ASA Study:
Aging Agencies Must Do More on Assistive Tech

For nearly 20 years the American Society on Aging (ASA) has pioneered the investigation of technology and its impact on the ability of older people to maintain or enhance independent living in later life. The use of assistive devices, such as wheelchairs and specially modified bathrooms, has been steadily growing, supplanting a reliance on personal services in recent years. Because assistive devices promote independence and autonomy, they would also seem to offer a natural area for collaboration between the aging network and the more traditional disability system.

Last year, with a grant from the Administration on Aging (AoA), ASA set out to learn whether our premise was correct. Were the aging and disability networks finding common ground around assistive technology issues? Our study focused on state units on aging (SUAs), area agencies on aging (AAAs) and the 56 state programs funded under the federal Technology Related Assistance for Individuals with Disabilities Act of 1988--generally called the "Tech Act." Tech Act Programs (TAPs) in each state are charged with promoting policy change in their states toward improving access to assistive technology for all people with disabilities.

Specifically, we wanted to know to what extent these agencies were addressing the assistive technology and home modification needs of older adults and what activities they found most challenging. We also sought to find out if and how agencies from the two different networks were collaborating. Our hope was that this data would lay the basis for future policy, program, research or training activities to improve services to older adults.

We expected to find relatively few Tech Act Programs focusing much attention on the needs of older people. Yet their response to our survey indicates that TAPs are more committed and involved in providing these services to older adults than we suspected. State Tech Act Programs demonstrate a surprisingly high level of interaction with the aging network, and in particular with the SUA, a state's top agency on aging. Fully 96% of TAPs are familiar with their state's SUA.

Unlike TAPs, which have a sole mandate to focus on assistive technology, this area is just one small part of a much broader mandate for Older Americans Act (OAA) programs. As expected, SUAs and AAAs were less involved than TAPs in assistive technology issues. Among SUAs about one-fifth gave assistive technology and home modification services high priority, although two-thirds gave these services a medium-priority rating. Given this reality, it came as a pleasant surprise to find a high level of awareness of the state Tech Act Programs. Nearly all state units knew of the TAP and could identify the agency responsible for it in their state.

Local AAAs are somewhat more engaged in and aware of assistive technology and home modification services than are SUAs. About one-third give a high priority to improving access to assistive technology and home modification services to elders in their service area. The same number feel their staff is adequately trained to address these issues, and one-quarter had assessed the need for such services in the past five years.

It is at the local level, though, that interactions with the TAPs drop off. Fewer than one-third of AAAs are familiar with the Tech Act and only one-quarter could identify the agency in their state responsible for implementing the act.

Funding is probably the biggest challenge agencies face in assistive technology and home modification services. Only a change in the system and collaboration at the federal and state level can address this. Although some funds for technologies that help older people and younger people with disabilities are available through state assistive-technology and vocational-rehabilitation programs, the biggest sources of funds for disability-related products, services and equipment are private health insurance and public health programs, such as Medicare and Medicaid.

To qualify for these funds applicants must prove that a product is "medically related." Too often older people and their healthcare providers are forced into strained arguments about the medical necessity of a particular technology. This only reinforces the perception that the major problems faced by people with disabilities are medical in nature, not social. Isn't it time for policies that recognize preventive measures that insure safety and health promotion as well as those that treat accidents and illness after they have occurred?

Federal mandates, such as under the Tech Act and the OAA seem to have had some success in encouraging interaction between the assistive technology/rehabilitation network and the aging network at the state level. But state-level collaborations, while on the rise, have not yet had a measurable impact on service delivery at the regional level of AAAs. In fact, 86% of TAPs reported that familiarizing the aging network with assistive technology issues was either somewhat or very challenging.

However, inroads into the AAA network are occurring. Many of the same states that had the most interaction between the SUA and the TAP also had the most aware and active AAAs. Still most AAAs remain unaware of the Tech Act Programs and their resources, and some were even unfamiliar with the basic term, assistive technology.

We need redoubled efforts on the part of SUAs and TAPs to increase awareness at the local level. AAAs or their subcontracting agencies are in an excellent position to offer services such as programs to lend or reuse equipment. About one-quarter of the AAAs already give either medium or high priority to this kind of program.

Another one of the programs often mentioned by both experts and older adults as being particularly important is the equipment-demonstration center, where older adults can learn about and try various devices prior to purchasing them. However, except for a few states like Maryland and Georgia, not many AAAs are now involved in operating them.

Why isn't there a higher level of awareness of assistive technology and home modification throughout our society, given the cost-effectiveness of such measures and the desire of older people to age in place? Older people, even those who have or are beginning to experience disabling conditions, do not self-identify as "disabled," and they avoid the perceived stigma of using assistive devices.

Our society needs to destigmatize the disabilities of aging. Mass media could take the lead in showing older adults using assistive and adaptive products that give them greater independence. Furthermore, professionals working in the field of aging need to take on the issue. There's still a lot of work to be done.

Gloria Cavanaugh is the executive director and Jim Emerman is associate executive director of the American Society on Aging. The full ASA report on assistive technology, including a compendium of state and local projects, is available for $5 from the American Society on Aging. To order, call (415) 974-9600 and request the "Assistive Technology and Home Modification Project Report."

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American Society on Aging
833 Market St., Suite 511
San Francisco, CA 94103
www.asaging.org
info@asa.asaging.org