Download Better care

Aging by
Design
BENTLEY
COLLEGE
Waltham, MA
September 27 & 28, 2004
Technology & Caregiving
Aging by
Design
John Rother
Director
Policy & Strategy
U.S. Caregiving Challenge

MORE PEOPLE

Better care

For less cost
Number of Medicare eligibles
Percentage of Total Population Age 65+
25%
% Age 65+
20%
% Age 85+
15%
2004
10%
5%
% Age
65+
Ye
ar
19
00
19
10
19
20
19
30
19
40
19
50
19
60
19
70
19
90
20
00
20
10
20
20
20
30
20
40
0%
% Age
85+
Source: U.S. Census Bureau, middle series projections and historical data, U.S.
The shrinking ratio of caregivers
Caregivers available
-
-
-
-
-
- -- -
-
^
-
-
-
-
-
For each sick person
-
-
-
-
^
-
-
-
-
-
-
-
-
-
-
-
11 for
10 for
-
1990
-
2010
6
for
-
2030
4
for
-
2050
U.S. Caregiving Challenge

More people

BETTER CARE
Some results of AARP’s first-ever
poll of people with disabilities
50 and older
Of majority who receive care, it is
from an unpaid FAMILY MEMBER
100%
80%
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
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
60%
100%
40%
80%
20%
60%
0%
PAID
40%
20%
0%
FAMILY
FRIEND
OTHER
UNPAID
Of majority who receive help, it is
from an unpaid family member
who is a SPOUSE or CHILD
MOTHER/FATHER IN LAW
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
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
DAUGHTER/SON-LAW
SIBLING
CHILD
SPOUSE/PARTNER
0%
20%
40%
60%
80%
100%
Most caregivers LIVE WITH
person helped
100%
Figure 38: Living
Arrangements of
Persons 50 and Older
Who Receive Help
with Daily Activities
80%
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
60%
40%
20%
0%
Caregiver lives with
person
Caregiver does not live
with person
Family caregivers



Where will they get
information?
How can they partner
efficiently with
professional providers?
How can they continue
their own employment?
Poll asked about worries & concerns
People with disabilities’ No. 1 answer:
LOSS of INDEPENDENCE and
Becoming
MOBILITY
housebound
Decrease/loss
of assets
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.
Unable to pay
Loss of
Mobility
65+
50-64
Loss of
Independence
0%
10%
20%
30%
40%
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
25
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?
The recipients of care

How can we design
technology to promote
better partnership
among physicians,
the caregiving team,
the patient,
and her family?
Large numbers of 50+ with
disabilities are computer users
Figure 53
65+
30%
20%
10%
0%
50-64
60%
50%
40%
By Age
SLIGHT/MODERATE
70%
VERY/SOMEWHAT SEVERE
90%
80%
By severity
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
Can
technology
help those in
institutional
caregiving
settings?
Today’s nursing home residents
have MORE SEVERE limitations
50%
Figure 20: Percent of
Nursing Home
Residents Age 65 and
Older at Various Levels
of Disability, 1984-1999
40%
Source: Urban Institute analysis of the
National Long-Term Care Survey for
AARP Public Policy Institute
30%
.20%
. .which require more monitoring
1984
1989
and attention
10%
1994
1999
0%
1
2
3
4
5
6
ADL ADLs ADLs ADLs ADLs ADLs
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%
15%
With
infections
10%
With pain
5%
With
pressure
sores
In
restraints
0%
Residents of Nursing Homes
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
Better care
Computer technology a key to
improved QUALITY
Better record-keeping, record access
• More accurate transfer of information
 Prescribing
 Diagnostic tests
 Concurrent treatments
Better care
Computer technology a key to
improved QUALITY
•Not only in long-term care,
but in hospital settings and
outpatient care
Better care
Bring computer technology
into the exam room

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
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
U.S. Caregiving Challenge

More people

Better care

For LESS COST
Health spending has taken off
10%
Real Average Annual Growth in Health Spending
8.1%
8%
5.2%
6%
4%
3.4%
1
6.2%
year
1
year
4
years
2%
6
years
0%
19931998
19992001
20012002
20022003
Less cost
Chronic care management key to
a large segment of cost
80
60
40
20
0%
% Health Care Dollars Spent
100%
30% of costs for
1% of people
10% of costs for
70% of people
20%
40%
60%
Percent of Population
80%
100%
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
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
A HEALTH
INFORMATION
SYSTEM
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-toprovider interaction
Envision an adequate
health information system



Speeding and adding
accuracy to professional-toprofessional consultation
Reminding patients when
to take meds, report for
tests, renew Rx’s
Better provider-patient
communications
Concerns:



Privacy issues
Cost to individuals &
providers to participate
Will technology
promote or impede
patient-caregiver trust?
Four Policy Recommendations:
1. Need for national health
infrastructure standards
2. Must create a funding
mechanism
Four Policy Recommendations:
3. Must create a system that
involves patients more
fully in their own care
4. Formulated in a way that
will support appropriate
healthcare decisions
Technology & Caregiving
Aging by
Design