caregiving - independa · the burden of informal caregiving on families is ... telecare uses...

CAREGIVINGAT THE CROSSROADSA proven case for change: Using technology

to reduce the cost of long term care.

RICHARD D. DELLA PENNA, MD

CAREGIVING AT THE CROSSROADS2

Executive Summary

The Current Situation

What Can Be Done?A Proven Case To Replicate In The United States

Technology Will Play A Starring Role

Putting The Technology Puzzle Pieces Together

But Will It Get Used?

The Time Is Now & The Answer Is Here

Conclusion

TABLE OF CONTENTS0305

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3 CAREGIVING AT THE CROSSROADS

EXECUTIVE SUMMARYThe leading edge of the post-World War II “Boomer“ generation turned 65 years of age in 2011, a milestone that marks the start of a huge demographic shift with far-reaching implications and opportunities for organizations, governments and individuals.

As the “Boomer” generation move into their advanced years, we will see a significant amount of human and economic costs associated with the loss of independence. The vast majority of this aging population will make great efforts to stay independent and live at home for as long as possible, even as the need for care increases.

Statistics show that 89% of seniors want to age in place and live out their lives without having to move from their homes, but more than half, 53% are concerned about their ability to do so 3.

In this paper, we will explore the significant challenges facing older adults and their caregivers and offer practical solutions that meet those challenges. The recommendations in this paper will greatly reduce government and individual health care expenses while greatly improving the quality of life for caregivers and care receivers alike, which today is estimated to be over 90 million Americans.

The good news - modern technology exists that can keep older adults healthy, happy, connected and independent at home longer. These technologies delay reliance on expensive “sick care” or long-term supportive services, postponing and even eliminating the need for in-home care or transition to assisted living facilities.

89%of seniors want to live out their lives without moving from their homes, but more than half are concerned about their ability to do so.


In 2008, there were close to 40 million adults 65 and older1. By 2050, this number will increase to almost 90 million2 or 20% of the entire U.S. population. Despite their wishes and best efforts, the 89% of Americans who want to stay in their homes to live out their lives will eventually experience increasing frailty and dependence before they die.

Advanced age increases the reliance on friends, family, community and institutions to perform the tasks older adults can no longer do alone. This increasing reliance often brings with it a sense of burden and fear of dependence which may result in older adults not asking for help in a timely fashion resulting in dangerous situations, hospitalization and accelerated loss of function.

According to AARP in 2013, family caregivers provided 7 billion hours of care to adults with limitations in daily activities. Over 40 million adults eighteen and over provide informal (unpaid) support to older adults and those with disabilities living in the community.

But what does it mean to care for an older adult? For those with less dependency, independence could be help with a single task or activity, anything from general monitoring, appointment coordination, medication management and housework. But for those with a severe disability, independence may come from assistance with eating, bathing and dressing. Regardless of the level of care, caregivers provide emotional support, encouragement and socialization to the care recipients.

With the right technology, we could reduce the anguish, complexity and costs to informal caregivers and provide a higher level of care engagement, even when the caregiver is unable to be with the care recipient.

The value of the informal caregiver workforce is estimated at $470 billion a year6, far exceeding the combined annual costs for nursing home and home health care. The annual out-of-pocket expense for the average family caregiver is more than $5,5005.

THE CURRENT SITUATION

With the right technology, we could reduce the anguish, complexity and costs to informal caregivers and provide a higher level of care engagement.

CAREGIVING AT THE CROSSROADS5


Economics aside, informal caregiving can cause serious psychological effects on the caregiver as a result of the high levels of stress and frustration of caring for an older adult. Informal caregivers often exhibit higher levels of depression and exhibit lower levels of

self-care which negatively impacts their health7.

The burden of informal caregiving on families is not equal. It is estimated that 66% of family caregivers are women who often need to leave the workforce to provide the necessary care to a loved one8. This reality creates wage losses, less contributions to social security and may result in withdrawing from family savings.

The burden of informal caregiving affects the nation as well. Caregiving is surely contributing to the unemployment rate and if left unmanaged, will become a considerable concern in coming years. When caregivers continue to work, some amount of time is spent on the job monitoring, coordinating care and worrying about their loved one, resulting in “presenteeism”, which can have significant impact on a company’s output. This unfortunate reality affects our country’s output by as much as $34 billion annually9.

$5,500The annual out-of-pocket expense for the average family caregiver.


One answer to the healthcare crisis in America is telehealth, defined as “the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living”.

Telecare uses high-tech devices to monitor and support the elderly, disabled, or those with mental health issues. These devices help individuals live independently within their residences, either at home or in a senior living community. Telehealth offers peace of mind for caregivers and those in need of care with access to 24-hour support services allowing for a fast response in case of an emergency. The United Kingdom and Scotland have made major investments in telecare.

In 2000, the Town Council of West Lothian, Scotland had the vision to transform care of older people at home with the introduction of ‘Smart Technology’. The aim was to increase independence and enable people to stay at home longer, while reducing the costs and anguish related to doing so. West Lothian had two motivations for engaging in this project:

1) The desire of their aging constituency to remain at home for as long as possible

2) The need for the Scottish government to produce significant net savings by having the constituency spend less time in costly facility-based care

The West Lothian program used an array of activity, environmental and safety sensors, incuding things like blood pressure and glucose monitors, weight scales and pulse oximeters, connected to a 24 hour call center.

The results were stunning. From 2002–2006, the average time older adults spent in facility-based care settings dropped from 36 to 12.4 months due to delayed placements.

WHAT CAN BE DONE? A PROVEN CASE TO REPLICATE IN THE UNITED STATES

The Town Council of West Lothian, Scotland had the vision to transform care of older people at home with the introduction of ‘Smart Technology’


As of May 2010, there were 4,200 older adults with telecare services living in 3,500 homes in West Lothian. Based on West Lothian’s successful programs, Scottish national policy now calls for the spread of telecare services across the country.

A cost benefit analysis of the spread of Telecare Development Programs performed for the Scottish Government for the period March 2007–April 2008, showed an impressive positive return on investment based on cost savings of $22.5 million for 7,902 enrollees, half of whom were 60 and older. This is equivalent to $2,850 per participant per year11. Participants enrolled in the program were highly satisfied.

THE IMPLICATIONS FOR PRIVATE AND PUBLIC FINANCES ARE SIGNIFICANT


TECHNOLOGY WILL PLAY A STARRING ROLE

“Baby Boomers” are surprisingly adept when it comes to technology with approximately 80% using a computer or smartphone. 63% say they provide some kind of help or support for their parents, but only 14% say they have looked into technology solutions that would help ensure the health and safety of their parents. Interestingly, we find that half of these older

parents are open to using new technologies to enable independence, including having sensors installed in their homes to monitor their health.

Personal emergency response systems or (“PERS”) used for summoning help when older adults fall at home have been available for more than three decades. PERS systems include sensors that capture data of prolonged inactivity, use of kitchen appliances, home environment and sleep patterns.

The problem with most PERS systems is that they narrowly focus on monitoring specific biometrics such as glucose level, blood pressure, oxygen saturation and weight as part of chronic disease management programs. There are several solutions on the market that monitor and improve medication adherence, safety and

other in home metrics, but are niche, one-off, silo’d products, that can be complicated to set up and more complicated to monitor separately without a central dashboard.

There are a number of single point technology solutions for senior care, each being relevant, but not sufficient to provide an important holistic benefit. Instead of helping the caregiver and care recipient, these single point solutions are actually compounding the greater problem.

80% OF BABY BOOMERS USE COMPUTERS OR SMARTPHONES.


What we desperately need is an integrated approach to care. An integrated solution provides one architecture for defining alerts, managing thresholds, and centralizing data inputs from the various care solutions including PERS.

An integrated dashboard and monitoring solution could include:

PUTTING THE TECHNOLOGY PUZZLE PIECES TOGETHER

Reminders for medications, calendar events, and activities of daily living

PERS (Personal Emergency Response System)

Remote monitoring of vital signs and other biometric data

Remote monitoring of activities and environmental data

Social engagement with easy access to video chat, messages, and photos


This integrated dashboard would allow for key facets of the care recipient’s life to be supported, including:

Health – threshold-based monitoring of biometrics, essential for timely intervention particularly for those managing chronic conditions

Safety – threshold-based monitoring of activity and environmental data, received from completely passive, cost-effective wireless sensors

Emergency Response

Social Engagement – the number one challenge for aging adults

MENUSSURVEYS

CALENDARS

CONTENT

CONCIERGE

PHOTOSCHAT

VIDEO


Equally important to the integrated approach is the consideration of how care recipients, professional care providers, friends and families will engage with a given technology. Technology devices commonly used by younger generations like smartphones and tablets, are of little value and often confusing to older adults; they simply haven’t been raised on them.

The right solution not only needs to be integrated, but also accessible to the senior, leveraging technology they are already familiar with. This presents a two-sided challenge:

Baby boomers are comfortable with smartphones, computers, and tablets, but their parents are more familiar with platforms like the TV or basic telephone.

Caregivers need access to an integrated dashboard, but accessible through the technology they use daily, like the smartphone, computer, or tablet.

Bridging the technological gap between generations is difficult, but not impossible. With the proper understanding, empathy and patience, software companies can create tools and services that improve the health and wellbeing of both caregivers and care recipients at an affordable price.

BUT WILL IT GET USED?


THE TIME IS NOW & THE ANSWER IS HERE

Recent developments in sensor, wireless and cellular technologies have expanded the potential for meaningful applications. However, to ensure widespread adoption and usage, the criteria for eldercare technology solutions should include:

Affordability

Scalability

Person-centeredness

Transparency

Usability

Integration

IndependaTVe™ is an integrated platform that enables a holistic approach to “supported independence” that is accessible by all participants in the continuum of care, spanning a wide range of functions and benefits including:

Central management of alerts

Customized threshold settings

Community event notifications

Smart reminders (birthday reminders, doctor appointments, medication reminders)

Social engagement technology to keep the care recipient connected with their loved ones

Rated #1 in senior care technology by Senior Housing News, IndependaTVe™ successfully bridges the generation gap, by using technology that is both familiar and easy to use - the television. Independa allows for a more holistic approach to care that helps aging adults stay independent and at home longer.

IndependaTVe™ successfully bridges the generation gap, by using technology that is both familiar and easy to use

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CONCLUSIONThe U.S. demographics and current trends in health care all point to a case for change in the senior care industry. Technology is a key element of bringing about the business and care model changes required for seniors to fulfill their most common desire of living independently for as long as possible.

Technology must be integrated and accessible by everyone in the care circle in order to fully realize its potential. As a society, we must continually invest in technological solutions that provide assistance for our caregivers and improve the quality of life for our older generations.

Implementing a simple solution as Scotland’s West Lothian’s did, could result in significant economic and welfare improvements in the United States, where there is a much larger and growing population of care receivers and caregivers. If we can employ solutions that delay facility-based placement, we will yield significant return on investment, decrease caregiver burden and improve the quality of life for older adults and their caregivers.


IndependaTVe™ is the world’s first and only integrated cloud-based care system that uses a TV platform designed specifically for seniors,

caregivers, and care teams.

ABOUT INDEPENDA

http://www.independa.com/request-demo#.Via6KxCrTBI

http://www.independa.com/tv-for-seniors-brochure#.Via6NRCrTBI


SOURCES1. U.S. Census Bureau: Population Estimates (2008). Retrieved July 14, 2010, from http://www.census.gov/popest/.

2. U.S. Census Bureau: Projections of the Population and Components of Change for the United States: 2010 to 2050. Retrieved July 14, 2010, from http://www. census.gov/population/.

3. Prince Market Research: Aging in Place in America (2007), Retrieved on July 14, 2010 from http://www.marketingcharts.com/direct/seniors-fear-loss- ofindependence-nursing-homes-more-than-death-2343/.

4. Paul A. London and Associates and Strategic Affairs Forecasting: State Medicaid Expenditures 2008-2027 (2008).

5. AARP (2008). Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update, retrieved July 13, 2010, from http://nfcacares.org.

6. National Alliance for Caregiving in collaboration with AARP (November 2009). Caregiving in the United States. Retrieved July 13, 2010 from http://nfcacares.org.

7. Family Caregiver Alliance. Population at Risk. Retrieved July14, 2010 from http:// caregiver.org.

8. National Alliance for Caregiving and Evercare (March 2009). Evercare Survey of the Economic Downturn and Its Impact on Family Caregiving. Retrieved July 13, 2010, from http://nfcacares.org.

9. National Alliance for Caregiving And MetLife Mature Market Institute (February 2010). MetLife Study of Working Caregivers and Employer Health Costs. Retrieved July 13, 2010, from http://nfcacares.org.

10. Prince Market Research: Aging in Place in America (2007), Retrieved July 14, 2010 from http://www.marketingcharts.com/direct/seniors-fear-loss- ofindependence-nursing-homes-more-than-death-2343.

11. York Health Economics Consortium at York University: Scottish Government Final Evaluation Report (2009). Retrieved July 14, 2010 from http://www. jitscotland.org.uk/.

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