Revolutionizing LTSS: Enhancing Care with Remote Support

Closing The Gap Solutions e-Magazine, October / November 2024 Volume 43 - Number 4

? leadership, policy & implementation

Revolutionizing LTSS: Enhancing Care with Remote Support Summary: The Long-Term Services and Supports (LTSS) sector faces significant challenges in delivering quality care due to the high overhead costs and staff burnout associated with institutional, in-person care models. These operational pressures have exac- erbated workforce shortages, severely limiting the sector's capacity to meet increasing demand. The use of remote support, particularly remote direct support professionals (rDSPs), presents a promising solution to these challenges. While still in its early stages, (rDSP) services show potential in enhancing the independence of care recipients, alle- viating DSP staing shortages, and expanding care capacity.

INTRODUCTION Technology is a powerful tool that significantly broadens the channels through which we communicate, facilitating social connections that transcend geographical and cultural barriers (Ruben, Stosic, Correale, & Blanch-Hartigan, 2021). This poten- tial extends to enhancing inclusion, independence, self-deter- mination, and engagement for individuals with Intellectual and Developmental Disabilities (I/DD) (Friedman, 2023a). Moreover, technology has gained significant popularity among older adults, particularly in response to the COVID-19 pandemic, as it helps to support overall well-being and maintain communi- ty connections (Sixsmith, Horst, Simeonov, & Mihailidis, 2022). This surge in technology adoption among seniors was part of a broader trend accelerated by the pandemic, which also saw rapid advancements in telehealth, assistive technology, remote support services, and home and community-based services (HBCS) (Friedman, 2022).

JASON RAY, CEO at SimplyHome; Certified Aging in Place Specialist. Since beginning with SimplyHome in 2008, Jason has been a national speaker on enabling technology, remote support, and technology first trans - formation to associations, state and national agencies, and provider organizations. Jason was named in 2012 as a recipient of the Stephen E Sallee Excellence in Technology Award, and accepted the 2012 Edison Award for Best New Product for SimplyHome. Jason’s work with SimplyHome has been featured on multiple episodes of ABC’s Extreme Makeover Home Edition along with many other national publications. From 2017-2019 Jason served as the Subject Matter Expert on Enabling Technology and Remote Support for Tennessee Department on Intellectual and Developmental Disabilities (TN DIDD) Technology First Initiative. From 2021-2024 Jason served in the same capacity for New Mexico’s Developmental Disability Supports Division’s Technology First Initiative. Jason also contributed to the founding of SHIFT in 2021, the Nation’s leading education and training platform on Technology First principles. Finally, in 2022, Jason helped to launch the Technology First Alliance, a non-profit organization focused on advancing technology first principles in long-term services and support.

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This white paper explores the social and economic benefits of remote support solutions as a promising strategy to tackle chal- lenges in LTSS. It highlights the emergence of rDSPs as an inno- vative service. By integrating rDSPs into existing care teams and combining human support with advanced technology, this ap- proach aims to alleviate financial constraints, mitigate workforce shortages, and effectively provide more independence and care to a wider population.

Below are the key findings from Ancor’s the State of America’s Direct Support Workforce Crisis 2023 survey: 95%

77% indicated they had to turn away new referrals over the past year due to staffing shortages

72% found it

75% struggled to connect

54% stated that

of participants reported facing moderate to severe staffing shortages in the past year

challenging to maintain established quality standards due to staffing issues

they operate in areas with few or no similar service providers

people with services be- cause of a lack of available providers

Key findings from Ancor

WAITLIST TIMES FOR HOMES AND COMMUNITY-BASED SERVICES: Medicaid Home- and Community-Based Services (HCBS)1915(c) waivers represent the primary funding for LTSS for individuals with I/DD in the United States (Friedman, 2023b). Despite a notable increase in HCBS waivers incorporating re- mote support services—from 7% in fiscal year 2013 to 18% in fis- cal year 2021—the utilization remains low, with only 0.35% of in- dividuals with I/DD receiving these services (Friedman, 2023b). According to a survey by the Kaiser Family Foundation, 692,000 individuals were on waiting lists for HCBS across 38 states at the time of the survey (Kaiser Family Foundation, 2023). Addressing these critical gaps, the Biden administration has proposed a $150 billion increase in Medicaid HCBS spending over the next decade (Park, Gardner, Kaneb, Schneider, Mondes- tin, & Guest, 2024). Simultaneously, the Center for Health Care Strategies and its partners, through initiatives like the Medicaid Innovation Collaborative, are aiding states in exploring and pro- moting the adoption of technology-enabled solutions in both Medicaid and managed care (Brykman & Joseph, 2024). These efforts acknowledge the immediate need to change existing care models through innovative, technology-based approaches. THE SOLUTION: REMOTE SUPPORTS WHAT ARE REMOTE SUPPORTS? Remote supports are designed to empower individuals by customizing services and reducing dependence on in-person staff. These tech-driven solutions help maintain routine adherence, alerting nearby staff or remote call centers as needed. Remote supports are often incorrectly percieved as strict vid- eo-monitoring and surveillance tools, rather than empowering, person-centered communication methods. Instead of being confined to a singular product or technology, remote supports typically integrate with various technologies like smartphones, environmental controls, medication dispensers, sensors, and

CHALLENGES TO PROVIDING SUPPORT

A WORKFORCE IN CRISIS: Direct care workers, comprising home health aides, person- al care aides, nursing assistants, and psychiatric aides, consti- tute the backbone of LTSS. Despite their critical role, a signifi- cant cant majority of these workers across 34 states earn wages below $20 per hour (Mohamed, Burns, & O’Malley Watts, 2023) due in large part to insufficient reimbursement rates in the Med- icaid program (Ancor, 2023). The demand for these roles is pro- jected to surge by 41% by 2036, outpacing the anticipated 22% growth in employment of home health and personal care aides over the next decade (National Center for Health Workforce Analysis, 2023). Alarmingly high turnover rates among direct care staff, ranging from 38% to 50% (PHI, 2023), underscore the urgency of this challenge.

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REMOTE SUPPORTS ARE SIGNIFICANTLY MORE COST- EFFECTIVE THAN IN-PERSON AND ON-SITE STAFF. SAVINGS EXCEEDING $50,000 PER PERSON THROUGH SIMPLYHOME’S REMOTE TECHNOLOGY IMPLEMENTATION. In South Carolina, over 9,000 individuals with I/DD faced a waiting list for residential support due to insufficient funding. In response, The Carles Lea Center (CLC) took proactive steps by partnering with SimplyHome, a leader in enabling technology and remote support consulting services. By integrating Simply- Home’s technology and remote support, CLC reduced the cost of providing client support to approximately $100 per day per individual, compared to $200 per day without technology (Sim- plyHome, 2016b). This initiative resulted in annual savings exceeding $50,000 per person through SimplyHome’s remote technology imple- mentation. These positive outcomes significantly improved ac- cessibility to care, ensuring individuals received timely and ef- fective support. AFFORDABLE AUTONOMY FOR INDIVIDUALS RECEIVING REMOTE SUPPORT The Long-Term Services and Supports (LTSS) sector faces significant challenges in delivering quality care due to the high overhead costs and staff burnout associated with institutional, in-person care models. These operational pressures have exacer- bated workforce shortages, severely limiting the sector's capaci- ty to meet increasing demand. The use of remote support, particularly remote direct support professionals (rDSPs), presents a promising solution to these challenges. While still in its early stages, rDSP services show po- tential in enhancing the independence of care recipients, allevi- ating DSP staffing shortages, and expanding care capacity. REMOTE SUPPORT HOLDS SIGNIFICANT POTENTIAL TO REVOLUTIONIZE THE CURRENT CARE MODEL AND ENHANCE ACCESSIBILITY TO CARE FOR ALL. In one SimplyHome case study, an individual receiving re- mote support realized annual savings of $78,629 by incorporat- ing technology into their independent living arrangement rath- er than opting for assisted living (SimplyHome, 2016b). Innovative Resources for Independence (IRI), a New York- based provider, saw close to 20% of residents transition to in- dependent living after using SimplyHome’s remote support ser- vices. (SimplyHome, 2016c). With benefits for both providers and recipients, remote sup- port holds significant potential to revolutionize the current care model and enhance accessibility to care for all. However, the field of remote support continues to evolve with ongoing inno- vations, among the most notable being remote DSPs.

communication devices. These supports frequently include app and phone functionalities for tasks such as managing medica- tion adherence, ensuring cooking safety, and preventing wan- dering or falls. They offer customizable alerts and prompts tai- lored to individual preferences, ensuring timely and effective assistance.

OPERATIONAL BENEFITS FOR LTSS PROVIDERS Remote supports are significantly more cost-effective than in-person and on-site staff (Wager, Tasse, Davies, & Stock, 2018), making it feasible to efficiently serve a larger population with- out increasing personnel or overtime hours for staff.

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HOW REMOTE SUPPORT WORKS: FURTHERING INDEPENDENCE

WHAT IS A REMOTE DSP? Remote Direct Support Professionals (rDSPs) integrate per- sonalized human interaction from off-site locations with ad- vanced, smart technology solutions. Utilizing real-time commu- nication and information from smart technology devices, rDSPs provide 24/7 support, personalized care plans, emergency re- sponses, and emotional support, empowering users to lead an independent life while feeling secure. Through close collabo- ration with individuals, families, and on-site staff, rDSPs ensure comprehensive and customized care that addresses the unique needs of each recipient.

WHAT MAKES REMOTE DSPS SO PROMISING?

1. BENEFITS FOR INDIVIDUALS

Providers can expand their services by utilizing rDSP support, ensuring that more individuals receive timely assistance regardless of location, thereby minimizing dis- parities in service access. For individuals receiving care, rDSPs are accessible 24/7, empowering them to utilize services according to their needs. This constant availabil- ity promotes independent living with enhanced security, ensuring that support is always within reach.

rDSPs ensure comprehensive and customized care that addresses the unique needs of each recipient.

2. BENEFITS FOR DSPS

Due to long hours and extensive on-site duties, DSPs of- ten experience extreme stress and burnout, leading to turnover and vacant positions (Keesler & Troxel, 2020). Remote DSP positions help mitigate burnout by reduc- ing the need for 24/7 on-site staff and offering the flex- ibility to share workload responsibilities remotely. This remote work setup promotes a better work-life balance for DSPs, potentially lowering stress, improving overall mental well-being, and enhancing staff retention.

3. BENEFITS FOR PROVIDERS

Remote DSPs allow providers more flexibility in their staing approaches. Proprietary technologies like Sim- plyHome’s sensor-based technology enable providers to seamlessly integrate their existing care teams with rDSP technologies and collaborate with external personnel, thereby boosting operational eiciency and accelerating and expanding the delivery of care services. Further- more, rDSPs can be more cost-effective than traditional on-site staffing models, allowing organizations to opti- mize budgets and potentially reallocate resources to fur- ther expand their capacity.

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CHALLENGES AND LOOKING FORWARD Every innovation-seeking widespread use and acceptance faces adoption challenges, and rDSPs are no exception. Some of these challenges include limited internet accessibility and adequate training. Many individuals with disabilities encounter barriers to accessing high-speed Internet and up-to-date tech- nology and are significantly less likely to use the Internet daily compared to the general population (Bureau of Internet Acces- sibility, 2022). Integrating rDSPs into LTSS provider workflows also presents a significant challenge, as highlighted by a survey indicating that only 28% of organizations feel adequately prepared to in- troduce and support technology for individuals with I/DD (Tanis & ANCOR, 2021). SimplyHome’s rDSP solution has the potential to address this challenge by enabling organizations to integrate their existing care teams and infrastructure into advanced technology sup- port systems. Despite initial challenges, rDSPs hold promise in transform- ing the way LTSS providers deliver care. With continued research and investment, this solution has the potential to empower more individuals to live autonomously and securely, while also reducing costs for individuals and providers alike.

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