They are known as electronic visit verification apps or EVVs. They keep track of the hours and movements of home care workers paid by Medicaid. States are just beginning to introduce them as part of an Obama-era program that promised to make domestic help work more efficient and to reduce fraud in the system.
Virginia Eubanks is the author of Automating Inequality: How High-Tech Tools Profile, Police, and Punish the Poor. She has followed the introduction of EVVs in Arkansas and wrote a story about it for the Guardian Newspaper with Alexandra Mateescu. Eubanks said the state’s app was buggy, resulting in missed paychecks for aid workers. She told me about LeDanté Walker, who depends on a nurse. The following is an edited transcript of our conversation.
Virginia Eubanks (Courtesy photo by Sadaf Rassoul Cameron)
Virginia Eubanks: [Walker] had it predictably difficult to sign up so quickly. When he got into the system and bought his caregiver an extra cell phone so she could use the app, her first paycheck was missing. And in the end it was out for $ 900 for two weeks [of] Work. He spent every single penny of his rainy day fund to keep her afloat, and he says it was total chaos.
Meghan McCarty Carino: One of the features that you write about these apps that seems particularly problematic is that they can use geofencing to keep track of where employees are to avoid fraud or to determine where those employees are. But that can kind of backfire, right?
Eubanks: Basically, the story is that while technology was supposed to ensure that caregivers were actually providing services when and where they were, geofencing makes all possible assumptions about it Who the People Are Associated Disabilities and what elderly Americans are and what they need that actually undermine the very purpose of programs like this one called home and community-based services. So this is the story of Melissa and Kevin, two of my sources, and they refer to electronic visit verification as an “invisible dog fence to humans” because of this feature called geofencing. And basically, geofencing uses GPS to set a maximum distance around a customer’s home that the caregiver can clock in or out without being marked as non-compliant. So Kevin and Melissa live together, and Kevin’s care plan includes things like meals and transportation and doctor’s appointments – all things that happen in the community, not necessarily in his home. And so one day Kevin and Melissa go to a doctor’s appointment, it’s a little late, they come home a little late and are hungry.
So they say, “Okay, we’ll stop and have something to eat.” So they stop, she stamps, and they have something to eat and go home. And the next morning Melissa got a call from her agency and they asked her, “Why are you stamping on Pizza Hut?” The fact that these tools log the whereabouts of caregivers because they are called personal care services for a reason has made many proponents argue that the tool is essentially the same as monitoring people with disabilities. The National Council on Independent Living surveyed people who use EVV last year in 2020 and found that a third of people say they have been staying at home more often since they started receiving electronic attendance confirmation because they fear that it would result in a service or An A visit will be marked as a scam and mean they will lose wages. And as we see in Melissa’s and Kevin’s story, agencies understand it that way too. So over and over again I heard sources say that the whole point of home and community service is to delay or prevent placement in a nursing home. But basically EVV does [them] turn [their] Homes in nursing homes. So they said, “It’s like house arrest. It’s like an electronic ankle monitor. “
McCarty Carino: How does what happens with EVVs align with other trends you have found in your research on the different effects of automated systems?
Eubanks: Home care workers are disproportionately made up of women of color, and many of them are immigrants who, like many low-wage workers, are closely monitored at work. The things that enable survival in a poor working class family, like flexibility, like relationships – these things are undermined when we switch to digital systems that are often very brittle and inflexible. One of the big concerns I have about electronic visit verification is that it actually undermines six decades of work that lawyers and people with disabilities have put in to achieve the fundamental right to autonomy in their life, home life, and maintenance of establishing services in their communities.
McCarty Carino: Something that shows up in our coverage of the show is that many tools designed for people with disabilities are not always built with their contributions or their specific needs. Has something like this happened here?
Eubanks: This is absolutely LeDante Walker’s analysis of the situation, as if you had basically repeated his words almost directly. But it seems that instead, these tools were really developed by people with no experience with home and community-based services. At its core, it is assumed that people with disabilities are tied to their home and are not active actors who lead a lively and fulfilling life.
McCarty Carino: How did Arkansas and the app maker react to this reporting?
Eubanks: Well, Arkansas and its contractor, Palco, sent a letter in response to my reporting in early July, saying that they were facing more challenges than they expected in introducing EVV for self-directed customers. But they said the problems were resolved and the caregivers were paid, geofencing, the messages people got were not errors. It was just informational messages. But it wasn’t until July 27 that I heard stories from sources about nurses who still weren’t paid, going back to March. And Arkansas Legal Aid, for example, reports that they are still getting many, many calls from people who have still not been paid. My interpretation of your letter is that in the beginning there were glitches, technical glitches, but they have largely been smoothed out. That wasn’t my experience, and it wasn’t what sources tell me.
The Federal EVV mandate is not rigid. Virginia chose to completely exempt family caregivers from EVV requirements. Geofencing is also optional. “You have to listen to people with disabilities,” says LeDanté Walker from ARSAILS. “Questions. That. People.” https://t.co/ASqjde1hNk pic.twitter.com/GE59We9i0b
– Virginia Eubanks (@PopTechWorks) July 28, 2021
Related Links: More Insights From Meghan McCarty Carino
A visit to Virginia Eubanks and Alexandra Mateescu is definitely worth it Full article for the Guardian, which features more personal stories about how the app affected the people of Arkansas.
And last year we covered innovations for the disabled on the show for a full week, including one Interview with lawyer Have Girmawho is deaf-blind and has developed her own communication system that combines a braille computer and a bluetooth keyboard. She said that people with disabilities constantly need to find their own solutions because technology reflects the prejudices of the people who develop them.
Eubanks explores how these distortions can exacerbate all kinds of inequalities in our digital systems. And we’ve seen that many times during the pandemic, as everything from work to school to court has been postponed online. A group of experts from the University of California, Los Angeles and Harvard wrote about the creation of the digital divide Barriers to access to vaccines for some parishes. And even for those who can break these barriers, Johns Hopkins Epidemiologist Stefan Baral tweeted that digital vaccination cards – such as QR codes or apps – are used to enter sports facilities or restaurants, could push some groups to the edge. “Do you want to come to our mall?” He writes. “Show me your smartphone.” He points out that such systems may also exclude vaccinated people who cannot prove their status.