Empowering Communities for Successful Aging Developing and Deploying Aging Services Technology

1. Empowering Communities forSuccessful AgingDeveloping and Deploying Aging Services Technology Leo Asen Vice President Senior Communities Caring for Generations November 13, 2008

2. Presentation Objective • Introduce you to Selfhelp Community Services a large home and community based service provider in New York City • Review how Selfhelp is using new technologies within housing and community settings to support independent living • Provide resources and contact information

3. Celebrating Over 72 Years of Service • Founded in 1936 to assist refugees from Nazi persecution build new lives • Programs serve over 20,000 elderly and chronically ill in their homes and at over 20 program sites located in Manhattan, Queens, Brooklyn, the Bronx, and Nassau County • www.Selfhelp.net

4. Celebrating Over 72 Years of Service • Housing with services for over 1,000 low and moderate income seniors in six apartment buildings in Queens and provide services to four large NORC communities • Six Senior Centers – serve over 8,000 seniors; serve over 157,000 hot lunches; and delivered over 35,000 meals to clients homes • Provide case management, case assistance (over 7,000 seniors received case management services) • Programs for Alzheimer’s patients and their families (provide over 21,000 hours of adult day care services) • Provide services to more than 5,300 Nazi victims • A leading provider of home care services in the New York metropolitan area extending beyond the elderly and homebound to families with special needs

5. Changing environment Longevity, more chronic disease 76 million boomers Increasing caregiver stresses, long-distance caregiving Shortages of skilled professional staff Changing technology picture Industry and academia are innovating Non traditional players entering healthcare space Consumer and healthcare devices converge Promise of new products and services Our Environment is Changing Technology will be a key component of future service delivery

6. How is Selfhelp Responding? • Our CEO’s vision…. “…for our clients there should be a comprehensive and individualized array of technology based services to help them remain in their communities and maintain their independence …” • Creating a technology friendly culture • Implementing new technologies • Looking for partnering opportunities to develop and test new products and services (living laboratory)

7. Culture Change – Become Technology Friendly • Our approach is to: • Define priority technologies • Build internal credibility • Get stakeholders on board • Achieve results and build on wins • Share our experiences • Recognize it’s a journey and not a destination

8. Current Priorities • Current priorities include: • Computer learning centers • Technologies that promote cognitive strengthening • Remote monitoring of client health data (vital signs) • Remote monitoring of resident safety and security • A robust infrastructure • Recognize the list will change over time • Be prepared to capitalize on opportunities

9. Build Internal Credibility • Early corporate sponsor of CAST • International coalition of 400+ organizations • Dedicated to developing & promoting technologies to improve aging experience • Member of the CAST Commission • CAST wins include • Technology exhibits at the WHCOA and recent Senate Staff Briefing and Technology Demo • Research reports and task forces • Web site • Imagine the Future of Aging video • Networking opportunities • Advocacy

10. Get Stakeholders on Board • Senior Management • Established organizational objectives • Established a Technology Task Force • Board • Created a Board level Technology Committee • Recently we changed our Mission Statement: “…Selfhelp… will lead in applying new methods and technologies to address changing needs of its community…” • Workforce • Communications and engagement • Clients

11. Get Stakeholders on Board • Funders - advocate for technology $ with local elected officials and others. A new computer learning center: NYC Councilman capital dollars + a Board Member’s generous gift = success

12. Results and Wins to Date • Computer learning centers • Cognitive strengthening • Remote monitoring of client vital signs data • Remote monitoring of resident safety and security

13. Computer Learning Centers • Growth – 4 programs in 2005; 7 programs in 2006; 9 programs in 2008 • Part time instructors • Clients pay a small fee about $5/ hour • Intergenerational program with local middle school • Advanced class members are creating blogs

14. Cognitive Strengthening – Dakim[M]Power • A new activity for early stage clients in our social adult day programs called SHARP • A new activity for senior center members and housing residents • SHARP saw increase in client census +14% - Dakim helped • High client satisfaction - over 88% expressing opinions of “neutral” to “love it” • Unintended benefit – some housing residents use it to practice English

15. Are Seniors Ready for Monitoring Technology? • Eureka moment! • Is mom ok? Phone call identified a need….. • Interviewed over 20 pairs of residents and their family members from Housing and NORC programs to hear what they thought about wireless monitoring technology • They got it • Families told us -- “Could save his life” ”Whatever it would cost, if she wanted it we would pay” • Residents told us -- “Help me feel safe” “Would keep me out of assisted living” Willing to participate with us in a pilot project

16. Pilot Project - High Tech Help for High Touch Care • A six-month pilot test between May and November 2006 of the commercially available QuietCare product • Assess the impact of QuietCare as a support tool for social workers and family caregivers • Help staff understand that technology is just another tool • Assess impact on social workers’ relationships with clients and family caregivers • Learn how to generate value added services and increase revenue (business case)

17. Recruiting • Social workers recruited client volunteers and family members • Living alone and perceived to be “at risk” • No pets • Family or friend caregiver willing to be first responder • Selfhelp pays most of the cost plus small client volunteer copay • Client volunteers • 25 females, 4 males • Average age 85 years; ranged from 66 through 95 • Approximately 50% Selfhelp Housing 50% NORCs • Multiple medications (average 4.5) • Lots of paperwork for clients to sign - releases, etc.

18. Project Details • Our project team: • Senior Management Champions • 11 Social Workers, building management staff, IT infrastructure staff • The product vendor - Living Independently Group • The researchers - Behavioral Informatics Inc. • Social workers had a web based data collection tool • Social workers were free to take action or not • Training is essential • Conducted regular team meetings and case presentations • Infrastructure considerations • Many family members accessed the secure web site (with client permission)

19. Results • 26 clients completed the six months • System generated 172 alerts • 26% changes in eating • 22% late wake up • 13% change in activity • 13% long bathroom visits • Social Workers took 213 actions (avg. of 20 /Social Worker) • 69% phoned or visited client • 13% spoke with family

20. Post Project Interviews – Client Volunteers and Families • 19 face to face interviews with clients: • “… Peace of mind and enhanced communications; happy not to wear pendants or push buttons…” • “… I feel a little safer knowing in case of a fall, or something else happens, someone will be coming…” • 16 phone interviews with families: • “…It gives my mother the freedom to still be in her home…and protects her at the same time…” • “… The system helps keep us informed as to how our mother is doing, especially since she is living alone. It gives us emotional comfort…” • “ …I can monitor my mother from where I am which is 60 miles away…” • “Big brother” was not a concern Social workers liked it too!

21. Case Study - Extending Independence • 95 year old male living alone, very active • Daughter observed increasingly unsteady gait and periods of dizziness • Social worker and client’s daughter received alert indicating fall in the bathroom • Daughter rushed to apartment to find father lying on the bathroom floor and unconscious • Social worker contacted EMS, they arrived and revived father • Decided not to hospitalize but needed to be watched closely • Family asked Social Worker to increase home care hours to 24/7 • Since daughter had not planned to visit father until the next day without the system his life would have been at risk

22. Remote Monitoring of Health Data • Remotely collecting health data which is then regularly transmitted from the home to the health care provider (telehealth nurse) • Examples: • Blood glucose • Blood pressure monitoring • Weight • Telehealth nurse is alert to changes in the data that may provide early warning of a health problem or signal an impending crisis • Telehealth focuses on the individual’s long-term wellness, self-management, and health

23. Selfhelp Home care gets timely information from patients when they cannot be physically in front of clinicians Self-Reported Symptom Information “Live” Virtual Diagnostic Assessment via Video/Stethoscope Medication Compliance Information Biometric Information via telemonitoring devices Selfhelp Home Care collects, sorts and verifies raw data and presents it as critical, actionable patient information on the secure web portal that care managers can access from any internet connection in the world

24. Remote Monitoring of Health Data • Two-year grant from the New York State Department of Health • Objectives: • Improve patient self-care and adherence to goals • Decrease re-hospitalizations and inappropriate usage of emergency rooms • Results to date: • Since inception 73 patients have been enrolled on program • Unplanned visits have decreased :

25. Remote Monitoring - Outcomes Identifying a Patient’s Adverse Reaction to Medication • Selfhelp’s Telehealth Nurse was receiving frequent alerts for a blood pressure outside of identified parameters • After fully assessing the situation, the Telehealth Nurse called the patient’s physician to discuss the case, expressing concern that the problem was being caused by the antihypertensive medication the patient was taking • The physician was resistant to changing the patient medication, and thought the elevations were related to other factors. However, the patient’s blood pressure trending report showed that the elevations coincided with the intake of the medication • After reviewing the trend report, the physician ordered a change in the medication • Afterwards, the patient’s blood pressure gradually decreased within normal parameters, and the alerts stopped.

26. Sharing Resources • AARP Healthy @ Home  / Research Report March 2008 http://assets.aarp.org/rgcenter/il/healthy_home.pdf • CAST www.agingtech.org • State of Technology in Aging Services, http://www.agingtech.org/documents/bscf_state_technoloy_phase1.pdf

27. Sharing Resources • State of Technology in Aging Services According to Field Experts and Thought Leaders http://www.agingtech.org/documents/bscf_state_technoloy_phase2.pdf • State of Technology in Aging Services: Summary http://www.agingtech.org/documents/bscf_state_technoloy_summary.pdf

28. Thank You Leo Asen Vice President Senior Communities Selfhelp Community Services, Inc. lasen@selfhelp.net