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Availability of Personal Emergency Responses Systems in HCBS

By Carli Friedman, CQL Director of Research

Personal emergency responses systems (PERS) are small devices that allow people to push a button in order to receive help in an emergency (like Life Alert), such as after a fall. Past research has found that PERS can provide people with a sense of peace of mind, promote self-determination, and help improve health outcomes. For these reasons, the aim of this study was to examine how states provided PERS to people with intellectual and developmental disabilities (IDD) in their Home- and Community-Based Services (HCBS) programs. To examine this, I analyzed fiscal year (FY) 2021 Medicaid HCBS 1915(c) waivers from across the nation.

I found that slightly more than half of states (57.8%) offered PERS for people with IDD in their HCBS programs in FY2021. While $9.9 million of spending was projected for PERS services, only 1.1% of people with IDD who received HCBS were projected to receive PERS services. In fact, the percentage of people with IDD projected to receive PERS varied significantly by state, from 0.03% in Illinois to 20.5% in New Jersey.

Percent of People with IDD Projected to Receive PERS

Percent of People with IDD Projected to Receive PERS by state: Illinois 0.03% DC 0.1% Tennessee 0.1% Idaho 0.1% Virginia 0.1% Hawaii 0.2% New Mexico 0.3% Pennsylvania 0.4% Alabama 0.5% Connecticut 0.5% Nebraska 0.6% Florida 0.6% Colorado 0.7% South Carolina 0.7% Kansas 0.8% Utah 0.8% Arkansas 0.9% Indiana 1.0% Michigan 1.2% Minnesota 1.7% Iowa 2.1% California 2.2% New Hampsire 4.5% Louisiana 5.6% Montana 6.7% New Jersey 20.5%

Average annual spending per person with IDD for PERS also ranged significantly by state, from $30 a year in Illinois to $14,788 a year in Michigan. But the average annual spending per person across the services was $751 a year, suggesting these services are relatively low cost, especially given their potential benefits.

Average Annual Spending Per Person on PERS

Average annual spending per person: $0 to $150 23.6%, $151 to $300 20.8%, $301 to $450 25.0%, $451 to $600 12.5%, $601 to $750 5.6%, $751 to $900 2.8%, $901+ 11.1%

“PERS has been found to improve the health outcomes of older adults and reduce their odds of institutionalization. Yet, in this study, we found PERS are not commonly being allocated for people with IDD in Medicaid HCBS waivers. We believe these findings provide useful information to determine areas of need and gaps in service delivery; in addition, our findings about the states that are devoting more resources to PERS, such as Michigan, Minnesota, New Hampshire, and New Jersey may also help provide guidance on how other states can best capitalize the limited funding available to them. We believe HCBS is a fruitful mechanism to expand people with IDD’s access to PERS, especially as PERS aligns with Medicaid HCBS’s goals to not only to promote the community integration of people with IDD but also self-determination and independence” (Friedman, 2023, p. 7).

This article is a summary of the following journal manuscript: Friedman, C. (2023). Personal emergency response systems and people with intellectual and developmental disabilities in the United States. Journal of Policy and Practice in Intellectual Disabilities, 20(4), 380-388.