THE ASSISTIVE TECHNOLOGY - CHICAGO PROJECT PRELIMINARY COST / BENEFIT RESULTS
Glenn Hedman, M.Eng. Coordinator Assistive Technology Unit / Institute on Disability and Human Development / University of Illinois at Chicago
ABSTRACT
While the potential benefit of assistive technology to a specific individual with a disability is a powerful argument for its acquisition, additional information is sometimes needed for a third-party payor to provide prior approval. The "Assistive Technology - Chicago" Project enabled Evaluations to be provided to 150 clients receiving city-provided Meals-on- Wheels or Homemaker services. An analysis of the first 50 individuals receiving equipment indicates that 90% were able to reduce or eliminate their need for services, with a return-on-investment of approximately 20:1.
BACKGROUND
Assistive technology service providers routinely ask third-party payors to make an investment in equipment to enable individuals with disabilities to maximize their independence. The concise, accurate description of the impact of that equipment on the life of the individual is the most important information that a service provider can produce, and is usually the result of significant time and effort.
Additional information is sometimes included to make the third-party payor more confident about the investment in the assistive technology equipment. One such piece of information is the economic impact of the equipment implementation.
The Assistive Technology - Chicago Project was designed to study the cost - benefit of assistive technology as it is used by individuals with disabilities in their homes. Specifically, individuals with disabilities receiving city-provided Meals-on- Wheels or Homemaker services received Evaluations to determine if assistive technology could enable them to perform all the activities involved in meal preparation and homemaking.
City residents with disabilities calling the city to inquire as to the availability of the Meals-on-Wheels or Homemaker services are referred to one of two community agencies based on the location of their home. A case manager from the community agency then visits the home to document the need for the service. The case manager also determines the appropriateness for concurrent referral for assistive technology services.
RESEARCH QUESTION
The Project lends itself to the examination of issues that include the following:
- types of equipment provided
- cost of equipment per client
- number of clients able to reduce need for services
- service savings ¥ time for equipment to pay for itself
- return-on-investment
Issues involving the costs of city-provided services were examined using the city-provided information on the cost of provision of the Meals-on-Wheels (cost per day of delivered meals) and Homemaker services (cost per hour).
METHOD Services were provided through clinicians with backgrounds in occupational therapy and rehabilitation engineering. Two clinicians were sent on each appointment, to combine the expertise of clinicians and for safety.
All Assistive Technology - Chicago Project services were provided through mobile units which enabled Evaluation and Fabrication services to take place in the community (Figure 1). This was an essential part of the Project, as the need for city-provided services was the result of the client's abilities and the environment in which those abilities are utilized (1).
Evaluations were performed that analyzed the individual activities within meal preparation and homemaking, so that instances where the client's abilities did not match the specific task needing to be carried out could be identified. The clinicians and client discussed the issues that presented themselves, and what options existed. Assistive technology equipment was identified that would enable the client to work with their abilities to perform the identified task. Most often, the Evaluation team had the piece of equipment to try out during the session. Reports were then generated to the city for prior approval of the equipment acquisition.
At the Implementation visit, clinicians provided training regarding the use and care for the assistive technology, and documented the ability of the client to perform the given activity. The community agency case manager then revisited the client to re- assess the need for city-provided services after the equipment had been issued.
RESULTS
Of the 154 clients receiving Evaluations, equipment was considered appropriate for 104. Of these 104 clients, prior approval was received for the acquisition of equipment for 65. For some clients, equipment requests were denied or referral was made to other agencies for funding consideration.
The type of equipment issued to the clients varied greatly. In all cases, commercially-available equipment was considered first, modified equipment was considered next, and custom-designed equipment utilized as a third option.
For clients receiving Meals-on Wheels, equipment issued included food storage containers with adaptive lids, storage shelving and carousals to locate food and kitchen equipment within an individual's functional range of movement, reachers, adapted can openers, adapted bottle and jar openers (Figure 2), adaptive knives, cutting boards, microwave ovens with tactile borders and programmable cooking capabilities, extra- long oven mitts, stools, plate guards, and adaptive utensils.
For clients receiving Homemaker services, equipment issued included long-handle brooms and dust pans (Figure 3), carpet sweepers, power-drive vacuum cleaners, adapted mops, and adapted irons. Some clients receiving Homemaker services also received accessibility equipment for the bathroom area, as some clients would bathe while their Homemaker was working in the home in case they fell and needed assistance. This group of equipment included bathtub transfer benches, grab bars, hand-held showers, bath mats, and raised toilet seats.
An analysis was made of the impact of the assistive technology for the first 50 clients receiving equipment. Of these 50 clients, 25 received equipment related to meal preparation. Of these 25, a total of 21 were able to reduce or eliminate their need for the delivered meals. Cost of the equipment ranged from $26.09 to $923.84, with the average being $234.85.
Of the 50 clients, 31 received equipment related to homemaking. Of these 31, a total of 24 were able to reduce or eliminate their need for the outside homemaker. Cost of the equipment here ranged from $58.50 to $729.20, with the average being 345.73.
Table 1 shows the results for the group of 50 clients. A total of 45 (90%) were able to reduce or eliminate their need for city-provided Meals-on-Wheels and / or Homemaker services.
Table 1.
Clients receiving equipment 50
Service Level after Implementation Reduced 45 Increased 2 Unchanged 3
Equipment cost Range $26.09 - $923.84 Average $324.27
Time required to cover cost of Assistive Technology Range 0.90 weeks - 66.76 weeks Average 10.31 weeks
When determining the return-on-investment for the city, the cost of the service savings (calculated from the year of service to the year that the client would turn 60 years of age and be served by another city agency) was compared to the cost of the assistive technology equipment. For the 45 clients that had been able to reduce or eliminate the need for services, the city would realize a total savings of $867,531, and the return-on-investment in assistive technology would be 20.58:1.
DISCUSSION
The preliminary results of the Project indicate that when service providers recommended equipment, and were able to implement that equipment, there was a 90% likelihood for assistive technology equipment to not only increase an individual's level of independence, but to save third-party payor funding.
This Project only addresses the issues of assistive technology used in the home environment, dealing specifically with the issues of meal preparation and homemaking. A cost / benefit analysis of the application of other types of assistive technology would involve the quantification of other types of cost factors, such as pressure sore or scoliosis treatment, unemployment vs. employment costs, and personal assistance. Also, the total savings for the city, and resulting return-on-investment, would be influenced by client longevity and changes in functional abilities.
REFERENCES
1. Connell, B.R., J.A. Sanford, R.G. Long, C.K. Archea, and C.S. Turner: Home Modifications and Performance of Routine Household Activities by Individuals with Varying Levels of Mobility Impairments. Technology and Disability, 2:4, 9- 18, 1993.
ACKNOWLEDGEMENTS
The "Assistive Technology - Chicago" Project was made possible by support from the City of Chicago - Mayor's Office for People with Disabilities, through its Assistive Technology Services initiative and Community Development Block Grant funding.
This analysis is possible because of the high quality services provided by the clinicians Beatrice Cammon- Parker, COTA/L, Kathy Hooyenga, OTR/L, RET, Eugene Tong, COTA/L, and the author.
Glenn Hedman, M.Eng. Coordinator Assistive Technology Unit Institute on Disability and Human Development University of Illinois at Chicago 1640 West Roosevelt - Room 415 Chicago, IL 60608-6904 (312) 413-7784 (Direct desk) (312) 413-1555 (ATU main office) (312) 413-1554 (TTY) (312) 413-3709 (Fax) GHedman@uic.edu (E-mail)
Figure 1.
Figure 2.
Figure 3.