Computer-Based Technology & Caregiving for Older Adults National Conference Natcher Center NIH Campus Bethesda, Maryland October 2-3, 2003

Computer-Based Technology & Caregiving for Older Adults John Rother Director Policy & Strategy

U.S. Caregiving Challenge U.S. Caregiving Challenge  Give more people  Better care  For less cost

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

Number of Medicare eligibles 2003

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

U.S. Caregiving Challenge U.S. Caregiving Challenge  Give more people  Better care

Some results of AARP’s first-ever poll of 50+ with disabilities

Of majority who receive help, it is from an unpaid family member (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 Figure 37

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 those with disabilities about their worries & concerns, 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.

If home care services are needed, 50+ with disabilities prefer own control over money and management of home care workers ( vs agency control) Table 26 Q. Home care services paid for by the government could be provided in several different ways. I’m going to describe three possible ways that the government could pay for home care services. Then I will ask you the option you would prefer if you needed these services. If you needed these services, which of these three options would you prefer? Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September

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 VER/SOMEWHAT SEVERE

How about those in the formal 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 requires more monitoring and attention

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

Better care Computer technology a key to improved QUALITY Better record-keeping, record access Better record-keeping, record access Better-informed medical practitioners and “hands-on” caregiversBetter-informed medical practitioners and “hands-on” caregivers More accurate transfer of informationMore accurate transfer of information  Prescribing  Diagnostic tests  Concurrent treatments 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 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)  All easy-to-use by stressed professionals  Plus, ability to track outcomes economically Better care Bring computer technology into the exam room

 Recent IOM Report suggested that as many as 98,000 unnecessary deaths a year occur in hospitals due to medical errors  Many of these could be prevented with well-designed computer technology Better care Extent & cost of medical errors widespread Better care Extent & cost of medical errors widespread

U.S. Caregiving Challenge U.S. Caregiving Challenge  Give more people  Better care  For less cost

Health spending has taken off Percentage rise 3.8% 6.3% Real average annual growth in health spending National Health Expenditures 6 years1 year 7.5% 1 year

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

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

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

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 us when to take our meds, report for tests, renew Rx’s  Storing for easy retrieval all the medical information in the world

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

Four policy recommendations: 1.Need for national health infrastructure standards 2.Must create funding mechanism

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

Computer-Based Technology & Caregiving for Older Adults National Conference Natcher Center NIH Campus Bethesda, Maryland October 2-3, 2003