Aging by Design

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• Aging by Design
• BENTLEY COLLEGEWaltham, MA
• September 27 28, 2004

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Technology Caregiving

• Aging by Design

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• John Rother Director
• Policy Strategy

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U.S. Caregiving Challenge

• MORE PEOPLE
• Better care
• For less cost

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Number of Medicare eligibles
2004
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The shrinking ratio of caregivers
Caregivers available
For each sick person
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11 for 1990 10 for 2010
6 for 2030 4 for 2050
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U.S. Caregiving Challenge

• More people
• BETTER CARE

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Some results of AARPs first-ever poll of people
with disabilities 50 and older
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Of majority who receive care, it is from an
unpaid FAMILY MEMBER
Data from Figure 37 50.3
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 pro
vides 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
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Of majority who receive help, it is from an
unpaid family member who is a SPOUSE or CHILD
Data from Figure 37 50.3
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 pro
vides 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
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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
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Family caregivers

• Where will they get information?
• How can they partner efficiently with
  professional providers?
  
• How can they continue their own employment?

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Poll asked about worries concerns People with
disabilities 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.
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If home care services are needed, 50 with
disabilities prefer their OWN CONTROL over money
and management of home care workers (vs agency
control)
78
53
Table 26
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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?

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The recipients of care

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

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Large numbers of 50 withdisabilities 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 S
urvey of Persons 50 and Older with Disabilities,
September 2002
VERY/SOMEWHAT SEVERE
SLIGHT/MODERATE
50-64
65
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• Can technology help those in institutional
  caregiving settings?

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Todays nursing home residents have MORE SEVERE
limitations
Figure 20 Percent of Nursing Home Residents Age
65 and Older at Various Levels of Disability,
1984-1999
Source Urban Institute analysis of the National
Long-Term Care Survey for AARP Public Policy
Institute
. . .which require more monitoring and attention
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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 www.medicare.gov
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Better care Computer technology a key to
improved QUALITY

• Better record-keeping, record access
• Better-informed medical practitioners and
  hands-on caregivers
  
• Auto-reminders of tests, procedures, medications,
  turning due patients

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Better care Computer technology a key to
improved QUALITY

• Better record-keeping, record access
• More accurate transfer of information
• Prescribing
• Diagnostic tests
• Concurrent treatments

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Better care Computer technology a key to
improved QUALITY

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

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Bring computer technology into the exam room
Better care

• Diagnostic checklists
• Data bases of best practices
• Computerized prescriptions, lab orders
• Automated patient records (AMR)
• Easy-to-use by stressed professionals
• Ability to track outcomes economically

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Better care Extent cost of medical errors
widespread

• The IOM found that as many as 98,000 preventable
  deaths a year occur in hospitals due to
  medical errors
  
• Many of these could be eliminated with
  well-designed information systems

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U.S. Caregiving Challenge

• More people
• Better care
• For LESS COST

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Health spending has taken off
Real Average Annual Growth in Health Spending
8.1
1 year
6.2
5.2
Source National Health Expenditures
Percentage rise
1 year
3.4
4 years
6 years
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Chronic care management key to a large segment
of cost
Less cost
100
30 of costs for 1 of people
80
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Health Care Dollars Spent
10 of costs for 70 of people
40
20
0
20
40
60
80
100
Percent of Population
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Inappropriate care adds risk and expense
Less cost

• 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

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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

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A HEALTH INFORMATIONSYSTEM
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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

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Envision an adequate health information system

• Speeding and adding accuracy to
  professional-to-professional consultation
  
• Reminding patients when to take meds, report for
  tests, renew Rxs
  
• Better provider-patient communications

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Concerns

• Privacy issues
• Cost to individuals providers to participate
• Will technology promote or impede
  patient-caregiver trust?
  

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Four Policy Recommendations

• Need for national health infrastructure
  standards
  
• Must create a funding mechanism

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Four Policy Recommendations

• Must create a system that involves patients more
  fully in their own care
  
• Formulated in a way that will support appropriate
  healthcare decisions

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Technology Caregiving

• Aging by Design