https://www.ajmc.com/conferences/whcc-2019/the-intersection-of-technology-and-care-management-ensuring-optimal-aging-at-home
The Intersection of Technology and Care Management: Ensuring Optimal Aging at Home

Jaime Rosenberg

More and more, older adults are choosing to receive care in their homes rather than in the hospital. While technology has a role in aiding home-based care for older patients by allowing providers to implement remote monitoring, these technologies must be met with care management for outcomes to truly be improved, according to a panel discussion at World Health Care Congress 2019.

When people hear telehealth, they often think of virtual health visits, but it’s much more than that, explained Scott Code, associate director, LeadingAge Center for Aging Services Technology. The term also encompasses remote patient monitoring, educational disease-specific content, medication management, activity and daily living monitoring, and safety technology. But, there is the question of what we do with all this data once it’s collected, Code said.

Meanwhile, Russell K. Portenoy, MD, executive director for MJHS Institute for Innovation in Palliative Care, and chief medical officer of MJHS Hospice and Palliative Care, cautioned that a large proportion of these technologies are in a constant search for well-defined patients with well-defined diseases or conditions, which isn’t the case for older and sicker populations who have an array of clinical, social and behavioral issues.

With most of these technologies, there’s also the question of how a patient, caregiver, or organization chooses which one to use in the home. It has to be something that patients want to have, said Alice Bonner, PhD, RN, former director of the Division of Nursing Homes at CMS; senior advisor on aging at the Institute for Healthcare Improvement; and adjunct faculty and director of Strategic Partnerships at Johns Hopkins School of Nursing.

And not every patient may be comfortable with being monitored all the time, she said. So, it’s also important to not skip past simpler kinds of home monitoring, such as lowering the heights of cabinets so older adults aren’t reaching up to grab something or adding an extra stair bannister so that there’s rails on each side.

With this shift to home care, many are recognizing the need for bridging the gap between the hospital and the home, and this means an understanding that the key care team member might not be the physician, said Bonner. It might be a nurse or an occupational therapist or a community health worker.

“We can’t do a good, thorough assessment in the office with this population that has multimorbid, complex care, and palliative issues,” said Bonner. “You have to see them in their environment, see where they’re living. You’ll see things you didn’t expect.”

Bonner also emphasized the importance of models of care that help the transition from the hospital to the home, such as PACE (Programs of All-Inclusive Care for the Elderly), a Medicare program that helps patients get their healthcare needs in the community rather than going to a nursing home or other care facility. She also highlighted Johns Hopkin’s CAPABLE (Community Aging in Place—Advancing Better Living for Elders) Program, designed for low-income seniors, which utilizes a care team consisting of a nurse, occupational therapist, and handyman to meet the needs of these patients and improve the home environment to enhance safety.

However, a rift still exists between healthcare and community-based care, and if the healthcare system continues to operate in silos, we’re never going to solve for this, said Bonner who urged healthcare organizations to engage with community-based programs, such as local Area Agency on Aging. Healthcare organizations also need to incorporate social connectedness into programs for these patients, who often report feeling lonely or isolated. If patients are not socially connected, they will not age optimally, according to Code.

When thinking about the technology being implemented in the home, Code explained that there needs to be the proper infrastructure in place to allow for this use when shifting to the home. For example, many older adults may not have the financial means to have broadband in their house, which these technologies rely on.

“If you want people to stay at home, you need to have a connection to them,” he said.

Another theme that emerged from the discussion was the importance and value of palliative care, and the misconceptions that often surround it. Too often, palliative care is associated with death and dying while these services are actually implemented to help patients live well with their illness, said Portenoy. And, he said, palliative care reduces utilization, not because it takes away disease management, but because it empowers the patient and their caregiver to make informed treatment decisions based on their values and priorities, he said.
 
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