REMOTE SUPERVISION WHAT S IT ALL ABOUT? Objectives Understand the role of remote supervision Best Practices on the use of remote supervision Review the Alternative Supervision License Financial implications of remote supervision Review current and future technology options Remote Supervision is a Minnesota term used to describe the use of technology to monitor, to supervise, or to provide oversight or supports that ensure the health and safety of persons served. 1
History 2008: Monitoring Technology Workgroup Comprised of a variety of entities Set of values for use of remote supervision. How can technology be used to support individuals in this industry? Remote Supervision Workgroup Values Remote Supervision will offer an enhanced quality of life to individuals. Everyone has the right to make an informed choice and to have all of the information available to them to make a truly informed choice. An individual s choice will be honored and respected. It is important and imperative to educate and provide information to people on monitoring technology options. Everyone has the right to privacy. The technology used needs to match the level of support and services that a person requires, and must be the most effective and least intrusive technology option for that individual. Cost-effectiveness will be balanced with individual safety and individual independence. Individual preference will not be compromised for costeffectiveness. Any remote supervision system that is selected must: Have proven and reliable technology Be respectful of privacy and dignity of people Be competent Be HIPAA compliant Have staff that go through the same screening process as on-site staff Meet appropriate federal and state standards, if accessing public funds Any cost savings that are achieved by the use of monitoring technology must be reinvested into services for people with disabilities and seniors. There needs to be an ongoing evaluation and remediation process to promote continuous improvement. It is important to monitor the staff and the monitors to ensure that they are doing what they are supposed to be doing. Emergency and contingency plans must be in place to reasonably assure an individual s health and safety. These plans must be reviewed as part of the continuous improvement process. Why do we need technology? Allows people to live more independently We have limited financial resources We have limited human resources We may have more information about the quality and frequency of supports and services 2
Important Philosophies Technology is NOT an absence of supervision. Technology should be recognized like that of staff. Technology is a different delivery method of supports and services. Principle: How would we answer this question if we weren t talking about technology but support and services? How Can I Possibly Consider Remote Supervision For This Setting Things to consider: What is my attitude about the need for a physical body to be present? Opening your mind to the possibilities. Think about what situations really need a physical body present in the home. Challenge each other about those thoughts to really narrow it down. Think big -not just about the people living in that home where you are considering remote supervision. Are there other homes in the area that I can share an awake overnight staff to address the issues? Can a person served use a phone at night to work through an issue with staff? The what ifs. Think about all the times a physical body sleeping in the home didn t prevent something from happening. Take data regarding what really goes on during the overnight related to how often the sleep person is dealing with situations at night. Is it possible that remote supervision be used during certain times throughout the day? For example for an hour or two when people first get home from work. In an apartment situation, can you reduce shared staff even further and supplement with technology? Situations Where Technology Can Help Behaviors Elopement Wondering Eating disorders Bringing unauthorized people home Failing to leave or return from school/work on time Night time agitation Documentation and Reminders Medication administration (by staff of person) Repositioning Toileting assistance Response to alerts Staff active (awake) General Monitoring for Safety Is person home? Is person in bed and if up, for how long? Frequency of eating Frequency of going to bathroom If/when person leaves If/when one person enters another s bedroom 3
Variety of Benefits Increased independence! Real data about what staff are doing Additional prompts for staff Reduce staffing needs Verification of cares Data for investigations, reports Fail-Safe, Back-up Alternate Overnight Supervision for Adult Foster Care Enacted July 1, 2009 Best Practices Everyone has the right to make an informed choice Everyone has the right to privacy The technology used needs to match the level of support needed and must be the least intrusive technology option. 4
Informed Consent Description of the technology applications envisioned. examples: Call for help button in bedroom and bathroom so individual can alert remote staff if help is needed Intercom in bedroom so remote staff can communicate with individual. Door sensors on exterior doors to alert remote staff of intrusion or elopement. Video Conferencing Station in living room for face to face communication with remote staff. Informed Consent (cont.) General Description of Client Needs Individual may need additional support during thunderstorms Individual gets up frequently at night. Individual has headaches at night. Service Site Description Map of site with location of technology. Site Map Example 5
License Statutes Sec. 18. Minnesota Statutes 2012, section 245A.11, subdivision 7a is amended to read: Subd. 7a. Alternate overnight supervision technology; adult foster care and community residential setting licenses. The license printed by the commissioner must state in bold and large font: (1) that the facility is under electronic monitoring; and (2) the telephone number of the county's common entry point for making reports of suspected maltreatment of vulnerable adults under section 626.557, subdivision 9. 1. Establish characteristics of target populations that will be admitted into the home, and characteristics of populations that will not be accepted into the home 2. Explain the discharge process when a resident served by the program requires overnight supervision or other services that cannot be provided by the license holder due to the limited hours that the license holder is on site; 3. Describe the types of events to which the program will respond with a physical presence when those events occur in the home during time when staff are not on site, and how the license holder's response plan meets the requirements in paragraph (e), clause (1) or (2); 4. Establish a process for documenting a review of the implementation and effectiveness of the response protocol for the response required under paragraph (e), clause (1) or (2). The documentation must include: (i) a description of the triggering incident; (ii) the date and time of the triggering incident; (iii) the time of the response or responses under paragraph (e), clause (1) or (2); (iv) whether the response met the resident's needs; (v) whether the existing policies and response protocols were followed; and (vi) whether the existing policies and protocols are adequate or need modification. Response Alternatives 1. Response alternative (1) requires only the technology to provide an electronic notification or alert to the license holder that an event is underway that requires a response. Under this alternative, no more than ten minutes will pass before the license holder will be physically present on site to respond to the situation; or 2. Response alternative (2) requires the electronic notification and alert system under alternative (1), but more than ten minutes may pass before the license holder is present on site to respond to the situation. Under alternative (2), all of the following conditions are met. 6
Foster Care/SLS Daily Worksheet (6790-C) When determining daily needs consider the following: Plan for down nights or nights that require on-site staff coverage(illness, weather, technology disruption, etc.). If you are paying an on-call staff to be on call, you want to count their hours. There will be times your on-call person will be called in and required to work. Number of people in the home who share electronic monitoring. Foster Care/SLS Daily Worksheet (6790-C) County case manager will use your numbers in the rate setting worksheet and determine daily allotment of compensation. Upfront costs (equipment, configurations, training) are not covered and absorbed by the provider. 7
WHERE S THE BEEF? THE FINANCIAL COST-BENEFITS OF REMOTE MONITORING Tangible Savings in Staff Expenses Reduction in Overall Wages. Savings in Wage & Benefit dollars. Can pay staff more & expect more out of your staff. Intangible Meaningful Work! More responsibility. Critical thinking & response. Professionalization of the DSP. Reduction in Needed Positions. Savings (time & money) in Hiring & Recruiting costs. Translates into tangible Retention! Show Me the Numbers! AFC/SLS Rate Framework reimbursements before geographic adjustment (6790-C): $25.36 per hours of awake staffing. $16.95 per hour of asleep staffing. $19.74 per hour of remote staffing (requires awake response staff). As a direct replacement for asleep staff, the hourly rate for remote staffing is $2.79 per hour higher. Savings occur when replacing awake orasleep overnight staff with remote staffing shared between 2 locations. 8
Independent Housing Options Market Rates for 24-Hour Emergency Response (T2034): Market Rate negotiated by provider and payer source (county). Used in conjunction with unit-based services like In-Home, ILS, or SLS 15-min. Additional Savings! No AFC License fees. Individual-Controlled leases and liability. All the additional trimmings. PICTURE TIME! WHAT IT LOOKS LIKE VISUALLY. 9
Sengistix Sensors Wireless Bed/Chair Contact Toilet Motion Pendant Wireless Pull Cord Adaptable Buttons and Switches Incontinence CONECT 2 way video/audio PTZ Night Vision Camera New Communication Over Network & Enhanced Connectivity Remote Alert Smoke Detector Stove Guard The MedMinder Sample Apartment 10
All activity viewed on web portal Sensors are self monitoring Alerts and system issues immediately reflected Data available for download and analysis Sengistix Response Center monitors system 24/7 24/7/information to Support the Support Team Even when 3 calls need to be made, it takes less than 2 minutes Standard Monthly Report Sengistix LLC - 2012 11
Situations Where Sengistix Can Help GENERAL MONITORING FOR SAFETY BEHAVIOR SUPPORT VERIFICATION AND REMINDERS Contact Information Tim Janssen, Sengistix Operations Director Tim.J@sengistix.com Anna Hegland, Dungarvin Operational Director AHegland@dungarvin.com Dan Millian, Remote Monitoring Systems Analyst DanM@hco.org John Paul Miller, Dungarvin Director of Budgeting JPMiller@dungarvin.com 12