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Evaluating the Quality of Life Impact of a Smart Home
- 1. EVALUATING IMAGINE!’S SMARTHOME Colorado WIN Partners/University of Colorado Dannette M. Muselman, M.A. Candidate Elizabeth Jo Woodruff, M.A. Yvonne Kellar-Guenther, Ph.D. – Research Mentor
- 2. Bob & Judy Charles SmartHome What is a SmartHome? Technologies in the SmartHome
- 3. Research Question Does living in the Bob and Judy Charles Smarthome enhance the quality of life for the residents? Quality of Life Indicators Studied Increased service to customers Increased active participation with community Increased communication Increased independence Improved health Satisfaction with services provided through the SmartHome
- 5. 5-Day Phone Call Overview Decision to do 5 day calls with residents Data directly from the Residents Daily phone calls with residents for 5 consecutive days Prior to moving into the home (July 2009) and 1 year later (August 2010) Calls included items from National Core Indicators and open ended questions
- 6. 5-Day Phone Call Overview National Core Indicators (NCI): Consumer Outcomes. Phase IV Final Report. Fiscal Year 2001-2002 Data. National Core Indicators, Human Services Research Institute (HSRI) Intends to provide state developmental disabilities authorities in measuring service delivery and system performance 22 states actively participating in NCI
- 7. 5-Day Phone Call Data: NCI Subscales Community Inclusion- participation in everyday activities in community Safety – feel safe in home and neighborhood Choices and Decision Making-making choices about everyday life (where to work, who to live with) Health- receive routine physical and dental care Respect and Rights- basic rights and treated with respect by others Relationships- friendships and caring relationships other than staff Satisfaction- satisfied with where live & work or day program Access- received support to do something and/or travel in community Service Coordination- know service coordinators and coordinators ask about needs
- 8. Supports Intensity Scale Overview Data directly from the Residents Supports Intensity Scale (SIS) Scale identifies the type, frequency and duration of supports needed Looked at scores computed prior to living (2006-2008) in the home and then scores computed after 1 year in the home (August 2010)
- 9. Supports Intensity Scale Overview Evaluate and measure the type, frequency and intensity of supports needed for an individual with a developmental disability in 85 areas covering the following domains: Home Living Community Living Lifelong Learning Employment Health and Safety Social Protection and Advocacy Medical Behavioral
- 10. Overview Feedback from Imagine! (Member checking)
- 11. Resident Demographics 8 Residents All have cognitive and developmental disabilities Gender 5 Female, 3 Male Age Range – 26-53 years Mean – 41years
- 12. 5 day Phone call data Results
- 13. National Core Indicators Results Analyzed quantitative NCI data by looking at each resident’s change in subscale mean scores from Time 1 to Time 2 Low sample size (n≤8) for most statistical analyses Outliers in range of scores would have thrown data off Not all residents had composite scores for each subscale
- 14. Choices and Decision Making There was a large increase in residents’ perception in control of their own lives.
- 15. 5 Day Call Data and QoL Results Overall, residents perceptions of their Quality of Life appears to increase Increase: Safety, Choices and Decision Making, Respect and Rights, Relationships, Access Stay the same: Community Inclusion Decrease: Health, Service Coordination
- 16. 5 Day Call Data and QoL Results 5 of the 6 residents reported feeling more in control of their own lives 3 of the 6 felt safer in their new home and neighborhood 3 of the 6 residents felt they were more respected by those around them 3 of the 6 residents reported having more personal relationships and/or having more contact with friends, family, and romantic partners.
- 17. 5 Day Call Data and QoL Results 4 out of 5 residents reported that they had better access to resources (e.g. transportation, people to help them) than they did before. The fifth reported that there had been no change. Little change in how involved residents felt they were in the community since moving into the home a year ago.
- 19. Imagine! reported that the residents may be turning to staff within the house vs. other service providers
- 20. This finding fit with what Imagine! expected, will hopefully help decrease costs of caring for these residents
- 21. Two Open-ended Questions What was the most interesting thing that happened to you today? Why did you like that? Do you use computers? If yes, tell me what you like to do on the computer. If no, why don’t you use a computer?
- 22. Qualitative Data Results In Time 1, residents reported going to work or a day program as the most interesting thing they did (n=4). By Time 2 this was expanded to include discussing the business the group was starting together. While the number of residents who reported having access to a computer (n=4 T1 & 6 T2) and using such technology for personal interests increased in Time 2 (n=5 T1 & 6 T2), it is interesting to note that 2 residents did not report having access to a computer or using technology for personal interests in Time 2.
- 23. Supports Intensity Scale - SIS
- 24. Changes in SIS Overall Support Needs SIS Support Needs Index Support Needs Percentile
- 25. Changes in SIS Ratings
- 26. Patterns in SIS changes Part A: Home Living Activities Q3 – Preparing food
- 27. Patterns in SIS changes Part C: Lifelong Learning Activities Q4 – Using technology for learning
- 28. Patterns in SIS changes Part E: Health and Safety Activities Q4 – Ambulating and moving about
- 29. SIS – Quality of Life Results Overall, support needs have decreased from Time 1 to Time 2 for 7 of the 8 residents Possible links to specific technologies found in the SmartHome
- 30. Correlation of nci & sis dATA
- 31. Data Correlation Imagine! asked to see the correlation between SIS and NCI Allows us to look at subjective vs. objective Quality of Life reports New Research Question: Would there be a relationship between resident self-report and staff report?
- 32. Correlation Results Two strong positive correlations (as one subscale increases/decreases, so does the other): NCI Access & SIS Employment (r=0.85, p=0.06) NCI Access & SIS Social (r=0.99, p=0.002)
- 33. Correlation Results Several negative correlations (as one subscale increases, the other subscale decreases): NCI Relationships & SIS Lifelong Learning (r=-0.77,p=0.07) NCI Satisfaction & SIS Lifelong Learning (r=-0.626, p=0.096) NCI Community Inclusion & SIS Employment (r=-0.75, p=0.08) NCI Community Inclusion & SIS Social (r=-0.792, p=0.06) NCI Relationships & SIS Social (r=-0.89, p=0.02)
- 34. Conclusions Use of subjective and objective data Complete approach/multiple viewpoints in understanding research question Would use both subjective and objective data in future research as both offer valuable insight that one alone cannot
- 35. Lessons Learned
- 36. Did Quality of Life Increase? Yes! Quality of Life in residents did increase Predictors of QoL: Have more relationships, greater independence & interaction with environment Overall, most NCI subscales increased & SIS subscales decreased Fits with what we expected to find Those who have greater access and choices will have less need for support and increased independence
- 37. Did Quality of Life Increase? Some Quality of Life increases may be due to public nature of house, not technology Doing more complex tasks so SIS may not be best indicator
- 38. Changes to Research Design In future, same person collect data directly from residents face-to-face Continue to collect data from both residents and staff, family, & friends Data from residents: Unique method and engages residents in the research process
- 39. Future Areas of Research Technology absorption, failure, satisfaction Staff satisfaction levels, tracking features Continue collection of this data a year from now and then talking with staff or Imagine! again to understand changes in values Family satisfaction levels
- 40. Contact Information Colorado WIN Partners:DannetteMuselman dannette.muselman@ucdenver.edu 303.946.9650 Elizabeth Woodruff elizabeth.woodruff@ucdenver.edu 303.315.1276 Yvonne Kellar-Guenther yvonne.kellar-guenther@ucdenver.edu 303.829.0819 Judith Emery judy.emery@ucdenver.edu 303.315.1272 Imagine!/SmartHome:Gregory N. Wellems gwellems@imaginecolorado.org 303.926.6466 Kevin Harding kharding@imaginecolorado.org 303.926.6441 Alex Andrews aandrews@imaginecolorado.org 720.544.6908 Sterling RW Wind swind@imaginecolorado.org 303.457.5668
Editor's Notes
- Beth-We would like to thank the Colorado Technical Vitality Council under the University Funding Program for supporting our research.-Elizabeth Woodruff – recent graduate from the University of Colorado with a Master’s Degree in Political Science-Dannette Muselman – a graduate student at the University of Colorado working towards her Master’s Degree in Counseling Psychology-Yvonne Kellar-Guenther – our research mentor for this grant
- Beth-I know a few of you have visited the SmartHome or were lucky enough to hear Greg speak last week. So this is quick overview of the SmartHome and its features. -Imagine! staff is in attendance today and I’m sure they will be happy to answer any questions you may have about the SmartHomes. -A SmartHome incorporates state-of-the-art residential technologies to enhance the quality of life for clients, augment the effectiveness of staff as caregivers, and provide cost and energy savings for direct care provider organizations. There are currently two SmartHomes in operation: the Bob & Judy Charles SmartHome in Boulder and the Charles Family SmartHome in Longmont. Our research involves the 8 residents of the Boulder SmartHome. -Imagine! has long been recognized as a leader in the state of Colorado and the nation in providing innovative services for people with cognitive disabilities. Theses SmartHomes represent the next step in creating new and unique opportunities for the people we serve to engage actively in their homes and communities.-As the first such homes in the nation, the SmartHomes will serve as demonstration models for the future of residential care for people with cognitive disabilities.-Technologies – The handout each of you has is a layout of the Boulder SmartHome and highlights the IT, green technology and assistive technology devices located throughout the home. -A few we specifically looked at. AbleLink Task PrompterMotorized adjustable kitchensink and induction rangeR.F.I.D. Location Badges for consumers and staff
- Beth-These research questions were developed by Imagine! And Colorado WIN Partners in December of 2008.-4 research areas were discussed. The research question that elicited the biggest interest to Imagine! & Colorado WIN Partners was how to Enhance the quality of life for consumers. -The following is a list of the areas WIN Partners addressed in our data collection and analysis.
- Dannette
- Dannette-Do research with residents---not really done in the literature -5Days==engage residents and empower them to be part of research project through being directly surveyedNCI (a quality of life scale) for persons with Developmental Disabilities and open-ended questions designed to capture what the resident valued and their comfort with technologySIS for an individual receiving services in order to complete particular tasks or participate in particular activities.
- DannetteCore Indicators= items that intended to measure central features of QoL through service delivery for persons with DDNCI Is nationally recognized!!Used the :Consumer Survey----Questions obtain expressions of satisfaction and opinions from each individual
- Dannette9 subscales, 46 itemsMeasures residents perceptions
- Beth-SIS identifies the type, frequency and duration of support needed for the individual receiving services in order to complete particular tasks or participate in particular activities.-Supports refer to an array of resources and strategies including individuals, agencies, money, assistive devices or environments with developmental disabilities live in typical community settings. “Rather than mold individuals into pre-existing diagnostic categories and force them into existing models of service, the supports approach evaluates the specific needs of the individual and then suggests strategies, services and supports that will optimize individual functioning.”-SIS was created to be used for the creation of measuring and planning supports and services with developmental disabilities. Can be used to develop Individualized Service Plans and to track the decrease or increase in support needs over time.
- Beth-SIS covers different domains, or categories, of support needed: Home Living ActivitiesCommunity Living ActivitiesLifelong Learning ActivitiesEmployment ActivitiesHealth and Safety ActivitiesSocial Activities-Each domain has 8-9 questions. For each question there are three answers that need to be addressed. Responses to the questions are chosen from the rating key of the assessment. What type of support would be needed for that activity? 0=none1=monitoring2=verbal/gesture prompting3=partial physical assistance4=full physical supportHow frequently would that support be needed? 0=none or less than monthly1=at least once a month but not once a week2=at least once a week but not once a day3=at least once a day but not once an hour4=hourly or more frequentlyHow much time in one given day would that support take? 0=none1=less than 30 minutes2=30 minutes to less than 2 hours3=2 hours to less than 4 hours4=4 hours or more
- DannettePart of Qualitative researchReported preliminary results to Imagine! in October and sought clarification on questions (member checking)
- BETH
- DANNETTE
- DannetteSample size of 8 very small, and cannot obtain significant statistical findings with such low samplenot all subscales had a sample of 8 because lack in composite scores. Composite scores were not made because of missing data.When refer to “6” residents, it is not that we left out 2 residents but that we did not have complete data for all 8Explain outliers: person a— t1=0, t2=0, vs. person b– t1=0, t2=10…mean would be 5, but does not tell you much about how the scores greatly increased for one person and stayed same for the other
- Dannette*Example of one of the subscales that had interesting findings as relates to QOLMeasures the level of which resident has control in choosing , for example where to work and where to liveRange of scores: Can change by dropping 5 points, 0=no change, or increase by 4 points5 resident’s mean scores stayed the same or increased2 resident’s mean scores increased by one point1 resident’s mean scores increased by two points2 resident’s mean scores increased by 4 points1 resident’s mean scores decreased by 3 points
- DannetteRemember to say “their perception” when reported resident call dataIncrease=5Same=1Decrease=2
- DANNETTE5/6= more in control of lives (choices and decision making)3/6= safer in home/hood, more respected by those around them (work, home, day programs), more personal caring rlxls with pple beyond staff
- DANNETTE4/5= better access to resources (i.e. transportation), while last person reported no changeLittle change=community involvement
- DannetteSLOW DOWN SLOW DOWNDecrease in service coordination and knowing service coordinatorNot what we expectedDuring membercheck with Imagine! found out that residents may now only have to turn to staff in home for service, rather than multiple service providers within communityImagine! expected this finding as it decreases costs in services
- DannetteInteresting results for these two open ended questionsDo we report Day 1 and 2?
- DannetteT1= 4 resident say work as most interesting thing they did. By T2, this response expanded to include the startup of the coffee grinding business that the residents are working on together.Use of computers: T1=4 & T2=6, and use for personal interests.However, we expected to hear all residents say that they have access to and use computers in T2.This is not what we foundWe learned= what you don’t hear that you expect to is valuable and important in the research process…not always about just understanding what you see/hear, but research is also thinking about the meaning of what it not heard.
- BETH
- Beth-The Support Needs Index indicates the overall level of supports needed for the individual. This is done by taking the raw scores of each Activity Subscale as ranked during the interview. Then using Standard Scores and Percentiles established in the SIS appendices. -These graph shows the overall support needs of each individual from Round 1 which was administered prior to the residents moving into the SmartHome (Range from 2006-2008) and Round 2 which was administered August 2010, 1 year after moving into the SmartHome. -2 stayed the same-5 decreased (3 had dramatic drops)-1 increased-The increase and the lack of change for 2 of the individuals didn’t quite fit with what we expected to see. Since these percentiles show the support needs as a whole we decided to look at the subscales of the SIS to get a better understanding of where support needs were specifically increasing and decreasing and then hopefully being able to better understand the results we are seeing.
- Beth-This chart includes the 6 subscales that we used in our research and lists out the areas of decreasing support needs, no change and increasing support needs. -In general we are seeing a high decrease in support needs in almost all areas. Although there are still areas which have increased. Why? -This still didn’t give us an adequate understanding of why the support needs were increasing or decreasing so I decided to look at specific questions of from the SIS in an attempt to better understand why we are seeing increasing and decreasing scores-The next three slides featured focus on specific questions in the SIS Interview
- Beth-Part A: Home Living Activities; Q3 – Preparing food-Technology in the Kitchen:AbleLink Computer Prompting System – allows the individual to see and hear prompts on how to make spaghetti. From what to grab from the pantry, wash hands, boil water, heat sauce, etc. As the individual needs less support the prompts can become more broad.Motorized adjustable kitchen sink, induction stovetop and work surface – allow individuals in wheelchairs/different heights to be able to use the devices at their comfort level. Induction stovetop – provides for a safer cooking experience. Heat is generated directly in the cooking vessel (pot, pan) rather than generated from electrical coils or burning gas. Induction heating significantly reduces the possibility of burn injury. -3 remained high which can be understood through the nature of their disability-Did see a decrease in two individuals down to 0 zero supports needed – meaning they need no support to engage in this activity. An area of independence we understand as a predictor of quality of life. -The most interesting is the fact that two individuals raised from 0 support needs in Time 1 to scores of 7 & 5 in Time 2. Seemed incorrect to us, or possibly flawed data. When talking with Imagine! we discovered that these two individuals, prior to the SmartHome, lived in “independent” or non-supported living situations where preparation of meals constituted a staff member making food once a week and freezing it so the individual could reheat it in the microwave. So of course an individual who is now empowered to be able to make their own meals when they never were before will have an increase in support needs in order to learn a new activity. -If a person was just to look at the numbers they would see an increase and understand it as a negative effect. But when taking a closer look at the question and understanding the nature of the SmartHome we consider a raise in support needs to be an indicator of improved quality of life.
- BethPart C: Lifelong Learning Activities ; Q4 – Using technology for learningAbleLink Computer Prompting System – Found in Kitchen/Dining Room and each persons bedroom. Includes weather prompt (allowing the individual to be better prepared for their day with appropriate attire), newspaper prompt (speak out loud, customize to interests), journal, internet, iTunes, email, games, movies, etc., different for each resident based on their priorities. -2 stayed the same-5 decreased -1 increased-Due to the technology aspect of the SmartHome we expected to see support needs decrease. -What we found most interesting was the resident whose support needs increased. This resident is writing a monthly diary entry for the Imagine! website, and in phone calls and a visit at the SmartHome expressed to me how much fun she is having learning how to make journal entries, write emails and is even talking about the possibility of writing a book. Impressive skills being learned to make this all happen. Can understand why here support needs would increase. As she uses the computer more and absorbs new skills and wants to attempt new things she will need help in the learning process. Don’t we all when it comes to technology and computers.
- Beth-Final pattern we found interesting when looking more closely at the SIS data. Part E: Health & Safety Activities; Q4 – Ambulating and moving about -The SmartHome has 3 individuals who use power wheelchairs, Mandy-joystick, Donna-joystick and Gerald-head switch. -It is expected that these individuals will always have higher support needs due to the nature of their disability. -Due to the layout of the home and the tech involved in helping encourage mobility these 3 individuals all saw a decrease in their support needs.
- Beth-Overall we saw a decrease in support needs for the residents which was what we expected. Meaning the levels of independence for these residents is increasing which is one of the predictors of quality of life. -But the overall numbers didn’t create an adequate understanding of how living in the SmartHome has effected their quality of life. -Looking at the specific questions of the SIS interview and piecing them together with the stories I have collected in my visits and phone calls with the residents we were able to better understand specific ways these residents lives are improving. -The point of SIS is create tailored to the individual service plans in order to help improve the quality of life of the individual. When looking at the specific questions and linking them with technologies in the SmartHome we were able to create a much richer picture of understanding the improved quality of life of the 8 residents.
- Dannette
- DannetteDuring member checking with Imagine! they asked about how the two data sets might be relatedSubjective=NCI b/c it is resident’s perceptions of their QoL and collected directly form them-Objective= SIS b/c it is done by family members, staff members who have different perspective on the resident’s livesNew Research Direction---is there a RELATIONSHIP?
- Dannette(+) correlation does not mean it is of better value---just change in same directionNCI Access (+) correlated with SIS Employment and SIS Social-Residents who perceive better access to supports (e.g. transportation) and people to help them also increases in the support needed for employment and social activities. - Alternatively, those who perceive less access to these supports were viewed as needing less supports around employment and social activities. 1. Possible that those who have greater access to services (i.e. transportation) are in need of more support in their job and social settings, which makes sense as they may have a need for support in traveling to see others in the community. Residents notice they need more support in doing these activities.2. Possible that those who have less access to services (i.e. transportation) are in less need of support in social settings and employment settings because perhaps more independent and are able to get out into community and socialize with others on their own. Residents who feel they do not have this access are viewed as not needing it.ALMOST PERFECT CORRELATION Perhaps the most interesting finding is that the SIS social subscale and the NCI access subscale are almost perfectly correlated.
- Dannette(-) correlation does not mean it is of better value---just change in opposite direction1. SIS Lifelong Learning (-) correlated with NCI Relationships and NCI Satisfaction-As life learning decrease, rlxl and satisfaction increase, or as life learning increase relationships and satisfaction decrease.-Possible those who perceive having more relationships are in less need of support in problem solving & self-management-Possible those who perceive having more satisfaction in work and employment are viewed as needing less self-management and problem solving support.2. NCI Community Inclusion (-) correlated with SIS Employment and SIS Social-As resident’s perception of community inclusion increases= viewed decrease need for support in employment and social activitiesAlternatively, resident’s perception of community inclusion decrease=viewed need for support in employment and social increase -Possible those perceive more involved in community are in need of less support because they are more able to go out to employment and day programs where they can socialize and be with others-Possible those who perceive less community inclusion are those who are in need of more support in their employment and social settings-This finding is expected: those who are viewed as need less support in employment/social settings are more integrated with in community through their physical and social presence at job setting and day programs. 3. NCI relationships (-) correlate with SIS social -As resident perceives their relationships as increasing, there are viewed as needing less support in social activities,Alternatively, those who perceive relationships decreasing are viewed as needing more supports in socializing -finding is expected-possibility that those who perceive themselves as gaining more friends and time spent with friends/family are more likely to not need as much support in social skills with those individuals because of the nature of such relationships.
- DannetteHolistic approach to understanding the quality of life of the residentsUses resident’s perceptions and staff/family perceptions– comparing multiple viewpoints is interesting because there may be the same or different perceptions of what is going on in the residents lives-makes understanding one set of data more in-depth because you have something to compare it toWould use in the future: important to gain as many different entry points of information on the residents and have that data to make sense out of the bigger picture. The NCI or SIS alone gives only a snippet of that aspect of the residents, but when combined you can see that changes in one area also found to change in the other
- Beth-So enough of all this explanation of data and charts. Onto what we actually learned from this research.
- Beth-The goal of this research project was to determine if living in a group home that utilized smarthome technoloogy increased the quality of life for eight adults with developmental disabilities. -The Predictors of improved quality of life we used to gauge our data were for the residents to:Have more relationshipsHave increased independenceHave greater interaction with their environment. -All those graphs and numbers and explanations we just showed you say that these predictors are being fulfilled for these 8 residents. -This fits with what we expected, and what is the drive for Imagine! in creating these SmartHomes: Those who have greater access and choices will have less need for support and increased independence.
- Beth-So we saw that quality of life for these 8 residents did increase. Due to the subject nature of the data we collected these increases might not be specifically linked to the technology in the SmartHome. -Some of these quality of life increases might be due to the public nature of the SmartHome. During the resident selection process each individual was made aware that their living situation would be of interest to many people and their home would be a show home and their lives would be made aware to the public and of great interest to the public. -In conversations with SmartHome staff they mentioned they were seeing many of the residents coming out of their shells since living in the SmartHome. The residents are introducing themselves to visitors, telling jokes and are excited to share all the cool aspects of their home and what they’ve been up to. -Another interesting factor of how the SmartHome has increased quality of life is that the residents feel empowered that are helping with the development and trialing of this new technology. In a conversation I had with one of the residents she expressed to me that she was proud of the fact that she was learning how to use the computers in the home and trialing new devices because she knows her work will help with development of technology that can be used by all the other Imagine! clients not lucky enough to live in this house. This is significant because we are seeing a group of individuals who have always needed others to help them, and now they are able to help others with their involvement in the SmartHome. -As stated earlier in my discussion of the SIS data, linking decreasing support needs with improved quality of life was not an adequate indicator. Instead it requires us to understand that these individuals are involved in more complex tasks which may require increased support needs. So although some of our data may not numerically allude to improved quality of life, we are overall seeing this improve.
- DannetteDo different: have same person collect T1 and T2 data so that there is nothing missing and do interviews in person so that you can gather all information needed and richer stories of the clients lives can be heard that may be lost over the phoneKeep same: continue to collect data in objective and subjective ways because it helps to make greater sense out of what is going on in the lives of the residents---both are valuable!!Data from residents: good because it is unique in the field of research of people with DD, and this approach helps to have their voice heard---gave them something to engage in, look forward to, and feel empowered that someone is interested in hearing their views and opinions about what their lives are like and how others can assist them to live fuller and more independent lives.
- DannetteAdaptation to technology----what features of technology and characteristics of the individual influence the use and satisfaction with tech?What does staff think about the tech? The are part of the residents lives in providing service, but as employees what does the technology do for their jobs?Collect data in another year to have 3 data points to compare and see if preliminary changes continue in same directionWhat do family members think? What changes do they see in their loved one’s quality of life? How are they able to use technology to connect with and socialize with their loved one in new ways?These possible areas of future research are consistent with the continued mission of Imagine!’ssmarthomes