October 2015: Reaching Seniors with Assistive Technology (Aging Part 2!)

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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.

4 images: a large button photo phone, a shoe horn, an E Z reacher, a nosey cup with handles.

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.

WisTech Assistive Technology.

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.

Young and old with technology for living and working in the community.

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.

Lessons Learned:

  • 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 

Maine CITE Partners with Senior Companions 

Maine CITE. Enriching lives through assistive technology.
Here's a unique approach to reaching seniors with assistive technology (AT). Maine's AT Act program, Maine CITE, is partnering with Senior Companions, a program of the Corporation for National and Community Service (i.e. SeniorCorps).

Senior Companions are community volunteers aged 55 years and older. They serve 15 to 40 hours each week to help between two and four adult clients live independently in their own homes. Maine CITE Director Kathy Adams reports she has provided numerous presentations and trainings about assistive technology with the regional Senior Companion groups across Maine. Devices include the Handybar for assistance entering and exiting a car and other low tech items that can begin the conversation about needs and solutions.

"The great thing about this program for us is that the volunteers are seniors themselves. Not only are they getting to know local residents who can benefit by AT, they're also learning about devices and strategies that they may use themselves or will in the future."

Seniors who volunteer can earn a tax-free hourly stipend. To be eligible, volunteers must be retired and have an income that does not exceed $23,540 for an individual or $31,860 if married (based on 200% of the federal poverty level). In Maine the Senior Companion program is housed at the University of Maine. Currently it serves 14 of Maine's 16 counties. 

Find Senior Companions in your state

MassMATCH TACLEs Transition with Assistive Technology

MassMATCH: Maximizing Assistive Technology in Consumers' Hands
Sometimes the barrier to moving home from a long-term care or rehabilitation facility is the need for a wheelchair, a grab bar, a threshold ramp or other assistive technology (AT). To help ensure that elders and adults with disabilities are screened for their AT needs as they consider their long-term care options, MassMATCH has funded TACLE, Transition Assistance to Community Living Environment.

TACLE is a simple assessment tool for use by case managers and other professionals providing transition services. MassMATCH contracted with Easter Seals Massachusetts to design and produce the tool with the help of the Metro West Center for Independent Living. The tool helps case managers, social workers, healthcare providers, and other related professionals determine an individual's needs for AT and AT Services. It also serves as a protocol for making referrals for AT services.

Since its design in 2008, TACLE has been promoted through targeted trainings to staff members at Independent Living Centers, Aging Services Access Points, supported living providers, brain injury programs, Massachusetts Money Follows the Person Medicaid Waiver program entities and other state agency personnel who provide transition assistance to individuals with disabilities and elders. Five trainings were held in 2009 and six more in 2014.

"TACLE's goal," emphasizes MassMATCH Program Coordinator Kobena Bonney, "is to lay a foundation for system-wide access to AT where it is needed the most, helping to bring adults with disabilities and elders back to their home communities."

Find all TACLE Tools for Download

Conference Discount!

ATIA 2016
ATIA, the Assistive Technology Industry Association, is holding its annual Orlando conference and expo on February 3-6, 2016 at the Caribe Royale All-Suites Resort and Convention Center. This year there is also an expanded offering of 1 and 2 day pre-conference seminars on February 2nd and 3rd.

Catalyst Project AT Act Entities receive 5% discount off the main conference with discount code: APD6

ATIA's conference and expo features more than 100 exhibitors of the latest products and services as well as valuable educational programs strands.

Learn more about ATIA 2016
Review pre-conference offerings 

AT Lab Highlights from WATAP and Tools for Life

4 staff stand by AT Lab table
Left to right: Martha Rust, Rachel Wilson, Maria Kelley, and Ben Jacobs at the HCBS Conference in DC last August.

AT Program News was delighted to have the opportunity to visit the AT Solutions Lab assembled by Tools for Life, GA and the Washington Assistive Technology Act Program at the Home and Community-based Supports (HCBS) conference in DC this past August. Dozens of devices, ideas, and strategies were on display in a presentation room off the main expo/convention hall at the Washington Hilton.

The HCBS conference draws hundreds of professionals who work with seniors and this year it ran concurrent with the RESNA Catalyst/Pass It On Center conference taking place just 2.5 miles away. Serendipity for ATPN and other attendees who made the effort to check it out! For those who could not, below are a few highlights:
Amazon echo with device brochure.
Ask for the weather, listen to audio books and music, turn off the lights! The Amazon Echo is a voice-activated environmental control and entertainment unit that's under $200 and is compatible with select Belkin WeMo, Philips Hue, SmartThings, Insteon, and Wink connected devices to control lights and switches.  
iPad with keyboard projected on table top.
A full-size projected virtual keyboard for under $100! Celluon EPIC Ultra-Portable is compatible with iOS, Mac, Android, Windows and Blackberry. Works on flat opaque surfaces.
Video screen shot of beamz connected to an iPad.
Beamz is an interactive inclusive music-making tech tool that has users feeling like rock stars! Click the image above for a Vimeo demonstration of Beamz connected to an iPad at the HCBS conference. 
Reminder Rosie: Personalized daily living voice reminders. Shows clock with speech bubbles suggesting tasks linked to times.
Record your own voice to remind a family member of a task at the appointed hour! Reminder Rosie is always there and always punctual.

A hand gripping the KFS Easy Eat. Tools for Life coasters in the background.
The KFS Easy Eat incorporates knife, fork and spoon functionality in one tool (plus bottle and soda can openers), and is shaped for secure gripping.

Low-tech Approaches to Wandering

High-tech strategies for wandering have been on the rise for several years. Everything from insoles and bracelets with GPS tracking to slick wifi-enabled home monitoring technologies are now on the market (coined "nana technologies" according to this NYTimes blog post). Each is designed to assure family members a loved one won't get lost. 

The popularity of these devices should come as no great surprise. The prevalence of dementia is steadily increasing and wandering, according the the Alzheimer's Association, can occur at any stage of the disease. In the U.S., 5.3 million adults have Alzheimer's in 2015. Worldwide,  47.5 million people are living with dementia--a figure that is projected to more than triple by 2050 due to global population aging (see the Word Health Organization's 10 Facts on Dementia). 

AT strategies for wandering are not all high tech, however. Indeed, elder care and AT specialists emphasize that often the most effective strategies are adjustments to a person's living environment that work to decrease anxiety and confusion or, conversely, take advantage of it.

In this vein, Rachel Wilson, TechMATCH Specialist at Georgia's Tools for Life, offers the following ideas:

Memory boxes can help reassure individuals with dementia that they are right where they belong. Memory boxes can be used to display cherished keepsakes such as familiar photos and may be particularly helpful for seniors no longer living at home.

Musical Slide Shows offer a related higher-tech approach. A tablet computer with an app or Animoto on a desktop can be used to play favorite soothing music synced to photos of family. Video slide shows may be cued to play at key disorienting the times of day such as waking up (with an app like Picture Scheduler).

Weighted Blankets:
some individuals with dementia are soothed by weighted blankets and find they help with staying in bed and sleeping through the night. 

Confounding door locks, locks on doors that are not at eye level and bells on door knobs are additional simple anti-wandering strategies that can alert caregivers or help keep elders safe.

Strategies to discourage wandering that make use of dementia's confusion include painting exit doors the same color as the wall, door knob included. Doors may also be camouflaged with bookcase stickers designed for this purpose.

Tools for Life Accommodations Specialist Ben Jacobs notes, too, that some caregivers take advantage of a dementia phenomenon known as "visual cliffing," or the perception that the color black is a hole in the floor. Solutions that make use of this confusion include laying black rugs, tape or paper in front of exit doors to trigger an aversion to walking across these areas.

The best approach of all, of course, may be to recognize what is triggering an individual to wander and work to deter the behavior. To help, the Alzheimer's Association provides tips to reduce wandering such as:
  • creating a routine for daily activities to provide structure,
  • identifying the most likely times of day wandering may occur and plan activities such as exercise to reduce restlessness,
  • avoiding busy places that can cause disorientation, and
  • reducing fluid intake two hours before bedtime.
Read the rest at this Wandering Behavior topic sheet (PDF).
In Memoriam:
This edition is dedicated to the memory of Anders Lennart Anderson
August 22, 1928 - October 15, 2015

A painter who found beauty everywhere, my dad persevered with advanced macular degeneration for over ten years, relying on his residual and inward vision to keep doing what he loved. Read his NY Times obit
Watch a short film about him created with support from the American Macular Degeneration Foundation
Reminder: AT Program News, the RESNA Catalyst Project and the Administration on Community Living (ACL) make no endorsement, representation, or warranty expressed or implied for any product, device, or information set forth in this newsletter. AT Program News, RESNA Catalyst, and ACL have not examined, reviewed, or tested any product or device referred to in this newsletter
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. Content may be reproduced for non-commercial uses!
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