Aging Services Technologies: Today and the Near Future

1. Aging Services Technologies: Today and the Near Future Majd Alwan, Ph.D., VP CASTLeadingAge 19th Annual Cellar Conference on Technology and Aging Aging 2.0 -- Technology, Trends and Transitions Friday, April 8th, 2010

2. What is CAST? Providers ofAging Services Tech Industry Partners University Researchers CAST Associations The Center for Aging Services Technologies is a national coalition of more than 400 organizations working together to improve the aging experience through technology

3. The Trends

4. HOME CARE Healthy, Independent Living 100% Community Clinic Chronic Disease Management Doctor’s Office RESIDENTIAL CARE ACUTE CARE Assisted Living QUALITYof LIFE Specialty Clinic Skilled Nursing Facility Community Hospital ICU 0% $1 $10 $100 $1,000 $10,000 COST of CARE/DAY “Shift Left” through Technology

5. Technology-Enabled Care Services Personal Health Maintenance Service Provider Analysis & Archiving Older Adult Data Adult Child Improved Communications Healthcare Professional Preventive Interventions

6. 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

7. State of Aging Services Technologies

8. Safety Wellness Health Socialization Home for Life Senior (Quality of Life) Supportive Services Physical Environment

9. Safety Technologies Wearable devices: (PERS, automatic fall detectors, fall prevention patches, tracking)

10. Safety Technologies • Environment/Passive (motion-based sensor monitoring systems, embedded fall-detection systems, stove use detectors, temperature/smoke monitors, safe lighting technologies)

11. Physical, Behavioral & Mental Health/Wellbeing • Wearable devices (activity monitors, cardiac monitor, ambulatory blood pressure monitors) • Environment/Passive (motion sensors based activity monitors, sleep/bed sensors)

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

13. Physical & Mental Health/Wellbeing • Medication Reminder systems • Portable (wrist watch, pager), cell phones with pill reminders, dispensers (mostly unmonitored). • Monitored dispensers

14. 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)

15. Social Connectedness • Phones (amplified phones, easy to use cell phones) • Two-way video conferencing phone • Entertainment/ Theraputainment (Cognitive and/or Physical exercise)

16. EHRs & Point of Care Technologies • 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.

17. Trends 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.

18. Results of Expert Interviews

19. Barriers 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. Remedies Effective advocacy Evangelization of the vision Tapping into untraditional funding sources Better understanding of seniors attitudes towards technology Designing better technologies

20. Critical Gaps • Lack of Awareness • Technical Uncertainty • Limited Evidence of Value • Absence of Business Models

21. Business 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.

22. CAST Activities • 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.

23. ARRA HIT Provisions • 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.

24. Now What? • 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

25. Healthcare 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

26. Next Steps Follow through on the agency level

27. The Near Future…

28. Robotic Assistive Devices • Robotic household • Smart robotic walkers • Robotic wheelchairs (touch screen, voice, and even thought controlled wheelchair)

29. Robotic Doctor/ Nurse/ Assistant/ Companion

30. Robotic suits

31. Advanced Materials and Smart Things!

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

33. Concluding 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

34. Concluding 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.

35. u I will win today. Used two-way video to talk to her son and the grand children. Electronic medication caddy notified son she took her medicine, so he did not have to nag her. Wearable sensors transmit health vitals to healthcare professional. 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. Instrumented walker assesses gait and balance.

36. Questions? Majd Alwan, Ph.D., VP CAST LeadingAge malwan@LeadingAge.org (202) 508-9463 www.LeadingAge.org/CAST.aspx