Network of Care - A New Community-Based Resource

Launched in August 2001 in Alameda and Sacramento counties, Network of Care is the new community- based Internet resource for elderly and people with disabilities. This new project funded by the California Department of Aging is created to target the long existing problems on long-term care delivery. Not only is the funding to these quality programs fragmented, there is an obvious lack of coordination among them. Consequently, effective access to these services becomes difficult if the consumers are aware of these programs, while many are still unaware of the services. As a solution to this problem, Network of Care serves as an information system on the web to disseminate information regarding various existing programs to the consumers and agencies and simultaneously connect providers of varying services.

The initiatives behind the project are Alameda and Sacramento counties with Trilogy Integrated Resources and Local Communities Network who received a Long-Term Care Innovation Grant from the California Department of Aging. Hence, the 17-months demonstration began on February 15, 2001.

Network of Care is an extensive website that contains materials beyond simply listing the current services and programs; it also offers essential information regarding diseases, situations, assistive devices, and caregiving issues. Furthermore, daily news on the aging and disability subjects are also available on the website. Visitors to the website do not only benefit from the convenient one-stop information clearinghouse, but also the unique feature that enables them to communicate ideas and opinions to elected officials in the legislature. Among numerous other useful features include government links, legislate, resource finder, and My Record where one can save records for easy future access. Providers and caregivers are also encouraged to visit Network of Care, for there are sections dedicated to the needs of both.

To visit the Network of Care website, click on www.networkofcare.org.

Perhaps one of the least valued rights, one that is most often taken for granted is the right to vote. Even more neglected, the right to vote in secrecy that ensures individual privacy in expressing one's political choice. However, for people with disabilities these privileges are only in theory, the Equal Protection Clause of the Fourteenth Amendment as well as the American with Disabilities Act (ADA) that guarantee their rights as those without disabilities seem to be only principles in writing. Disabled residents in the city of Washington DC epitomize the victims of this discrimination, as they try to adapt to the 23 inaccessible polling sites in every election. They can only resolve to trust family members, close friends, or even strangers to assist them in casting their "non-secret" paper ballot votes.

The plaintiffs consist of 5 individuals with disabilities, 2 disability rights groups that are the Disability Rights Council of Greater Washington (DRC) and the American Association of People with Disabilities (AAPD). They are suing for the physically inaccessible polling sites and the lack of technological accommodation that allow disabled persons to vote in the same manner as other Americans without disabilities.

Specifically, the plaintiffs point out there are voting equipment that would enable them to vote independently, but the city chooses to purchase the inaccessible optical scan voting system from a company that also manufactures accessible voting system. The optical scan system requires voters to feed the paper ballot into a scanner to be recorded and tabulated. However, such equipment is difficult for people with visual and manual impairments to vote independently without the assistance of others who can help them feed the paper ballot, read the instructions, or press the operating buttons. On the other hand, there are accessible systems that utilize voice command or remote switches among many other high technology features that enable persons with physical impairments to vote independently in secrecy.

Furthermore, the physical environments of the polling sites are deemed inaccessible to persons in wheelchairs and those who cannot climb stairs. Such condition is accounted for in 23 out of the 140 polling places in Washington DC and the plaintiffs are also suing for accessible requirements on these sites.

Ironically, these demands are included under the ADA and the Fourteenth Amendment. The former requires all public facilities to accommodate to people with disabilities and guarantee equal opportunity to participate in any programs or activities. The latter ensures all citizens the right to equal protection by the laws, including the right to vote in secrecy. Consequently, the District of Columbia is sued for violation of the written law. However, the effort to demolish voting right discrimination will need to extend beyond the city of Washington DC, as it is not the only city that is perpetuating discrimination against people with disabilities.

(Source of article is taken from Half the Planet September newsletter.)

Applied Digital Solutions, Inc. is another step closer to launching its highly anticipated product - the Digital Angel Wanderers to the market. The company revealed on Aug 14, 2001 the process of Beta Testing that the product will undergo, and is expecting product roll-out in the fourth quarter this year. This high technology product is a hopeful device to help alleviate caregiver stress for those who care for Alzheimer's and other dementia patients. It will also help endorse further protection for these patients whenever the caregivers are absent.

Company expressed that this testing will involve multiple efforts from several groups to try the high technology over a period of 6 weeks. The participants include one or more of the national Alzheimer's/Autism or Caregiver organizations, which will offer insightful input on the effectiveness and potential outcome of the product. The company will also gather first-hand information from personal follow-ups as well as from focus groups that will evaluate the product from the perspectives of both caregivers and patients.

The company firmly believes the introduction of Digital Angel is on a timely manner to accommodate the steadily growing group of Alzheimer's and other dementia patients. The President and COO of Applied Digital Solutions also expressed the company's goal to use Digital Angel to meet a crucial, yet unfulfilled need of caregivers around the world by allowing a sense of freedom and independence for both the patients and the caregivers.

The Digital Angel Wanderers product is designed to target dementia patients, who are at risk of wondering away, and be exposed to higher incidence of injury, such as falling. The technology also helps caregivers to monitor the patients more closely without requiring them physically being there. With the currently estimate of roughly 10 million people who suffer from dementia around the United States, 70% are estimated to be living at home, Digital Angel will undoubtedly play a major role in providing quality in-home care.

Digital Angel is a combination of advanced biosensor technology that incorporates location and sensor technologies through Global Positioning Satellite (GPS), Web-enabled, and wireless telecommunication. One of the resulting key functions is transmitting the patient's location information through changes in temperature and pulse to any Web-enabled devices or phones. Thus, whenever the patient travels outside a pre-set boundary, the technology will alert the caregiver of this potentially dangerous situation.

Furthermore, Digital Angel, in the future may save the continually rising healthcare cost by reducing the number of caregivers and the amount of hours spent on monitoring the patients. Also, with higher quality in-home care for longer period of time, nursing home placement or other form of institutionalization may be delayed. For more information on Digital Angel, visit the website at www.digitalangel.net.

(Source of article is from SiliconInvestor Company news dated August 14, 2001)

In the September 2001 issue of the American Journal of Public Health published the result of a study that looks at the state inspections of about 14,000 nursing homes. The results show obvious inadequacy in investor-owned nursing homes relative to public or not-for-profit homes. The finding shows more deficiencies and lower nursing staff in private nursing homes, with the statistic of averaging 6 deficiencies per home, equivalent to nearly 50% more deficiencies than those found in non-profit and public nursing homes.

The study uses the On-line Survey Certification and Reporting (OSCAR) system database to analyze surveys conducted in 1998. The stability is ensured by repeating the analyses on the same facilities in the 1997 OSCAR database. There are several components to the method of this study. One of which focuses on 3 categories of deficiencies to provide clear comparison between investor-owned nursing homes and public and non-profit homes. The three categories include quality of care, quality of life, and others such as administrative, and personnel policies. For quality of care deficiencies, measures are related to a series of services including resident care, nursing, rehabilitation, dietary, physician, dental, pharmacy, and infectious control. The quality of life deficiencies are concerned with patient dignity and choice, the physical environment, and the availability of social activities and services.

Subsequently, the study rates the degree of effects these deficiencies have on patients. The ratio of nursing staff to patients is also utilized as an indicator of quality. However, due to the diverse health background of residents where some homes have sicker and frailer patients than others and the varying healthcare plans where some homes have more Medicaid residents, the variables need to be controlled. Using the Activities of Daily Living (ADL) index that targets 3 ADLs: eating, toileting, and transferring as control, researchers are able to analyze multivariate models of nursing homes.

The results show investor-owned facilities have more Medicaid patients than non-profit and public facilities. The investor-owned nursing homes also have more of all types of deficiencies than the other two. Similarly, the nurse staffing ratio is lower at investor-owned facilities, as well as lower licensed nursing hour per patient-day, and nursing aide hours. In essence, nursing homes with higher ADL index and more Medicaid patients have higher deficiencies and are mostly investor-owned. On the other hand, nursing homes that are certified as Skilled Nursing Facilities for Medicare Only have fewer deficiencies.

Gathered from the results, the study suggests a link between higher registered nurse staffing levels and lower death rates, also more licensed practical nurse staffing helps maintain higher quality of life for the patients. Hence, an obvious explanation for poor quality in investor-owned facilities is that profit-seeking homes often generate insufficient staffing, as the focus is distant from the quality of clinical care. However, the result does not insinuate guaranteed high or adequate quality of care in all non-profit or public facilities. It simply draws a comparison between the nature of business-oriented, profit-seeking homes with those that are non-profit or public with more focus on the patients, their health condition, and the services available to accommodate their needs. Moreover, it reminds families and friends to take more precaution and inspection before they entrust frail, sick elderly patients in a profit-oriented nursing home.

(Source of this article is from the State Legal Services Development website that is part of the Center for Social Gerontology at www.tcsg.org/lsdpage.htm.)

The U.S. Housing and Urban Development (HUD) in July 2001 awarded 475 Public Housing Authorities (PHAs) a total of $44 million worth of new Section 8 vouchers called Fair Share vouchers. Over 78,000 new Section 8 Fair Share vouchers are distributed to PHAs this year and approximately 12,600 of them are set aside for people with disabilities by 422 PHAs.

The Fair Share vouchers are conventional Section 8 vouchers that are set aside for people with disability, and are available to people of low income. They are awarded from HUD to PHAs who applied through a competition. As an incentive to encourage PHAs to assist people with disabilities, those who use a minimum of 15% of their Fair Share vouchers for households with disabilities would receive extra points from HUD in the competition. Moreover, additional points are given to those that set aside at least 3% of the vouchers for people with disabilities with Medicaid Home and Community Based Waivers.

To follow up on the winners of the Fair Share award as well as PHAs who choose to set aside percentages of the vouchers, Technical Assistance Collaborative (TAC) track the actual numbers of vouchers been distributed. The eligibility criteria of Fair Share vouchers are analogous to that of traditional Section 8 vouchers. However, only people with disabilities are entitled to the set-aside vouchers encouraged by HUD. Individual advocates who wish to increase the Fair Share voucher availability for people with disabilities should contact their local PHA to find out the number of Fair Share vouchers won, the percentage that is allocated aside, as well as the plans for distributing the vouchers. To view the FY 2001 award winners, visit the website at www.tacinc.org/hc/fairshare.htm.

(Source of article is taken from the TAC website at www.tacinc.org.)

"Visitable" homes are often misinterpreted and regarded as accessible homes for residents with disabilities. In reality, that quality is only a fraction of the actual purpose of visitable homes. Visitability does not only allow individuals to navigate around their own home, but also the homes of their friends and families, both disabled and non-disabled alike. Hence, the word "visitability" suggests the ability for disabled persons to visit other homes, to freely interact and socialize with people of all abilities in their homes, and not only those living in modified environment.

There poses much challenge for disabled individuals when they encounter inaccessible homes. The risk of falling off narrow staircases, the frustration and embarrassment of not able to access the bathroom, and the need to be carried over a few steps of stairs all create concern to the disabled individuals. Consequently, the factors to consider before attending a social function, or visiting a close friend or relative is not only the availability of time, but the level of accessibility of the home. Moreover, disabled people are sometimes isolated as a result of inability to attend social functions that are held in inaccessible homes, or even unable to leave one's own home because of stairs.

The existing regulations ensure the disabled community the right to gain accessibility in public facilities and in their own homes. Examples are the Americans with Disabilities Act (ADA) and the Fair Housing Act. While the ADA implements access to public places, the Fair Housing Act requests landlords to allow reasonable modification and provides disabled tenants and homebuyers some access to buildings. However, visitability addresses the issue of accommodating residential facilities to the disabled population, not just the renters or owners, and it aims to remove any restrictions to social interactions due to physical environmental barriers. Furthermore, it is different from Universal Design that requires accessibility to a much greater degree, including all products and environments to be usable and accessible by people of all ages and ability. Visitability is more focused on specific aspects of the residential buildings, that include zero-step entrance, accessible main door, hallways, and bathroom that is modified with mobility aids like grab bars.

In essence, these criteria allow buildings to be "visitable" by the disabled persons, friends, and family; it accommodates to not only the physical but also the social well being of people with disabilities. On the other hand, there is still a lack of awareness on the concept of visitability and its importance still needs to be promoted to the public, contractors, and various building associations. For more information on advocacy efforts, contact William Altaffer, the vice chairman of the Tucson Commission on Disability Issues at william.altaffer@azbar.org.

(Source of article extracted from another article titled "A NICE PLACE TO VISIT" Making Homes "Visitable" for people with Disabilities, by Phil Ivory on the MDA Muscular Dystrophy Association) website www.mdausa.org.)