A University Center for Excellence in Developmental Disabilities
About Remote Supports

 

Remote Supports

Remote support is the use of electronic equipment to support and assist people with developmental disabilities in their home. This service is provided from an off-site location, typically using home and community based waivers to fund the cost and maintenance of equipment and staff. It is an alternative to having the constant physical presence of staff in someone’s home.

As of January 2017, only 170 people of the more than 37,000 eligible Ohioans were taking advantage of remote monitoring services. A part of the Technology project is to identify out why that number is so low and expand these services to people throughout Ohio. This project is part of a collaborative enterprise between the Ohio Department of Developmental Disabilities and The Ohio State University Nisonger Center. The project aims to take an in-depth look at the role technology, including remote supports, plays in the lives of people with developmental disabilities and their families, create a vision for how the use of technology may be improved and expanded upon, and identify technological advances that might benefit people with developmental disabilities by increasing their independence and self-determination.

 

 

For more information contact:

Jordan B. Wagner
Coordinator, Technology Project
Tel: (614-688-3155)


Videos

If you would like to see what remote supports commonly looks like, here are some helpful videos.*

 

 

 

 

 

 

*The Ohio State University Nisonger Center does not endorse any specific company or organization*

Stories
Below is a collection of real stories about people who have used remote supports and their families
Independent Living 
When Carol and Howard reached their 50s, they had a conversation about the need to plan ahead for their son, Christopher. Realizing they wouldn’t be able to take care of Chris throughout his lifespan, they began to consider ways in which they might prepare Chris to live more independently and give him support as he sought to achieve goals that he wanted to set.Therefore, they were prepared when Chris came to them and said “I’m an adult and I need to move out.” In order to assist Chris in meeting this goal, his parents converted an attached garage into an apartment that Chris would be able to live in. It was in this setting that Chris first piloted the use of remote supports. After some time at this location, Chris found a 2 bedroom apartment with an attached garage (for his John Deere) which he found suitable to make his home and continued the service from there.Chris needs assistance understanding time and money and he also suffers from a liver condition that requires some support. When Chris has a fever, it could be an indication that he is having serious liver difficulties. While Chris does take his temperature three times a day and shows the results to a remote supports worker using a camera, they are also trained to identify other signs of fever onset. Once, a worker recorded Chris’ temperature and, when it was determined he had a fever, the backup support was called. They were able to assist him before it became an issue. In this situation, the fever was a sign of the flu rather than a liver incident. But, the event solidified that, if there was an incident involving liver problems, the protocol would work in such a way that Christopher would continue to be safe.In Carol’s own words, she said “Our initial [thought] was: Are they going to be able to do everything that we would like them to be able to do, for us to feel confident enough that Christopher is going to be safe? There isn’t a doubt, in our minds, that he is safe.” Without the use of remote supports, Chris would not be able to live independently. Howard and Carol feel secure, knowing that their son is safe.
Crafting a Safe Environment to Enjoy a Midnight Snack: A story from a remote supports vendor

An individual we were asked to support had a previous episode of placing popcorn in the microwave long enough that it turned it into a ball of fire, creating safety concerns and ruining the microwave. In these situations, a common response to a behavior such as this would be to place overnight staff in the home to monitor for health and safety.

Using remote supports we were able to greatly reduce his reliance on direct support professionals, reduce expenses to his waiver, and increase his independence. We knew that his target behavior was to get up in the middle of the night and make a snack that was always in the same cabinet. Our solution was as follows:

  1. We installed a remote supports system to meet various needs throughout the home, such as perimeter sensors and smoke detectors.
  2. We installed motion detectors throughout the home so we would know when he was getting up and moving around, and so that we could locate him in his home based on the activity of the motion sensors.
  3. We installed sensors on the refrigerator, microwave and cabinets so that we knew what he was accessing for his snacks. Since our staff personally know each of their consumers, they could tell what he was up to while he was moving around at night.
  4. We also installed a two-way video device that would allow for our remote supports staff to automatically connect with him and coach him through whatever he was doing.
  5. Lastly, we installed various home automation devices to enable us to complete tasks such as unlocking doors and turning off the microwave.

Once the system was in place and configured for his needs, we were able to see when he was up at night, including making popcorn, by following the activity as it rolled in to our system. As our staff were monitoring him, they’d connect and talk to him when they saw that he was making popcorn. While talking, they could provide verbal prompts and reminders as part of his training to properly use the microwave. If he did not follow their prompts and, therefore, allow for a situation where the operation of the microwave would be unsafe, our staff would simply shut the microwave off from the monitoring center. Luckily, their coaching and prompts trained him to the point where he became completely safe on his own. This is the story that we see all the time. We want to design a system that is least restrictive and would allow for us to provide training in and of these activities of daily living. The intention is to work ourselves out of a job by increasing the freedom and independence that our consumers experience.

Increased Alone Time  

Julia McCampbell, a guardian from advocacy and protective services, provides guardianship services for 2 individuals who have experience using remote supports. Jane currently uses remote supports and the other, Eric, had quit using remote supports. Both had a similar response to the service.

The two reasons why Julia and the rest of the team wanted to pursue remote supports with Jane were to promote independence and provide supervision. Jane had difficulty being at home by herself. Not having someone in the home, initially caused anxiety. When alone, she would often call direct support staff, friends and family, hoping someone would come over to the house. Remote supports were chosen as an alternative to having staff in the home during some hours. Now, however, after using remote supports, being alone no longer causes anxiety and she has been able to add alone time without either remote or direct supports. Other changes, including taking more initiative to clean without prompt, have been noted as well.

Eric had 24 hour staffing and would often become physically aggressive with staff. The team decided to try remote supports. As the hours with staff decreased, the aggressive behavior also declined. Today, Eric no longer has 24 hours of support, remote or otherwise. Now, the staffing are considered drop-in staff. Meaning, Eric will have people come to the home to assist him on an as-needed basis. Remote supports provided a safe environment to provide support without having staff in the home. This freedom enabled Eric’s needs to be reevaluated and assisted him as he transitioned to have drop-in staffing rather than 24 hour support.

Ms. McCampbell believes that remote supports enabled Jane and Eric to become more comfortable living with greater self-reliance, in an environment without the physical presence of direct support.

*Names have been changed for confidentiality

*Ms. McCampbell’s opinions are her own and not, necessarily, the views of the company she works for

Remote Supports Frequently Asked Questions
How do I know if I’m eligible?
All Ohioans with a developmental disabilities waiver are eligible. The person’s support team should assess and discuss whether or not remote monitoring will meet the needs of the individual.
What are the duties of the remote support staff?
Remote monitoring is done in real time, not through a recording, by awake staff at another location. While remote support services are being provided, the remote support staff will not have other duties other than providing remote support services.
What happens if the power goes out?
The monitoring base is equipped with a backup power supply. In case this fails, direct-support staff will be notified and will respond accordingly. In the case of a power outage at the consumer’s residence, direct-support staff will be notified and will respond in a timely manner to ensure that the person is safe.
What happens if there is an emergency?
The provider of remote support services will notify first respondents. A direct support staff will also be contacted and respond accordingly. While the individual awaits emergency services, remote support staff will remain engaged with the individual until the first respondents and direct-support person arrive.
Who has access to shut down the equipment?
Remote monitoring equipment will be designed so that it can be turned off only by the authorized people and those specified in the Individual support Plan.
How are people prevented from hacking into the live feeds?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only.

The following are questions that were generated for a session titled “Technology First and Remote Supports” held at the 2017 Spring OACB conference*:

 

What codes are used for billing backup support?

Paid Backup Support I/O AMR
   Level One FMR
  Self-Empowered SMR
Unpaid Backup Support I/O AMS
  Level One FMS
  Self-Empowered SMS

                                                                                                                                                                                                                                

The remote monitoring equipment vendor is required to calculate the amount to be billed for remote monitoring equipment and to provide a monthly “lease” amount to be billed to the waiver.  This amount is the vendors’ cost to procure the equipment plus a setup and maintenance fee divided by the useful life (i.e. 36 months).  No other equipment costs are required and lump sum payments are permitted.

What codes are used for billing remote monitoring equipment?

Equipment codes/limits I/O  AML $5,000/Span (Equipment only)
  Level One FML $7,500/3 years (Equipment & Service)
  Self-Directed SML $25,000/Span (Equipment & Service)

 

Is it acceptable to authorize both HPC and remote monitoring for a short time to transition an individual/team/guardian into the new service?
HPC services and remote monitoring services cannot be billed at the same time. While an individual may use HPC services and remote monitoring at different times of day, they do not occur simultaneously. However, in a situation in which an individual has 2:1 staffing, remote monitoring may be used to reduce the ratio to 1:1 in addition to remote monitoring. Therefore, while there may only be one staff physically present within the home, the other staff is assisting from a distance.
What happens when the remote monitoring provider is responding to one individual while another individual requires assistance?
Multiple remote monitoring caregivers are available to respond to requests from any individual for whom services are being provided
Who is doing the monitoring?
Remote monitoring services are being provided by people who are familiar with the individuals ISP. In many cases, those providing services are Direct Support Professionals or have received the same training. Remote monitoring providers must fill out paperwork in the same way a direct support professional would. The rule specifically states: “Service documentation for remote monitoring shall include… [the] Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.”
What happens to the information?
While the rule does not guarantee recordings, it does say that IF recordings are made then they must be retained in the case of an UI or MUI. When there is not an MUI the recordings can be discarded.
How do you know they are not monitoring during other hours?
Remote monitoring equipment includes an indicator to the individual being monitored that the equipment is on and operating. The indicator shall be appropriate to meet the individual’s needs. Sometimes this is as simple as having a light on the device.
How long/where is the information stored?
In the case of an UI  or MUI, documentation is stored for seven years within a secure network system.
Who has access to the information?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only; those permitted by the ISP.
What kind of certification is required for providers?
Remote monitoring equipment shall be provided by an independent provider or an agency provider that has a medicaid provider agreement with the Ohio department of medicaid.
 
How many homes/individuals does one remote monitoring provider serve at one time?
This varies from provider to provider for various reasons. The rule requires that during the provider selection process the provider must disclose the ratio of monitoring staff to individuals receiving remote monitoring to the individual and the individual’s team. However, this specific rule is scheduled to be removed in July. You may read the new rule here: revised rule.
How are other counties providing actual backup staff if someone needs to actually go to the location? Are there provider agencies willing to be the “on-call” person or is it generally family or county board staff?
The rule leaves room for many options. If it is in the individuals best interest to have a family member provide the backup support, then that is a possibility. Alternatively, if it is in the individual best interest they ought to receive backup support from a HPC provider. Normally this is not an additional expense because the provider agency already has someone on-call.

 

 

 

*Answers based off of a presentation from Ken Smith and Dustin Wright*