音声ブラウザご使用の方向け： SKIP NAVI ／ GOTO NAVI

WHERE DO WE GO FROM HERE? TRENDS IN STATE POLICIES AND PROGRAMS ON ASSISTIVE TECHNOLOGY

Debra J. Sheets, RN, Phoebe S. Liebig, Ph.D.
Andrus Gerontology Center, University of Southern California
Los Angeles, CA 90089-01911

Web Posted on: December 12, 1997

ABSTRACT

This descriptive study provides a comparative analysis of individual state assistive technology (AT) activities in three areas:

  • general AT services,
  • general AT policies, and
  • targeted AT efforts to older adults.

Data come from two national surveys:

  • a study on state legislative analysts (AT Policies for Aging with Disability, 1995);
  • a study of State Units on Aging (SUAs) and State Tech Act projects (TAPs) (American Society on Aging, 1995);

and a compendium of information on Tech Act programs and practices (RESNA, 1996).

The analyses suggest that much remains unknown about the AT activities of individual states. Typically, patterns of state AT activities are concentrated on one of the three areas; only Missouri and Illinois rank high across two of the three areas examined. Both states also ranked high in overall AT activities. However, inconsistencies in some of the available data collected give rise to policy concerns. With the current trend of devolution to the states, research efforts need to be concentrated at the state level. Data are particularly lacking on individual state policy activities; more research is needed to fill these gaps. With the current trend of devolution to states, an understanding of state level differences and variations in state activities will become increasingly important in developing public policy and programs.

BACKGROUND

About 35 million Americans have disabilities that limit their daily activities, according to conservative estimates (Institute of Medicine, 1991). The demographics of the older population suggest that these numbers will continue to rise in coming decades since the prevalence and severity of activity limitations is known to increase with age. About 5 percent of the population less than age 18 have a disability, while 84.2 percent of those age 85 and over have a disability (National Council on Disability, 1996) Most adults can anticipate aging into disability in later life, with on average, about 13 years of activity limitations (Institute of Medicine, 1991).

The demographics of the disabled population are also changing due to increased survivorship and longevity among persons with early onset of disability. For the first time in history, significant number of individuals with long-standing disabilities such as spinal cord injury, cerebral palsy, post-polio, or developmental disabilities, are achieving nearly normal life expectancy. These individuals are aging with disability and are facing unanticipated and premature changes in their functional ability. These new problems often threaten independence and efforts to work.

The National Coalition on Disability and Aging projects that by the year 2000, approximately 75 to 85 million Americans will be either aging into disability in later life or aging with disability. These demographic trends and growing concerns about the high personal and social costs of dependency have caught the attention of aging and rehabilitation professionals, researchers, and policy makers. Increasingly, assistive technology (AT) is receiving attention as a means to address many of the problems of disability. Assistive technology refers to any devices or services that are used to increase, maintain, or improve the function of individuals. During the past decade, a number of national surveys indicate that use of AT is rising and use of personal assistance is declining. Yet research also indicates that many middle-aged and older adults do not receive the benefits of AT due to financial, attitudinal, and/or informational barriers.

PURPOSE

The purpose of this study is to describe and compare individual state AT activities in the areas of services, policies, and efforts to address the needs of older adults. Our objectives include:

  • 1. identifying the states that appear to have the highest, as well as the lowest, levels of general AT activities in the areas of services, policies, and aging,
  • 2. examining the state patterns of activities to determine whether some states display high levels of AT activities across all three areas of general AT services, general AT policies, and targeted AT for older adults, and
  • 3. identifying which AT activities are most frequently initiated by states in the areas of general AT services, general AT policies, and targeted AT for older adults.

This study is unique in its focus on state policies and our effort to describe and compare patterns of AT activities. Most AT research has focused on federal policies, not only because they provide the largest source of funding, but also due to the greater ease with which they can be identified and examined since federal programs are relatively uniform across the nation. Individual state activities are much more difficult to identify and analyze since they vary considerably in administrative structures, eligibility requirements, and program services. To our knowledge this is the first comparative analysis to examine state AT activities across three domains- general AT services, general AT policies, and targeted AT efforts for older adults

Despite these difficulties, state activities are important because they often generate new policies and lead to federal initiatives. In keeping with their roles as laboratories for innovation, states are often unwilling to wait for action by the federal government and move ahead to develop policies and programs that are self- generated, financed, and administered. In the AT policy arena, states have taken the lead to enforce access (e.g., protection and advocacy) and initiate consumer protection to assure quality of AT (e.g., lemon laws). With the current shift towards greater devolution, both state activity and interstate differences are likely to increase.

METHOD

This comparative analysis is based on data from two national surveys and a compendium of Tech Act programs and practices:

  • 1. Survey of State Legislative Analysts. This study, conducted in August 1995, sought to determine what legislation legislative committees, funding, policies and programs individuals states have in place for AT and home modifications (HM) for adults with disabilities. A 10-question survey was mailed to 62 state legislative analysts representing all 50 states and the District of Columbia. The response rate was 48 percent (30 responses) representing 27 states. This study was conducted by the AT Policy Project on Aging with Disability at the Andrus Gerontology Center of the University of Southern California, supported in part by the National Institute on Disability and Rehabilitation Research (NIDRR).
  • 2. Survey of State Tech Act Programs (TAPs) and State Units on Aging (SUAs). This study, conducted in June 1995, examine collaborative efforts among the TAPs and SUAs to improve the access of older persons to AT and HM. A 9-question survey was mailed to 56 TAPs and 54 SUAs. The response rate was 89 percent for TAPs (50 responses) and 80 percent for SUA (43 responses). This study was conducted by the American Society on Aging, supported in part by the Administration on Aging.
  • 3. Compendium of Tech Act Grantees Programs and Practices. This compendium is meant to serve as a resource to the state Tech Act Projects (TAPs) to provide them with descriptions of Tech Act programs and practices so that projects will learn from each other and benefit from the experiences of others. Information is provided on funding, service delivery, information referral, training and public awareness, interagency coordination, and products and resources. Currently, there are 52 TAPs and full information is available only for the 42 Tech Act grantees funded in May 1993. This information was collected by the Rehabilitation Engineering Society of North America's (RESNA) Technical Assistance Project, funded by NIDRR.

MEASURES

State AT activities were categorized in three domains-- AT services, AT policies, and AT efforts in aging

  • 1) General AT Services. A sum score (range 0 - 10) for general AT services was calculated based on presence or absence of information and referral system; state appropriations for AT, HM or Independent Living (IL); financial loan program; equipment loan program; mobile van services; interagency cooperation; home- and community-based care AT services, and expanded Medicaid AT coverage.
  • 2) General AT Policies. A sum score (range 0 - 7) for general AT policy activities was calculated based on the presence or absence of lemon law, ear-marked funds, tax policy, AT advisory council, disability rights efforts, AT and health care policy initiatives; and vocational rehabilitation policy on AT.
  • 3) AT Targeted to Older Adults. A weighted score (range 0 - 36) was calculated for TAPs and SUAs efforts in four areas- cooperation, collaboration, other activities, and unique AT/HM aging programs. Cooperation was measured using the sum score for two variables: participation on an AT advisory committee and providing information and referral for older adults. Collaboration was measured using two variables: joint staff training and resource sharing for AT funding for older adults. The collaboration measures received a 50 percent higher weight than cooperation since they represent more active effort. Other Joint Efforts were assessed as presence or absence of other activities between tech and aging programs. Designated AT/HM aging programs were scored using 3-levels: 6 = clearly designates as an aging and AT/HM program; 3 = general aging or AT/HM program providing AT; and 1 = general social service program which provides some AT.
  • 4) Overall Ranking for AT Activities. Each of the sum scores for general AT services, general AT policies, and AT targeted to older adults were rescaled from 0-1 with 1 representing the highest score and 0 representing the lowest score. These rescaled scores were summed to create an overall ranking (range 0-3).

RESULTS (see attached tables)

  • States that rank high in providing general AT services include Missouri, New York, and Illinois.
  • States that rank high in general AT policy activities include Missouri, Louisiana, Montana, and Oklahoma.
  • States that rank high in AT targeted to older adults include Arkansas, Delaware, Iowa, Illinois, Minnesota, and the District of Columbia.
  • Only two states rank high across at least two of the three areas: (1) Missouri ranks high in both general AT services and general AT policy activities.
  • States with overall high ranking of AT activities include: Missouri, Arkansa, New York, Delaware, Montana, and Illinois.
  • The timing of tech act funding is significantly related to services and policies: (1) earlier funding is associated with higher ranking in AT services and AT targeted to older adults; and (2) later funding is associated with higher ranking in policy activities.
  • Among general AT services, states are most likely to provide information and referral for AT and AT training (39 states).
  • The most frequent state policy activities include lemon laws (13 states) and tax policy (9 states)
  • AT efforts targeted at older adults are more likely to be cooperative (i.e., referral (35 states) or participation on joint AT advisory committees (28 states) than more active forms of collaboration (i.e. staff training and resource sharing).

LIMITATIONS

The limitations of this study reflect the sources of data used for analysis and include:

  • variable response rates across the surveys with a low rate of 53% for the state legislative analysts;
  • significant gaps in information about AT policy activities;
  • numerous inconsistencies in TAP and SUA responses raising questions about the reliability of the data and giving rise to policy concerns.
  • compendium data were not collected systematically and therefore are probably incomplete.

CONCLUSIONS

  • The current trend of devolution to the states suggests that research efforts need to be concentrated at the state level. An understanding of state level differences and variations in state activities will become increasingly important in developing public policy and programs.
  • Some states stand out as leaders in developing comprehensive AT systems; more studies are needed to confirm the identity of these states so that their "best practices" can be widely disseminated.
  • Current state AT activities are likely to change when Tech Act funding ceases; however, it remains unknown to what extent states are planning to maintain current activities when this occurs.

Go to the top of this page. | Go to the upper category.