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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