Two generations of computer-savvy gamers and networkers have teased their parents and grandparents about a lack of technological skill, but the coming “silver tsunami” of aging Americans may claim ultimate victory by conjuring up the wizards of digital health.
In what is being called “connected independence,” more seniors are staying right where they want to be – at home – where they receive medical care assisted by technology that monitors chronic disease, provides early detection of illness, reminds seniors to take pills, coordinates care among providers, and may even improve cognitive function using “brain fitness” programs.
This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.
As Baby Boomers hit retirement age, both homes and assisted-living facilities are being outfitted with new technology that reduces medical costs, comforts patients, and limits the time relatives must take to supervise their elders.
One of the most immediate and powerful uses of technology in healthcare – often termed telehealth – is Remote Patient Monitoring (RPM). Home devices monitor cardiac function, glucose levels, blood pressure, and other vital signs. Patients fearful of recurring episodes of cardiac arrest or diabetes are relieved to know that they have constant supervision.
Also gaining popularity are devices for “medication adherence” – taking the proper dose of prescription drugs at the right time.
Unlike the latest Apple product release, however, awareness about technical solutions for the aging is relatively scarce – for both the public and doctors.
“We find the awareness level of telehealth solutions is pretty low,” said Lynn Redington, senior program director for the Center for Technology and Aging. Headquartered in Oakland, the national center increases awareness and interest of technology solutions for the aging largely through grants.
That awareness level is sure to rise along with the age of Californians. The state estimates that by 2040 more than 10 million of its 54 million citizens will be aged 65 and over – one in five.
While these figures terrify healthcare providers already overwhelmed with elderly patients needing round-the-clock care, others view this tidal wave as an opportunity to streamline healthcare delivery and sell products.
At the Oregon Center for Aging and Technology, participants test new technology in real-world living situations.
The center’s Living Laboratory monitors 30 Portland-area residents in their homes who test new monitoring and assistance products to see how well they work, and whether they’re ready to market.
The goal is to track habits of health and movement to give caregivers a better health picture than the simple snapshot in time of an office visit.
“The most useful comparison (of health) is how that elder is doing compared to themselves six months ago,” said Tracy Zitzelberger, the lab’s administrative director. Instead of providing doctors an imprecise verbal health history, elder patients will now have precise data so doctors can provide truly personalized medicine.
Far from being averse to technology, she says, the elderly embrace it, especially when it improves their health and keeps them connected with distant friends and relatives.
“The kids say ‘This is kind of Big Brother,’” said Zitzelberger, “but elders get it.”
The man seen by many as the evangelist behind this movement is Eric Dishman, Intel’s director of health innovation, who in the 1990’s saw how technology could cure many ailments in the elder care health system.
Voted one of the 100 Most Creative People in Business 2011 by Fast Company magazine, Dishman has said that modern healthcare delivery is founded on a wildly outdated notion from the 1850s: that patients must meet doctors face-to-face.
At Intel, Dishman has supervised thousands of hours of ethnographic studies, visiting homes to find out what motivated and worried patients.
Colleague Douglas Busch said these “ethnographic harvest sessions” gave Intel a “deep sense of what these products need to do.”
During the same period, General Electric’s health division saw the same worldwide business opportunities in treating the aging with new technology.
So in January, the two corporate giants formed Intel-GE Care Innovations, where Busch now serves as chief operating officer.
Headquartered in Roseville, a suburb of Sacramento, the firm currently offers four products: a monitor that collects vital signs, a device that tracks patient movement and provides alerts if an elder falls, a wellness and social networking hub for assisted-living facilities, and a reader for dyslexics that translates text to spoken words.
Busch says the feedback the firm gets from patients who use their vital sign monitor is often dramatic. “It feels like they have a better relationship with their care provider,” he said, with many seeing it as an essential component of their family’s health. And Busch says online wellness portals, even in smaller retirement communities, “help build a tighter community.”
There are many companies already addressing what Busch calls “a nascent market,” with more on the way. “If you look at the demographics, the numbers are mind-bogglingly large,” said Busch. “The market opportunity is attracting a lot of people.”
But there are still several obstacles ahead.
The costs of these technologies generally aren’t covered by Medicare, and only rarely by health insurers. Most family doctors aren’t tech-savvy enough to promote at-home technologies. In some cases, there’s the potential that systems could harm patients if they don’t work properly. Finally, there are concerns that technological gadgets replace human interaction, leaving the elderly more cut off from society at a time of great vulnerability.
Redington said concerns about technology causing further isolation are largely groundless. Typically, patients are also in contact with nurses or doctors by phone and see remote monitors as “sort of a guardian angel.”
Many studies have already shown the cost savings in patient monitoring to prevent recurring episodes of chronic disease like heart failure, and health experts say it’s only a matter of time before health plans see the savings potential.
“It’s in the best interests of private health plans to apply these tools to control costs,” said Busch. Busch said Medicare executives will likely follow the lead of health plans if they start to reimburse for these new digital tools.
Provisions of the Affordable Care Act that take effect in 2014 “are encouraging,” Busch added, because they reward both innovation and prevention.
“You can prevent a hospitalization that will save you thousands.” Zitzelberger agreed.
The longer aging Americans stay at home, the less expensive the cost of healthcare. Busch estimated that costs rise dramatically from the $10/day for providing care at home to $10,000/day in an Intensive Care Unit. Between these extremes are costs for hospitals, assisted living, and skilled nursing.
Keeping the elderly in their homes is beneficial to everyone concerned about costs: families, healthcare officials, and government policymakers trying to balance budgets.
Telehealth also helps patients with transportation woes; monitoring healthcare conditions at home removes the strain from family members who often need to take time off from work, and often escalates family tensions.
Technology can “alleviate a lot of the running around that people have to do,” said Murch.
AgeTech California is a collaborative effort of home care providers seeking to make technology-based health services available to seniors who want to live independently for longer periods.
California has “by far the highest” number of family caregivers nationwide, said AgeTech executive director Scott Peifer, and they spend on average $5,500 of their own money yearly, while suffering from further economic and personal stress when the conditions of their patients worsen. Faced with reduced reimbursements and higher transportation costs, family caregivers can use at-home monitoring to help them make smart interventions to prevent recurring episodes, especially of chronic disease.
The national readmission rate for patients within 30 days of hospital discharge is 18%, Peifer said, with more than three-quarters of these preventable. The cost to Medicare alone in 2004 was $17.4 billion.
The Eskaton assisted living community, a Sacramento-area neighbor and technology partner of Intel-GE Care Innovations, currently uses “passive monitoring” to track patterns of movement by its residents.
“If a resident starts going to the bathroom 10 times a night maybe they’re developing a urinary tract infection,” said Todd Murch, Eskaton’s president and CEO.
In 2008, Eskaton built a demonstration home with design elements focused on independent living. The home caught the attention of several technology partners, and changed Eskaton’s approach to technology solutions for the aging.
“We started thinking different strategically,” said Murch.
Despite Murch’s enthusiasm about technological solutions for the aging, he says adoption has to be done incrementally. Some residents, for example, want to know if there’s a camera in their monitoring systems. There is not, says Murch.
Murch is most excited about digital “health portals” that allow residents to connect with families and research to expand their sense of belonging using online wellness hubs. At Eskaton, many seniors are excitedly using Skype to connect with distant friends and relatives. The key to better health, says Murch, is keeping clients engaged and connected to their surroundings.
Several telecommunications companies are fueling the spread of mHealth – disseminating health information using mobile applications like cell phones and iPads.
Redington says California is on par with a handful of other states in its advancement of technology to address health issues, pointing to San Diego in particular.
San Diego is home to both Qualcomm, which is creating health applications for mobile devices, and the West Wireless Health Institute, a nonprofit research organization.
The city also received more than $15 million as one of 17 “beacon communities” to improve its health information technology from the Office of the National Coordinator for Health Information Technology.
Collectives of concerned healthcare groups and businesses are sprouting up everywhere, most recently the Global Coalition on Aging, which plans to foster a better understanding of the “new middle age” — Americans between 55 and 75 – as both healthy and wealthy contributors to society.
With charter members including Bank of America Merrill Lynch, Microsoft, Johnson & Johnson and Pfizer Pharmaceuticals, the coalition wants governments and businesses to see this demographic as both powerful and important contributors to the workplace and economy.
When the UC Davis Medical Center opens its Telehealth Resource Center next summer, the four-story, $36 million building will be used to train “the next generation of clinicians how to use home telehealth technologies (which) expand the reach of healthcare and can help address important needs in a rapidly increasing population,” said Thomas Nesbitt, associate vice chancellor for Strategic Technologies and Alliances at UC Davis.
Busch says the future promise of technology to revolutionize healthcare for the aging is enormous. He hopes that going to a doctor to have vital signs checked, or waiting in line to have a prescription filled, will seem arcane.
“My hope over the next 25 years is that the way we do healthcare and age in our home changes so we can look back and say ‘Oh my god, I can’t believe we did that.’”