No Wrong County for Assistive Technology in Wisconsin!
WisTech grows its reach with ADRCs
Assistive Technology (AT) Act programs have a long history of learning from and building on one another's ideas. One example that continues to evolve began in Iowa where Program Director Jane Gay equipped Area Agencies on Aging (AAAs) with "Elder Kits" of assistive technology as far back as the 1990s. Twenty-plus years later, the portable kits approach is bringing AT to a new generation of information and assistance centers: the now burgeoning network of Aging and Disability Resource Centers (ADRCs) in Wisconsin.
The Elder Kits model
In the 1990s, Elder Kits were a way for the Iowa Program for Assistive Technology (IPAT) to grow its reach statewide. IPAT supplied each of Iowa’s Area Agencies on Aging (AAA) with a kit of devices and a flip chart of strategies supporting aging in place. According to Gay, the AAAs used them in their local catchment areas: one to one with clients, for group presentations such as at congregate meals or elder housing, and for tables at events geared to seniors.
The approach proved effective. Gay went on to create kits for use with mental health and early intervention programs; and among the national field of AT Act programs, Gay provided technical assistance to over a dozen states interested in replicating or creating their own kits strategy.
Wisconsin’s AT Act program, WisTech, was one of the programs to receive Gay’s technical assistance on Elder Kits. In 2007, Wisconsin was getting ready to launch its first round of Aging and Disability Resource Centers, and WisTech (then a program of Wisconsin’s Dept. of Health Services [DHS]) recognized an opportunity. Here was a way to further expand AT and WisTech program awareness into local communities.
The Administration on Aging and the Centers for Medicare and Medicaid Services (CMS) were creating the ADRCs as “one stops” for seniors and persons with disabilities to access and navigate options for long-term care services and supports. In Wisconsin their launch was part of the state’s broad long-term care systems overhaul--Medicaid-funded reforms which sought to “rebalance” services away from facility-based models of care in favor of options for living and working in the community. WisTech and its then-parent agency, DHS, recognized the role AT consideration should play in that effort. Empowered with Medicaid dollars designed to support these “systems change” goals, WisTech and DHS considered Iowa’s kits as a way to bring the ADRCs into the AT fold.
ADRCs are supported through a collaboration of the federal Administration on Aging (part of the new Administration for Community Living), the Centers for Medicare and Medicaid Services (CMS) and the Veteran's Health Administration. Terms associated with the ADRCs (and their grants) include "Long Term Services and Supports" (LTSS), "No Wrong Door/Single Entry Point" (NWD/SEP), "One-stop Shops," "Options Counseling," "Evidence-based Care Transition programs," and "Dementia-capable LTSS systems." ADRCs were first funded in 2003-2005; to date a total of 54 states and territories have them. (Learn more from this CMS informational bulletin [PDF].)
WisTech Program Director Ralph Pelkey (since retired) and Rehabilitation Technologist Laura Plummer studied Iowa’s kits strategy and adapted the model to serve their own objectives. Like IPAT, WisTech would create kits for use by a separately-funded network of outreach staff with a related mission. Plummer explains, however, that “an additional goal for Wisconsin was to encourage a working relationship between these ADRCs and the existing statewide network of Independent Living Centers (ILCs).”
That relationship was important because ILCs in Wisconsin are providers of Information and Referral services to both persons with disabilities and elders, and they house and provide WisTech’s assistive technology demonstration and loan program services. The ADRCs, Plummer emphasizes, were established to play a related role and their success would depend, in part, on how well they understand the service network and work within it.
One way to encourage this integration, Plummer decided, was to enlist regional ILCs with kit design and ADRC training. To carry this out, she invited three AT demonstration and loan program staff at ILCs in different regions to collaborate with her. “It was also a way to ensure the kits were not viewed as just a top-down directive and encourage project buy-in,” she reflects.
WisTech’s kits were rolled out in three phases over an eight year period, paralleling the rollout of Wisconsin’s ADRCs. Local and regional half-day trainings were provided with each phase and served as an introduction of new ADRC staff to the ILC network. Kit content was chosen, in part, by ILC staff, and in subsequent funding rounds content was adjusted and updated through feedback from the field.
All told, Plummer reports, over 100 kits were assembled and distributed throughout Wisconsin between 2007 and 2015. These included kits to each ADRC and ILC in the state as well as one managed care organization.
“I’m proud of the way we reach every county and every tribe in Wisconsin,” Plummer says, “and of the potential we now have to reach every resident who needs assistance.”
Program Nuts and Bolts:
- Each WisTech AT Kit is made up of a rolling suitcase packed with 90+ items covering daily living activities, hearing and vision impairments, transportation needs and personal care. A comprehensive resource manual is additionally included. View the 2013 AT Kit list (PDF)
- WisTech’s goal for kit use is the demonstration of equipment and for constituents to feel comfortable enough to talk about their lives, needs, and functional limitations.
- Trainings for ADRCs staff provide an overview of the SETT framework (assessment process), discussion of each kit item, statewide resources, and how to introduce and talk about technology to consumers (what Plummer terms “Acceptability!”) View the WisTech AT Kit training slide presentation (PDF)
- Data from sites on their use of the kits is provided quarterly, but voluntarily.
- Medicaid Infrastructure Grant dollars funded phases one and two of WisTech’s AT Kits, and DHS identified separate grant funding for round three.
- Data reporting should be a requirement for ADRCs receiving AT kits for demonstration.
- Kit deployment works best when integrated into the ongoing and routine work of the ADRCs. Kits should not be available only upon request!
- Kits get used by sites when there is someone on staff who is “into technology.”
- Regional trainings should be periodically repeated to ensure kits remain in circulation beyond staff turnover at ADRCs (or other entities). WisTech invited new staff at existing ADRCs to trainings for newly-established ADRCs in phases two and three of the project.
- Trainings may also be video recorded and made available online for year-round access by staff (a WisTech AT Kit training at an aging conference was uploaded for this purpose).
WisTech next directions:
WisTech continues to learn from other statewide AT Act programs. Currently, Plummer is taking a page from Arizona’s dedicated device loan program for schools and considering a pay-for-performance model with her ILC network to encourage school outreach.
Questions? Email Laura Plummer
Learn about ADRCs in your state