Saturday, July 18, 2015

How the White House & Others are "Gauging Aging"

If you were to host a conference on aging, what would you put on the agenda?

And how would you talk about it?

I found myself mulling this over as I watched the first part of the White House Conference on Aging (WHCOA), which took place on July 13th.

What's your frame on aging? Start with the Gauging Aging report

It's especially interesting to consider the WHCOA in light of the recently published "Gauging Aging" report by the Frameworks Institute.

"Gauging Aging," simply put, is a report about the differences in how aging experts and the public think about aging. It's based on an in-depth analysis of how experts talk about aging and supporting an aging society, compared to how the public views the issues and the potential solutions.
By understanding the differences, experts can then get better as using communications that brings us to a shared understanding of the problems to be addressed,  in order to effect changes that are meaningful and beneficial. After all, narratives and ideas are important in framing how people perceive problems, and their options for addressing them.

Monday, July 6, 2015

Fascinating Facts on Family Caregivers: Highlights from Caregiving in the US 2015

If you follow aging and caregiving, then you've probably already heard about the major new caregiving report that was released last month: "Caregiving in the US 2015,"a joint effort from the National Alliance for Caregiving and AARP. The study was funded by AARP, Archstone Foundation, Eli Lilly, Home Instead Senior Care, MetLife Foundation, Pfizer, UnitedHealthcare, and the Family Support Research and Training Center in conjunction with the University of Illinois at Chicago.

Strangely, this report seems to have been hardly covered by the major newspapers. I say this is strange because the findings are incredibly important and should be part of the national discourse, instead of only being covered by aging and caregiving wonks.

After all, everyone knows someone who's struggling to help an aging spouse or parent. This nationally representative survey found that 18% of respondents were caregivers. Of those, most (79%) were helping an older person, as you can from this excerpt of the executive summary:

Caregiver prevalence & basic, from page 9 of the executive summary

The report also later notes that nearly half of caregivers provide care to someone age 75 years or older.

For this survey, caregiving for an adult was defined as providing "unpaid care to a relative or friend 18 years or older to help them take care of themselves." (For child care recipients, the survey sought to identify people providing care due to "medical, behavioral, or other condition or disability.")

Highlights from the executive summary

If you are involved in aging, caregiving, or even healthcare, I would strongly encourage you to review the report's executive summary. It is chock full of fascinating data, which I'll summarize below.

You should also consider signing up for the related webinar, which will be on July 15th from 2-3p EST. Sign up here.

Thursday, June 18, 2015

GeriTech's Take on AARP's 4th Health Innovation @50+ LivePitch

On Thursday May 14, 2015, AARP hosted its fourth Health Innovation@50+ LivePitch event, an event that "features the most exciting start-up companies in the “50 and over” health technology sector."

In this post, I'll list brief descriptions of the finalists, comment on how promising they seem to me -- in terms of improving the healthcare of older adults -- and tell you which products I'm most interested in. To see what I've thought of past LivePitch finalists, here's my coverage of the first, second, and third cohorts. (Now what would be interesting is to see what's happened to all those companies since, esp the winners. No time now to do it, but let me know in the comments if you have an update re a past LivePitch finalist.)

As usual, the start-ups were judged by venture capitalists and by a consumer audience. No judging or input from anyone whose primary work and expertise is to improve the health of people aged 50+.

See the FAQs for the eligibility criteria for this year. More interesting to me are the judging criteria and AARP's categories (also listed in FAQs):

"The Judges will focus on these five critical elements:
  • Functionality – Is the company’s product easy to use, and does it get the job done?
  • Potential – What is the company’s business model and likely profitability, size of the market, likelihood of adoption, and growth potential?
  • Team / People – What experience does the team have, and can they make the product or service a success?
  • Creativity/Differentiation – Why would someone use this product and/or service over alternatives?
  • Scalability – Is this a small business not capable of scaling or is it a large business that has a lot of growth potential?
The AARP Consumer voting will focus on these four critical elements:
  • Need – Why should consumers want this product? Does the product/service address a significant unmet or under-met need? Is it unique?
  • Marketing – How easy is it to get the product?
  • Usage – Why is the product easy to use?
  • Value – Why does the value and cost of the product makes it a “must have”? What is the value proposition? Would someone use it and/or refer it to family and friends?"
 AARP's Categories for Health Innovation @50+:
  • Medication Management
  • Aging with Vitality, e.g. increase daytime energy, maintain muscle strength, manage arthritis, improve or aid in memory/cognition, brain fitness improve/aid hearing, improve/aid vision
  • Vital Sign Monitoring
  • Care Navigation
  • Emergency Detection & Response
  • Physical Fitness
  • Social Engagement
  • Diet & Nutrition
  • Behavioral & Emotional Health
  • Other
Compared to last year's categories, AARP seems to have dropped the category of "aging in place." They still don't have a category about managing one's chronic health problems, which I would argue is extremely important to maintaining the health and wellbeing of people aged 50+.

AARP's list of this event's ten national finalists is here. They also had an additional group of five Florida finalists, which I won't have time to cover.

GeriTech's quick take on the AARP LivePitch finalists

Friday, June 5, 2015

Notes from the Institute on Aging's Tech Conference

Last week I attended another one day aging & tech conference. But it was very different in feel compared to most events I go to, because this one was not hosted by an organization with an entrepreneurial background. Instead, the event was hosted by an aging services non-profit: the Institute on Aging (IOA). (Conference agenda is here.)

For those who aren't familiar with the IOA,: it's a terrific organization that has spearheaded a number of innovations related to better care of older adults over the past 30 years, including launching the first fellowships in geriatrics and creating the Friendship Line, the nation's only crisis hotline to address isolation and suicide risk in seniors. (For more on the history of the IOA, see here.) The IOA has also often collaborated with the City and County of San Francisco on aging services.

This conference provided continuing education credits for nurses, social workers, therapists, attorneys, and residential facility providers. So the audience mainly seemed to be those individuals, rather than entrepreneurs and innovators.

This struck me as a bit of a pity, because the content of the talks seemed more focused on what aging people need -- rather than how to make your entrepreneurial venture succeed -- and I think the more entrepreneurs can hear about this, the better.

In truth, my overall impression was that this conference was "by the aging community, for the aging community" whereas most tech and innovation conferences are "by the innovation business community, for the innovation business community."

Is there a way to merge these two groups more?? I don't know the answer to that.

At the end of this post, I've embedded the Storify with all my tweets from the day, which hopefully will share a sense of the event, for those who weren't able to attend.

A few particular talks that I really enjoyed

Friday, May 22, 2015

Notes from the Aging 2.0 Global Innovation Summit

This past week, I attended the second Aging 2.0 Global Innovation Summit.

I wrote about the first one here. It's now a year later, and I would say that the health and aging experience of the average older adult still hasn't changed much.

But this perhaps isn't so surprising. It's been said that
"We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run."
So presumably we're on track. The aging innovation community certainly seems to be growing and expanding its horizons, and this year again, I heard about many intriguing ideas and technologies.

I did live-tweet most of the summit, so for details on what was covered and what technologies were presented on stage, see the Storify here, or below. (Full disclosure: Aging 2.0 graciously extended a complimentary invitation to me.)

In the rest of this post, I'll share some thoughts on what stood out to me during the conference.

Key Themes of the Aging 2.0 Innovation Summit

Friday, May 8, 2015

What PBS Forgot in its Caregiver Resources Section

As many know, family caregivers of aging adults are of extra-special interest to me. I've been studying their needs and creating health content for them since 2008, and these days I spend over half my time working on and a related site.

So I was thrilled to find out that PBS was releasing a special titled "Caring for Mom & Dad," which is premiering this month.

But then I took a look at the website, clicked "Caregiver Support," and I was a bit dismayed. Here are the resource sections I saw listed:

  • Getting Started
  • Managing Finances
  • Government Resources & Support
  • Workplace Resources & Support
  • Communicating with Family
  • Technology
Notice anything important that is missing? That's right. Nothing about how to manage health or medical. (Sorry, but the Medicare Nursing Home Locator does not count.) 

I also noticed there is nothing about addressing advance care planning, which is really crucial for family caregivers since nearly half of seniors require surrogate decision support during hospitalizations.

This is a disappointing oversight. Because as any family caregiver will tell you, they spend a lot of time dealing with health issues. 

This was confirmed by an important 2012 report published by the United Hospital Fund and AARP's Public Policy Institute. Titled "Home Alone: Family Caregivers Providing Complex Chronic Care," it reports that 46% of family caregivers are performing medical and nursing tasks.

And of course, underlying health issues are why families step in to help aging adults. If it weren't for health problems, then aging challenges would mainly be about things like dealing with losses and age-related discrimination and loneliness...all of which are very important but those are not why people end up having to take care of Mom and Dad.

Aging Problems, Caregiving Problems, & Health Problems Are Always Interconnected

I am going to say this again, mainly because it seems clear that it's not top of mind when people think about caring for aging relatives, and it really should be:

Friday, April 24, 2015

My Process for Meaningful Use & Chronic Care Management

What is actually involved, in providing good ongoing medical care to a frail older adult who is medically complex?

I've been thinking more about this, since earlier this week I attended a Code for America event about meaningful use. And in an interesting coincidence, Christopher Langston of the J. Hartford foundation published a blog post yesterday titled "Making Electronic Health Records Responsive to Needs of Older Adults (Really Meaningful Use)."

Now, since my consultative geriatrics practice is direct-pay and I've opted-out of Medicare, I don't have to use a certified EHR that is going to help me attest to meaningful use.

Nor do I have to figure out how to qualify for the new chronic care management (CCM) payment.

But of course I use my EHR (MD-HQ) very meaningfully. And the clinical work I do meets the 99490 criteria:

  • Multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient,
  • Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, 
  • Comprehensive care plan established, implemented, revised, or monitored. 
(The one criteria I don't meet is that I don't provide 24/7 access to my services, although all my patients can access their clinical information -- including detailed clinical notes -- via my patient portal. Because my practice is small, solo, and consultative, everyone has to have a PCP and that's who they can call after hours or on weekends. It's not ideal but oh well.)

Helping an older person with health is like managing a complex ongoing project

One could write a long book listing everything that goes into providing ongoing health help to an older adult.  Especially since this usually means also helping family, as well as the paid individuals providing assistance.

For an older adult with functional impairments, it's easy to have a very large number of people involved, when you consider specialists, home health, family, residential facility staff, paid in-home caregivers, geriatric care managers, etc. And usually we have lots of ongoing health issues to collectively address.

So those are the circumstances in which I usually do my doctoring. In this post, I'm going to focus on what I've noticed when it comes to what I need from my EHR, and my personal clinical workflow.

First of all, it's important to have a way to capture and store all the relevant data that emerges between face-to-face visits. This includes things like: