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Mona Pereth

Joined: 11 Sep 2018
Age: 63
Gender: Female
Posts: 4,170
Location: New York City (Queens)

30 Jul 2021, 3:19 pm

‘We don’t deserve this’: new app places US caregivers under digital surveillance by Virginia Eubanks and Alexandra Mateescu, Guardian (UK), Wed 28 Jul 2021:

Electronic visit verification systems make homecare more difficult, trap people with disabilities, and cost more than paper timesheets. So why are they rolling out across the country?

Tech companies and lawmakers promise that EVV will increase efficiency and accountability in home care and will reduce fraud, waste and abuse in government-funded programs. But the tool has been a catastrophe for many [...]. Advocacy groups and people with disabilities warned from the start that EVV systems would erode clients’ autonomy, make home care more difficult and threaten the progress of the disability rights and independent living movements.


At the heart of these disagreements are clients and workers – often women of color or immigrants – who feel as if they are constantly surveilled and under suspicion.

The Obama administration passed legislation requiring that EVV be implemented to manage all in-home personal care services paid for by Medicaid, the program that helps poor and working families in the US with healthcare costs.

Minor quibble here: The "Obama Administration" could not have "passed legislation." Either Congress passed legislation, or the Obama Administration issued an executive order. I haven't yet taken the time to look up which of these is the case, but it seems more likely to be legislation passed by Congress, judging by this article's subsequent mention of a "2016 federal law that paved the way for EVV – the 21st Century Cures Act." Be that as it may....

And on 1 April, under a federal deadline to implement or lose a percentage of its Medicaid funding, Arkansas rolled out EVV for self-directed clients like Walker who manage their care workers directly rather than go through a home healthcare agency. Most other states are also currently unveiling EVV systems.


As far back as April 2019, Brenda Stinebuck, the executive director of Spa Area Independent Living Services, worried that the system would be a catastrophe. Arkansas did not include self-directed clients or live-in caregivers in pilot testing. DHS had no communication about EVV with her office. “The ability to direct your own care is getting harder and harder and harder,” she said at the time.

The article contains many accounts of bugs and glitches that have caused all manner of chaos resulting in under-payments and delayed payments -- often with catastrophic consequences for low-paid home health care workers.

But, even if the roll-out had somehow managed to be bug-free, there are also other, more fundamental problems, such as:

The 2016 federal law that paved the way for EVV – the 21st Century Cures Act – requires that the systems be “minimally burdensome.” But Arkansas, like many other states, appears to have implemented an approach with burdens galore.

As Morell wrote in an 11 June letter to Arkansas DHS: “What took a total of 15 seconds – to sign a timesheet and submit to Palco – now takes many hours; hours that should be given to the client for care.”

EVV vendors promise their solutions will save states money by cutting down on what they claim is pervasive fraud and waste. A 2016 federal report claimed that EVV use across the country would eventually lead to $290m in cost savings over a ten year period, in part by reducing improper billing.

But in practice there is little evidence to suggest fraud is either widespread or significant. Only seven people were charged with fraud in self-directed personal care services in Arkansas in 2020, out of a workforce of more than 4,500, according to data collected by Applied Self-Direction, a Boston-based consultancy. The state secured three convictions, recovering $1,930 total – $643 per case. The EVV system has cost the state $5.7m so far.

Worst of all, for the disabled clients:

Digital timesheet or ankle monitor?

For some, the new system feels like being under house arrest. The EVV app incorporates GPS to verify a home care worker’s location and a feature called “geofencing”. It establishes a maximum distance around a client’s home inside which a care worker is allowed to clock in or out without getting flagged as noncompliant.


Before the home care agency she works for started using the AuthentiCare app in November 2020, she and Hoover, who has used a manual wheelchair since he lost the use of his legs in 2009, were always on the go. She could take him to therapy, grocery shopping, to see friends. “And now we can’t. You have to be at home to clock in and clock out,” Harville says.

The intentions behind using GPS to verify a home care worker’s location might be to keep workers accountable and clients safe, but the implications are digital borders that undermine the philosophy behind independent living, advocates say.

For more than six decades, disability activists have asserted the right to autonomy over one’s life and the ability to live, work and receive services within the broader community. Geo-fencing in EVV is built on a premise that contradicts this: it assumes that people like Kevin Hoover, who loves to fish, work on cars and play music with his friends, are homebound, not living active and vibrant lives.

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Snowy Owl
Snowy Owl

Joined: 24 Jul 2021
Age: 40
Gender: Non-binary
Posts: 173
Location: Wellington, New Zealand

30 Jul 2021, 3:36 pm

Standard business practice? Leech money under disguise of helping. Working as intended I think?