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Stan has sheltered employment, which means that although he works in one of the businesses in our community and meets the public in his work, he has a job coach, who helps him understand the needs of his employer and trains him to do the work expected of him. The organization that provides his job coach has permission from the Department of Labor to pay Stan less than the minimum wage because his productivity is lower than what is expected of other employees. Stan is like the rest of us in many ways, but notably unlike people who are not disabled with respect to how much time and effort it takes him to learn new tasks.
Stan and his housemates also need support staff in their home. They need help coping with circumstances that upset them, managing their money, remembering to take medications, planning nutritious meals, self-care and protection from people who might take advantage of them. But they would like to live like most of us do — independently of a human service agency staff member. Sometimes they wish they could be alone. They would like to be freed of the continuous presence of other people — people who do not live in their home.
In recent years, adult foster care home providers have been challenged to continue providing quality services with dwindling resources. Money to pay the bills for these homes depends on state appropriations. Some years, our state Legislature has not approved any increase in funding. In other years it has approved small increments that are less than the rate of inflation of nonlabor costs of operating homes. Skyrocketing health care insurance premiums and sharply increasing energy expenses have made continuing to provide quality services very difficult. Staff compensation for these homes, as well as nursing homes, has not kept up with inflation. Operators of these human services compete for workers with fast food restaurants and other businesses that employ low-skilled people.
In this context, the programming people in the state Department of Human Services have challenged residential service providers to develop new, less expensive ways of delivering services. Home and Community Options accepted this challenge. It questioned whether the physical presence of a staff member in Stan’s home is required whenever any of the men are there. What about the middle of night when all of them are sleeping? If there were some way to monitor what is going on, without being physically present, and send help to Stan’s home immediately, when help is really needed, wouldn’t that be satisfactory?
Technology has developed ways of monitoring remotely. Using computers, cable connections, the Internet, sensors and cameras, keeping track of what is going on in location “A” from location “B” is now possible. For example, if Stan or one of his housemates gets up in the middle of the night, a staff member in a different home will know immediately, and can check in to determine whether on-sight help is needed.
With a financial grant from the Blandin Foundation, an in-kind grant from Hiawatha Broadband Communications and contributions from generous local philanthropists, Home and Community Options has, according to project director, Peter Walsh, almost completed the development of a dependable remote monitoring system. HCO would like to use this system in place of the night attendant in Stan’s home. A night staff member based in another home would be kept informed of what was going on, and be able to call for immediate help whenever a physical presence was needed. Most nights one staff member would do the work that two are now being paid to do.
HCO Executive Director Dennis Theede anticipates that about $30,000 a year could be saved for each home operated with nighttime remote monitoring. These savings could be used to enhance the quality of services provided Stan and his housemates, to offer more competitive compensation for the staff positions, to maintain the home and to pay utility bills.
Parents and/or guardians of Stan and his housemates have approved the use of remote monitoring in place of a physically present night staff person. But the licensing people (as distinguished from the programming people) at the state Department of Human Services say that remote monitoring cannot be substituted for the physical presence of staff members. They say that operators of adult foster care residences in Minnesota must provide on-site staff members at all times. Monitoring a home from a remote site in the middle of the night does not meet licensing requirements, they claim.
Government officials must begin to “think out of the box.” They must free their thinking from the limitations of a pre-Internet, fiber optic communications era. As long as government is unable to support outdated ways of solving problems, agencies with government contracts to provide services must be allowed to implement effective, lower-cost solutions.
Despite this roadblock, Home and Community Options will use remote monitoring. It will be used to support clients in semi-independent living situations. Licensing of these programs does not require the continuous physical presence of staff members. And it will also be used for other purposes, for example to confirm that staff have given medications in a timely way. Hospitals and home health care providers that serve people with other disabilities and seniors are also looking at remote monitoring as a less expensive way of providing services. Theede hopes to demonstrate that remote monitoring is reliable and safe, as well as being cost effective.
We should encourage state government officials to allow our tax dollars to be used more efficiently.
Stewart Shaw is a former Winona State University registrar who is getting a second education in retirement.
He also volunteers for several local organizations.
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