Aging by Design BENTLEY COLLEGE Waltham, MA September 27 & 28, 2004

Technology & Caregiving Aging by Design

John Rother Director Policy & Strategy

U.S. Caregiving Challenge U.S. Caregiving Challenge  MORE PEOPLE  Better care  For less cost

Number of Medicare eligibles 2004

The shrinking ratio of caregivers ^ for for for for ^ Caregivers availableFor each sick person

U.S. Caregiving Challenge U.S. Caregiving Challenge  More people  BETTER CARE

Some results of AARP’s first-ever poll of people with disabilities 50 and older

Q. Is the person who provides the help to this person with a disability or health condition paid or unpaid? Base: Those who receive help. Q. Is the person a family member or friend or some other type of relationship? Base: Those who receive care. Q. What type of family member provides you with this help? Base: People who receive care from a family member. Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002Disabilities, September 2002 Data from Figure Of majority who receive care, it is from an unpaid FAMILY MEMBER

Of majority who receive help, it is from an unpaid family member who is a SPOUSE or CHILD Q. Is the person who provides the help to this person with a disability or health condition paid or unpaid? Base: Those who receive help. Q. Is the person a family member or friend or some other type of relationship? Base: Those who receive care. Q. What type of family member provides you with this help? Base: People who receive care from a family member. Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002Disabilities, September 2002 Data from Figure

Most caregivers LIVE WITH person helped Figure 38: Living Arrangements of Persons 50 and Older Who Receive Help with Daily Activities Q. Does this person live with you? Base: People who receive help on a regular basis. Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002

Family caregivers  Where will they get information?  How can they partner efficiently with professional providers?  How can they continue their own employment?

Poll asked about worries & concerns People with disabilities’ No. 1 answer: LOSS of INDEPENDENCE and MOBILITY Table 18 Q. Looking to the future, what are your biggest worries or concerns about having a disability or health condition? Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002 Note: Percentages do not total 100% because of “other” responses.

Table If home care services are needed, 50+ with disabilities prefer their OWN CONTROL over money and management of home care workers ( vs agency control) 78%

The recipients of care  How can they get information?  How can they stay in touch with the world outside?  How can they manage their own affairs?

The recipients of care  How can we design technology to promote better partnership among physicians, the caregiving team, the patient, and her family?

Large numbers of 50+ with disabilities are computer users Figure 53 Q. Do you personally use a computer at home, work, or in some other place such as a computer terminal at school, a library, a post office, or someplace else? Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002 SLIGHT/MODERATE VERY/SOMEWHAT SEVERE

Can technology help those in institutional caregiving settings?

Today’s nursing home residents have MORE SEVERE limitations Figure 20: Percent of Nursing Home Residents Age 65 and Older at Various Levels of Disability, Source: Urban Institute analysis of the National Long-Term Care Survey for AARP Public Policy Institute...which require more monitoring and attention

Problems with QUALITY OF CARE persist in U.S. nursing homes Source: Centers for Medicare and Medicaid Services, Nursing Home Compare Web site Figure 21: Selected Quality Measures for Long-Stay Nursing Home Residents, 2002

Better care Computer technology a key to improved QUALITY Better record-keeping, record access Better-informed medical practitioners and “hands-on” caregiversBetter-informed medical practitioners and “hands-on” caregivers Auto-reminders of tests, procedures, medications, “turning” due patientsAuto-reminders of tests, procedures, medications, “turning” due patients

Better care Computer technology a key to improved QUALITY Better record-keeping, record access More accurate transfer of informationMore accurate transfer of information  Prescribing  Diagnostic tests  Concurrent treatments

Better care Computer technology a key to improved QUALITY Not only in long-term care, but in hospital settings and outpatient careNot only in long-term care, but in hospital settings and outpatient care

 Diagnostic checklists  Data bases of best practices  Computerized prescriptions, lab orders  Automated patient records (AMR)  Easy-to-use by stressed professionals  Ability to track outcomes economically Bring computer technology into the exam room Better care

 The IOM found that as many as 98,000 preventable deaths a year occur in hospitals due to medical errors  Many of these could be eliminated with well-designed information systems Better care Extent & cost of medical errors widespread Better care Extent & cost of medical errors widespread

U.S. Caregiving Challenge U.S. Caregiving Challenge  More people  Better care  For LESS COST

Health spending has taken off Percentage rise 3.4% 5.2% Real Average Annual Growth in Health Spending Source: National Health Expenditures 6 years 4 years 8.1% 1 year 6.2% 1 year

Percent of Population 100% %40%60%80%100% 0% 10% of costs for 70% of people 30% of costs for 1% of people % Health Care Dollars Spent Chronic care management key to a large segment of cost Less cost

Inappropriate care adds risk and expense  Study done by the Chicago Midwest Business Group on Health estimated 30% of healthcare dollars are spent on inappropriate care Reducing the Costs of Poor Quality Health Care Through Responsible Purchasing Leadership June 2003 Less cost

 Tracking and publishing outcomes improves care  Measuring outcomes at reasonable cost requires computerized data systems, patient records Inappropriate care adds risk and expense

A HEALTH INFORMATION SYSTEM

Envision an adequate health information system  Giving consumers and providers the latest information to make informed decisions  Expanding consumers’ ability to participate in their own care  Facilitating patient-to- provider interaction

Envision an adequate health information system  Speeding and adding accuracy to professional-to- professional consultation  Reminding patients when to take meds, report for tests, renew Rx’s  Better provider-patient communications

Concerns:  Privacy issues  Cost to individuals & providers to participate  Will technology promote or impede patient-caregiver trust?

Four Policy Recommendations: 1.Need for national health infrastructure standards 2.Must create a funding mechanism

3.Must create a system that involves patients more fully in their own care 4.Formulated in a way that will support appropriate healthcare decisions Four Policy Recommendations:

Technology & Caregiving Aging by Design