Assistive Technology Services through Independent Living Centers

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Assistive Technology Services through Independent
Living Centers

• Teresa Favuzzi, E.D.
• CFILC
• Patricia Yeager, P.I.
• CR4AT
• a project of CFILC

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RSA 704 Report calls for AT Outcomes

• What is Assistive Technology?
• assistive technology device means any item,
  piece of equipment or product system, whether
  acquired commercially, modified or customized
  that is used to increase, maintain or improve
  functional capabilities of individuals with
  disabilities Assistive Technology Act of
  2004
• In other words, tools for living!

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Are ILCs providing AT services?

• If they are providing information and referral,
  assistance with getting equipment or helping to
  find funding-they are providing elements of AT
  services.
• AT is often at the core of helping people get out
  of institutions or their home and participating
  in community life.

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Community Research documents usage, need and
impact

• California ILCs conducted 5 year research project
  to determine, from the consumers perspective,
  whether AT is effective in the areas of IL,
  health, community participation and work. We also
  looked at funding issues and minority issues

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Community Research for Assistive Technology
(CR4AT)

• Participatory Action Research
• A survey of Independent Living Center consumers
  throughout California
• Development of the survey
• Conducting the survey

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Respondent characteristics

• 1,919 respondents from 20 ILCs
• Age 81 are 1864, 19 elderly
• Only 20.4 of working-age adults employed
• Gender 61 female
• Race/ethnicity
• 17 Latino
• 16 African American
• 6 American Indian / Alaska Native
• 3 Asian or Pacific Islander
• Income 10-15K median household income

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Respondent characteristics

• Disability type
• 63 mobility impairment
• 29 mental health disability
• 24 cognitive, developmental, or TBI
• 23 visual impairment
• 20 hearing impairment
• 14 other physical disability (e.g., chronic
  illness)
• 13 speech impairment
• 55 reported more than one type of disability

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Text descriptionAssistive technology usage, by
disability type

• 66 of the sample uses some type of AT
• Heaviest AT users are people with mobility
  impairments (83) or sensory impairments (80
  hearing, 77 visual)
• Those least likely to use AT are people with
  mental health disabilities (48) and people with
  cognitive disabilities (55).

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Text descriptionAssistive technology usage, by
age group

• AT usage increases steadily with age
• Usage doubles from 47 of people between the ages
  of 18 and 24 to 95 for people 85 or over.

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Text descriptionMean number of AT devices used,
by race/ethnicity

• There are large gaps in AT usage by race and
  ethnicity this graph shows the average number of
  devices used among all respondents
• African American and Latino respondents reported
  an average of 1.4 devices used, compared to 2.2
  devices for whites.
• Asian Americans and Pacific Islanders use an
  average of 1.6 devices
• American Indians and Alaska Natives reported the
  same usage as whites, but the sample was small

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Text descriptionSatisfaction with commonly used
AT devices

• For all commonly used AT devices, between 60 and
  80 of users are satisfied with those devices
  (overall satisfaction score is 4 or 5 on a scale
  of 1 to 5).
• People are most satisfied with scooters (79) and
  adapted telephones (77) and least satisfied with
  hearing aids (60) and computers (61).

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Text descriptionExpressed unmet need for AT, by
disability type

• 45 of the sample report that they do not have
  all the AT devices they need
• Expressed unmet need is particularly high among
  people with hearing impairments (57), visual
  impairments (54), speech impairments (53),
  mobility impairments (53), and other physical
  disabilities (52).
• Expressed unmet need is lower among people with
  cognitive or mental health disabilities (43 and
  41, respectively).

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Text descriptionReasons for not having needed AT

• Among respondents expressing unmet need for AT,
• 61 said it was too expensive
• 53 said their health insurance or public program
  didnt cover it
• 45 said they didnt know where or how to obtain
  it
• 11 said their condition wasnt serious enough
• 7 said devices were not available

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Sources of AT Information
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Text descriptionSources of AT Information

• Healthcare settings are the primary source of
  information about AT (62 percent)
• Family and friends are the next highest source at
  27 percent and disability organizations are third
  at 22.5 percent. Department of Rehabilitation
  comes in significantly less (17 percent) as a
  source of information about AT.
• Other information sources include television,
  catalogs, Internet and even the Yellow pages for
  under 20

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Principal Sources of Paymentby Income
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Text descriptionPrincipal Sources of Payment by
Income

• As people's income increases, they are less
  likely to get their AT from public programs
  (Medicare or Medi-Cal), from 47 of people with
  the lowest incomes to 20 for those with the
  highest incomes.
• Private health insurance increases as a source of
  AT as income increases, from 3 to 21.
• People are also more likely to pay for their AT
  themselves as their income increases, from 25
  for the lowest income category to 42 for the
  highest.

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Text descriptionFeelings of Isolation due to
Disability

• When asked how often people experienced feelings
  of isolation due to disability
• 32.5 percent said they experienced isolation most
  of the time or always
• 39 percent said sometimes
• 28.5 percent said rarely or never

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Text descriptionFrequent social isolation, by
age group

• People ages 45 to 54 were the most likely to
  report frequent social isolation41.
• Reported social isolation decreases steadily with
  older age, down to 15 for people 75 and over.

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Text descriptionExtent to which AT helps cope
with isolation

• Among AT users experiencing social isolation
• 37 say their AT helps them cope with isolation
  most of the time or always
• 43 say sometimes
• 20 say rarely or never

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AT usage at work

• 54.2 of employed respondents use AT or assistive
  services (job coach, assistant, PAS, reader,
  interpreter) to perform job duties
• 64.1 of AT users say it helps a lot or
  immensely
• Payers
• Employer 41.5
• Employee 38.5
• Dept. Rehab. 26.2
• Insurer 20.0
• Of those requesting AT as a job accommodation,
  59.7 got it

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Text descriptionBenefits from using AT at work

• People using AT at work reported the following
  benefits
• 84 said it improved their productivity
• 73 said it improved their self-esteem
• 59 said it improved their attendance at work
• 43 said it enabled them to work more paid hours

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Conclusions AT usage

• Highest among those with mobility or sensory
  impairments
• Lowest among people with mental health or
  cognitive disabilities
• Increases with age for low-tech devices
• Big gaps by race and ethnicity
• Increases with educational attainment
• High degree of satisfaction with most AT

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ConclusionsUnmet need for AT

• Expressed by 45 of respondents
• Greatest for sensory, speech, mobility, and other
  physical disability
• Cost lack of coverage is primary cause
• Lack of knowledge is a barrier
• Heavy AT users educated respondents know what
  theyre missing others dont

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ConclusionsSocial Isolation

• A major problem, especially for working-age
  respondents
• Except those with jobs
• AT helps vast majority of users cope with
  isolation
• The more AT you use, the better
• Unmet need for AT doubles risk of isolation

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Conclusions AT at work

• Among those with jobs, majority use AT or
  assistive services for work duties
• Employers pay for much of AT used at work often
  provide requested accommodations
• AT helps most users a lot or immensely
• Greatest benefits are improved productivity and
  self-esteem

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• There is no doubt that devices, equipment, and
  tools significantly help people with disabilities
  live independently, work, play and take part in
  community life.
• Working along with healthcare providers, ILCs
  have a role to play with consumers in finding and
  getting their tools for living. We have the
  practical, on-the-ground experience given our
  belief in consumer empowerment and our value of
  peer to peer relationships.

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Four Barriers to AT

• Finding information about AT
• Identifying and selecting specific technology
  (devices)
• Acquiring technology (devices)
• Learning how to use, maintain, repair, replace
  and upgrade it
• Alliance for Technology Research, 1998

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Call to Action

• Put DME benefits back into private health
  insurance
• Public Health Insurance programs need to keep DME
  coverage and strengthen it
• Create funds for IL and Community Participation
  AT
• Step up awareness activities in minority
  communities

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• CR4AT is funded by the National Institute on
  Disability Rehabilitation and Research, grant
  H133A010702
• Contact information
• Patricia Yeager patricia.yeager_at_unco.edu