HRST and Technology's Place Mitigating Risk

The regulatory environment in which we find ourselves, with its emphasis on cost-effectiveness, necessitates more efficient spending on the part of service providers who draw money from the state. In the I/DD world, these cost savings are often difficult to achieve without sacrificing quality of care. Technology has emerged as a way to avoid this dilemma. Using sophisticated algorithms, the Health Risk Screening Tool (HRST) is able to identify at-risk groups within a provider’s population. This means dollars can be spent in prevention of health problems, as opposed to treatment of them down the line. But just identifying the at-risk populations and detailing what they are at risk for does not itself prevent health issues from occurring. Technology has provided solutions here as well. By taking a look at some of the categories of the HRST (as told by HRS President Dr. Craig Escude), we’ll survey assistive technology solutions already working toward addressing those issues.

In a Tech:Huddle with Disability Cocoon, Dr. Escude spoke about the particular categories HRST looks at, one of which was “Frequency of Service.” This included “professional healthcare services, ER visits, and hospitalizations.” People have already created technology systems to address this aspect of care. For example, StationMD allows doctors to visit a patient remotely in order to determine whether an ER visit is really necessary for a given health event. Providers who use StationMD report cost savings due to reduced hospitalizations and ER/Urgent Care visits. The potential combined efficacy of implementing both the HRST and StationMD to address any identified “Frequency of Service” risks is astounding and demonstrates how technology can operate on many different levels to address the needs of people with disabilities. 

Another HRST category was “Functional Status” which included the subcategories “Eating, Ambulation, Transfer, Toileting, Clinical Issues.” To aid with eating, there are AliMed’s Freedom Plates and Bowls ( and comparable plate-ware that resist spills, tipping, and sliding. There are even more complex tools such as Liftware spoons like the Level, which keeps the bowl of the spoon steady even when the handle is turned at odd angles ( To take another subcategory from “Functional Status” Transfer is another area in which technology has begun to address needs. Lifts like the Drive Medical Auto Bath Lifter ( and the LiftUp Raizer ( allow for more independence for the individuals but preserve and enhance safety at the same time. Just another demonstration of how effective screening combined with ingenious preventative measures can improve quality of life and reduce unnecessary costs. 

A third category in the HRST, “Safety,” is concerned with Falls and Injury. Tech systems like SafelyYou ( are designed to lower fall rates and reduce the need for emergency services. Their system uses AI to determine whether a fall has occurred based solely on a two-dimensional representation (the video) of the event.

Finally, we would also be remiss if we did not at least mention the indirect benefits of improving health and increasing independence, happiness. The ability to be more independent thanks to a piece of technology improves well-being beyond what is commonly quantified. It could mean a little pep in their step, or more smiling during the day. The possibility they could feel more autonomous and self-actualized with a life-improving technological solution should be recognized as part of its important benefits. 

All in all, HRST can help identify risk-areas in populations,  and assistive technology can be a hefty part of the toolkit when it comes to addressing those risks to effectively manage health.

ElliQ Shows There's Much To Love About Aging Tech

Why is some technology considered assistive, adaptive, or enabling, and some isn’t? If we’re splitting hairs, all technology possesses at least one of these attributes. So why is it that in the world of disability services, people take such a narrow approach when drawing those lines? That is the question that has been on my mind lately: What makes a piece of technology properly “assistive technology?” I don’t have an answer to that question, but being aware of the fuzziness of the boundaries between regular technology and assistive technology provokes us to widen our consideration of what could be assistive to the people we serve.

Part of opening our minds to new technology possibilities includes recognizing the similarities and differences between ours and another industry, the aging assistive technology market. While the needs of the two populations are varied, the technology designed to serve them may not be as different as they appear. For this article, in order to compare and contrast these technologies, I will examine the ElliQ robotic companion. After going through its features, I will discuss how they are poised to serve similar needs in the population of people with disabilities. Following this, I will talk about how ElliQ could be changed to better suit the needs of people with disabilities. Altogether, I believe exploring ElliQ and its potential in the disability technology area will disrupt previously held notions about what constitutes assistive technology and encourage exploring solutions on the basis of the needs they serve and not who they are marketed to. 

To begin, what is ElliQ? ElliQ is the creation of Intuition Robotics, an Isreal-based company formed in 2016. Their team of roboticists, industrial designers, developers, gerontologists, and machine-learning experts worked together to create this flagship product. ElliQ won the 2018 CES Best of Innovation Award. The device itself is small, opaque white robot with a large, expressive head and an attached screen. ElliQ responds to voice commands but can also be interacted with via the screen. Similarly, ElliQ can talk but also uses the screen to display information. This combination of audial and visual representation provides accessibility for the hard of hearing or visually impaired. However, it should be noted that for many people with disabilities, standard speech patterns aren’t the norm. It is possible that the speech recognition software could have trouble understanding speech-divergent individuals. Form aside, what is ElliQ’s purpose? ElliQ was created to serve as a helpful companion. It combines the connective features of modern technology with added utility features such as reminders. Users can play music, video chat with loved ones, and even play trivia. What’s more, ElliQ is equipped with machine learning, which means that it can get to know the specific person who is using it. 

The possibilities of machine learning are dizzying in and of themselves, but how does machine learning and all of ElliQ’s other features serve the needs within the I/DD world? First and foremost, I believe that fundamentally ElliQ would serve a unique social role in the individual’s home. ElliQ’s ability to give reminders, for instance, could be equipped to prompt the individual to take their medication. Med reminders are not unique to ElliQ, lots of other technologies and people (staff, parents) can give them. What makes ElliQ unique in this situation is it’s social role in the home. The reminder is not being given by a parent or by a caregiver. It’s not a nag, it’s not impertinent. It’s more like a pet, without as many responsibilities. What’s more, it’s connectedness, the ability to video chat with loved ones, brings it closer to a family friend. The power that sort of companion could have for a person with disabilities is great. 

Additionally, and somewhat paradoxically, it increases independence. I say paradoxically because adding an entity to give reminders, etc. is not typically thought of as independence-increasing. ElliQ is not a person. ElliQ is an AI companion. Truly, with its modular expressions and soothing (albeit somewhat flat) voice, it presents itself with person-like qualities. Though ElliQ isn’t used to replace human relationships, but rather to supplement them. ElliQ can give people with disabilities true independence, provided they possess a certain ability level. I’m not sure that the utility of ElliQ is yet fully understood (especially regarding the machine-learning potential), but it’s connectivity potential and reminders options already make it something that addresses some needs of some people with disabilities. 

Which brings me to my final thoughts on ElliQ: the future possibilities. As we move toward a world of greater accessibility through technology, I think it would be nice to see Intuition Robotics introduce more integration with other systems. For example, can ElliQ call emergency services if the individual falls and is unable to get up? Do they have plans in the future for ElliQ to be able to turn lights on/off? To turn the TV on/off? I think these features are essential to creating a lasting impact on the world of disability/aging technology as the industry moves toward greater integration. Also, an interesting development could be a companion that people with disabilities could talk to, someone they could share details about their day with and get feedback. I don’t know how sophisticated the machine learning would have to be to create something that works well for people with disabilities, but it definitely presents an opportunity. It would also be interesting to see if there would be any utility (like working on responsibility or empathy) in creating an artificial “need” ElliQ has. It could be instructive, in terms of responsibility, to require that ElliQ be “fed.” Something that would require that you be nice to ElliQ could also be instructive on the empathy side. Creating something that “requires” a bit more effort on the part of the user may help habilitate people with disabilities to the notion that if certain needs are met, the reward is companionship. 

Altogether, I think ElliQ is an interesting development in the world of assistive technology. While I don’t claim that it would be great for every person with a disability as it currently is, I do think that it should be explored. I hope that the features of ElliQ and how they could serve people with disabilities has moved you a little on the question of what is AT. With technology developing rapidly and clear possibilities for where it could go in the future, I would expect that more products like ElliQ will be coming out soon. It’s our responsibility to evaluate them, criticize them, and celebrate them. We are all part of this disability technology movement. You, me, ElliQ, the industry, and the people they serve together form the future of compassionate care. 

"Uber type" Platform for Prequalified I/DD Professional Sitters

Synapse Sitters provides real solutions and opportunities to underserved and under recognized markets. Specifically families of children with special needs and those qualified to care for them. 

The Beginning: 

In 2016, Marie Maher’s 3 year old son was diagnosed with autism. Also at that time she founded and was running an online babysitting network (Lullaby Sitters)  that served the Indianapolis area. After her son’s diagnosis, her needs for a sitter drastically changed. She needed someone that understood his behaviors but also knew he was still a child. She quickly realized that she couldn’t use the very network of 500+ sitters she had spent 2 years growing. She tried to look elsewhere and found that there was no national online childcare network that was DEDICATED to the special needs community. So Maher decided to create it.

The Solution:

Mid 2017 Maher decided to pivot and become Synapse Sitters and focus on recruiting a very specific type of sitter and serving families in the special needs community. Synapse Sitters requires and verifies  each sitter member have either education or employment within human services. This gives families a better pool of sitters to begin connecting with and hiring. By setting this requirement and focusing only on children with developmental disabilities, parents do not have to worry or stress about their child’s diagnosis being a deterrent to finding a sitter. Parents also have the peace of mind that their child is with someone that understands and knows how to address any behaviors or concerns while they are away. 

Synapse Sitters also provides opportunities for those that want to continue helping within the special needs community. By highlighting the education, employment, and training the sitters have obtained, sitters can ask for and receive a higher hourly rate versus a “typical sitter”.  Synapse Sitters is also looking to bridge the gap between families, DSPs, and service providers. The beta test for this is currently happening. 

Synapse Sitters is currently a web based app with plans to develop a mobile app to aid in becoming a nationwide resource. 

Differentiating Enabling Technology, Assistive Technology, & Remote Supports

After reading this please leave your thoughts in the comments. Thanks

Last week’s newsletter email listing 12 Remote Support providers available in the United States had lots of feedback and questions.  People are wondering how we defined Remote Supports compared to Assistive Technology and Enabling Technology. This is our attempt to help clarify and describe a few key differences and similarities.  This is meant to be the start of a conversation that needs to happen, and is not intended to be the “final word” on this subject.

There are many amazing technology solutions available to support people with varying abilities.  These low-tech and high-tech solutions are all classified as Enabling Technologies. There are many technology vendors - each vendor is slightly different than the next and offer varying services using different and similar technologies.

This article is our attempt to: Define the difference between Enabling Technologies (ET), Remote Support (RS), and Assistive Technology (AT).


Enabling Technology:  “Enabling Technology (ET) is the use of various forms of devices and tech to support a person with disabilities to live as independently as possible.  These types of technologies include sensors, mobile applications, remote support systems, and other smart devices. Enabling Technology can support a person in navigating their jobs and communities, gain more control of their environment, and provide remote support and reminders to assist a person in independent living.” -TN DIDD

Assistive Technology:  “Assistive Technology (AT) is any item, piece of equipment, software program, or product system that is used to increase, maintain, or improve the functional capabilities of persons with disabilities.” -ATiA

Remote Supports:  “Remote support (RS) means the provision of supports by staff of an agency provider at a remote location who are engaged with an individual through equipment with the capability for live two-way communication. Equipment used to meet this requirement shall include one or more of the following components……” -Ohio Administrative Code 5123-9-35

In looking at these three definitions a few key differences jump out:

  • Enabling Technologies encompass both AT and RS

  • AT is an item, hardware, equipment, software, and/or a product system.  These terms make me think of something someone uses.

  • RS are supports by a remote caregiver.  RS are a human to human service that use technology to facilitate caregiver support.  The person receiving the support doesn’t necessarily have to “use” any of the technology.

  • AT does not require live two-way communication and is very broad in what qualifies (low-tech and high-tech).  RS require that the individual can communicate through two-way communication.

There are other key differences between RS and AT in many states’ Waiver service definitions, but for purposes of simplification I’m proposing we simply define the difference as:

Remote Supports are the provision of a caregiving service where the individual can interact in real-time with an offsite caregiver using Enabling Technologies.  AT (which is also ET) assists a person in improving functional capabilities without a live caregiver involved.

How are they the same:  RS and AT are both a form of Enabling Technologies that are assistive to the person (aren’t all technologies assistive by nature?).  RS are a form of ET, in that this remote method of support helps the person improve functional capabilities (but that’s also the definition of AT).  Are we having fun yet???

The fundamental difference of the presence of a caregiver in Remote Supports are why most states are creating new service definitions independent of AT (not many states recognize the term ET yet).  However, some states are not making this distinction and have included remote supports (remote caregivers) in their AT service definitions. (Tennessee has coined the term Enabling Technology to lump RS and AT together under one umbrella term.)

Ohio is a great example the need for different service definitions related to RS and AT.  In 2011 they amended Waivers that included a new service definition for RS (called Remote Monitoring at that time).  In late 2018 they realized that they wanted to fund/regulate other technologies that didn’t fit in the RS service definition because of the lack of caregiver involvement in these other techs (AT/ET).  They created a new service definition for AT that includes the equipment/hardware used when RS is being provided. However, the RS service (the caregiving part) was left as its own service definition. (Both of these separate service definitions could be grouped together under a new future service definition called Enabling Technologies.)

This is a perfect example of how the RS service is not AT, but the RS equipment/hardware kind of is AT; but is better defined as ET.

Clear as mud?  Please don’t get bogged down in these details.  All of these technologies have their place and are often used side-by-side or in succession, as a person’s capabilities and preferences change.


  • Remote Supports are caregiver supports facilitated by technology

  • AT is technology used by the person that improves functional capabilities

  • ET is both AT and RS (we need more acronyms don’t we)

  • Many ET vendors offer a form of RS and AT that can be independent from one another or blended together.

In all situations, start by looking at the person’s goals, desired outcomes, and preference - then find the best form of Enabling Technology that meets their needs – then, if necessary, figure out if the tech should be defined as RS and/or AT.

Up Next

Disability Cocoon will put together a new list of Remote Support providers that distinguishes between 1) RS providers that have their own support center (staff with their employees as remote caregivers), and 2) RS providers that have platforms that allow other entities to provide the support themselves with their own paid staff and/or natural supports.

We will also put together a list of the other Enabling Technology vendors we have interacted with.  As you know, AT has been around for decades and it isn’t possible to list all ET/AT vendors.

Until then….I hope this helps. Please leave your thoughts below.

Explore WayAround Using Aira - 2 Cutting Edge Low Vision Solutions

This blog post focuses on two technology-based assistive devices that are designed to help individuals with vision impairments, WayAround and Aira (eye-ruh). These two products accomplish different goals, but both are proving to be of immense help to the individuals who have them.

            WayAround is a digital tagging system that allows individuals with vision impairment to place a physical tag on an item in their home. This tag is then scanned with the individual’s phone (without any use of the camera). Then, the individual can dictate notes about the particular item that will be saved on that particular tag. To illustrate, imagine you loved the feel of a particular shirt so much that you bought three in different colors. Well, with WayAround saving information about their color is easier than ever. When you go back to the shirts in your closet you can scan the tag to find out what color shirt you want.

            But that isn’t the extent of the uses for WayAround. They recommend using their tags for nutritional facts and expiration dates on food, tagging storage containers to be able to know their contents quickly and easily, and tagging items with directions (like face wash or a drain cleaner) to be able to use them effectively. Having WayAround allows you to quickly access information about any item at any time. Additionally, their tags don’t use batteries and they don’t need charged. The tags even come in four different forms: stickers, buttons, magnets, and clips. That way you have the right tag for anything you might need to remember something about.

            While WayAround assists individuals with storing certain information about items around the house or office, Aira is primarily for quickly getting helpful visual information about your environment in real time. Their device is a pair of glasses that are in conjunction with an app to get their “Explorers” (as they call their users) information quickly. The glasses contain a camera, microphone, and speakers. The Explorer puts on their glasses and, when they want to know something about their environment, can contact a live person at Aira who receives the live video feed from the glasses. Then the individual at Aira describes the Explorer’s visual settings in real time, allowing them to choose between different fruits at the supermarket or help their child as they learn to read.

            What’s impressive about Aira is the versatility. Explorers can call someone at any time, 24/7, to learn about any environment. Imagine being able to go on a safari, smelling the savannahs and listening to the wonderful sounds of the birds and other animals and then quickly getting in contact with someone who can describe what it all looks like to you as well. But it’s not solely for the adventurous, Aira can help someone browse a local store or watch a fireworks display. Additionally, the use of live people to describe the visual features of an environment allows the two individuals, Explorer and Aira contact, the opportunity to share in an experience. That aspect of preserving the human connection while taking advantage of technology fits right in with us at Disability Cocoon.

            Together, WayAround and Aira prove to be a powerhouse duo that works to assist individuals with visual impairments. It goes to show how many different applications there are for simple and effective technological solutions. We at Disability Cocoon hope you’ve found this information helpful and invite you to continue checking up on our blog to stay up to date on the latest developments in assistive technology.

How Can Alexa Understand People with Speech Difficulties?

Sorry, I didn't get that....png

Enter Voiceitt to the Rescue

Most of us have experienced the occasional “Sorry, I didn’t get that” response from our Alexa enabled devices. In her article “When Alexa Can’t Hear You” for Slate Magazine, Moira Corcoran points out an often unseen problem with the rise in smart-home technology, particularly voice-based technology like Alexa or Cortana (thanks to ARRM Technology Resource Center in MN for bringing this article to our attention). For many people with non-standard speech patterns due to illness, traumatic injury, or disability, getting these devices to understand what they’re saying proves difficult. That’s because systems like Alexa use machine learning to teach their software how to understand spoken words by feeding it data from thousands of users. Most of the users that systems like Alexa get their data from have standard speech patterns. But when these systems are only programmed to recognize these common patterns, they aren’t able to understand non-standard speech patterns of people with speech disabilities.

Corcoran also mentions a company working toward a solution for this problem, Voiceitt. They’re developing software that recognizes irregular speech patterns and pronunciation so that individuals who don’t pronounce words the same way as most people can still get all the benefits from their smart devices (video how it work). Disability Cocoon’s Dustin Wright sat down for an interview with Voiceitt’s Danny Weissberg during which he broke down Voiceitt’s plan to make this technology more accessible.

They are currently beta-testing (think soft-open of a store or restaurant) the first generation of their app, which works on smartphones and tablets. The first generation of technology requires users to record words/commands they wish to use on their device so the device can respond to each individual’s specific speech. Sometimes it takes a while to get the commands recorded, but training Voiceitt to understand one individual’s pattern of speech means that it doesn’t matter what language you speak, Voiceitt simply listens to the sounds and executes the command. Additionally, even individuals with speech patterns that are far from standard can use their smart devices with this generation of Voiceitt.

The second generation of Voiceitt is already being developed. This generation only requires that users record a sample of their speech reading certain sentences. After a user reads these sentences to Voiceitt, the app will be able to understand other words or commands that aren’t part of those sentences. It will learn how the individual speaks. This means no more training the app to respond to every command.

Their third generation, though still in the distant future, will use the data collected from Voiceitt users to generate software that understands common types of non-standard speech among certain populations. For example, if many people with Down Syndrome use Voiceitt, the app will be able to see if there are any common ways those people pronounce words and phrases. That way it will already have some understanding of how people with Down Syndrome speak, removing the need for users to train the app themselves.

To sum it up, the growth of technology and the convenience that comes with it is exciting, but we need to remember that when it comes to technology, if we’re not doing all we can to make it accessible to people with disabilities, injury, or any other condition, then we’re not doing enough. That’s what inspires us about the people over at Voiceitt, they’re working to make sure everyone can enjoy the convenience of voice-based technology.

For people who want to see what Voiceitt is doing now, take a look at their page here. If you or someone you know is looking for a way to make Alexa or similar voice-recognition devices more accessible to people with non-standard speech patterns, let us know! Voiceitt will be expanding their beta-testing in the future and Disability Cocoon would love to try to get you in on it.

AI Virtual Phone "Check-Ins" with KareCall

We at Disability Cocoon like to highlight new and exciting technologies that work to help the lives of individuals with disabilities, the elderly, or people who just need some assistance in their day-to-day lives. While our last blog post looked at TechLab and their low-cost alternatives to potentially expensive assistive technology, this post takes a look at the people of KareCall and how their virtual calls are allowing individuals with health concerns to maintain or increase their independence. Some individuals need to answer questions about medical concerns on a daily basis so that their loved ones and caregivers can keep up with their health. While traditionally this required a caregiver to travel to the client’s home or the client to go to a care facility, KareCall calls the patient with a virtual caregiver to ask these questions.

            There are a number of benefits for both the provider and the client to having a virtual caregiver, instead of an in-person caregiver, ask about a client’s health. Providers no longer have to spend the time or money sending staff to clients’ homes just to ask a series of questions about their health. They no longer have to work around staff schedule. Additionally, in-person conversations are limited by physical distance. If your client is in a small town, hours away from the provider office, it can be costly sending staff that far for a few questions. Of course, any provider would gladly do that for their client, but now they don’t have to. KareCall offers an inexpensive alternative. It isn’t limited by distance, because it works over the internet. Providers set up the questions they need asked and the virtual caregiver makes the call at the scheduled time, every time.

            For the client, the benefits are even greater. Now there is no need to invite someone into your home just to ask a few questions. The KareCall virtual caregiver doesn’t require any small talk, doesn’t ask any questions other than the ones set up by the provider, and doesn’t linger in your home after your done. One quick call, that’s it. There’s no longer a need to make sure the house is always ready for visitors, you could answer in your bathrobe if you wanted to. KareCall allows individuals who aren’t ready for in-home staff to keep their freedom and allows concerned parties to stay up-to-date on the client’s health at the same time.

            KareCall is another example of what technology can do when it is harnessed with an aim to cut costs and improve care for individuals with health concerns. They represent the better parts of growing old in the twenty-first century. Technology should work for you, and that’s why we at Disability Cocoon will continue to highlight these new products and services that aim to improve the lives of individuals who require a little help.


Often, people who don’t experience mobility issues or don’t have intellectual or physical disabilities take for granted the simple daily tasks we’re able to accomplish with relative ease. For others these tasks can be more difficult, even impossible without assistance. While a variety of technological solutions are being offered for these problems, the price tag may be a barrier when it comes to getting your hands on them.

            Connie Melvin and Richard Harrington at the Trinity Services TEC Lab in Joilet, IL are tackling that issue head on. They understand that technology doesn’t always need to come with a hefty price tag and fancy screens, sometimes all that’s needed are simple solutions to simple problems. TEC Lab produces DIY solutions for these daily adversities by using low-cost materials in creative ways. When Disability Cocoon’s own Dustin Wright took a tour of their facility, they showed a food/drink holder for wheelchair users with a long, flexible, semi-rigid straw for individuals who may find it difficult to grasp utensils or lift cups. What’s astonishing about this product is that TEC Lab manufactures it for nearly a tenth of the cost of comparable items on the market. As Connie says, that’s the power of DIY.

            Additionally, the folks at TEC Lab understand that it’s not just about making a product that’s cheaper, it’s about understanding the individual’s specific needs and fulfilling them. Some companies produce items that could be useful, but there’s usually one thing about it that’s just not quite right. If only it could be tweaked a little, then it would be perfect. TEC Lab gets this as well, they evaluate each individual’s unique needs in the development process to ensure that the finished product does exactly what they need it to do. They even offer classes in DIY, so that you, a caregiver, or family member can, you guessed it, do it yourself.

            We’re inspired by the people at TechLab who are working to break down the financial barriers between individuals and assistive technology. They recognize that everyone, especially individuals with mobility issues, physical or intellectual disabilities, or other impairments, deserves access to affordable assistive technology solutions. That fits right in with what Disability Cocoon is all about, sharing the great things people are doing with technology to help people improve their lives.