Remote Monitoring and Technology-Enabled

Support

DISCLAIMER

Service has NOT been approved by CMS yet; items included in the presentation are subject to change…

CHANGE IS REQUIREDSOLUTIONS ARE NEEDED

Budget Projected budget deficit of 15% at minimum

Workforce instability Direct support professional wages down 50% DSP turnover 80% reporting employees on public assistance Public DSP wages 73% higher

27,000 people on waiting list Administratively complex Unsustainable course for individuals and

system

WHAT DO WE DO?

Everybody talks about the weather, but nobody does anything about it. Mark Twain

ADMINISTRATIVE SIMPLIFICATIONS

Waiver Simplification Task Force Cost Projection Tool web based application Single page summary of the individual

service plan Redesign of existing waiver services

PROPOSED WAIVER PILOT

Alignment of incentives to accomplish mutual benefit

Shift focus from inputs to quality Fiscal stability Efficiency strategies

Natural supports Staffing patterns New waiver services

PROPOSED NEW WAIVER SERVICES

Respite Personal emergency response system Adult family living Remote monitoring – focus for today’s

remarks

SOME GUIDING PRINCIPLES

Useful Affordable Accessible Easy to operate for end users Value added

OHIO’S PROPOSED NEW WAIVER SERVICE – REMOTE MONITORING Status of waiver amendment

– Conference calls took place with Centers for Medicare and Medicaid Services (CMS) summer 2010

– Submitted IO Waiver Amendment (October 1, 2010)

– Anticipating next round of CMS questions this quarter

– CMS stopped the clock on waiver amendment with questions about another service (Late 2010)

– Final Rule filing process (after CMS approval; rules have been submitted to CMS)

– Training and implementation (Early 2011)

REMOTE MONITORING: SERVICE DEFINITION

Service Definition in the IO Waiver Amendment:

“’Remote Monitoring’ means the monitoring of an individual in his or her residence by remote monitoring staff using one or more of the following systems: live video feed, live audio feed, motion sensing system, radio frequency identification, web-based monitoring system, or other device approved by the department. The system shall include devices to engage in live two-way communication with the individual being monitored as described in the individual's ISP.”

REMOTE MONITORING SERVICE

Ensure health and safety & reduce or replace the current or future amount of Homemaker/Personal Care

Only agency providers Three primary components

– Equipment– Monitoring staff– Off site/on call staff – backup support

person

REMOTE MONITORING SERVICE REQ’TS

At individual’s residence Staff and individual training on remote

monitoring system required Provided as specified in ISP Backup support paid or unpaid

REMOTE MONITORING SERVICE REQ’TS

Backup power systems required at monitoring base and at individual’s residence

Contact backup support person if system stops working for any reason

System for notifying emergency personnel

Disclose monitoring staff : individuals receiving remote monitoring during selection process

REMOTE MONITORING SERVICE REQ’TS

Prohibited in Adult Foster Care, supported employment or non-residential habilitation setting

Individual/guardian informed consent required - all individuals remotely monitored

Visitor notification of audio/video recording

Contact 911 then backup support person

Individual may request that remote monitoring system be turned off – backup support person must be on site

REMOTE MONITORING SERVICE REQ’TS

Monitoring base cannot be at residence

Timeline for backup support response in ISP

Must be done in real time, not via recording

Monitor cannot have other duties and must be awake

HIPAA compliance required to ensure appropriate access only

Data retention for 7 years when Major Unusual Incident occurs

REMOTE MONITORING SERVICE PAYMENT

Remote Monitoring Rates: Payment $9.83 per hour per site for

paid backup (Homemaker/Personal Care provider is provider of record)

Payment $6.47 per hour per site for unpaid backup

“Contracting” Options Payment for equipment is separate

REMOTE MONITORING EQUIPMENT

Technology as a service– Contact or motion sensor– Camera/web cam– RFID– Web-based monitoring system– Live video or audio feed– Ultra mobile personal computing devices– Smoke detectors

REMOTE MONITORING EQUIPMENT SERVICECovers a wide range of equipmentVisual indicator of equipment on

and operating Can only be turned off by remote

monitoring staff

REMOTE MONITORING EQUIPMENT SERVICE Equipment can only be leased Amounts billed for the leased equipment

shall be actual; calculated based on the cost of the equipment, a reasonable maintenance and repair factor, and a useful life of at least three years

Lease amounts billed monthly Annual limit of $5,000 for equipment leasing CMS feedback anticipated on some issues

around Remote Monitoring equipment

REMOTE MONITORING DOCUMENTATION REQUIREMENTS Date/Place of serviceName of individual receiving serviceMedicaid identification number of individual Name of providerProvider identifier/contract numberSignature of the person delivering the serviceNumber of units of the delivered service or

continuous amount of uninterrupted time during which the service was provided

Group size

ISSUES SPECIFIC TO RECIPIENTS OF REMOTE MONITORING

Independence Community integration Stretch funding resources Privacy issues Appropriateness One example - Rusty

ISSUES SPECIFIC TO THE SYSTEM

Providers incentive not resolved Capitalization of software, equipment, staff

and individual training Data collection on savings Reinvest efficiency dividends

– Direct care wages, benefits, training and supervision

– Waiting list– State/county fiscal relief

Changing the face of how services are delivered

Importance of focusing on quality in time of diminishing resources

Part II

USING TECHNOLOGY Improve Consumer Services/Supports

Assess Service/Support Needs Facilitate Communication/Involvement Families TeleHealth/Education

Improve Organizational Efficiency/IT IQ Coordinate Information Assess/Evaluate DSP (Direct Service

Professional) Engage in Research and Development

Design/Develop New Products Demonstrate Success/Failure

Create New Service Models Address Waiting Lists

Establish/Develop New Partnerships Social Ventures

Bob and Judy Charles SmartHome, Boulder, CO Charles Family SmartHome,

Longmont, CO

Imagine! SmartHomes

The goal of the Imagine! SmartHome: Through the application of technology, we will improve the quality, efficiency and access of supportive services for individuals with developmental and other disabilities in a permanently affordable, cost effective, and energy efficient community setting.

http://imaginesmarthomes.org

FUNDING

•HUD•CDBG•CDOH•Local Businesses

Grant Funding

•Direct Appeal•Special Events•Naming Rights

Imagine! Foundati

on

PARTICIPATORY PROCESS

Consumer/Family InvolvementDesignSelection ProcessOutline Expectations

House Guidelines Consumer/Family Satisfaction Technology Assessment/Evaluation

AREAS OF TECHNOLOGY

Consumer Specific Supportive Services Family Communication and Access Operational – Management and Line

Staff (DSP) Support and Information Environmental – Home Management

and Monitoring Systems

CONSUMER/FAMILY SPECIFIC

Universal Interface - UMPCEnvironmental Control SystemCommunication – VOIPRFID, IR and GPS CapableTeaching and Prompting Systems Family Information Systems

NEEDS-DRIVEN, PERSON-CENTERED TECHNOLOGY

What is Cognitively Support Technology?

Simply, Good

Design!

Prompting Technologies for Task Support

Endeavor Desktop Environment – Task Prompter

PROMPTING ON MOBILE DEVICES

Personalized task prompting on a PDA using customizable

visual and auditory step-by-step instructions with pictures or video.

Available

Visual Assistant – Mobile Device Task Prompter

VISUAL COMMUNICATION TOOLSCognitively accessible “Skype” for desktop communication, picture-based cell-phone for mobile communication.

Available

Visual ACE – Developed in collaboration with Imagine!

Pocket ACE – Developed in collaboration with Univ of Kansas

OPERATIONAL

SaaS ModelManagement Interface -Browser BasedEmployee Time TrackingDSP Interface - Browser Based Automate Documentation

Incident Trending Care Plans Billing/Utilization

Multiple Platform IntegrationLMSFamily Access/Portal

CHANGING STATIC TO DYNAMIC

Consumer Actions Learning/Independence Direct Care Interactions Billing for Reimbursement Notification and Prompting Health/Wellness Family Involvement

SupportNetwork

USING RFID INFORMATION

Sensors Alerts

Sensors

Just In

Time Log

Portal Use

ProfilesAlert

Preferences

StaffMembers

Clients

Managers

•Alerts & Notifications

•Live View•Care Zone Summary

•Performance Metrics

Staff Members

Staff Members

•Global Perspective•Client Overview•Employee Overview

ManagersManagers

• Live View• Historic Trends• Health

information • Social

information

CARE System

CLIENT SUMMARYInformation Summary and Documentation

Hub* Metrics * Communication * Quick Documentation *

Medication Administration and prompting system

Intuitive User Interface improves efficiency and accuracy

Easily manage staff and medications records from a central location or remotely

Improved compliance with Medication Administration

Improved communication between DSP and Nursing

75% reduction of medication administration errors

Reduces staff training by 18 hours per residence

Integrated with Pharmacy to reduce transcription errors

Time Based Prompting System Integrates Medications, Vitals and Tasks

LONG TERM GOAL

Through the application of technology, we will improve access and availability of supportive services for individuals with developmental and other disabilities so that they may lead fulfilling lives in their homes and communities.

VARIETY OF REMOTE MONITORING SYSTEMS

Cameras PTZ – Fixed Units

Motions Sensors Detect Falls/Proximity

Security/ Health and Safety Sensors Doors/Windows - Alarms

GPS- Community Remote Health Monitoring RFID – Specific Location

Environmental Control Data - Trends

ENERGY MANAGEMENT

Energy Efficiency Intelligent Monitoring –Data Mining to

Create Usage Profiles Create and Optimize Load Profiles Integrate Adaptive Technology with

GridAgents Technology

CURRENT AND POTENTIAL RESEARCHWorking with Colorado WIN

Partners Identified 31 areas of research

Quality of LifeEffectiveness of servicesProvide Cost and Energy SavingsImproved Health and Safety

Funded through Grants

RESEARCH QUESTION

Does living in the Bob and Judy Charles Smarthome enhance the quality of life for the residents?

Quality of Life Indicators Studied Increased service to customers Increased active participation with community Increased communication Increased independence Improved health Satisfaction with services provided through the

SmartHome

RESULTS -CHOICES AND DECISION MAKING

There was a large increase in residents’ perception in control of their own lives.

5 resident’s mean scores stayed the same or increased 2 resident’s mean scores

increased by one point 1 resident’s mean scores

increased by two points 2 resident’s mean scores

increased by 4 points

1 resident’s mean scores decreased by 3 points

-5 -4 -3 -2 -1 0 1 2 3 4Change in mean scores

0

1

2

3

4

5

6

7

8

Choices & Decision Making 1 (n=6)

Number of Resi-dents

RESULTS - RESPECT AND RIGHTS

Overall, there was a slight increase in feeling of being respected by others around them.

4 resident’s mean scores stayed the same or increased 1 resident's score stayed the

same 2 resident’s scores increased

by two points 1 resident’s mean scores

increased by 4 points

2 resident’s mean scores decreased 1 resident’s mean score

decreased by one point 1 resident’s mean score

decreased by 2 points

-5 -4 -3 -2 -1 0 1 2 3 4Change in mean scores

0

1

2

3

4

5

6

7

8

Respect and Rights (n=6)

Number of Residents

SUPPORTS INTENSITY SCALE – SIS OVERVIEW

Evaluate and measure the type, frequency and intensity of supports needed for an individual with a developmental disability in 85 area covering the following domains: Home Living Community Living Lifelong Learning Employment Health and Safety Social Protection and Advocacy Medical Behavioral

Collected directly from participants in a structured interview format.

CHANGES IN SIS OVERALL RATINGS SIS Support Needs Index

Man

dy Rae

Geral

dJo

hn

Rebec

caChr

is

Donna

Lana

0

10

20

30

40

50

60

70

80

90

Round 1Round 2

Support Needs Score

PATTERNS IN SIS CHANGES

Part B: Community Living Activities Q1 – Getting from place to place throughout the

community

AREAS OF DEVELOPMENT Consumer Assessment Integrating Multiple IT Platforms DSP Training Product Development and Assessment

Adaptive EquipmentBehavioral SupportsBehavioral Patterns Recognition through

Energy UsageSocial Networking

Capturing Life History Remote Monitoring Waivers

Check us out

SmartHomes - http://Imaginesmarthomes.org

FaceBook – http://www.facebook.com/pages/Imagine-SmartHomes/86609388388

Twitterhttp://twitter.com/ImagineColorado

THOUGHTS! QUESTIONS?

Mark Davis

Ohio Provider Resource Association

1152 Goodale Boulevard

Columbus, Ohio 43212

614.224.6772

mdavis@opra.org

Greg Wellems

Imagine!

1400 Dixon Ave

Lafayette, Colorado 80026

303.926.6466

gwellems@imaginecolorado.org