Technology for Housing

Blueprint for System Change

Background of the project

In 2004, The Oregon Department of Human Services was awarded a Centers for Medicare and Medicaid Services Real Choice Systems Change Grant consisting of two objectives:

1. Exploring ways to make technology a more meaningful part of the delivery of services and creation of affordable housing for Medicaid eligible seniors and people with disabilities; and
2. Streamlining payment systems for services providers in the mental health arena.

The total amount of the award was $828,233. Of that amount, $555,098 was designated for the technology portion of the grant, which is the focus of this report. The term of the grant is 4 years, and will conclude in October 2008.

To accomplish the first objective of the grant on technology integration, administered by Seniors and People with Disabilities (SPD) in collaboration with Oregon Housing and Community Services (OHCS), SPD established a contractual relationship with Eugene Research Institute, a leader in the application of technology to help persons with disabilities become more independent, safe, and to achieve their potential for growth. SPD also hired an assistive technology specialist to acquire data necessary to plan system changes and suggest ways to move this agenda forward. A stakeholder council provides direction for the activities of the grant.

Purpose of This Document

The purpose of this report is to present a “blueprint” for systems change, consisting of series of recommendations that describe specific changes in policy and service delivery to increase the use of technology to support low income seniors and persons with disabilities in affordable housing. These recommendations flow from grant activities conducted during the past three years as highlighted in the next section.

Grant Activities and Accomplishments

The Real Choice Grant team has:

• Conducted 18 key informant interviews with leaders of DHS, Oregon Housing and Community Services Department, persons with disabilities, advocates, families and professionals in technology and human services.
• Gathered information through a survey tool designed to take a snapshot of the awareness and use of housing related technology among low-income seniors and persons with disabilities, and barriers that prevent greater utilization.
• Explored administrative rules and statutes to discover where technology is addressed, and, more importantly, where it might be introduced into the fabric of law and rules that control the delivery of services and the development of affordable housing.
• Developed and maintained a website that reports on various grant activities, provides a communication tool for stakeholders and staff, and provides information and resources concerning technology resources in Oregon and nationally.
• Developed six demonstration sites to test the possibilities for extending the use of technology with various residential settings, and gain insight into future development.
• Provided computers, software, training and other assistive devices to residents in demonstration sites.
• Conducted 12 presentations and in-service training throughout Oregon and at several national conferences.

Recommendations

1. Maximize access to technology as a powerful tool to enhance service delivery.
   1. Require all service planning processes for Medicaid-funded services to seniors and people with disabilities to include assessment of how technology can be used to meet individual goals for health, safety, independence, communication, and quality of life.
      • A review of these planning processes revealed that the protocols for such plan development include no consideration of the role of technology. A model to promote such consideration exists in the provision of educational services to children.
   2. Ensure that information about technology for affordable housing is readily available and easily accessible to care providers, families, consumers, organizations, and agency personnel.
      • Many stakeholders lack awareness of useful technologies that are readily available and could significantly improve quality of life for consumers. Easily accessible materials such as checklists and Web sites specific to technology for housing are needed to facilitate consideration of technology solutions when planning service delivery.
   3. Develop plans to increase the availability of personal computers for low-income seniors and people with disabilities.
      • People with disabilities continue to lack access to basic technology hardware and software, and what they do receive is often outdated. The demonstration sites developed in this grant clearly show the benefits to consumers when that digital divide is removed and they are given access to state of the art technology.
   4. Ensure that all OHCS-funded projects require plug-in-ready network wiring and broadband services in all new affordable housing developments.
      • Current standards require network pre-wiring in new projects, and this should be expanded to specify plug-in ready networks including finished data ports, broadband service, and router equipment to enable low-cost shared broadband access.
   5. Convene a work group within state government to explore ways to obtain favorable shared broadband arrangements and rates from DSL and cable providers for use by residents in subsidized housing.
      • Residents of affordable housing pay expensive rates for broadband access. Since public funds are used to create affordable housing and provide support to tenants, the State as a high-volume consumer of telecommunications services could take a leadership role in negotiating more favorable terms for telecommunications access.
2. Provide training in technology for affordable housing for seniors and people with disabilities.
   1. Use state resources and leadership to develop training materials on technology for housing for case managers, providers, family members, and consumers.
      • There is currently no structure to extend grant activities on technology access promotion beyond 2008. Technology access needs to remain a supported goal within the SPD system. At a minimum, this should include resources to build on the training materials arising from grant activities, including maintaining www.technologyforhousing.org, the Web site developed through the grant.
   2. Develop training goals and curriculum to increase the technology literacy of residential care providers – from administrators through direct care staff.
      • Many provider agencies are in the process of considering how to integrate the use of technology into management of the services they provide. It is important that agencies develop in-house expertise to upgrade their management systems and to support technology access for consumers.
   3. Explore possible incentives for agencies to increase the use of technology in the delivery of residential services to seniors and people with disabilities.
      • As provider agencies engage in the process of technology integration, SPD should consider its interest and role in supporting those efforts and perhaps developing incentives that encourage migration to technology-based systems.
   4. Develop case management training materials that address technology awareness and implementation in various residential settings.
      • One barrier to technology access for consumers is the fact that case managers receive little or no training in the area of assistive technology generally, its potential role in improving quality of life, independence and productivity, and funding options to pay for it. SPD is in a position to support development of training materials toward that end. Such materials could also provide a basis for development of materials for other groups such as direct care staff, family members, and consumers.
   5. Explore partnerships with the community college system to provide training and certifications in assistive technology.
      • Community colleges typically play an important role in training paraprofessionals in various vocations, including job preparation in the medical and human services fields. With the increase in both licensed and unlicensed services for seniors and people with disabilities, opportunities should be explored for a program of training direct care staff as assistive technology specialists.
      • Community colleges also have enormous untapped potential to provide technology awareness and computer literacy instruction to consumers.
   6. Increase awareness of funding options to pay for assistive technology.
      • There is a lack of clarity about what kinds of assistive technology can be paid for either as durable medical equipment or through various waiver options. There is also a poorly understood patchwork of other private and public funding options that could be better utilized, including support available through community development organizations, civic groups, city-specific programs, and private foundations.
3. Deploy technology to increase quality assurance in a service system that is increasingly decentralized and self-directed.
   1. Evaluate licensing requirements in light of a changing technological environment.
      • Current administrative rules governing the licensing of homes for persons with developmental disabilities and for seniors in congregate care settings don’t take into consideration the advantages afforded by technology in service delivery. Specific requirements should be reviewed with the goal of facilitating technology based quality assurance applications.
   2. Use technology to help track health and safety variables in non-licensed or supported living services provided by agencies, brokerages, and home healthcare workers.
      • Client health and safety information is tracked haphazardly if at all in non-licensed settings. Continuity of care could be improved by more systematic recording of important client information. Such recording would ameliorate the negative impact of high staff turnover in these settings. Families, caregivers, and consumers need to engage in discussions of how to use technology to provide effective quality assurance in non-licensed residential settings.
   3. Encourage use of mobile devices to track aspects of care ranging from medication administration to personal care and individual preferences.
      • As the cost of mobile devices and software declines, there are increasing possibilities for agencies to use transferable hand held devices to store client information, including activity schedules, medication administration records, and personal care protocols. DHS should support an agency-based pilot project that would pay for equipping staff with handheld devices, software, and training in order to evaluate the impact of a mobile system for tracking client care.
   4. Tap the potential of remote caregiving technology for health and safety monitoring.
      • Motion sensing and video monitoring equipment can increase the power of the service delivery system by communicating with clients who may be at risk or who require a “check in” on a regular basis to insure that basic health and safety requirements are met. Public and private stakeholders should collaborate to fully investigate implications for Medicaid reimbursement, liability, privacy, and possible rule changes stemming from deployment of this technology.
   5. Address the ethical issues involved in deploying systems that are potentially intrusive and impinge on privacy.
      • Advocates for persons with disabilities and seniors, families, government agencies, caregivers and clients of services all have a stake in assuring that technology is used in a manner that balances the possibility for improved support with respect for client rights. DHS should take a leadership role in organizing forums with all players to identify ethical issues stemming from technology deployment and to forge policies and rules that address these issues.
4. Collaborate with other public and private entities.
   1. Take full advantage of caregiving technology research and development at such places as the University of Oregon, Intel, Oregon State University, OHSU, and many other private sector firms explore the potential for partnership.
      • The Department of Human Services should assign a section within its infrastructure to act as a liaison with educational and commercial technology efforts around the state. That section could act as a clearinghouse for gathering information and facilitating links with various parts of the system.
   2. The Oregon Legislature should fund an initiative to advance the state’s role as national leader both in provision of community services for seniors and people with disabilities and for research and development of technology to support those services.
      • Recent legislative economic development initiatives in the area of nanotechnology through the Oregon Innovation Council (Oregon InC) offer a model for how to structure a similar effort around technology to enhance quality of life for seniors and people with disabilities.