Refining Technology Definitions
Background
In the last two decades, there has been an explosion of technology integration into services and supports for individuals with disabilities. The addition of higher-technology options to the traditional pantheon of assistive technology devices and the development of more complex technology-based services, such as remote supports, has fundamentally changed the world of disability services.
CAIRSS could not be happier about the greater involvement of technology in disability services. Technology not only addresses chronic issues such as the national direct care staff shortage and limited funding for individuals trying to receive supports, but they have also demonstrated a capacity to improve outcomes for the individuals served by allowing them to access greater independence at home, work, and play.
Unfortunately, as is the case with the introduction of any new service, there have been some obstacles along the way. One example we’ve seen has been the lack of coherent and standardized definitions for the various emerging services. There are numerous terms for the same service, and different services being reimbursed and regulated under the same terms. The problem is both intra- and interstate.
The state-based model for disbursing HCBS waiver benefits has given rise to 50 separate conceptions of technology and its use as a service for people with disabilities. While no doubt each of the persons in working to add technology have individuals’ best interests at heart, there is no established national framework of concepts they can draw upon as they build policies, regulations, and reimbursement methods. The effects of these disparities in definitions, terms, and reimbursement structures proves detrimental to technology integration at many levels.
For the individual and family members doing research about technology services, the information gathered can be extremely disorienting. In one state assistive technology is not provided, but adaptive aids are. However, some items and services allowed under the adaptive aids service are identical to those defined elsewhere as assistive technology. Any effort to understand, let alone evaluate, different technology services and supports for themselves or their loved one is bogged down by ambiguities and homonyms.
For providers, especially providers of technology, the lack of a coherent set of definitions presents problems as well. For one, technology providers may be allowed to provide a piece of technology or service under the service definition designed by one state, but not another, even if the services have identical names. Secondly, their efforts to engage with stakeholders, such as family members and individuals, is hindered by the need to change their use of certain words to match whatever terms the state has adopted.
We must not forget the states in all of this either. Departments administering HCBS waivers suffer from this confusion of definitions as well. In addition to indirectly being affected by the problems for their provider and family stakeholders, state funds are affected.
One state recently implemented remote supports but also reimburses PERS and simple phone calls under that service definition. Presumably this means a PERS provider could be reimbursed at the same rate as a remote supports provider. For those unfamiliar with the difference: PERS (personal emergency response system), staff only respond to crisis calls from individuals, whereas remote support professionals are more actively engaged minute to minute with the individual. This difference in engagement means providers of remote supports are spending more for every hour they’re being reimbursed, whereas PERS units have much lower per-service-hour costs. Why should states care? Because they’re losing money. PERS units can and have been reimbursed at significantly lower rates in other states, states who understand PERS is separate and distinct from remote supports. Money the state could save separating RS and PERS services could be spent providing more services to individuals on waitlists.
Additionally, states looking to increase rates of technology utilization by introducing new tech-based services can be hindered in their efforts by this confusion about terminology. For example, if a state does not appreciate the difference between remote supports services and PERS, it will not appropriately regulate and reimburse these activities in a way that incentivizes provider organizations to participate. To reimburse remote supports at an existing PERS rate reveals is to reveal a fundamental misunderstanding of the core elements of both services.
It is important for states to understand and appropriately codify conceptions of these discrete technology services if we are to enjoy the full benefits of what technology has to offer people with disabilities. Any equivocation or confusion serves only to hinder access to life-changing opportunities for the individuals serve.
These are just a few examples intended to illustrate the negative effects of not having a robust, national set of definitions about technology. Without a concentrated movement toward interstate cooperation on definitions, we will continue to experience these roadblocks to greater implementation, and, consequently, enjoy fewer of the potential benefits of full technology integration.
To begin to address this issue, we at CAIRSS have compiled a set of definitions we believe capture the core differences of technology solutions and services. We hope these definitions will serve as a basis to clarify and refine terms for states which have already implemented technology services and those which have not yet integrated technology.
Enabling/Supportive Technology
“Enabling and supportive technology is the umbrella term used to describe all aspects of technology which are and may be used to support an individual with a disability. Assistive technology, as defined by the AT Act of 1988, falls into this category, as does remote supports, remote alert systems, PERS, telehealth services, environmental/home modifications, and vehicle modifications.” - CAIRSS
Assistive Technology
“Any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” – (29 U.S.C. Sec 2202(2))
Remote Supports
“Remote supports is a technology-based service that allows trained, remote support professionals (RSPs) to deliver live support to an individual at a remote location. Its primary goal is to foster an individual’s independence while maintaining their safety as they live in the community. Remote supports are delivered by awake, alert RSPs whose primary duties are to provide remote supports from the provider’s secure facility. To ensure safety and HIPAA compliance, this Remote Supports facility should have appropriate, stable, and redundant connections. This should include, but is not limited to; backup generators, multiple internet service connections, battery backups, etc. Remote supports should always be selected as the result of decisions made by the individual and their team. Remote supports must be incorporated into the individual’s personalized service plan and must be executed in a person-centered fashion. Remote supports are not intended as a wholesale substitute for in-home direct support professionals. They are intended to replace some staff hours for individuals who do not require in-home staff at all times, but still need some support.” - CAIRSS
Remote Alert Systems
“Remote alert systems are technology setups which combine discrete pieces of technology (such as sensors) into a system which sends information (such as sensor alerts) directly to DSPs, provider professionals, or natural supports like family members. These systems are designed to link the actions and events in an individual’s home to a DSP or natural support. Remote alert systems function similarly to remote supports in that both often capture and send sensor information from the participating individual’s home. However, they differ in that remote alert systems may not utilize awake, alert RSPs or have the technical redundancies built in like many remote support services.” - CAIRSS
Virtual Supports
“‘Virtual Supports’ is an umbrella term that encompasses the service delivery method whereby DSP-backed, in-person services are provided through technology. In the wake of COVID-19 era Appendix-K flexibilities, many states began allowing traditionally in-person services to be accomplished virtually. Virtual Supports does not refer to any specific in-person service, but the method of providing any service virtually, without a physically present staff person.” - CAIRSS
Personal Emergency Response System (PERS)
“PERS is an electronic device that enables participants to secure help in an emergency. They participant may also wear a portable ‘help’ button to allow for mobility. The system is connected to the participant’s phone and programmed to signal a response center once a ‘help’ button is activated. The response center is staffed by trained professionals.” - Indiana HCBS Waiver Definition
Telehealth/Telemedicine Services
“Telehealth is… the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, health administration, and public health.” - Health Resources & Services Administration.
The central difference between remote supports and telehealth is the clinical nature of the latter. While remote supports are a supportive & habilitative services, telehealth focuses on facilitating clinical activities between a patient and healthcare provider.
Environmental/Home Modifications
“Environmental/Home modifications are deliberate alterations made to an individual’s living environment in order to make said environment more accessible to the individual or to facilitate the execution of necessary tasks for daily living. Examples of environmental/home modifications may include, the installation of wheelchair ramps, accessible bathtubs, or grab bars, or the widening of doorways.” - CAIRSS
Vehicle Modifications
“Vehicle modifications are deliberate alterations made to a vehicle in order to make that vehicle more accessible to an individual with a disability. This could include installing a wheelchair lift, removing seating to accommodate a secure wheelchair position, or installing grab bars.” - CAIRSS
