Aging in Place
Definition
"Aging in Place” is a broad term that defines living independently – that is, living where the patient decides to live – which typically is at home and not in an institution, such as a nursing home, assisted living facility, or even a hospital. It has been estimated that more than 95% of seniors over the age of 75 have expressed a desire to age in place as long as possible. As millions of baby boomers retire and age, the marketplace is already beginning to develop to offer a multitude of products and services to help seniors age in place. Products ranging from smart homes to private duty home care services and everything in between are arriving on the scene to meet this budding consumer demand.
Home Care Technology and Aging in Place
Home care by its very definition helps people to age in place. In addition, home care technology provides essential tools to permit aging in place on a widespread, cost-effective scale. There are many examples of how technology is being deployed to achieve greater patient outcomes and lower the overall cost of care delivery. Examples of such technology include Telehealth/Remote Monitoring, Telephony, Point-of-Care, Scheduling, and other Operations Management Software.
Remote patient monitoring or telehealth is an all-inclusive term that encompasses a number of high-tech applications that involve providing care for patients remotely. The applications can range from monitoring a person’s heart rate while working out on a treadmill in a fitness club to transmitting a patient’s telemetry readings to a nurse over the Internet. There is a wide variation in terms of the types of clinical conditions that can be monitored, how often the conditions should be monitored, and, whether the monitoring should occur real-time or periodically.
Remote patient monitoring systems can be used to collect and transmit the physiological data of patients with chronic diseases, such as diabetes, asthma, hypertension, and congestive heart failure – some of the costliest and most prevalent chronic diseases in the US, and is being used very effectively for the individuals enrolled in disease management programs.
A high-resolution camera can be used digitally to bring a healthcare provider into the patient’s home, which is particularly beneficial in wound-care management and chronic disease monitoring requiring face-to-face interaction with a healthcare provider. The technology also allows the health care provider to communicate with their patients, make changes to their behavior or diet on a real-time basis, and then monitor their physical reactions to those changes.
New technologies allow the telenurse to use his/her time to care for patients instead of driving. TeleCare cannot replace those times when direct, hands-on care is required, but a survey by TeleMedicine Today (Allen, 1997) reported about 50% of home care visits reviewed could have been done by TeleCare. This provides a solution to the sheer volume of seniors who will need home care in order to age in place.
What the Future Holds
TeleCare systems are being integrated into new concepts of caring to assure access to compassionate and consistent care across the continuum. The new strategies will look beyond hospital, home health, assisted living, or skilled nursing facility, as we have known them. TeleCare entrepreneurs are implementing strategies to provide case management across these environments with the main goal of keeping patients in their preferred environment as long as possible.
TeleCare centers will be developed to follow patients with terminal, chronic, or long-term diseases. They will be available to provide health care -- no matter where the patient is located -- with the goal to provide access and continuity of care as long as the patient requires such care. TeleCare centers and staff will be a central link for patients, their doctors, and their families. This technologically enhanced continuity of care is available should be embraced by health care organizations to improve quality of care.
Help for Rural Areas
Home care delivered in rural areas by nurses and aides is expensive due to the added time of long driving distances and the increasing cost of fuel. With the severe nursing shortage we are experiencing in this country, there are not enough qualified caregivers to meet current or future demands. With these barriers in place, aging in place in rural areas may become a luxury only for the very wealthy.
Other Essential Technologies
One the biggest challenges facing home care providers today is managing the logistics of service delivery, which is Scheduling. Many computerized systems used advanced software technology to assist the provider in mapping out and determining the most efficient and effective methods of service delivery. These systems have the capability to analyze several key variables that affect the way care is scheduled for the home care patient. Some of these important factors include the patient’s location, personal preferences, clinical needs, physician orders, HR compliance, payer source requirements, and nurse availability. All of these factors and others can have great impact on how caregivers are deployed in the home.
Once in the home, the caregiver is responsible for delivering the prescribed care and ensuring that the visit has been properly executed. Depending on the level of care, the caregiver is required to collect and report on information gathered during the visit. This reporting requirement places a tremendous "paperwork” burden upon the provider. Home care technology plays an important role in enabling the provider to collect the information required for reporting, tracking, benchmarking, and analyzing. Point-of-Care technology allows the nurse to collect necessary information essential to home care delivery. In addition, this technology can provide the nurse with the appropriate clinical pathway based upon the patient diagnosis. Following these clinical pathways, greatly improve the quality of care and allows the provider to evaluate patient outcomes better.
In addition to technologies aimed at improving home care at the Point-of-Care, Telephony can provide another important methodology for data collection and care monitoring. Typically, telephony systems utilize the patient’s telephone to report the exact start and stop time for each visit. Other data elements can also be collected via telephony such as basic vital signs, care performed, mileage and other essential to the provider’s operations. Telephony systems can operate via voice recognition or digitally using the telephone key pad. With the concern for fraud in our healthcare system, telephony is a simple and cost effective technology to combat such fraud within home care.
Home care technology extends from the patient’s home to the provider’s back-office. Many software systems are designed to automate the HR, billing, payroll, and other accounting requirements for the provider. These systems take into account all of the various rules and regulatory requirements imposed by a vast array of payer sources including; private pay, Medicare, Medicaid, HMO, insurances, Managed Care programs and others. In addition, these systems enable providers to remain HIPAA compliant while managing sensitive and confidential patient information. Utilizing advanced Internet technologies, many of these systems make available relevant and secure information via the provider’s own website in a portal format servicing the patient, caregiver, and physician populations.
There are many examples of how providers throughout the home care industry have adopted these and other technologies to better manage their operations and improve patient care. However, today’s home care provider faces many operational and clinical challenges that will continue to grow as the baby-boomers come of age. Providers must seek technological solutions to these challenges in order to provide patients with the means to age in place both cost effectively and comfortably.
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