David Braddock, Ph.D., Professor and Executive Director of the Coleman Institute for Cognitive Disabilities gave a keynote address at the National Association of State Directors of Developmental Disabilities Services (NASDDDS) 2010 Annual Conference in November. His address offered a sobering view of the state of the states. Dr. Braddock said that, for the first time since he began collecting federal spending data in 1972 – and probably since the Great Depression, total inflation-adjusted public intellectual and developmental disabilities (I/DD) spending declined in the U.S. in 2009.
However, he did provide some examples of new approaches to service delivery that offer rays of hope for the future of DD services, including a substantial shout-out to Imagine!’s SmartHomes project.
Check out slides 52-60 for more on the SmartHomes, and check out the rest of the slides to get a better sense of why this ambitious project is so necessary.
Many thanks to Dr. Braddock for giving us permission to share his presentation.
4. TOTAL I/DD SPENDING DECLINED IN 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
5. ANNUAL % CHANGE IN INFLATION-ADJUSTED I/DD SPENDING IN THE U.S.: 1978-09 Source: Braddock, D., Coleman Institute and Department of Psychiatry, University of Colorado, 2010.
6. THE AVERAGE ANNUAL RATE OF TOTAL I/DD SPENDING HAS STEADILY DECLINED BY DECADE Source: Braddock, D., Coleman Institute and Department of Psychiatry, University of Colorado, 2010.
7. NUMBER OF STATES WITH INFLATION-ADJUSTED CUTS IN I/DD SPENDING: 1978-2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. (e)
8. Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. INFLATION-ADJUSTED GROWTH IN I/DD SPENDING IN THE STATES, 2008-09
9. INSTITUTION SPENDING GROWTH IS NEGATIVE OVER THE LAST TWO DECADES Source: Braddock, D., Coleman Institute and Department of Psychiatry, University of Colorado, 2010.
10. COMMUNITY SERVICES SPENDING ASCENDED 1970-90, THEN GROWTH SLOWED Source: Braddock, D., Coleman Institute and Department of Psychiatry, University of Colorado, 2010.
11. REDUCTIONS IN STATE ONLY FUNDING: FY2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
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13. INSTITUTIONAL RESIDENTS WITH I/DD IN THE U.S.: 1848-2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. *Excludes nursing facilities [32,570 persons in 2009].
14. CUMULATIVE CLOSURES OF STATE-OPERATED 16+ INSTITUTIONS Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. UNITED STATES
15. MOST RECENT INSTITUTIONAL CLOSURES: 2007-10 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
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17. WHO’S NEXT? Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
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19. Utilization Rate: 193 per 100,000 INDIVIDUALS WITH I/DD IN OUT-OF-HOME PLACEMENTS IN THE U.S., 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
20. INDIVIDUALS WITH I/DD IN OUT-OF-HOME PLACEMENTS IN 2009 SMALL NEW ENGLAND STATES (MAINE, NEW HAMPSHIRE, RHODE ISLAND, VERMONT) Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. Total Consolidated General Population in 2009: 4.3 million.
21. MOST EXTENSIVE UTILIZATION OF 7-15 PERSON SETTINGS* Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. *Percentage of total served in out-of-home residential services
22. GROWTH RATE OF COMMUNITY PLACEMENTS FOR SIX OR FEWER PERSONS DECLINES 50%: 2006-09 UNITED STATES Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
23. MEASURING STATES’ COMMITMENT TO I/DD SERVICES Fiscal effort is a ratio that can be utilized to rank states according to the proportion of their total statewide personal income devoted to the financing of I/DD services. Fiscal effort is defined as a state’s spending for I/DD services per $1,000 of total statewide personal income.
24. FISCAL EFFORT FOR I/DD SERVICES IN THE TOP TEN AND BOTTOM TEN STATES 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. TOP 10 BOTTOM 10
25. FISCAL EFFORT FOR I/DD SERVICES IN THE STATES: 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
26. PUBLIC SPENDING FOR I/DD LONG-TERM CARE HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER
27. FEDERAL HCBS WAIVER SPENDING SURPASSED ICF/MR SPENDING IN 2001 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. Intercept (2001)
28. GROWTH OF FEDERAL HCBS WAIVER SPENDING BY DISABILITY GROUP: 1997-2007 Source: Braddock, D. (in press). Public spending for services to persons with disabilities in the United States. Boston: Federal Reserve Bank of Boston. UNITED STATES Mental Health Waivers ($41.5 million)
29. TOTAL DISABILITY SPENDING IN THE U.S.: 1997-2007 Source: Braddock, D. (in press). Public spending for services to persons with disabilities in the United States. Boston: Federal Reserve Bank of Boston.
30. DISABILITY SPENDING IN THE U.S. BY ACTIVITY CATEGORY: 1997-2007, INFLATION ADJUSTED Source: Braddock, D. (2010). Public spending for services to persons with disabilities in the United States. Washington, DC: Federal Reserve Bank of Boston.
31. PERCENT INSTITUTION/NURSING HOME SPENDING BY DISABILITY GROUP Source: Braddock, D. (2010). Public spending for services to persons with disabilities in the United States. Washington, DC: Federal Reserve Bank of Boston.
32. MEDICAID INSTITUTIONAL/NURSING FACILITY SPENDING VS COMMUNITY SPENDING Source: Braddock, D. (2010). Public spending for services to persons with disabilities in the United States. Washington, DC: Federal Reserve Bank of Boston.
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35. STATES REPORT CONTINUING GROWTH IN FAMILIES SUPPORTED: 1988-2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. $3.77 BILLION, 2009
36. BUT ONLY 17% OF FAMILIES RECEIVED I/DD AGENCY SUPPORT IN 2009 Sources: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary; family caregivers estimated from Survey of Income and Program Participation (SIPP) data (Fujiura, 1998).
37. HCBS WAIVER PROVIDED 73% OF THAT I/DD FAMILY SUPPORT SPENDING IN 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
38. Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. 22 STATES HAVE I/DD CASH SUBSIDIES
39. SELF-DIRECTED COMPONENT OF SUPPORTED LIVING IN NEW YORK STATE:1988-09 NEW YORK Total Supported Living $s Self-Directed $ Source : State of the States/NASDDDS pilot study of individual and family support, preliminary data, 2010.
40. NEW YORK SELF-DIRECTED SUPPORTED LIVING SPENDING INCREASES FOURFOLD 2006-09 Source : State of the States/NASDDDS pilot study of individual and family support, preliminary data, 2010.
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42. NUMBER OF SUPPORTED EMPLOYMENT WORKERS PLATEAUS 2002-09 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. SUPPORTED EMPLOYMENT WORKERS WERE 21% OF TOTAL DAY/WORK PARTICIPANTS IN 2009
43. HCBS WAIVER SPENDING PROVIDED 68% OF I/DD SUPPORTED EMPLOYMENT SPENDING IN 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
44. TOP TEN STATES’ GROWTH IN SUPPORTED EMPLOYMENT WORKERS FROM 2006 TO 2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
45. NUMBER OF SUPPORTED EMPLOYMENT WORKERS IN WASHINGTON STATE 1986-2009 Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary. SUPPORTED EMPLOYMENT WORKERS WERE 62% OF TOTAL DAY WORK PARTICIPANTS IN 2009
46. I/DD PARTICIPANTS IN DAY PROGRAMS, SHELTERED WORK & SUPPORTED/COMPETITIVE EMPLOYMENT Source: Braddock, D., State of the States in Developmental Disabilities, 2010, preliminary.
47. “ I think we can do a ‘virtual nursing home’ with technology”… Andy Grove Co-Founder, Intel Corp. In USA Today , 2006 IIa: EMERGENCE OF SMART HOME TECHNOLOGIES
48. U.S. DEMAND FOR NEW I/DD RESIDENTIAL SERVICES IN THE NEXT DECADE IS 166,000 Source: Braddock, D., State of the States in Developmental Disabilities, 2010. Projected from 2000-2009
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51. MIT PLACELAB - BEHIND THE SCENES Context-aware PDA with wireless sensors/motes Source: MIT PlaceLab website at http://architecture.mit.edu/house_n/placelab.html
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53. IMAGINE! SMART HOME, LONGMONT, CO, OPENED MAY 2010 Imagine! Smart Homes in Boulder and Longmont, Colorado http://www.imaginesmarthomes.org/
54. IMAGINE! SMART HOME, BOULDER, COLORADO: COMPLETED 2009 Imagine! Smart Homes in Boulder and Longmont, Colorado http://www.imaginesmarthomes.org/
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56. IMAGINE! SMART HOME, BOULDER, COLORADO: GREEN TECHNOLOGIES Geothermal systems heat and cool the home Photovoltaic cells generate electricity
69. INDIANA GOVERNOR MITCH DANIELS ENDORSES SMART HOME TECHNOLOGY “ We can alleviate some of the demand for Direct Support Professionals (DSPs) by identifying new service options for people who do not need intensive DSP support. The system is tailored to the needs of each person who uses it and has been shown to improve personal independence, as well as alleviating the needs for a direct support professional where one is not needed.” Mitch Daniels, Governor, State of Indiana The Arc of Indiana, Meet the Candidates , Summer 2008
75. Adapted Web Browser The Web Trek adapted web browser improves access to the World Wide Web for people who have difficulty with reading and writing. ADAPTED WEB BROWSER AND E-MAIL SOURCE: Ablelink Technologies, Colorado Springs. Adapted E-mail Program
78. TREKKER BREEZE GPS Verbally announces the names of streets, intersections and landmarks as you walk. Source: http://www.visabilitystore.org/browse.cfm/trekker-breeze-gps/
79. INDOOR WAYFINDING SUPPORT SOURCE: http://cognitivetech.washington.edu/assets2006_liu.pdf . Participants preferred images with arrows, not audio alone [In Development]
80. PERSONAL SUPPORT ROBOTS Can serve as “life support partner” to follow a person from place to place, respond to commands, aid in activities of daily living, help with route finding, interact with others. Source: Maja J Mataric, University of Southern California, Viterbi School of Engineering
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82. REHABILITATION ENGINEERING RESEARCH CENTER ON ADVANCING COGNITIVE TECHNOLOGIES (RERC-ACT) University of Colorado – Boulder Cathy Bodine, Ph.D., Principal Investigator Co-funded by the Coleman Institute University of Colorado School of Medicine - Anschutz IIc. THE NEW CU RERC 2009-14 www.uchsc.edu/atp/RERC-ACT.html
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85. RERC-ACT: 2010 DEVELOPMENT PROJECTS D1. Uniform standards for cognitive technologies D2. Interactive animated agents platform for home, school, work and community D3. Non-linear context-aware prompting for adults with cognitive disabilities in the workplace D4. Mobile life coach vocational applications D5. Socially interactive early childhood robotics D6. Inclusive collaboration technology for employment
86. RERC-ACT: 2010 RESEARCH PROJECTS R1. THE RERC-ACT Product Testing Laboratory R2. Context-aware prompting system R3. Mobile-based job-coaching intervention R4. Cognitive decline and recovery from work interruptions in the IT workforce R5. Vocabulary development in mild cognitive impairments R6. Socially assistive robotics for skills acquisition.
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88. COMPUTATION AND ENGINEERING Artificial intelligence Human-computer interaction Pervasive computing Electrical & Biomedical Engineering HEALTH-RELATED SCIENCES Gerontology, Neurology, Rehab Medicine Medical Informatics Psychology and Cognitive Science PT, OT, Nursing COGNITIVE ASSISTANCE DISCIPLINES
93. U.S. INDUSTRIAL CAPACTIY UTILIZATION COLLAPSES : 2008-2010 Source : Federal Reserve (2010). G.17 Industrial Production and Capacity Utilization for October 18, 2010. FACTORIES, UTILITIES, MINES
94. STATE TAX REVENUES PLUNGE, 2008-09 Source: The Nelson A. Rockefeller Institute of Government, August 30, 2010.
100. STATE BOND RATINGS: JANUARY 2010 Source: Standard & Poors Ratings , NY Times, 2/3/10
101. CHANGING POPULATION MIGRATION IN THE STATES 2006-09 Source: Federal Funds Information for States (2009). State Policy Reports, Vol. 27 , No. 21.
102. AMERICA’S TAX BURDEN IS AMONG THE SMALLEST IN THE DEVELOPED WORLD Organisation for Economic Co-operation and Development (OECD). (2008, preliminary) . Tax burden: Personal income, employee and employer social security contributions, and payroll taxes as a % of GDP (households of married couples, two children).
103. What To Do? Galbraith’s Guidance “… we could begin to develop a society in which our work, our cultural accomplishments, social life, sense of fairness, the general standard for the whole population, your work with helping people who come into society with disabilities and impairments, these things become the true and dominant measure of how well we’re doing….” James Galbraith University of Texas Economist and Professor of Government At the Coleman Conference, November 5, 2009.
104. FROM (GDP) PRODUCTION TO WELL-BEING … the time is ripe for our measurement system to shift emphasis from measuring economic production [GDP] to measuring people’s well-being…. Stiglitz, Sen, & Fitoussi, Report by the Commission on the Measurement of Economic Performance and Social Progress , 2010, p. 12. [www.stiglitz-sen-fitoussi.fr]
105. BERNANKE: NATION MUST TAKE ACTION SOON TO SHAPE FISCAL FUTURE “ The arithmetic is, unfortunately, quite clear…To avoid large and unsustainable budget deficits, the nation will ultimately have to choose among higher taxes, modifications to entitlement programs such as Social Security and Medicare, less spending on everything else from education to defense, or some combination of the above. These choices are difficult, and it always seems easier to put them off—until the day they cannot be put off any more.” NY Times , April 8, 2010.
106. STATES OUT OF BALANCE “… .There is no way that these newly elected Republican lawmakers and governors can follow through on their promises to erase huge deficits without raising taxes—except by making irresponsibly draconian cuts in the critical state services, particularly for the poor [including people with disabilities] and for education. The states, like the federal government, need to get control of spending. That may mean dealing with out-of-control pensions. It may mean careful cuts in services combined with, yes, higher taxes. NY Times , November 10, 2010.
107. STATES OUT OF BALANCE:II States have long been in the paradoxical position of being closer to the lives of voters than the federal government, while receiving far less scrutiny and attention. But if Republicans begin abusing the privilege they have been handed, imposing unconscionable cuts and claiming an unfair partisan advantage, they may find the public’s outrage turning back on them in a hurry. NY Times , November 10, 2010.
108. CONTACT INFORMATION David Braddock, Ph.D. Associate Vice President, University of Colorado Coleman-Turner Chair/Professor in Psychiatry Executive Director Coleman Institute for Cognitive Disabilities (SYS 586) 3825 Iris Avenue, Suite 200 Boulder, CO 80301 Financial support from the US Administration on Developmental Disabilities,& State DD agency assistance in data collection, is gratefully acknowledged. Data provided in this presentation are preliminary. Your feedback is welcomed.
Notas do Editor
Info for staff, residents, families State-of-the-practice tracking systems could provide feedback to direct support employees and relatives on daily living activities (Elite Care, 2002); pattern-recognition and learning software could be used to alert direct support employees of impending risks or adverse events, including social isolation and abnormal behavior (Elite Care, 2002); building automation could simplify or control operation of household systems, including disabling an appliance or unlocking a door when a resident reaches their room. Assisted care systems (ACS) can also be used to monitor the health of persons with intellectual or developmental disabilities. For example, ACS can integrate data from other devices that passively and non-invasively monitor biomedical signs (e.g., smart bedsheets or more conventional vital signs monitors). With novel algorithms to estimate health states (Pavel, 2002), ACS could provide an unobtrusive, continuous picture of an individual’s health. Research is also being conducted involving more focused, personal health advisory systems for the home (Fauchet, 2002).
User-centered R&D: users involved fm concept to trials Rapid, evolutionary development; modular integration Co-evolve technology w/ culture & organization change Financial & organizational feasibility; AWA technical Responsive to ethical concerns (e.g., privacy) Pilot to fit needs & risk tolerance want to get involved -> next presentaters
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