Aging Services Technologies: Aging Services Technologies: Today and the Near Future Today and the Near Future

Majd Alwan, Ph.D., VP CASTMajd Alwan, Ph.D., VP CASTLeadingAgeLeadingAge

19th Annual Cellar Conference on Technology and Aging19th Annual Cellar Conference on Technology and AgingAging 2.0 -- Technology, Trends and TransitionsAging 2.0 -- Technology, Trends and TransitionsFriday, April 8Friday, April 8thth, 2010 , 2010

What is CAST?

The Center for Aging Services Technologies is a national coalition of more than 400 organizations working together to improve the aging experience through technology

Providers ofAging Services

University Researchers

AssociationsCAST

Tech Industry Partners

The The

TrendsTrends

““Shift Left” through Shift Left” through TechnologyTechnology

$1$1 $10$10 $100$100 $1,000$1,000 $10,000$10,0000%0%

100%100% Healthy, Healthy, Independent LivingIndependent Living

Chronic Chronic Disease ManagementDisease Management

Doctor’s Doctor’s OfficeOffice

Community Community ClinicClinic

HOME CAREHOME CARE

Assisted LivingAssisted Living

Skilled Skilled Nursing FacilityNursing Facility

RESIDENTIAL RESIDENTIAL CARECARE

Community Community HospitalHospital

ICUICU

Specialty Specialty ClinicClinic

ACUTE ACUTE CARECARE

COST of CARE/DAYCOST of CARE/DAY

QUALITQUALITYY

of LIFEof LIFE

Technology-Enabled CareTechnology-Enabled Care

Older AdultData

Service Provider

Adult Child

HealthcareProfessional

ServicesPersonal Health Maintenance

Preventive Interventions

Improved Communications

Analysis&

Archiving

CAST Focus Areas

– Pilots: Identifying needs that can be addressed by technology and accelerating applied research with older adults and aging service providers

– Policy: Identifying barriers to the proliferation of proven and appropriate technologies and advocating to remove these barriers (Federal and State)

– Standards: Promoting development of standards to ensure interoperability and widespread access to aging services technologies

– Education: Disseminating information and resources

State of Aging Services Technologies

Home for LifeHome for Life

Safety Wellness Health Socialization

Physical Environment

Supportive Services

Senior(Quality of Life)

Safety TechnologiesSafety Technologies

Wearable devices: (PERS, automatic fall detectors, fall prevention patches, tracking)

Safety TechnologiesSafety Technologies• Environment/Passive (motion-based

sensor monitoring systems, embedded fall-detection systems, stove use detectors, temperature/smoke monitors, safe lighting technologies)

Physical, Behavioral & Physical, Behavioral & Mental Health/WellbeingMental Health/Wellbeing

• Wearable devices (activity monitors, cardiac monitor, ambulatory blood pressure monitors)

• Environment/Passive (motion sensors based activity monitors, sleep/bed sensors)

Physical & Mental Physical & Mental Health/WellbeingHealth/Wellbeing

• Telemedicine/ Tele-health (biometrics: pulse, BP, glucose, temperature, weight; daily wellness check; 2- way video health consultations care coordination; medication compliance)

Physical & Mental Physical & Mental Health/WellbeingHealth/Wellbeing

• Medication Reminder systems – Portable (wrist watch,

pager), cell phones with pill reminders, dispensers (mostly unmonitored).

– Monitored dispensers

Reminder Systems/ Cognitive Orthotics

• Assisted way-finding using indoor localization data or GPS (CMU, Rochester, Michigan)

• Cueing on handheld devices (Rochester and Michigan)

• Coaching in activities of daily living (Toronto)

Social ConnectednessSocial Connectedness• Phones (amplified

phones, easy to use cell phones)

• Two-way video conferencing phone

• Entertainment/ Theraputainment (Cognitive and/or Physical exercise)

EHRs & Point of Care EHRs & Point of Care TechnologiesTechnologies

• EHRs• Point of Care

systems; Electronic clinical charting; Documentation systems; Shared care planning systems; e-Prescribing; e-MAR systems; bedside medication dispensing; Wound care applications.

Trends and RecommendationTrends and Recommendation• Convergence between different technologies

• Push for standardization:– Interconnectivity – Interoperability

• Providers are looking to adopt technologies that:– Are Versatile– Are Expandable (multiple peripherals from the same

vendor/ product pipeline) – Use open or known interconnectivity/ accepted

interoperability standards.

Results of Expert Results of Expert InterviewsInterviews

BarriersBarriers

• Perverse payment system

• Liability exposure for providers

• Shortage of workforce • Lack of cross state

licensure

• Shortage of funding

• Perceived intrusiveness- overemphasis on privacy

• Inverse relationship between the need for, and the ability to use, technology

• Lack of information systems’ interoperability and device interconnectivity.

RemediesRemedies

• Effective advocacy

• Evangelization of the vision

• Tapping into untraditional funding sources

• Better understanding of seniors attitudes towards technology

• Designing better technologies

Critical GapsCritical Gaps

• Lack of Awareness

• Technical Uncertainty

• Limited Evidence of Value

• Absence of Business Models

Business Model RealitiesBusiness Model Realities

• Stuck in legacy reimbursement/ payment mechanisms

• Critical need for integrated socio, cultural, economic model of care; may evolve more quickly in other countries

• Promising aspects of current models (VA, Kaiser, PACE, P4P, etc.), exist but hard to generalize to other systems

• Medicaid related programs may evolve more quickly due to extreme pressure.

• Introduced senate bill S.908, amendments to H.R. 6357, and provisions to the stimulus bill (ARRA)

• Participating in EHR standardization efforts on the national level

• Launched state technology policy initiative

• Launched pilots initiative to help providers objectively evaluate technologies, compile evidence to change reimbursement

• Creating knowledge and raising awareness: State of Technology reports, EHR in NH & HH

• Sharing provider stories, experiences and case studies.

CAST ActivitiesCAST Activities

• Definition of Health Care Providers inclusive of LTC

• Broad definition of Health Information Technologies (HIT)

• Study of the need for payment incentives for LTC providers

• Grants to States/ State-designated entities Requests for Proposals already issued

• Loans to care providers (uncertain)

• Study of Aging Services Technologies.

ARRA HIT ProvisionsARRA HIT Provisions

• Advocating to shape Grant RFPs to encourage active participation from LTC providers

• Advocating to ensure that any investment in the national infrastructure is inclusive of LTC

• Prepared a state advocacy template letter and Guide for LeadingAge States Affiliates and members:

– Get informed– Partner with acute care providers– Identify Health Information Exchange facilitators and

explore partnership on grants– Push the state to obtain stimulus funds and provide loans

to LTC providers

• http://www.LeadingAge.org/article_cast.aspx?id=10200

Now What?Now What?

Healthcare Reform BillHealthcare Reform Bill• Certified EHR Grant Program for Long-term Care

Facilities • Demonstration Project for Use of HIT in Nursing

Homes• Development of Medicare Part D Prescription

Dispensing Techniques in LTC Facilities • New Models of Care that leverage Technology

– The ‘‘Community Living Assistance Services and Supports Act’’ (CLASS Act)

– Use of Technology in New Cost Efficient Payment Models-Center for Medicare and Medicaid Innovation

– Use of HIT in Health Homes for Enrollees with Chronic Conditions

– Use of Technology in New State Options for Long-Term Services and Supports

Next Steps

Follow through on the agency level

The Near Future…The Near Future…

Robotic Assistive Robotic Assistive Devices Devices

• Robotic household• Smart robotic walkers• Robotic wheelchairs

(touch screen, voice, and even thought controlled wheelchair)

Robotic Doctor/ Nurse/ Robotic Doctor/ Nurse/ Assistant/ CompanionAssistant/ Companion

Robotic suitsRobotic suits

Advanced Materials and Advanced Materials and Smart Things!Smart Things!

……it’s closer than you it’s closer than you might think!might think!

Concluding Remarks- IConcluding Remarks- I• Technology is a tool that can increase staff

efficiencies, improve care coordination, improve accuracy and timeliness documentation (and hence impact the bottom line) in different care settings

• It has the potential to enable providers to deliver levels of services equivalent to assisted-living in the home cost-effectively and efficiently

• Keep your development projects grounded in reality and in the context of other systems

• Pursue interconnectivity and interoperability to facilitate integration with other systems

Concluding Remarks- IIConcluding Remarks- II• Conduct the research in partnership with the

target users in community settings

• Conduct objective assessment of the technology with focus on quality measures the ROI to the provider, as well as the payers

• Focus on translation aspects including: – Produce practical implementation guides – Explore new care delivery and sustainable business

models that may be feasible with today’s technologies, including financing options

– Effective dissemination with large provider communities: Peer to Peer, effective storytelling, social networking, etc.

• CAST and LeadingAge can help with dissemination among LTPAC providers.

u

Used two-way video to talk to her son and the grand children.

Wearable sensors transmit health vitals to healthcare professional.

Instrumented walker assesses gait and balance.

Electronic medication

caddy notified son she took

her medicine, so he did not have to nag

her.

Her senior-friendly cell phone has a

GPS chip, and an emergency

alert button.

Telemedicine helped her

send a picture of a scrape to

her doctor, avoiding a trip to the office.

I will wintoday.

Questions?Questions?Majd Alwan, Ph.D., VP CAST

LeadingAgemalwan@LeadingAge.org

(202) 508-9463www.LeadingAge.org/CAST.aspx