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Friedman C, VanPuymbrouck L. Environmental Modifications for People With Intellectual and Developmental Disabilities: A Policy Analysis of Medicaid Home- and Community-Based Services. Am J Occup Ther 2024; 78:7803205090. [PMID: 38767469 DOI: 10.5014/ajot.2024.050393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
IMPORTANCE Environmental modifications are targets for occupational therapy intervention because they support activities of daily living, self-efficacy, personal control, independence, and community living for people with intellectual and developmental disabilities (IDDs). OBJECTIVE To examine how environmental modifications were provided to people with IDDs through Medicaid home- and community-based services (HCBS) waivers across the United States in fiscal year (FY) 2021. DESIGN Using a mixed-methods policy analysis, we examined FY 2021 Medicaid HCBS 1915(c) waivers from across the United States to examine whether, and how, states provided environmental modifications to people with IDDs. RESULTS In FY 2021, 35 states projected spending $68.8 million on environmental modifications for 12,671 people with IDDs. The purpose of environmental modifications was most often to promote the health, welfare, and safety of people with IDDs (82.68%), and to promote their independence (69.29%). The most common examples of environmental modifications included ramps and/or lifts (70.08%), widening doorways and/or hallways (61.42%), bathroom modifications (58.27%), specialized electrical and/or plumbing for medical equipment (54.33%), and grab bars and/or handrails (53.54%). CONCLUSIONS AND RELEVANCE HCBS waiver data on environmental modifications for people with IDDs enhances an understanding of this funding source and provides a foundation of advocacy for occupational therapy practitioners to support people with IDDs with living, as well as aging, in the community rather than in institutions. An expansion of environmental modifications in HCBS for people with IDDs aligns with the aim of Medicaid HCBS waivers to promote community integration, self-determination, and independence, which are all benefits of environmental modifications. Plain-Language Summary: This study can help occupational therapy practitioners determine what funding sources are available in their state to help their clients with intellectual and developmental disabilities access environmental modifications. The findings can also help guide advocacy and lobbying efforts to expand access to environmental modifications.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, PhD, is Director of Research, The Council on Quality and Leadership, Towson, MD;
| | - Laura VanPuymbrouck
- Laura VanPuymbrouck, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Rush University, Chicago, IL
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Friedman C. Technology first: The impact on technology availability for people with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1251-1263. [PMID: 37482893 DOI: 10.1111/jar.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/02/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND In the United States, 16 states have adopted Technology First initiatives to improve people with intellectual and developmental disabilities' access to technology. METHOD Our aim was to examine if Technology First initiatives impact the allocation of technology in Home and Community-Based Services (HCBS) for people with intellectual and developmental disabilities. To do so, we analysed HCBS programs from across the United States in fiscal year 2021. RESULTS Technology First states were more likely to offer telehealth service delivery in their HCBS programs. However, we found few other significant differences in allocation of technology - the number of people receiving and projected spending - based on states' Technology First status. CONCLUSIONS While these findings do not mean that there is no value in Technology First initiatives, it appears these initiatives have yet to truly impact resource allocation when it comes to HCBS.
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Affiliation(s)
- Carli Friedman
- CQL | The Council on Quality and Leadership, Towson, Maryland, USA
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Gough C, Barr C, Lewis LK, Hutchinson C, Maeder A, George S. Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach. BMC Public Health 2023; 23:172. [PMID: 36698158 PMCID: PMC9875767 DOI: 10.1186/s12889-023-15093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities , considering their capacities and preferences, to facilitate community participation are required.
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Affiliation(s)
- Claire Gough
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Chris Barr
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Claire Hutchinson
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia. .,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia. .,Caring Futures Institute, Flinders University, Adelaide, Australia.
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