Computer-Based Technology & Caregiving for Older Adults

1. Computer-Based Technology & Caregiving for Older Adults National Conference Natcher CenterNIH CampusBethesda, Maryland October 2-3, 2003

2. Computer-Based Technology & Caregiving for Older Adults John RotherDirector Policy & Strategy

3. U.S. Caregiving Challenge • Give more people • Better care • For less cost

4. U.S. Caregiving Challenge • More people

5. Number of Medicare eligibles 2003

6. The shrinking pool of caregivers Caregivers available For each sick person - - ^ 11 for 1990 10 for 2010 6 for 2030 4 for 2050 - - - - - - - - - - -- - - - - - - - - - - ^ - - - - - - - - - -

7. U.S. Caregiving Challenge • Give more people • Better care

8. Some results of AARP’s first-ever poll of 50+ with disabilities

9. Of majority who receive help, it is from an unpaid family member (spouse or child) Figure 37 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

10. 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

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

12. Poll asked those with disabilities about their worries & concerns, 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.

13. If home care services are needed, 50+ with disabilities prefer own control over money and management of home care workers (vs agency control) 53 53 53 25 27 24 Table 26 Q. Home care services paid for by the government could be provided in several different ways. I’m going to describe three possible ways that the government could pay for home care services. Then I will ask you the option you would prefer if you needed these services. If you needed these services, which of these three options would you prefer? Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities, September 2002

14. 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?

15. The recipients of care • How can we design technology to promote better partnership among physicians, the caregiving team, the patient, and her family?

16. 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 Survey of Persons 50 and Older with Disabilities, September 2002 VER/SOMEWHAT SEVERE SLIGHT/MODERATE 50-64 65+

17. How about those in the formal caregiving settings?

18. Today’s 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 requires more monitoring and attention

19. 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

20. Better care Computer technology a key to improved QUALITY • Better record-keeping, record access • Better-informed medical practitioners and “hands-on” caregivers • More accurate transfer of information • Prescribing • Diagnostic tests • Concurrent treatments • Auto-reminders of tests, procedures, medications, turning due patients

21. Better care Computer technology a key to improved QUALITY • Not only in long-term care, but in hospital settings and outpatient care

22. Better care Bring computer technology into the exam room • Diagnostic checklists • Data bases of best practices • Computerized prescriptions, lab orders • Automated patient records (AMR) • All easy-to-use by stressed professionals • Plus, ability to track outcomes economically

23. Better careExtent & cost of medical errors widespread • Recent IOM Report suggested that as many as 98,000 unnecessary deaths a year occur in hospitals due to medical errors • Many of these could be prevented with well-designed computer technology

24. U.S. Caregiving Challenge • Give more people • Better care • For less cost

25. Health spending has taken off 7.5% 6.3% National Health Expenditures Percentage rise 3.8% 6 years 1 year 1 year Real average annual growth in health spending

26. Less cost Chronic care management key to a large segment of cost 100% 30% of costs for 1% of people 80 60 % Health Care Dollars Spent 40 10% of costs for 70% of people 20 0% 20% 40% 60% 80% 100% Percent of Population

27. Less cost Inappropriate care adds risk and expense • 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

28. Less cost Inappropriate care adds risk and expense • Tracking and publishing outcomes improves care • Measuring outcomes at reasonable cost requires computerized data systems, patient records

29. A HEALTH INFORMATIONSYSTEM

30. 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

31. Envision an adequate health information system • Speeding and adding accuracy to professional-to-professional consultation • Reminding us when to take our meds, report for tests, renew Rx’s • Storing for easy retrieval all the medical information in the world

32. Concerns: • Privacy issues • Cost to individual to participate • Will technology promote or impede patient-caregiver trust?

33. Four policy recommendations: • Need for national health infrastructure standards • Must create funding mechanism

34. Four policy recommendations: • Must create a system that involves patients more fully in their own care • Formulated in a way that will support appropriate decisions

35. Computer-Based Technology & Caregiving for Older Adults National Conference Natcher CenterNIH CampusBethesda, Maryland October 2-3, 2003