org/ ) In addition to ATP and CAP specialists, evaluations can be done by a whole host of individuals: Occupational Therapists (OT), Physical Therapist (PT), Speech Language Pathologist Therapist (SLP), Rehab Engineers and others.

37. Resources Abledata Searchable on-line database of Assistive Technologies http://www.abledata.com/ The Boulevard On-line Mall of Durable Medical Equipment and Assistive Technology http://www.blvd.com/

38. Resources – Home Modifications Center for Universal Design North Carolina State University http://www.design.ncsu.edu/cud/index.htm Visitability – Basic Home Access for everyone http://www.visitabilitypa.com/

39. Other Resources • My Place CT – Resources for care and support http://www.myplacect.org/ • My Place CT – Resources for caring fro a living and making a difference http://www.myplacect.org/careers-and-training • CT Money Follows the Person http://www.ct.gov/dss/cwp/view.asp?Q=414524&A=2345

40. Conclusions • Assistive Technology can: • provide a cost effective supplement to paid care givers. • be a key support in individual’s ability to live in the independently in the community • There is a wide variety in the type and complexity of assistive technologies available today • Proper evaluation, training and support can be key to an individual’s success in utilizing Assistive Technology

41. Questions?

42. Thank you! Paul C. Ford Training & Technical Assistance Money Follows the Person Department of Social Services 25 Sigourney Street – 11th Floor Hartford, CT 06106 (V) 860-424-5376 (Fax) 860-951-9544 E-mail: paul.ford@ct.gov