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Electronic Monitoring: Cost Saving Technology or Potential Ethical Dilemma?

By Carli Friedman, CQL Director of Research

As a result of staffing shortages, technology is more frequently utilized to help fill in gaps. Electronic monitoring equipment, such as video communication systems or electronic bracelets, can be used as a form of telecare to monitor for safety and harm while assisting with independence and staff burden. In theory, video surveillance may be an alternative to more restrictive settings because it can prevent harmful incidents or abuse, thereby easing the worries of families who may not otherwise want their family member to live alone. However, as it is relatively new, there is still little evidence about electronic monitoring’s benefits. Therefore, the aim of this study was to examine how states have begun to implement this technology, particularly in the largest provider of long term services and supports (LTSS) for people with intellectual and developmental disabilities (IDD), Medicaid HCBS waivers. To do so, fiscal year (FY) 2013 IDD waivers from across the nation were examined to determine if and how electronic monitoring equipment was allocated.

Findings revealed 5 states provided 9 different electronic monitoring services. Electronic monitoring services in HCBS waivers were generally for the purposes of providing off-site electronic surveillance with the aim of reducing services or increasing people with IDD’s independence. In FY 2013, a total of $31.8 million of spending (figure L) was projected for electronic monitoring services for approximately 800 people with IDD. On average states projected spending approximately $24,000 per person on electronic monitoring services (figure R), with the average person receiving approximately 3,000 hours of electronic monitoring a year.

Total Spending By State

Average Spending Per Person

Our study found few states are utilizing remote monitoring equipment. Yet, as states continue to grapple with limited financial landscapes more may consider implementing electronic monitoring equipment to reduce costs. While the services we found often detailed requirements such as informed consent before use of this technology becomes widespread, attention must be directed to its ethical implications. “While some researchers working in the area of telecare and monitoring suggest ‘technology denies personhood altogether,’ others remind us of the importance of the balance between the right to autonomy, privacy, and safety” (Friedman & Rizzolo, 2017, p. 283).

This article is a summary of the following journal manuscript: Friedman, C., & Rizzolo, M. C. (2017). Electronic video monitoring in Medicaid home and community‐based services waivers for people with intellectual and developmental disabilities. Journal of Policy and Practice in Intellectual Disabilities, 14(4), 279-284.