At LEO, our commitment to evidence is unwavering. Over the past two months, our partners—nonprofits who support those experiencing poverty—have faced an unprecedented test. As many fight for survival, we at LEO have been amazed by their resilience and ongoing commitment to evidence. In this series, we’ll highlight the stories of these nonprofits to showcase how they are adapting to the realities of COVID-19, and the innovations of those on the front lines of the war on poverty.
Sam Provence has the inauspicious distinction of being one of the last polio cases in Ft. Worth’s Tarrant County in 1958. But that’s not why thousands of Texans still know his name.
In 1977, he founded an organization to enable Tarrant County residents with disabilities to live an active and independent life. Helping Restore Ability (HRA) Texas now operates across the entire state. Its 1,500 caregivers help people with disabilities remain in their homes.
Their commitment to cost effectiveness is core to their model: 95% of the funding they receive goes directly to caregivers. But when COVID-19 began to wreak havoc, HRA’s costs to keep both its caregivers and clients safe skyrocketed. What happened next will likely transform their approach to home health for years to come.
In 2019, HRA partnered with LEO to begin the journey to better understand the impact that increased training for caregivers has on the health outcomes of their clients. Almost 1 in 4 U.S. adults—61 million Americans—lives with a disability. The burden for their care typically falls on family members: around 90% of caregivers are family members, many of whom lack training on how to provide adequate care. Organizations nationwide struggle to motivate caretakers to undertake—and to complete—training programs.
Even for those with formal training, caretaking responsibilities evolve over time, requiring new skills and techniques. For example, serving those with dementia requires correctly identifying key markers along the disease’s progression. Proper and consistent training improves quality of life for those with disabilities by enabling them to stay in their homes longer.
Together, HRA and LEO have selected different approaches to increase training completion rates. These approaches will be tested over time to identify which method leads to better results; what they learn could change how managed care providers operate across the country.
Evidence and Experimentation in Uncertain Times
HRA’s founder insisted that they be good stewards of the limited funding they had to operate. HRA’s current CEO Vicki Niedermayer decided that truly good stewardship meant looking objectively at what works, and what doesn’t. To do so, HRA partnered with local universities to understand their needs and to build their capabilities. They brought on two former interns—David and Girish—full-time and HRA’s Department of Research and Informatics was born.
Just as HRA set out to implement the program they’d developed as a part of LEO’s rigorous innovators cohort, COVID-19 hit. Immediately, HRA got to work ensuring that their caregivers were sufficiently equipped to safely continue their work in homes. Providing gloves, masks, and sanitizers added significant costs onto their existing delivery model.
Next, they looked to technology solutions to enable remote work, and to automate costly (and potentially dangerous) in-person processes. For their administrative staff, this meant remote desktops to assist clients and caregivers, as well as updated communications infrastructure. They began digitizing intake forms, the mounds of paperwork delivered by staff crisscrossing the state. By reducing the miles traveled, HRA not only saved money, they also saved time, which allowed staff to whittle down its waitlist for services—typically dozens long—within weeks.
The new environment may have changed their approach, but it hasn’t shaken their desire to know what works. If anything, COVID-19 has increased the importance of remote training; improper care could result in institutionalization for clients, which carries with it increased risk for infection among an already vulnerable population. Luckily, HRA had already laid the groundwork to measure this exact phenomenon with LEO.
One of the silver linings for HRA has been the increased availability of qualified caregivers forced into the job market by COVID-19. The generosity of new and existing funders has enabled HRA to raise wages and to offer comprehensive benefits unmatched in their sector. This not only lets HRA give back to their community through providing good jobs, it also helps them fulfill their mission: more qualified caregivers are better able to notice small but potentially meaningful changes in those they serve. This means a better, healthier life at home for those with disabilities. HRA’s commitment to evaluating their work with LEO will allow them to see how these changes can transform their impact going forward.
Helping Restore Ability works to bring normalcy to the lives of the disabled. In this new normal, they’ve paired innovation with confidence from knowing what works and what doesn’t. This ensures that whatever world we return to will continue to allow for full and independent lives for those with disabilities.
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