University of Wisconsin Active Aging Research Center National Advisory Committee Report and Update Dave Gustafson PI July

Over 600,000 will enter nursing homes in 2012 Average NH stay 893 days; $161,500/admission Total cost exceeds: $10,000,000,000. Many people do not enter poor, but they leave poor.

Does it have to be that way?

Active Aging Research Center Waukesha County Richland County Milwaukee County

What will ECHESS be?

Elevator Speech There are many good technologies, products, and online resources to help the elderly remain independent. Few are used. Why? – Disparate stand-alone products and services – Not proven to work – Not sanctioned by trusted organizations – Environment is not prepared to adopt, sustain and spread. ECHESS will: – Integrate key technologies, – Test them to find which parts work, with who, and how, – Work with communities, payers, elders, families and clinicians, to ensure that ECHESS honors the strengths and limitations of everyone. – Make independence-empowering technology accessible to all. – Do it within a walled garden. – Improve outcomes including costs. – Reduce re-admissions to hospitals and emergency departments.

National Advisory Committee (PoA) Sandra J. Ball-Rokeach Professor, Communications, USC Paul Batalden: Professor, Dartmouth Health Policy and Clinical Practice Noshir Contractor: Northwestern Science of Networks Research, Brian Joiner Founder Joiner Associates Inc. Quality Improvement. Peter Kissinger: President AAA Foundation for Traffic Safety. Adrian K. Lund President, Insurance Institute for Highway Safety. Jeffrey Michael Assoc Administrator, National Highway Traffic Safety Admin. Brian McLaughlin Assoc Administrator, National Highway Traffic Safety Admin. Wendy J. Nilsen Administrator, NIH Behavioral & Social Science Research. Kevin Patrick Professor, Preventive Medicine, UCSD Susan C. Reinhard, Senior Vice President for Public Policy at AARP. David Rose Innovator, Vitality LLC. Vinod K. Sahney, PhD, Senior Fellow, Institute for HealthCare Improvement. Andrew H. Van de Ven, Professor, Organizational Innovation, Minnesota. Nancy A. Whitelaw; President, Gerontological Society of America Clive Hohberger. President (Ret) Zebra Tech; Automatic identification technology

Goals: Use sensors, information & communication technology To help elders & family improve: Service dependability. Loss of driving privileges. Quality of life. Medication management. Falls. Readmissions. Sustain and spread to 20 other Wisconsin counties.

Focus: Older adult (>70; Hospital discharge in 180 days) and Family caregiver (Distant; Nearby; Live-in ) Measures Primary – Readmissions to hospital – Health care costs – % now living in ALF or NH – Quality of life Asset Based Community Development – # uses of community resources – Type of resources used – Have organizations to take on ECHESS Isolation – Number of contacts per day – Minutes of contacts per day Driving – Attend appointments – Accidents per driver – Number still driving – Number rapid stops &starts. Service Dependability – Service timeliness – Anxiety of family caregiver. – Satisfaction w service quality. Medication – Number of adverse events – Missed medications rates

Premise: Technology Can Help

Two interlocking systems Older adult “Family”

Our challenge: Making a complex system simple.

NAC suggested Next Steps Stories from each group ✔ Decide on measures ✔ Elevator speech ✔ Baseline data Starting Target population defined ✔ Simplify Increase size of RCT Exploring Interview OAs forced to go to NH or ALF Starting Doing too much

Activity Needs & Assets – Over 200 elders interviewed – Information classified – Loneliness, Transport & Community events Developed – Stories – Vision – Elder Tree Being Developed – Loneliness Community Calendar & matching – Medication Side effects predictor Glow-Caps – Falls Booster Gait – Driving Sensors measuring drives – Service Dependability Pilot testing in rural area

Next Steps Waukesha County – New Berlin – Implement Elder Tree in 1000 households Getting Community Buy-in Seeking resources Milwaukee County (urban) – Northwest area – Building political base – Completing asset assessment. Richland County (rural) – Community bought in – Asset assessment done – Community calendar Systems development – Programming – Data collection – Pilot tests – Integration Prepare randomized trial. – Final outcomes & measures – ADRCs prepare to recruit

To sustain, technology needs support systems Financing Incentives Processes Regulations Interagency agreements Welcoming environment Community development Working on this now.

NAC Caution We are trying to do too much! Maybe. We’ll see.

Thank you again