by Pamela Fields, CEO, ATECH
As with other direct-care service organizations, Midstate Arc and ATECH share in the need to reach 100% compliance with the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Service (HCBS) final ruling. This ruling is tantamount to a sea-change for agencies in that we must now empower and assist the individuals in our care to live more independently, as opposed to providing care that for lack of a better term, has been delivered within a closed system. This change has provoked much anxiety, fear and financial worry among caregiving agencies, but my position is that we have the tools and technology at our disposal to help our agencies make this change. We can continue to provide top quality care and reach compliance – we simply need to be smart about it and use the explosion of technology to our advantage. In this article, I will explore 5 ways that assistive technology can help organizations meet the challenge of the March 2023 deadline safely, effectively, and efficiently.
In this light, CMS has created a list of specific requirements promoting independence for individuals, as well as measures to support direct care workers. These new requirements must be met in order for funding to continue. Medicaid funds over 57% of all HCBS spending, and this money in turn accounts for nearly 75% of revenue for many agencies. The financial need for agencies to comply with the new ruling is great, and the need to provide these types of services to individuals with IDD is even greater. Assistive technology hits all the touchpoints to getting to compliance in supporting employment and to enabling individuals to access the community. How can assistive technology help agencies to meet the HCBS requirements?
Chart source: Truven Health Analytics Report, 2017
Tracking and Security
As agencies, in order to provide individuals with independence we need to provide service and safety, but without a human being providing direct service all the time. Assistive technology can bridge this gap between direct care and remote care. Using tracking devices together with communication and security software, agency staff can monitor where an individual is within the community at all times. Should the individual need a ride or miss a bus stop, communication can be established instantly via a phone call, text, or smartwatch and in-person assistance can be provided. The individual can feel confident that they are supported wherever they are, and the staff can feel confident that they are in touch at all times.
Looking at this from an agency standpoint, we’re already in a labor shortage, and it’s my view that this shortage will continue. Smart use of assistive technology can take the burden off of in-person staff while providing the appropriate level of supervision either within a group home or out in the community. Allowing staff to remotely monitor individuals gives agencies more flexibility in staff coverage while also giving real-time feedback to in-person staff and the individuals receiving care.
Assistive technology has helped our agency with our staff in that we’ve been able to conduct group trainings online. We have held training webinars and then followed up afterwards with in-person demonstrations to reinforce the learning. The ability to hold a portion of the training remotely and on a flexible schedule has also been very helpful in managing our overall staffing.
The new service direction promoting independence requires changes for the staff as well for the individuals receiving support. As I mentioned, we have been working with our staff since 2014 and what we’ve seen is that initially, there was a lot of anxiety and fear around the changes. Whenever something changes, there’s a level of newness and fear. The challenge for us as agencies is to address this fear, and to provide continued, consistent training on the new service direction. We’ve found that we’ve been most successful by a constant gentle pressure to change the culture and move the team forward. Without consistency, people revert right back to their old behaviors.
From an ideological point of view, if you look at history, most cultures and societies that have been marginalized have had breakthroughs in moving forward. People with IDD have been held back more than any other community. In the past, people with IDD were literally locked away in institutions and faced discrimination of every kind. In many ways, these individuals are like a little paper boat tossed in the middle of a storm. Historically they have been at the mercy of others. If a service provider said they had to do something they had no choice. If a funder said they had to do something, there was no choice. Individuals with IDD have never had a voice; they have always been in someone else’s control.
We’ve done tons of training with our staff to get them to change their thinking and become aware of their own actions and thoughts, but it’s a work in progress. This kind of major change is not a one-and-done kind of thing. It takes continual training to keep it top of mind. Change is hard and it takes work.
Assistive technology is a critical tool that can and must be used to help agencies move forward. Whether used for community access, tracking and security, promoting independence in general, training, or communicating, assistive technology is here and at our disposal.
As I see it, the CMS rule changes coming in the near future are an opportunity for us to break people with IDD out of the marginalization frame where they’ve been locked. It will require consistent support for the individuals to make these changes for themselves, and the same is true for agencies.
As the direct care system is starting to evolve, we need to push ourselves to be ready. We will backslide, but we need to keep pushing forward. In this technological age, it’s the perfect storm. It’s the perfect timing to use assistive technology to help move forward. We have all these converging pressures: the pressure from CMS for HCBS compliance, the pressure that there’s not enough funding in the system, the pressure of a staffing shortage, and on the other hand we have all this technology booming all around us.
Our challenge is in how we will use technology: will we go with the old thinking of using it to put barriers in place, or will we use technology to get around and overcome the barriers we’re facing?
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