Aging by Aging by DesignDesign

BENTLEY BENTLEY COLLEGECOLLEGE

Waltham, MAWaltham, MA

September 27 & 28, 2004September 27 & 28, 2004

Technology & CaregivingTechnology & Caregiving

Aging by Aging by DesignDesign

John RotherJohn Rother

DirectorDirector

Policy & StrategyPolicy & Strategy

U.S. Caregiving ChallengeU.S. Caregiving Challenge

MORE PEOPLEMORE PEOPLE

Better careBetter care

For less costFor less cost

Number of Medicare eligibles Number of Medicare eligibles

Percentage of Total Population Age 65+

% Age 65+ % Age

85+0%

5%

10%

15%

20%

25%

% Age 65+

% Age 85+

Source: U.S. Census Bureau, middle series projections and historical data, U.S.

2004

The shrinking ratio of caregiversThe shrinking ratio of caregivers

- - - - - - ^ - - - - 11 for 1990

10 for 2010

6 for 2030

4 for 2050

- - ---

^

- - - - -

-

-

- - - -

- - - -

Caregivers available

For each sick person

-

-

-

-

U.S. Caregiving ChallengeU.S. Caregiving Challenge

More people More people

BETTER CAREBETTER CARE

Some results of Some results of AAAARP’s first-ever RP’s first-ever poll of people with disabilitiespoll of people with disabilities

50 and older 50 and older

0%

20%

40%

60%

80%

100%

PAID UNPAID

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 37 50.3

0%

20%

40%

60%

80%

100%

FAMILY FRIEND OTHER

Of majority who receive care, it is Of majority who receive care, it is from an unpaid FAMILY MEMBERfrom an unpaid FAMILY MEMBER

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

who is a who is a SPOUSE or CHILDSPOUSE 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 37 50.3

0% 20% 40% 60% 80% 100%

SPOUSE/PARTNER

CHILD

SIBLING

DAUGHTER/SON-LAW

MOTHER/FATHER IN LAW

Most caregivers LIVE WITH Most caregivers LIVE WITH person helpedperson helped

0%

20%

40%

60%

80%

100%

Caregiver lives withperson

Caregiver does not livewith person

Figure 38: Living Arrangements of Persons 50 and Older Who Receive Help with Daily ActivitiesQ. 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 caregiversFamily caregivers

Where will they get Where will they get information?information?

How can they partner How can they partner efficiently with efficiently with professional providers?professional providers?

How can they continue How can they continue their own employment?their own employment?

Poll asked about worries & concernsPoll asked about worries & concerns

People with disabilities’ No. 1 answer: People with disabilities’ No. 1 answer: LOSS of INDEPENDENCE and LOSS of INDEPENDENCE and

MOBILITYMOBILITY

0% 10% 20% 30% 40%

Loss ofIndependence

Loss ofMobility

Unable to pay

Decrease/lossof assets

Becominghousebound

65+50-64

Table 18

Q. Looking to the future, what are your biggest worries or concerns about having a disability orhealth condition?Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002Note: Percentages do not total 100% because of “other” responses.

Table 26

53

25

If home care services are needed, 50+ If home care services are needed, 50+ with disabilities prefer their OWN with disabilities prefer their OWN

CONTROL over money and CONTROL over money and management of management of

home care workers (home care workers (vsvs agency control) agency control)

78%

The recipients of careThe recipients of care

How can they get How can they get information?information?

How can they stay in How can they stay in touch with the world touch with the world outside?outside?

How can they manage How can they manage their own affairs?their own affairs?

The recipients of careThe recipients of care

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

Large numbers of 50+ withLarge numbers of 50+ withdisabilities are computer usersdisabilities 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

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

By Age By severity

SLI

GH

T/M

OD

ER

ATE

VER

Y/S

OM

EW

HA

T S

EV

ER

E

50-6

4

65+

Can Can technology technology help those in help those in institutional institutional caregiving caregiving settings?settings?

Today’s nursing home residents Today’s nursing home residents have MORE SEVERE limitationshave MORE SEVERE limitations

Figure 20: Percent of Nursing Home Residents Age 65 and Older at Various Levels of Disability, 1984-1999Source: Urban Institute analysis of the National Long-Term Care Survey for AARP Public Policy Institute

0%

10%

20%

30%

40%

50%

1 ADL

2ADLs

3ADLs

4ADLs

5ADLs

6ADLs

1984

1989

1994

1999

. . .which require more monitoring. . .which require more monitoringand attentionand attention

Problems with QUALITY OF CARE Problems with QUALITY OF CARE persist in U.S. nursing homespersist in U.S. nursing homes

With pressure

sores

With painIn

restraints

With infections

0%

5%

10%

15%

20%

Residents of Nursing Homes

Source: Centers for Medicare and Medicaid Services, Nursing Home CompareWeb site www.medicare.gov

Figure 21: Selected Quality Measures for Long-Stay Nursing Home Residents, 2002

Better careBetter care Computer technology a key to Computer technology a key to

improved QUALITYimproved QUALITY

Better record-keeping, record accessBetter record-keeping, record access

• Better-informed medical practitioners Better-informed medical practitioners and “hands-on” caregiversand “hands-on” caregivers

• Auto-reminders of tests, procedures, Auto-reminders of tests, procedures, medications, “turning” due patientsmedications, “turning” due patients

Better careBetter care Computer technology a key to Computer technology a key to

improved QUALITYimproved QUALITY

Better record-keeping, record accessBetter record-keeping, record access

• More accurate transfer of informationMore accurate transfer of information PrescribingPrescribing Diagnostic testsDiagnostic tests Concurrent treatments Concurrent treatments

Better careBetter care Computer technology a key to Computer technology a key to

improved QUALITYimproved QUALITY

•Not only in long-term care, Not only in long-term care, but in hospital settings and but in hospital settings and outpatient care outpatient care

Diagnostic checklistsDiagnostic checklists

Data bases of best practicesData bases of best practices

Computerized prescriptions, lab ordersComputerized prescriptions, lab orders

Automated patient records (AMR)Automated patient records (AMR)

Easy-to-use by stressed professionalsEasy-to-use by stressed professionals

Ability to track outcomes economicallyAbility to track outcomes economically

Bring computer technology Bring computer technology into the exam roominto the exam room

Better careBetter care

The IOM found that as many as The IOM found that as many as 98,000 preventable deaths a year 98,000 preventable deaths a year occur in hospitals due to occur in hospitals due to medicalmedical errorserrors

Many of these could be eliminated Many of these could be eliminated with well-designed information with well-designed information systemssystems

Better careBetter care Extent & cost of medical errors Extent & cost of medical errors

widespreadwidespread

U.S. Caregiving ChallengeU.S. Caregiving Challenge

More people More people

Better careBetter care

For LESS COSTFor LESS COST

0%

2%

4%

6%

8%

10%

1993-1998

1999-2001

2001-2002

2002-2003

Health spending has taken offHealth spending has taken offPerc

en

tag

e r

ise

3.4%

5.2%

Real Average Annual Growth in Health Spending

Sou r

ce:

Nat

ion a

l Hea

l t h E

xpen

ditu

res

6 years

4 years

8.1%

1 year

6.2%

1 year

Percent of Population

100%

20

40

60

80

20% 40% 60% 80% 100%0%

10% of costs for70% of people

30% of costs for 1% of people

% H

ealt

h C

are

Dolla

rs S

pent

Chronic care management key to Chronic care management key to a large segment of costa large segment of cost

Less costLess cost

Inappropriate care adds risk Inappropriate care adds risk and expenseand expense

Study done by the Chicago Study done by the Chicago Midwest Business Group on Midwest Business Group on Health estimated 30% of Health estimated 30% of healthcare dollars are healthcare dollars are spent on inappropriate carespent on inappropriate care

Reducing the Costs of Poor Quality Health Care Through Responsible Purchasing Leadership

June 2003

Less costLess cost

LessLess costcost

Tracking and publishing Tracking and publishing outcomes improves careoutcomes improves care

Measuring outcomes at Measuring outcomes at reasonable cost requires reasonable cost requires computerized data computerized data systems, patient recordssystems, patient records

Inappropriate care adds risk Inappropriate care adds risk and expenseand expense

A HEALTH A HEALTH INFORMATIONINFORMATIONSYSTEMSYSTEM

Envision an adequateEnvision an adequate health information system health information system

Giving consumers and Giving consumers and providers the latest providers the latest information to make information to make informed decisionsinformed decisions

Expanding consumers’ Expanding consumers’ ability to participate in their ability to participate in their own careown care

Facilitating patient-to-Facilitating patient-to-provider interactionprovider interaction

Envision an adequateEnvision an adequate health information system health information system

Speeding and adding Speeding and adding accuracy to professional-to-accuracy to professional-to-professional consultationprofessional consultation

Reminding patients when Reminding patients when to take meds, report for to take meds, report for tests, renew Rx’stests, renew Rx’s

Better provider-patient Better provider-patient communicationscommunications

Concerns:Concerns:

Privacy issuesPrivacy issues

Cost to individuals & Cost to individuals & providers to participateproviders to participate

Will technology Will technology promote or impede promote or impede patient-caregiver trust?patient-caregiver trust?

Four Policy Recommendations:Four Policy Recommendations:

1.1. Need for national health Need for national health infrastructure standardsinfrastructure standards

2.2. Must create a funding Must create a funding mechanismmechanism

3.3. Must create a system that Must create a system that involves patients more involves patients more fully in their own carefully in their own care

4.4. Formulated in a way that Formulated in a way that will support appropriate will support appropriate healthcare decisionshealthcare decisions

Four Policy Recommendations:Four Policy Recommendations:

Technology & CaregivingTechnology & Caregiving

Aging by Aging by DesignDesign