Aging by Aging by DesignDesign
BENTLEY BENTLEY COLLEGECOLLEGE
Waltham, MAWaltham, MA
September 27 & 28, 2004September 27 & 28, 2004
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
-
-
-
-
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
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: