How Case Managers "Say Yes" To Purchasing Assistive Technology

I’m a board member of Minnesota Network & Education for Assistive Technology, where we did a live webinar for and by case managers around obtaining assistive tech for their clients. You can watch the full webinar here when we post it.

Community supports and staffing for those aging and with disabilities are in crisis mode.

According to AARM’s 2022 Annual Industry Report, a staggering 56.6% of residential facilities and 6.7% of Intermediate care facility/developmentally disabled-nursing (ICF/DD) operators in Minnesota permanently closed programs or facilities in 2021. 

These closures are in large part due to funding and staffing shortages — with a reported turnover rate of 45.4% among Direct Support Professionals (DSPs) and 27.4% of supervisors. Two thirds of DSPs left in the first year of employment along with half of supervisors following suit.

While there is a larger issue here of funding for our programs needed, an additional solution is already funded: assistive technology to enable people to live more interdependently.

Say yes first

The funding we need for higher paid DSPs, residential facilities, and ICF/DD facilities are not in place.

Federal and state agencies are fully aware of this crisis, and, in response, they have changed the narrative on funding for assistive technology.

Our historical knee jerk to say “no” to assistive tech — either due to the expense being perceived as too high, the tech being a want vs. a need, or concern about usage — has been rendered obsolete. 

Now, you can say: “Yes. How can we use this to improve your life?”

In fact, the federal waiver program is begging participants to take this approach.

Minnesota is updating their T2029 codes for assistive technology funding (TBD this summer) as well as coming out with new guidelines to hasten approvals and increase funding limits. Other states are following suit to meet demand in this staffing crisis. 

With the “yes first” approach, you’ll be amazed by the change in tenor of conversation and ideation that can happen. I was working with a young man that loved the latest tech. He came to me (as his case manager) wanting the latest Apple Watch. I took the “yes first” approach, and we saw it could have tremendous benefits to his daily life:

• When he eloped, his family could easily track him.

• When he inevitably wandered away in the mall, his family could voice call him

• The location feature gave him more independence to go on bike rides alone around the neighborhood safely.

• If he fell, it would alert his emergency contact.

• He could use Tiimo to keep up with his daily routine

• The health sensors assisted his family in monitoring some significant health needs he had while he was away from them

The best feature? He actually wore it because he liked it! Assistive tech is only useful if it’s used by the client, and that often means choosing a solution that may be more expensive at first glance, but will actually accomplish the goal to help clients live more independent lives.

Using federal and state funds to choose a subpar solution defeats the program’s intended purpose, which is to make up for lack of staffing with an increase in technology that can enable interdependent living.

How to get to “Yes First”

Change doesn’t happen overnight. And getting to a “yes first” mindset may be a hard pivot to make in an environment that is often underfunded. Case managers also still need to justify the cost!

Here’s how case managers can take their first steps in a “yes first” approach to assistive technology.

You don’t need to be an expert 

The most common concern I hear from case managers is “I’m not a technology expert.” 

The great thing about assistive tech is you don’t need to be an expert. 

As a case manager, you are a funding advocate: it’s okay and expected that you don’t have all the answers. Your client is an expert in themselves, assistive technology professionals are experts in the tech, and you secure the funding. 

It’s a team effort that can work pretty flawlessly when you’re open to working together!

In my experience, what makes it go smoothly is remembering assistive tech is simply a tool. If you or your client identifies a task they want to become more independent in or make more automated, that information is all you need to start. 

For example, a child I was working with absolutely loved going to the park, but they were not able to walk more than about 10 feet. This made trips to the park (as well as anywhere else) pretty difficult. They were too heavy for their mother to carry, and they no longer fit in a stroller. 

We requested a wheelchair (as you’re supposed to try billing insurance prior to using the waiver for medical equipment), but insurance denied it as they said a child under 7 in his condition did not require it.

That was quite the blow to their mother and I. We had identified the task we wanted to solve for, reached out, but were rejected. 

So we took another route! I reached out to an assistive tech vendor and they saved the day with waiver funding. They made this boy a fantastic adaptive stroller that he was able to wheel himself and that his mother was able to push when he got too tired. The stroller was also able to extend for when he grew and lie back for him to take naps. It isn’t the exact equipment or timeline we expected, but it turned out to be better.

So, if you hit a roadblock keep going. There’s almost always a solution with the right mindset and right people in your corner.

Here are the steps that you can take to overcome these obstacles.

Funding

Obtaining funding isn’t always as simple as putting in a code and hitting enter, as many of you reading this post know. 

It often takes proposals, meetings, and some darn good arguments. 

There are 3 main parts to every great assistive tech funding proposal: increasing independence, cost effectiveness, and reaching goals in the support plan. 

There is always a way to tie the assistive tech to all three, sometimes with a bit of creativity.

#1: Increasing independence

How will this piece/set of assistive technology increase the person’s independence and decrease their reliance on staff? Keep in mind, this piece of tech does not need to do so immediately. Sometimes the tech is just a small part in gaining a greater skill for the future. 

For example, a man living at home with his parents wanted to live in his own home eventually. This likely wouldn’t happen for several years - he needed 24 hour supervision, had significant seizure activity, and needed supports around maladaptive behaviors to a high extent. However, we should do everything in our power to help him reach this goal. What’s a good first step? In my opinion safety and medical are number one, so we started with him learning to take his own medication. We got him a DOSE Flip. His mother filled it and still needed to remind him to take it when it went off, but the goal was for him to eventually take his medications on his own when the reminder went off. It’s a small start to a much larger goal, but it is working towards increasing independence and decreasing reliance on staff/supports for a task in his daily life.

#2: Cost effectiveness

Cost effectiveness comes up a lot and has turned into a bit of a buzz word. In essence, it can boil down to what is the best price for the quality and effectiveness of the technology.

There may be two items that do the same thing, but due to quality one will last 6 months and the other will last several years - just because one is cheaper does not mean you need to go with that one. Get the more expensive one as it is actually more cost effective for long term use.

In government we used to have the “3 bids, take the lowest” situation, and I think we’ve gotten stuck in that mindset. We need to break out of this and think of what is best for our clients throughout their lifetime and the services they are receiving. Not simply taking the lowest bid and moving on.

One example is Apple products. Although they are more expensive typically, they do have better accessibility features. I’ve gotten several clients the iPad Pro due to the facial recognition unlock feature as they don’t have the fine motor skills to unlock the iPad with their finger, and should be entitled to locking their iPad like anyone else.

#3: Reaching Goals

Tying the assistive tech you’re wanting to a goal in order to secure waiver funding is essential if it isn’t a safety or home modification technology.

A woman I was working with was interested in cooking. She did not receive any services around this and received few services in general. However, she got very into the British Baking Show and wanted to start working in the kitchen herself! 

We created a goal around her and her staff cooking one meal per week. We funded all of the adaptive cooking equipment she needed to stay safe and gain the skills needed. This goal would also eventually lead to her having a reduced need on dependence for staff in cooking when she gained these skills, and we opted for the low tech tools so they would be most cost-effective.

Never forget the user is in charge

Assistive technology is in the hands of the user — if the user isn’t interested in using it, then it doesn’t make a difference if it was purchased or not. Please remember that your client is the ultimate user and purchaser of the assistive tech. Their opinion is ultimately what matters, whose experience should be excellent, and whose life should be improved by this technology.

It can be difficult to have candid conversations at times about the staffing shortage, finding ways to stay in their own home, or moving homes. Remember your expertise as the case manager is in being the advocate for your client and getting the funding they need. You don’t need to know everything - simply be kind and open to conversations.

Stay awesome, and happy Case Manager Appreciation Month. I appreciate you <3