1998 Conference Proceedings

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Assistive Technology Use by Individuals with Disabilities Who Live in Rural Areas Or Who Are Members of Under-represented Populations

Patti Bahr
Gillette Technology Center
550 County Road D, Suite 12
New Brighton, Minnesota 55112
Voice: 612.636.9443

Rachel Wobschall
Minnesota STAR Program
658 Cedar Street, 300 C.O.B.
St. Paul, Minnesota 55155
Voice: 612.296.2771

INTRODUCTION AND BACKGROUND

The Minnesota STAR (A System of Technology to Achieve Results) Program partially funded a number of mobile "clinics" for the consumers of Gillette Technology Center's services who reside in rural areas. These mobile clinics provided many of the same services the consumers would have previously had to travel to the Twin Cities for, such as adjustments and repair to their assistive technology devices. STAR and NIDRR (the National Institute on Disability and Rehabilitation Research) requested information from Gillette Technology Center about the clients who used the mobile clinics and their needs. Gillette contracted with Wilder Research Center (WRC) to assist them in this process.

Methods

STAR requested that a portion of the National Health Inventory Survey be used as the instrument for collecting information from their clients, largely because it could eventually be used for national comparison purposes. Although the survey was originally designed to be completed in person, WRC adapted the survey to a format for telephone interviewing.

This report is structured according to four information areas which are: (1) demographic background information; (2) limitation of activities (asked of each member of the household; (3) assistive devices; and (4) health care coverage.

Gillette provided a list of clients who had participated in seven of the mobile clinics. Of these 75 potential respondents, 63 interviews were completed for a response rate of 84 percent. Whenever possible, the client completed the interview over the telephone. About three quarters of the clients were unable to complete the interview; however. in those cases, a relative, foster or adoptive parent, care provider/guardian completed the interview on behalf of the client. The telephone interviews lasted about 30 minutes on average.

The client is the primary unit of analysis throughout this report, although in the assistive devices section the device becomes the unit of analysis. Comparative analyses are done by age, where applicable, but other demographic information is not varied enough to expect significant differences. For example, the vast majority of the sample are White and have never been married, so analyses using race and marital status were not attempted.

CLIENT DEMOGRAPHIC CHARACTERISTICS

Place of Residence

Forty-one percent of the clients considered their family home their place of residence, while 29 percent reside in a group home. Seventeen percent are in an intermediate care facility and one-tenth are in a regional health care center. Two of the clients (3%) were living in a foster care home at the time of the survey.

Of those living in their family home, the number of household members ranges from one to seven, averaging four per household.

Gender and Age

Just over half of this sample is female (51%). Clients in this sample range in age from three to 86 years, averaging just over 27 years. The age groups with the highest representation are 6-10 years (17%) and 36-40 years (14%).

Education

About 40 percent of the clients surveyed have never attended school, or have attended kindergarten level classes only, but about one-tenth of these are not of school age and the remainder have mental limitations such as mental retardation or cerebral palsy. For one-fifth of the clients, elementary school is the highest grade attended; of these, the majority (8 of 12) are elementary school age. Thirty-eight percent of the clients have attended at least some high school or college. Thirty-seven percent of the clients have completed the highest grade they have attended; about half of these indicate high school graduation.

Income

Nearly two-thirds report that their combined family income during the previous twelve months, including wages, salaries and other forms of income such as social security and public assistance, was less than ten thousand dollars. For context, the national poverty level for a family of four is $15,600.

ACTIVITIES AND LIMITATIONS

Client Activities

Thirty-eight percent of these clients have been going to school as their primary activity in the year prior to the survey. These clients are nearly all (n=22 of the 24) ages 4 to l9, averaging about 14 years of age.

About one-fifth of the clients have been working (22%; for more detail see next section), and 17 percent have been attending job training for most of the past year. The remaining clients were involved in other various activities, such as therapy at home or at a center, or keeping house.

Type and Place of Employment

Fifteen of the clients, or nearly one-quarter, report that they had a job or business the week or two weeks prior to the survey; of these, 14 said they had worked during this time period. The organizations where these clients worked primarily include developmental achievement centers and workshops or training centers for people with disabilities. When asked what the most important activities or duties they performed at those jobs were, most indicated packaging or assembly work, and a few said painting.

Of the 47 clients who did not say they had a job or business during this time period, one client was looking for work and the others were neither looking for work nor had they been laid off.

Seventy percent of the clients surveyed have never worked or never worked at a full-time job lasting two weeks or more; this includes clients who are not of working age. The types of employment the remaining respondents are in include private companies (n=8), state government (n=4), self employed in own business (n=2), local government (n=1), working without pay in family business or farm (n=1), federal government (n=0) and no response (n=3).

Client Needs and Limitations

According to those surveyed, the vast majority of these clients need the help of other persons for their personal care needs due to an impairment or health problem (n=59 or 94%). Nearly all (n=54) of the limitations named are known non-accident related disabilities. For those clients who need help with their personal care needs, about half report that cerebral palsy is the main cause for this limitation, followed by about one-fifth who report mental retardation as the main cause. Mental retardation is also common among persons with cerebral palsy, with more than one-half experiencing mild to moderate (26%; IQ 30-69) or profound (27%; IQ <30) retardation; for context, about three percent of the general population have these levels of mental retardation (IQ <70).

Injuries and Operations

Six of the clients report having a condition caused by an injury. For four of the clients, the injury occurred at birth; one was injured at age four and one at age 19. For five of these six clients, the injury had occurred three or more years prior to their visit to the clinic.

Eight clients report having an operation for one or more of the conditions they named as cause of their limitations. Five of these clients were between infancy and nine years old at the time of the operation (birth, two years, five, eight and nine); the other three were twelve years, nineteen, and twenty-nine at the time of their operation. Six of the eight had had their operation three years or more prior to their clinic visit.

SPECIAL EQUIPMENT AND ASSISTIVE DEVICES

Special Equipment-Types of Special Equipment Used

About 90 percent of the clients were using some sort of special equipment for getting around at the time of the survey. More than half (56%) were using a brace; about one-third had a communication aid for speech problems.

As noted previously, 91 percent (n=57) of the clients reportedly use some sort of special equipment for getting around. When asked to describe this equipment further, the majority reported having a manual wheelchair, while about one-fifth of those with this equipment have electric wheelchairs. Clients with manual wheelchairs are slightly older than those with electrical wheelchairs, on average. Of those using braces (n=35), the most common place they are used are the feet (n=20) and legs (n=19).

Assistive Devices-Number and Frequency of Use

The 61 clients who responded to survey questions about their devices use a total of 219 different assistive devices. Clients use from one to thirteen devices, averaging 3.6 assistive devices each. The majority of the clients (61%) use just one, two, or three assistive devices. Clients report that they use the majority of these devices (86%) at least some of the time, with 61 percent of the devices reported to be used all or most of the time.

Source(s) of Payment

Clients were asked to name the sources they used to pay for only those assistive devices which they were using at work and/or at school (n=126 devices). Medicaid paid for nearly two-thirds (62%) of these devices, while private insurance and/or the client's own or family income paid for one-third of them.

Clients report that most (89%) of these devices are also used at home or somewhere else, and that most of these devices (85%) are the same ones they use at work or school. Those devices which are not the same ones they use at work or school were primarily paid for by Medicaid or Medicare.

Home Features-Types of Features Available

From a list of features designed for disabled persons, clients checked off which ones they currently had installed in their homes. About three-quarters of these clients said they had ramps and/or extra wide doors/passages in their homes. Features checked by about half of the clients include raised toilets and levers. About half of the clients also checked off "other special features," but were not asked to specify what those were.

Source(s) of Payment

Nearly half of the home features mentioned above were already installed so that clients did not have to make payments on them. Almost one-third of the features were paid for by the client or his/her family.

Need for Special Equipment

Eighteen of these clients (29%) report that they are in need of special equipment that they do not currently have. The types of equipment they are most frequently in need of are related to communication needs, such as special computers or speech devices (n=12), followed by a house feature designed for people with disabilities such as hydraulic lifts or specially designed commode (n=6), and transportation equipment like lifts for a van (n=4).

When asked why they did not currently have this needed equipment, about half of them mentioned cost as one of the barriers. Seven of the 18 clients are in the process of getting the equipment. Of the reasons mentioned, nearly half of them (with a combined total of 93 mentions) are related to issues of accessibility, including prohibitive costs, lack of training, equipment unavailable in their area, equipment is unsatisfactory, and a lack of awareness about what is available and where.

HEALTH CARE COVERAGE

The large majority (87%)of these clients had a Medicaid or Medical Assistance card at the time of their clinic visit, and were covered by Medicaid during the month of the visit. Most of these clients had had this coverage regularly or off and on for 5 years or more. Two-thirds of the clients had received health care covered by Medicaid or Medical Assistance in the year prior to their visit.

Forty-three percent (n=27) of these clients were covered by Medicare during the month of the visit. Of these, nearly all of them (n=25) were covered by both Part A, which pays for hospital bills, and Part B, which pays for doctor's bills. All had had this coverage for two or more years.

Just about one-quarter of these clients were covered by any private health insurance plan during the month of their visit to the STAR Clinic. Three of the clients (5%) were covered by military health care, including CHAMPUS or CHAMP-VA (n=1) or another type such as armed forces retirement benefits (n=1).


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