“This isn’t something that replaces people. It’s not about spying,” said Mark Gerhardstein, superintendent of the Montgomery County Board of Developmental Disabilities. “It would be a personal choice.”
Use of remote monitoring equipment was approved for Ohio on May 6 by the Centers for Medicare and Medicaid Services. Residents with developmental disabilities who are eligible for services through the Medicaid Individual Options Waiver program may participate.
The state Department of Developmental Disabilities supports about 80,000 clients and their families, including 16,404 who use waiver services.
Remote monitoring will be tailored to individual needs and may include a web-based monitoring system, motion sensors, live audio or video feeds and equipment for two-way communication with the person being monitored.
Cameras would be installed only in common areas such as kitchens and living rooms and turned on at set times, unless activated by the resident.
“This would allow some people living in a setting with more supervision than they need to live in a less supervised setting,” Gerhardstein said. “I’m willing to try it and see if it works.”
More independence for some
Tom Weaver, executive director of the Dayton-based, Choices in Community Living, said the technology could be “a door-opening experience” for some.
The nonprofit provides services to about 150 people with developmental disabilities who live in group and private homes or apartments.
Weaver said some clients yearn for more independence and others wouldn’t want the freedom the monitoring could offer.
“The technology has great potential for some folks to accent their strengths and provide them greater independence so their life isn’t so controlled,” Weaver said.
“It potentially has a down side if people are not comfortable with the technology and other folks are making decisions for them.”
Christina Miller, Medicaid health systems administrator for the Ohio Department of Developmental Disabilities, said the service won’t be forced on anyone.
“Everyone living in the home has to agree, whether they use the service or not,” she said.
The new service will cost less than sending someone to a residence to ensure medicine is taken or meal preparation goes smoothly, Miller said.
“Real monitoring in addition to other new services approved under the waiver amendment can save the state money and allow individuals to live at home,” she said.
The state had no data available regarding projected savings numbers.
Monitoring part of ‘arsenal of support’
A 2005 investigation by the University of Wisconsin-Madison into the cost effectiveness of remote monitoring for 138 Dane County, Wisc., residents with developmental disabilities found a saving of nearly $1 million in a fiscal year, when compared to sending staff to homes.
The cost for the monitoring equipment, installation and maintenance in Ohio is capped by Medicaid at $5,000 and would be paid by the waiver.
Ohio has set $6.47 as the per-hour, per-site maximum waiver service rate for individuals with a family member or friend on call in an emergency. The allowable rate increases to $9.83 per hour, per site, if the individual has no unpaid back-up, emergency support.
Margaret Nygren, executive director of the Washington, D.C.-based American Association on Intellectual and Developmental Disabilities called remote monitoring part of the “tele-health movement” for delivering services via telecommunications.
She said the industry has grown during the last 10 years starting in remote rural areas and is becoming more mainstream.
Nygren said it’s easy to envision privacy issues with remote monitoring.
“It appears camera use is episodic, turning on at a predetermined time, not continuous. That’s key,” she said. “It’s not intended to be exclusive care. It’s just part of an arsenal of support.”
No cookie-cutter template of services
No Ohio companies currentlyprovide remote monitoring for this use, according to the state. But, a few out-of-state providers hope to be certified to start working in Ohio.
Individuals and families decide on a provider, not the state, Miller said.
Wisconsin-based, Night Owl Support Systems LLC delivers in-home support using sensors that are programmed to send an alert to a central monitoring system. Night Owl is managed by the same group that developed the Sound Response system for Dane County.
“There is no cookie-cutter template of services for folks. Some clients require multiple sensors. Others may only have a few,” said Christopher Patterson, co-owner of Night Owl.
Indiana-based Rest Assured LLC uses electronic sensors, speakers and microphones, tele-cams in common areas such as living rooms and kitchens, temperature detectors, and personal emergency response systems. These devices link each home to remote caregivers who provide electronic support. The company serves 400 clients in eight states, said Dustin Wright, general manager.
“They can talk face to face with the person monitoring the system,” Wright said.
The monitor displays a slide show of digital family photos when not in use.
Julia Holloway, director of Developmental Rehabilitation Services for the Indiana Family Social Services Association, said Indiana got approval to include remote monitoring as a waiver service in October 2009.
“It hasn’t spread as wide as we thought it would, but people are asking more questions now that case managers are getting familiar with the technology,” Holloway said.
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