What Accenture Says Seniors Want re Health & Technology

From http://newsroom.accenture.com/news/tech-savvy-seniors-want-online-options-to-access-care-from-home-accenture-survey-shows.htm

 

This week I almost fell out of my chair when I came across Health Populi’s recap of an Accenture survey on seniors and healthcare technology.

The particular finding that surprised me was this one:

  • 3 in 5 older people are likely to join an online community to check a clinician’s advice before taking it on

Really??

I was surprised since as far as I can tell, it doesn’t cross most people’s mind to look for an online community to check a clinician’s advice, although I do think it’s become quite common for people to look things up on WebMD and at MayoClinic.

Of course, I’d be thrilled if more people would adopt an e-patient approach and do some double-checking before accepting a doctor’s advice. This is a good way to make sure you’ve explored other options, and can help reduce medical errors. But sorting through information online takes skills, as does bringing up what you found to the doctor. (Doctors should be amenable, but many are not.)

Accenture’s press release for the survey is here. I found this finding striking too:

  • A third of seniors would prefer to work with a patient navigator to manage their healthcare. Last year, $384 million was invested in solutions, like patient navigators, for care navigation.

Interesting, no? Does this represent a failure of primary care for seniors? Shouldn’t the role of a good PCP is to be a navigator for choices and health strategy? (People also often want help managing healthcare logistics, which is something that could be done by a medical home, a care manager, etc.)

Other findings Accenture highlights are:

  • “More than two-in-three seniors prefer to use self-care technology to independently manage their health”
  • “More than three-in-five seniors are willing to wear a health-monitoring device to track vital signs, such as heart rate and blood pressure”
  • “A quarter of seniors regularly use electronic health records for managing their health, such as accessing lab results (57 percent)”

Accenture seems to conclude that the “top five areas for growth” are self-care, wearables, online communities, navigating healthcare, and health record management.

What to make of Accenture’s findings?

Over ten thousand adults aged 65+ were surveyed for this report (in May-June 2014) but only 354 were U.S. Medicare beneficiaries. That’s because this is a survey of seniors in ten countries, assessing “their perceptions of using technology to manage their health.”

The press release didn’t have a link to Accenture’s full report, much less the survey questions they actually asked.

Personally, I found these results intriguing but they also seem a bit tech-optimistic, as does much in the digital health arena.

One could raise endless methodological questions about this press release: How representative were the respondents of other seniors in their country? Were there differences by country? What are the seniors thinking of when they hear “self-care technology” and what does it mean to “independently manage their health”?

And how much does the Accenture team know about the best way to help seniors manage health, and health problems?

Consider this, from the press release:

“The survey showed seniors who place a higher priority on technology are more likely to proactively manage their health. For example, most seniors (75 percent) who value technology are active in tracking their weight digitally, compared to 43 percent of those who do not. Similarly, half of tech-savvy seniors are actively monitoring their cholesterol, compared to 31 percent of those who do not value technology.”

Wow. This is a good example of data that doesn’t help you solve useful problems. (If you’re a clinician that is; I guess this might help businesses figure out who they should market their products to.)

Clinically, I am perplexed by what it means for seniors to “actively monitor their cholesterol.” Unlike monitoring weight and exercise, monitoring cholesterol is something they can’t do without partnering with doctors. Sometimes I think business people act as if managing health is like managing your banking or travel plans: just give me a good website and I’ll conveniently take care of it myself! But once people have active health problems, it’s much more complicated.

So what to make of Accenture’s report? My main take-away is that interest in senior health technology is on the rise. Whether or not Accenture is right, it’s interesting to see how they are framing the digital health needs for the people we care for.

[Many thanks to Carla Berg for bringing this survey to my attention. Do read the Health Populi piece; it includes data from the Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees, published in February 2015.]

A Tale of Two Sore Throats: On Retails Clinics & Urgent Care

[This post was first published on The Health Care Blog on 1/28/15, and was re-posted to KevinMD on 2/21/15. The comments are worth reading at both sites.]

Six
years ago, just after arriving in Baltimore for a winter conference, I fell
sick with fever and a bad sore throat.
After
a night of feeling awful, I went looking for help. I found it at a Minute
Clinic in a CVS near the hotel. I was seen right away by a friendly NP who did
a rapid strep test, and prescribed me medication. I picked up my medication at
the pharmacy there. The visit cost something like $85, and took maybe 30
minutes. They gave me forms to submit to my California insurance. And I was
well enough to present my research as planned by day 3 of the conference.
Fast
forward to this year. After feeling a bit blah on a Monday evening, I developed
a sore throat, headache, and fever overnight.
I
figured it was a winter viral pharyngitis, rearranged my schedule, and planned
to make it an “easy day.” Usually a low-key day plus a good night’s sleep does
the trick for me.
But
not with this bug. This one gave me chills, a splitting headache, body aches, a
fever of 102, and a sense of serious misery. Plus that awful sore throat. A
dose of ibuprofen 400mg would beat back the symptoms a bit, and allow me to eat
and sleep. But after about four hours, I’d find myself shivering and feeling
horrible again.
And
the following day, Wednesday, I felt even worse. I started wondering if maybe I
had the flu, or could it be strep throat, since I didn’t have a cough?
I
thought about going to the doctor, but I felt so sick and I didn’t want to go
through the hassle unless there was a decent chance of benefit.
Because
in truth, even though I get my care from a large well-regarded health system
that offers online appointment scheduling, a portal to review my outpatient lab
results, telephone advice nurses, and other conveniences, I still don’t like
going in because it’s a big place and the experience never feels…delightful,
shall we say.
I
looked through UpToDate online and tried to figure out the likelihood that a
doctor’s visit would change management (most adult pharyngitis is viral) but my
mind was too fuzzy and so I stayed home in bed.
However,
that night my husband said he was starting to get a sore throat. I also spoke
to a doctor friend on the phone. She thought my symptoms sounded an awful lot like
strep, and urged me to go in and get a rapid strep test. I decided that if I
didn’t feel a lot better by the next morning, I’d go in.
I
was a little better the next morning (day #3 of my illness) but not a lot. The
body aches were better, but I’d developed a killer earache, and it still hurt
too much to eat unless I had recently taken ibuprofen. My temperature off
ibuprofen remained 101-102.
So
I called the phone appointment line, explained my symptoms, and was given an
appointment to see my own assigned doctor. (No urgent care clinic available I
was told; this health system encourages open access to your own doctors.)
As
I had expected, it was a miserable hassle.

The big facility’s big underground
parking lot was full but they kept letting cars in, so I found myself along
with twenty other cars on the bottom floor, with a staffer waving his arms and
telling us to find a way to turn around.

My
doctor’s waiting area was pleasantly uncrowded, and after I’d paid my $20
co-pay I was called by the medical assistant (MA) right away. This, I’ll admit,
was nice. “How’re you doing?” she asked as we walked to the vitals station.
“Sick,”
I replied. “That’s why I’m here. I haven’t felt this bad in years.”
The
MA made a sympathetic noise, checked my vitals, and then put me in an exam
room. She asked me to tell her about my symptoms, which I did.
And
then she proceeded to quiz me about my lifestyle habits. Did I exercise
regularly? Just what type of exercise do I do? How many times a week? And for
how many minutes? What about drinking? How many times a week? How many drinks
in an evening?
Now,
I have always found it intrusive and annoying when clinic staff ask me these
types of questions. I know why they do it and why it’s overall important, but
as a patient I’ve always disliked it.
This
time, having come for an acute care visit after feeling miserably sick for
days, I was seriously annoyed. I have a low BMI, low blood pressure, and a
beautiful lipid profile. (I credit genetics/epigenetics.) In other words, I am
not in dire need of lifestyle interventions. But I gave the MA some brief
answers and in truth I inflated my exercise levels a bit, because I didn’t want
them to get on my case, or get distracted from my top priority, which was
getting my illness evaluated.
A
few minutes later, my doctor arrived. I had to repeat the story of my symptoms.
She listened to my lungs and peered in my throat. And then she announced she
would do a throat culture.
What?
What about a rapid strep test, I wanted to know.
“This
is a rapid test. It’s a rapid throat culture which gives us results in 6-8
hours. We don’t have any other strep tests.”
I
looked at my watch. It was 11:40am. “Let’s get your culture in to the lab,”
said my doctor. “If they start running it soon, we might have a result by
evening. You can check online and if it comes back positive, call the advice
nurse and they’ll have a doctor order your prescription, which you could pick
up tonight.”
I
sat there, sick, spaced out, and very disappointed that there wasn’t a rapid
strep test available.
My
doctor handed me a paper bag. “Take this to the lab on your way out.”
It
took me a little while to process this last bit. Not only did they not have a
rapid strep test, but they were now telling me to go deliver my sample to the
lab. Helpfully, the doctor gave me a “After Visit Instructions” handout, on
which she had checked “Specimen drop off: Please take a number and the next
available receptionist will help you.”
I
went to the lab. The waiting area was overflowing with people. I took a number
(361) and then discovered they were now serving number 329; there were at least
30 people ahead of me. There was no bin or spot to drop off my specimen, so I
sat huddled in a chair as my ibuprofen started wearing off and my fever
returned.
It
took them twenty-five minutes to call my number. I had to tell them my name and
address, and give them my ID again. “No co-pay required today!” the
receptionist announced brightly. I told her I’d been waiting quite a while just
to drop off a specimen and why didn’t they have a bin? She apologized and said
they used to have something like that, but then the space was rearranged and
they took it away. I consoled myself thinking that since I’d dropped off my
specimen at 12:25pm, hopefully I’d have a result by 8:30pm.
I
went home to my bed and my ibuprofen. That evening I started checking the
portal online. No result. No result. No result. I took more ibuprofen and spent
another restless night with fever, sore throat, and earache.
The
next morning, I checked again. Hallelujah! A positive strep culture! Which, I
noticed, had been reported at 9:45pm after the specimen was “collected” at
1:57pm.

I called the advice
nurse, she arranged for the phone doc to call in my prescription, and then I
had to schlep back to the health center to get my penicillin. And finally that
afternoon, I started to really feel better.

Should I go to a retail clinic next time?


I
don’t like being sick but it’s always instructive to be on the patient side of
things.
Because
my PCP didn’t offer a rapid strep test, my treatment was delayed by almost 24
hours. I lost an additional day of work and some income. My beleaguered spouse
took care of our two little kids on his own for an extra day. Plus it’s not fun
to have fever and a splitting earache.
All
of these problems are a big deal to me. But they are an externality for the big
organization that manages my healthcare. Rapid-strep tests can be expensive for
a provider; only 5-15% of adult pharyngitis is strep so unless you are
selective about who gets tested, you end up with a lot of negative rapid tests
that often get followed by a throat culture.
As
for making your patients drop off their specimens at an over-crowded lab,
well…it’s quite easy to see how that happens in a big organization. (Presumably
it’s cheaper or easier than having staff do it.) I didn’t like it but I’m not
going to leave the provider over that.
I
will, on the other hand, probably go look for a retail clinic next time I’m
acutely ill and think I might have a treatable infection. I haven’t yet decided
just how much a day of health is worth to me, but it’s surely more than the
cost of a retail clinic visit minus my $20 copay.
Now,
you may be scoffing and thinking that since I’m a doctor of course I can afford
a retail visit. But if you have low socio-economic status, a day not working
can be an even bigger deal than it was for me. When I worked a salaried doctor
job I had paid sick days, but that’s not true for
many workers
.
However,
I would be worried if many older adults with chronic health problems started
going to retail clinics. That’s mainly because I’m skeptical that retail
clinics can provide the right care – whether acute or chronic – to people who
are medically complex and getting care from other providers.
I
also worry that retail clinics will over-prescribe antibiotics and other
medications, in part because patients often want these things.
Of
course, more conventional primary care urgent care clinics suffer from the same
problems. Over-prescribing
of antibiotics

is common in outpatient care, and medically complex people often get
sub-optimal care during acute and chronic visits. So perhaps it’s not fair to
bash retail clinics excessively, until our primary care clinics get much better
at what they do.

What constitutes good urgent care?


No
matter what one’s age or medical history, one should be able to access a good
urgent care experience when acutely ill. By good, I mean that:
·        
The encounter
involves a minimum amount of friction and burden.
I put off my
own doctor’s visit because I was reluctant to face the hassles while feeling
sick. Imagine if I were employed and had cancelled an additional day of clinic,
in part because I was sick and avoiding the hassle of my doctor’s office. My
employer and patients would’ve been upset, and rightly so.
·        
Delays in
diagnosis and treatment are minimized
. Even when delays in treatment aren’t
medically dangerous, they impose a serious burden on patients when the delays
affect ability to work or care for others.
·        
Diagnosis and
treatment are in accordance with recommended practices
. It can be hard to agree on the finer
points of what is recommended practice, but in general, care should be similar
to what is recommended in UpToDate, for instance. Avoiding over-prescribing of
antibiotics is an issue in all urgent care settings.
Should
patients be quizzed about healthy lifestyle habits during an urgent care visit?
This would be an interesting topic to debate, as it requires weighing
population health benefits with patient satisfaction.
Will
I go back to my PCP next time I need urgent care? Maybe, but if I think it’s
strep again, I’ll probably look for a reliable urgent care provider who offers
rapid strep tests. For working adults who aren’t medically complex, convenience
and minimum delays in treatment are key.

Resolve to Become Fit for Frailty & Do Great Things in 2015

This week I came across a fantastic resource that I want to recommend to any and all who are serious about solutions to support aging adults. (Or healthcare, for that matter, since older adults are the power users of healthcare.)

It is the Fit for Frailty report, the second part of which was recently released by British Geriatrics Society.

Part 2, “Managing Frailty” is particularly important, as implementing good care is generally much harder than identifying those in need of better care. (Focus on the constraint, people. Implementation is almost always the constraint.)

For geriatricians, this is a nice resource summarizing the best of what we do. If you’re in geriatrics, read it and enjoy.

But I think this is especially valuable for the entrepreneurs, innovators, and health problem-solvers who are interested in aging.

Your job, as I see it, is to take the best of what we know and do in geriatrics, and make it more easily doable by everyone: older adults, families, communities, clinicians with no particular training in geriatrics, and even geriatricians. (I am eternally in need of tools that will make doing what I’m trying to do easier.)

Now here is a wonderful document that outlines how we go about modifying healthcare so that it’s a better fit for frail older adults.

Thinking you’re interested in older adults but not frail older adults? Think again.

Although frailty does have its own characteristics and isn’t the same as being old, or having multiple chronic conditions, products and services that meet the needs of the frail are the healthcare equivalent of universal design.

That is to say, the approaches we’ve developed for frail older adults — like carefully weighing the benefits and burdens of medications, and tending to the needs of the family — are generally good for all patients.

Plus, frailty is strongly correlated with healthcare utilization, so if you develop tools to better help frail older people, someone might be willing to pay for them.

Must-reads from the Fit for Frailty report

The whole report is worth reading, but below are the some highlights from the sections I think are especially important:
  • Managing frailty” This page summarizes the core components involved in optimizing the health of a frail older person. I actually think most of these are good for all patients. Shouldn’t we “ensure that reversible medical conditions are considered and addressed” for everyone? Same goes for establishing systems to share health information. Of course, great comprehensive healthcare is expensive and studies usually find it’s not economically worth it unless you target “high-risk” patients. But some of these strategies are things that “low-risk” people could do for themselves, or perhaps use health savings account funds for.
  • Comprehensive Geriatric Assessment: This page details what’s involved in a geriatric assessment. Again, much of it sounds like things that are sensible to consider for all patients. The domains to check include:
    • Physical symptoms
    • Mental health (which includes cognitive function)
    • Level of function in daily activities (oh wait, that sounds like the macrofunction in my recent “What is health” model).
    • Social support networks currently available, both “informal” (family & friends) and “formal” (social services). This report doesn’t include online patient communities but that’s becoming an increasingly more common form of social support, although your online peers generally won’t check your symptoms or pick up your medications for you. 
    • Living environment, which includes mention of “ability and tendency to use technology.” (yeah!)
    • Level of participation and individual concerns. “i.e. degree to which the person has active roles and things they have determined are of significance to them (possessions, people, activities, functions, memories). Will also include particular anxieties, for example fear of ‘cancer’ or ‘dementia’. Knowledge of these will help frame the developing care and support plan.” In other words, understanding what’s important to a person!
    • Compensatory mechanisms and resources that the person uses to respond to having frailty. For non-frail adults, it is generally relevant to figure out how they are compensating for whatever health problems they have, although we routinely neglect to ask about this in a rushed primary care environment.
  • Holistic Medical Review: This is basically a comprehensive review of one’s health problems, and the current management plan. This means a careful check on the chronic medical problems, and thoughtful assessment to identify new health problems. This also includes a medication review. In other words, this is basically what one’s annual physical exam should involve, but often doesn’t.
  • Individualized Care & Support Plans: This page describes the key characteristics of a good care and support plan (CSP). I love love love that it’s described in part as an “optimisation and/or maintenance plan,” because that is exactly what is involved when it comes to older adults: optimizing rather than curing. Particular highlights include:
    • Determining what the person’s goals are
    • What actions are going to be taken
    • Who is responsible for doing what
    • The timescale and plan for follow-up and review
    • An escalation plan which describes what patient and caregivers need to look out for, and what to do. 
For more commentary on the Fit for Frailty highlights, also see Dr. Muriel Gillick’s excellent blog post on the topic, Learning from the Limeys.

Help and Innovations Needed

Needless to say, it’s currently hard to do the things above consistently. Even geriatricians struggle, because it’s there’s a lot to cover and keep track of.  (I’ve often thought that what we need is to build on project management software for care and support plans.)

Understandably, it’s hard to come up with tools that are a good fit for the complexity at hand, esp since healthcare as usual is already spectacularly ill-suited to properly managing complexity and allowing patients to participate.

But at least we now have a good resource to summarize what we can work towards. Fit for Frailty offers a blueprint for the kind of comprehensive person-centered care that everyone can benefit from.

Is your work fit for frailty? Shouldn’t it be?

The Trouble with Home Health Care & Care Coordination

Home health care is in many ways a fantastic service, especially for those Medicare beneficiaries who are essentially home bound due to frailty or illness.

But it’s often feels surprisingly hard to synergize with home health care.

The main problem, as I see it, is that home health care agencies have set themselves up to provide only administratively required communication with the ordering doc. (There are rules governing home health care, you know!)

Now, what I need is clinically relevant communication. As in, how is the patient clinically doing, so that you and I can coordinate our efforts together. This has apparently not been built into the home health care workflow.

And things get even more complicated when it’s a patient in assisted living, because then you have the facility nurse who should be kept in the loop as well.

Right now, I am trying to follow up on an elderly woman who lives in assisted living and has paid in-home aides (which are provided by a separate company).

I referred her to home health care a few weeks ago for help managing her skin. On one hand, she was starting to develop a pressure sore from sitting too much in the same position. And on the other hand, she had a fungal rash in her groin, under her incontinence brief.

I prescribed an antifungal cream to be used twice a day for two weeks.

Now it’s been three weeks, and the pharmacy is requesting a refill.

Well…what’s going on with that rash?

What I want to do is send an email to everyone who is involved and might know something. That means an email that would include:

  • The patient’s son, who visits weekly. He’s not a medical expert but he has the most at stake in ensuring that things are checked up on, plus I had him take a look at the rash when I visited.
  • The home health agency RN
  • The paid home aides; I strongly urged them to start keeping a log of the patient’s skin condition at my last visit. (Is that part of their job? Should it be? Who knows.)
  • The facility RN, who is supposed to keep tabs on things when residents have active health issues, and who helped recruit home health care to the situation
  • The pharmacy, to tell them why I’m not renewing the medication right at this moment.
I would also like to loop in the primary care doc, but her patient hasn’t been able to come in to see her for a while, so she is the least actively involved member of the care team at this particular moment.
The great thing about email is that you can address it to several people, and when someone replies everyone else can see the response.
The bad thing about email is that it’s not secure. It is really not an option.
So what am I left with? The doctor’s old standbys: the phone and the fax.
Oh sure, someone out there has developed care coordination software that includes secure messaging. 
But if we are not already all subscribed to it (which seems unlikely, unless you consider people working in an integrated care system), it’s really not usable unless someone wants to go through the hassle of getting each individual player subscribed.

So fax it is. Fortunately my EMR allows me to associate a given patient with a variety of other providers (and their fax numbers). It’s still a minor pain to fax a message to several different people, but it’s faster than calling them all.

BTW, I do occasionally call home health care agencies and ask to talk to the nurse. They are usually so surprised to hear from me…because most doctors never try to coordinate much.

What came first: the chicken or the egg?

What will come first: the communication framework or the desire to truly coordinate care?

Health Care for Dummies (and Innovators): In search of a practical definition of health

[This post was first published on The Health Care Blog on 11/26/14.] 

For a while now, I’ve been working on an ebook about making digital health more useful and usable for older adults.

(Don’t hold your breath, I really have no idea when it will be done. I can only work on it for about an hour every weekday.)

In reflecting on the health innovation conferences and conversations in which I’ve participated these past few years, I found myself musing over the following two questions:

  1. What is health? 
  2. What does it mean to help someone with their health?

After all, whether you are a clinician, a health care expert, or a digital health entrepreneur, helping people with their health is the core mission. So one would think we’d be clear on what we’re talking about, when we use terms like health and health care.

But in fact, it’s not at all obvious. In practical parlance, we bandy around the terms health and health care as we refer to a wide array of things.

Actually defining health has, of course, been addressed by experts and committees. The World Health Organization’s definition is succinct, but hasn’t been updated since 1948:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A more recent attempt to define health, described in this 2011 BMJ editorial, proposed health as “’the ability to adapt and self manage’ in the face of social, physical, and emotional challenges.”

This left me scratching my head a bit, since it sounded more like a definition of one’s resilience, or self-efficacy. Which intuitively seem much related to health (however we define it), but not quite the same thing.

I found myself itching for a definition of health that would help me frame what I perceive as the health – and life – challenges of my older patients.

Also, it seemed impossible to articulate how digital health tools might help us care for an aging population, if one didn’t start with a practical definition of health.

So after doing an hour of research in the literature (and finding endless scholarly rabbit holes), I ended up trying to sketch a model of health that felt true to my experiences.

In this post, I’d like to share what I came up with, and get your feedback. Then in a follow-up post, I’ll write about what this might mean for defining health care, and our efforts to improve or facilitate health care.

What is health?

Health is a dynamic state. For an individual, it involves three core components:

  • How are you feeling? How do your body and mind feel? Are you experiencing any pain? Bothersome sensations? Mental distress? This component of health addresses the individual’s experience of suffering. 
  • How well are your body and mind outwardly working? Are your body and mind working as you expect them to, or need them to, or want them to? Can you get around physically as you usually do? Can you manage your thinking tasks? Can you see, hear, speak, and otherwise communicate effectively with others? This component addresses the individual’s ability to leverage body and mind in order to manage one’s usual activities and life tasks. 
  • How well are your body and mind internally working? This component relates to one’s inner physiology and function. When we peer inside, whether with modern technology, via the careful pulse auscultation used in some cultures, or any other method, is anything awry? Do we find signs of disease, disorder, or disruption? In Western medicine, we consider the workings of organs and cells, but other cultures have their own “inner workings” that they assess when evaluating health.

These three components are in constant interplay with each other. Right now I’ll refer to them your wellbeing, your macrofunction, and your microfunction. (But I’m not sure those are best terms.)

These three components of health are also in constant interplay with our social and physical environments, as well as with our nutrition and our “lifestyle choices.” For instance, rich social encounters and purposeful work improve wellbeing, as well as immune function and other aspects of our microfunction. Air pollution might make us cough, and can negatively impact our lung function, along with other less visible parts of our health.

Are these many external factors, and our behavior choices, synonymous with “your health”? I would call them influences on your health, or in certain cases “health care”, rather than your health itself. (And they aren’t diagrammed above, although I’d like to add them eventually.) These factors are incredibly important, but we confuse matters when we conflate things that influence health — such as access to clinicians, clean water, walkable cities — with the actual health of an individual.

Why does a person’s health matter?

Better health is an important end in of itself.

But to a large extent, health is a means to a more important end: that of living life.

In other words, being able to do the things we care about, need to do, and want to do. Being able to do things that give purpose, meaning, and pleasure to our lives. Being able to do the things that make us feel like our selves.

This is kind of obvious, but it’s actually fairly easy to lose sight of this when we get immersed in the weeds of health and health care. (Which is why the Unmentionables at Health 2.0 is so fantastic: it’s a much-needed reminder that health serves life.)

[Caveat: There is a lot of overlap between the life activities, but I haven’t yet figured out how to diagram this. Graphic design is not my forte.]

What is a health problem?

As a doctor, my job is to help people address their health problems. And I’d like for the digital health entrepreneurs to create tools that work better for this purpose.

So what is a health problem? How to define what people seem to need help with? How to define what digital health tools should help us – whether we are a patient, a clinician, or a family caregiver – address?

Here is a practical definition: a health problem is anything that is “wrong” with one or more of the three components of health above.

For instance:

  • Wellbeing Problems: Examples include being in pain, being fatigued, having insomnia, feeling depressed, feeling anxious, feeling short of breath, and so forth. Many symptoms, pains, discomforts, and any other forms of suffering fall into this category.
  • Macrofunction Problems: These might include having difficulty walking due to arthritis, problems exercising due to shortness of breath, or problems thinking due to dementia. You could also include vision problems, hearing problems, and speech difficulties due to stroke. These issues often cause noticeable functional impairments.
  • Microfunction Problems: These would include problems such as having impaired glucose metabolism, high blood pressure, osteoporosis, kidney disease, as well as early stage cancer.

You’ll notice that problems with wellbeing and macrofunction are primarily person-defined. It’s the affected person – sometimes known as “the patient” – who experiences suffering, or difficulties in how the body and mind are working. Whereas microfunction problems are generally “expert-defined”: nobody knows they have osteoporosis until clinicians tell them.

Many diagnoses, diseases, or health stressors will cause problems in all three parts of health. For example, cancer symptoms and the related functional impairments (e.g. problems doing anything you can usually do) are the consequence of the cancer cells running amok within.

Congestive heart failure might cause uncomfortable dyspnea, as well decreased exercise tolerance, such that a person has difficulty managing usual ambulation and activities.

Of course, there is a lot of room to argue about what constitutes “wrong” with a given health component. Cultural and social factors influence how people perceive their own suffering, or overt impairments. And we could quibble endlessly about what is ideal blood pressure, and how we might otherwise assess how right or wrong a person’s body and mind are internally working.

Still, in many cases, if most of agree that something seems “wrong” with a given component of health, this should provide us with a decent practical starting point for identifying health problems.

Do we need to distinguish between microfunction and macrofunction?

I believe we do. Problems with macrofunction are the things that people notice in themselves (or in others, when it comes to cognitive macrodysfunction). These are what patients are often most concerned about.

Macrofunction problems, along with forms of suffering, are also what directly impacts people’s ability to participate in life tasks, and their short-term quality of life.

So helping people correct, mitigate, or adapt to these types of functional impairments is incredibly powerful, if you want to address health problems in a way that makes people’s lives materially better. This is an approach that is common in geriatrics, palliative care, physical and occupational therapy, and behavioral therapy.

Microfunction, on the other hand, is what people need technical assistance to assess. (Historically that assistance have been clinicians, but we’re on the cusp of seeing advanced diagnostic tools in the hands of the public.)

Much of the work that we doctors do in modern medicine, especially in primary care, is address physiologic problems that are scarcely perceptible to the affected person: high blood pressure, high cholesterol, type 2 diabetes, kidney disease, asymptomatic atrial fibrillation.

We do this work because we are trying to prevent or delay more overt health problems, such as those associated with suffering and macrodysfunction. So it’s certainly worthwhile work. But it doesn’t always feel satisfying or worthwhile to patients, especially if they are pre-occupied by other problems which are causing suffering or overt functional impairments.

In fact, it seems to be fairly common that patients and clinicians are focused on different aspects of health. A typical example: a doctor might decide to unilaterally prioritize tinkering with the microfunction, such as by prescribing more statins, even though a patient’s most pressing concern is falls or pain.

Feedback? Suggestions?

All models are wrong and incomplete, but some are useful, as the saying goes.

Is this model of health and health problems useful?

What do you like, and what do you think I absolutely should change?

[Many thanks to Leslie Salmon-Zhu of GraphicRecorders.com, for drawing a preliminary version of Three Components of Your Health graphic.]

What A Caregiver Said Was Hard About Hospice

[November is National Family Caregivers Month. In this post, I share the eye-opening letter I received from a Geriatrics for Caregivers reader who has cared for his mother — now 100 years old — in his own home for 3 years. She is now on hospice. 


The writer has given me permission to share this letter, noting that his mother, a former teacher, would have been glad to know people were learning from her story. Please note: all emphasis below was added by me.]

Howdy Dr. Leslie –
Mom has progressed quite a ways down the road and actually I am quite amazed that she is still with us. I think that, somewhere in the back of her head, she had the 100th birthday in her mind as a goal. She has deteriorated quite a bit in the last 10 days since her birthday.

Two months ago we placed mom on the local hospice program (we have one, run by the hospital) and we were just recertified for another 60 days. You may remember the difficulties our hospital was having and the possibility that it might actually close due to some incredibly bad CEO’s and bad management. Fortunately, they have located a fellow who used to be the CEO here about 15 years ago and he has gone on to form his own hospital management company and they have several hospitals located around the country. Things appear to be on a new track.

Now to your question – the thing that has probably frustrated me the most in caring for my mother are two:

  1. the lack of resources and available training to function as a caregiver and
  2. the continuing lack of resources that I have received from our hospice program. 

As mom progressed, I had located several dementia units that I felt would be a good match and found that unfortunately 3 of them have discontinued their dementia care units due to rising liability issues. The remaining ones didn’t make me feel comfortable.

Since mom has been unable to walk back in February, I have had one night off and I know it is beginning to affect me. I have found caregivers (including my sister when she is able to come up) but none will stay overnight and none will do any lifting. Even the hospice program offers volunteer caregivers but only for about a two hour time period and they do not do lifting. We tell caregivers to watch out for their health, but then don’t provide the resources to accomplish that.

A local nursing home now offers respite care and our hospital has once again started accepting Medicare and Medicaid patients for respite care up to 5 days. (Prior to this, the other CEO refused to accept anyone except self pay for respite care).

Much of what hospice offered I didn’t need: harp player, chaplain, social worker, respite volunteer (although I have utilized her 3 times when I haven’t had a choice). What I have taken advantage of is a personal care individual who washes mom’s hair and trims/cleans her fingernails as my eyesight made this difficult), a physical therapist to see if mom could improve her ability to stand on her own as an assistance to me when I was changing her and of course, the nurse. All of them, with the exception of the physical therapist seemed to come with their own agenda of what they wanted for mom’s care – despite my stating and restating what I wanted done.

The PT was cut after the first 60 days. Hospice offered things such as pull-ups, latex gloves and a pharmacy program from somewhere in Pennsylvania – all of which I have taken care of already. I try to maintain a routine for mom’s sake and they seemed to want to constantly change the routine both with their actions and constantly changing scheduling of visits. I had also thought that the hospice would provide more help in securing respite care and possible assisted living assistance such as help with requirements and paperwork, but found I knew more than they did. 
They just recently received a renewal of their gold star accreditation. The hospice nurse tried to change some of mom’s medication and ordered new ones despite the fact that her primary care doctor had just recently reviewed mom’s medication and was satisfied with what she was taking. The nurse even tried to convince him to prescribe morphine (just to have on hand in case . . . ) which he refused to do. Her hospice doctor even tried to override the primary care doctor on the morphine but eventually backed off. Both the hospice, hospital and clinic are under the same company.

The head nurse and I have had multiple discussions about their program, but I’m still not comfortable with it.

I have so far decided to keep the hospice for one main reason – I think it will make it easier to get mom into the hospital’s respite care if I should get sick or need help due to an accident in a hurry.

It was my feeling that the health care system should be of assistance to me and yet I have found them to unable to do so and in a few cases, an actual obstacle. I understand that some of this may be due to being in a low income rural area, but I have spoken with others who have experienced similar problems with the health care system and hospice programs even in larger cities.

Hope that helps a little. The good thing is that it has pushed me towards trying to make things better for other families once my commitment with mom is completed. 

[A RAND study recently valued the care provided by family caregivers to the elderly at $522 billion per year. This letter shows us what some of that care actually entails. This Thanksgiving, don’t forget to thank the family caregivers you encounter. They are doing amazing work and we don’t thank them — and support them — nearly enough.]

What Caregivers Say is Hardest About Helping Aging Parents, and Atul Gawande’s Insights in Being Mortal

Several weeks ago, I asked my caregiving audience at Geriatrics for Caregivers a question:

What’s your biggest frustration with helping aging parents, or aging loved ones?

The answers were enlightening. Nobody, unsurprisingly, said avoiding delirium, or minimizing medication side-effects, or any of the other very important things we talk about in geriatrics.

Instead, the biggest frustrations overwhelming had to do with managing relationships, and finding ways to provide help and support, while respecting the older person’s desire for autonomy and independence.

(Want to see just what people said is hard? I highly recommend you read their quotes here.)

So, I had a real “Aha!” moment when I read Atul Gawande’s new book, “Being Mortal,” shortly after hearing from the Geriatrics for Caregivers readers.
It turns out that “Being Mortal” is mostly about getting old, and about caring for those who are getting old. 
In other words, he has brought his signature style to the topics of aging, and caregiving.
But you could easily not know this if you’ve mainly read the press about the book. The media has mainly focused on this book being about “end of life,” and Gawande himself chose to highlight a cancer-and-the-magic-of-hospice story in his widely read New York Times op-ed
He also, when I saw him speak in San Francisco last month, chose to deliver his prepared remarks on the same topic: the better cancer death of his daughter’s piano teacher.
This struck me as a shame. Although as a society we certainly need to have more conversations about how we die, and how to make it better, we really need to have more conversations about aging, declines in independence, and caregiving.
(Full disclosure: My father died of cancer at age 61, while I was in medical school, and we certainly could have used more palliative care involvement. Rest assured that I consider terminal cancer a devastating experience well worth any and all improvement efforts. But I still think cancer and death are hogging the limelight.)

As far as I can tell, people would rather plan to die than plan to be old and slowly declining.

And I am pretty sure that right now people would rather train in palliative care than in geriatrics.

So. We need people to champion and spearhead a thoughtful discussion about what’s hard about helping older people, especially when they become frail and start to need more assistance. 
And we need good, compelling, readable books that can help people reframe how they might offer help to an aging parent, and what kinds of goals to strive for during those last years. 
I personally think Being Mortal is one of those books: a compelling read that could give families throughout the country some really valuable insights on how to help aging relatives during the last few years.

But in the end it will come down to what the family caregivers think, not me.

(I’ve already had one person tell me she thinks it’s “good for doctors.” Which it surely is, but I’m especially eager to find books that are good for families.)
At some point, I’d like to write a more in-depth summary of the many insights Being Mortal offers, when it comes to helping people manage aging and declines in independence. But as I’m not sure when I’ll have time to write it, I offer you instead a substitute: my tweets from Atul Gawande’s talk at the Commonwealth Club last month.
If you’ve read Being Mortal: what did you think of its insights on aging and caregiving?

Props to RWJF for Improving #CultureofHealth, & the power of social media

In my last post, I explained why I felt that #CultureofHealth wasn’t quite working for me, and I proposed that we try to brainstorm complementary memes.

In particular, I was concerned that an intense focus on “being healthy and staying healthy” might not offer enough support to those who struggle with illness, or to clinicians whose work it is to care for “sick people.”

The CEO of the Robert Wood Johnson Foundation, Dr. Risa Lavizzo-Mourey, was kind enough to write a response on THCB, and several people commented on both posts.
Furthermore, on October 17th, Dr. Lavizzo-Mourey posted a comment announcing that RWJF had made some tweaks to their message, to better clarify that a Culture of Health includes everyone, “be they sick or well.”
I am, of course, hugely grateful to RWJF for taking the time to thoughtfully consider the issue. 
I’m also especially grateful to those who took the time to comment and relay their own reactions to RWJF’s previous definition of a Culture of Health; I’m sure this input was vital to the process of considering the Culture of Health messaging.
In this post, I want to share the “tweaks” so far in defining the Culture of Health. I’ll also share some of the complementary meme ideas I heard from other people this month. And then I’ll close with some thoughts on the power of blogging and social media.

Culture of Health before and after

“We believe an American Culture of Health is one in which:

  1. Good health flourishes across geographic, demographic and social sectors.
  2. Being healthy and staying healthy is valued by our entire society.
  3. Individuals and families have the means and the opportunity to make choices that lead to healthy lifestyles.
  4. Business, government, individuals, and organizations work together to foster healthy communities and lifestyles.
  5. Everyone has access to affordable, quality health care.
  6. No one is excluded.
  7. Health care is efficient and equitable.
  8. The economy is less burdened by excessive and unwarranted health care spending.
  9. The health of the population guides public and private decision-making.
  10. Americans understand that we are all in this together.”
As I said, other people’s comments provided truly vital input to the conversation. I especially want to highlight Dr. Peter Elias, a remarkably thoughtful primary care physician who I know through the Society of Participatory Medicine. He commented:

“[This] talks about being and staying healthy, but doesn’t speak to the people who are ill and struggle for even some improvement in health, let alone those who just want dignity and comfort because health is no longer an option for them. 

I think I understand the intent: a society that values the things that foster health. But the message I hear (and my patient heard) is that health is not just the goal, but the only acceptable state. That’s pretty hard on the ill. It lends itself to a culture of blaming patients for their misfortunes, something I see on a regular basis. 

How does a dying patient related to a culture of health? Probably by feeling alienated, disrespected and disposable. How will clinicians behave in a medical culture of health? Will they be unwilling to care for patients who cannot become healthy or do not try hard enough (by someone’s definition) to get healthy? 

I fear that a culture of health would make it less acceptable to care about those who are not healthy.”

Again, it is a HUGE credit to Dr. Lavizzo-Mourey and RWJF that they really took these comments under consideration. They could have ignored me and Dr. Elias and kept doing what they do, and we all still would have mostly kept loving them because their foundation plays a vital role in improving health and health care.
But instead, RWJF made some modifications. And here’s how they are now defining a Culture of Health:

We believe an American Culture of Health is one in which:

  1. Good health flourishes across geographic, demographic and social sectors.
  2. Attaining the best health possible is valued by our entire society.
  3. Individuals and families have the means and the opportunity to make choices that lead to the healthiest lives possible.
  4. Business, government, individuals, and organizations work together to foster healthy communities and lifestyles.
  5. Everyone has access to affordable, quality health care because it is essential to maintain, or reclaim, health.
  6. No one is excluded.
  7. Health care is efficient and equitable.
  8. The economy is less burdened by excessive and unwarranted health care spending.
  9. The health of the population guides public and private decision-making.
  10. Americans understand that we are all in this together.

This, in my mind, is a big improvement.

Now, having just read Atul Gawande’s new book (which is mostly about supporting the well-being of aging adults during their last years of vulnerability, even though it is being hyped as an “end of life” book), I am very much thinking about how do we make sure the healthcare system offers older adults more of the right care and less of the wrong care.

And I can’t say that the points above — or the Culture of Health mantra for that matter — provide a lot of guidance. Instead, I’m feeling much more inspired by the Lown Institute, who recently emailed me the following statement:

“We are assembling a national network of impassioned medical students, residents, senior clinicians, patients and community groups who have joined us in building the RightCare Alliance, a movement dedicated to ensuring that human presence is central to scientific ministrations. Members of the RightCare Alliance are creating programs for transforming medicine, by addressing issues of overuse and underuse of our existing healthcare system and working to ensure that the heart of medicine is preserved over the business of healthcare.”

(Sign me up!)

In truth, the scope of what health, health care, and healthcare cover is likely too big to be adequately represented by any one meme, or even 10 point bullet list.

There is addressing upstream health factors, there is getting people to adopt healthy behaviors, there is the patient-healthcare system interaction when someone relatively healthy comes in with an acute problem, there is the the hard work of helping people manage their chronic illness for decades, and then there is my favorite work: helping aging adults with multiple medical problems make the most of their health and their situation. (Plus there are hospitalizations, surgeries, rare diseases, and even the possibility that much of how sick or old we feel is being driven by our mental attitudes.)

At this time, as best I can tell, RWJF is not focusing on either aging or the optimal primary care of aging adults with multimorbidity.

That’s ok. We all have our piece of health care (and healthcare, which I define as the professional services often covered by insurance) that we are going to work on.

We just may need to be more clear in the future, in specifying which part of health care we are talking about, in order to focus on the right memes and priorities.

Complementary meme ideas

Several people endorsed “Culture of Care,” but here are some others that came up during the #CultureofHealth conversation:
  • “Care can be complicated, but then so can people”
  • How about: “Wellness didn’t work out…now what?” or “Prevention: the things you do before you get sick.”
  • #cultureofcare also communicates more partnership opportunity, IMO.
  • “Collaborative Team”
  • #Cultureoflove
  • #CultureofCaring
I myself brainstormed several in the comments thread (which no one really responded to but I’ll share them here anyway):

  • Culture of Caring & Better Health
  • Culture of Optimizing Health & Wellbeing
  • Culture of Comprehensive Health Care
  • #CultureofBetterHealth
  • #BetterHealthBetterCare
  • #CultureofHealth&Care
If you particularly like any of the above, I hope you’ll speak up in the comments below.

In closing: the power of social media

Obviously, this whole affair is a testament to the power of social media and the public conversations it enables. 
Before the blogging era, a small fry such as yours truly could never have had her opinion heard by the leadership of a big foundation. Blogging and social media also make it easy for others to add their opinion. 
After all, a blogger’s work matters the most when it 
  • Gives voice to what many others were thinking, but didn’t have the time or capacity to say prominently.
  • Sparks constructive conversations among a group that might not otherwise be talking to each other.
It also helps to have a bigger blog give you a microphone, and I’m indebted to Matthew Holt and John Irvine of The Health Care Blog for enabling me to share my thoughts with a much bigger audience than I’d ever reach on my own.
The morals of the story: 
You can’t make change alone. 
Conversations are important. 
Social media facilitates those conversations, and can allow small players to be heard by big players. 
It is hard to capture everything we want in health care with a single meme.
Comment. Tweet. Blog. Make change.

Why We Need a Complement to #CultureofHealth

[This post was very recently published on THCB and RWJF’s president has already posted a response. Esp if you are involved in the care of older adults or people who are medically complex, please consider posting a comment at THCB. Memes can be very influential, especially when they are promoted by major organizations. I hope you’ll weigh in on the conversation!]
Last week, I attended the Fall Annual Health 2.0 conference. There was, as usual, much talk of health, total health, and of extending healthy years. 

And this year, there was a special emphasis on promoting a “Culture of Health,” a meme that has become a centerpiece of the Robert Wood Johnson Foundation’s work.

So much so, that when I approached a conference speaker, to briefly comment on my interest in helping beleaguered family caregivers with their carees’ health and healthcare issues, I was advised to work on promoting a culture of health.

Hm. Funny, but as a generalist and geriatrician who focuses on the primary care of older adults with multiple medical problems, I’d been thinking more along the lines of:

  • Promoting the wellbeing of older adults and their caregivers.
  • Optimizing the health – and healthcare — of my aging patients.
In other words, I’d been thinking of a “Culture of Care.

As in: “I care about how you are doing, and I will provide care to help you with your health.”

Since all my patients have multiple medical conditions, that care means finding ways to help them with their many health concerns. These include diseases, such as diabetes, COPD, heart failure, and Alzheimer’s, as well as “problems,” such as pain, falls, depressed mood, and worrying about whether some recent snafus are a sign of dementia.

It even includes issues like tense relations with anxious children who think Mom should move to assisted living; a common “relationship issue” that inevitably tracks back to the present and future state of Mom’s underlying health problems.

My work, as a doctor, is to collaborate with my patients in order to minimize symptoms, maximize function, improve wellbeing, and prevent health complications. All of which, if I do it well, generally ends up helping their family caregivers.

Is promoting a #CultureofHealth the same as promoting a #CultureofCare? As a front-line clinician, they feel very different to me.

Namely, one strikes me as about working way upstream to prevent health problems before they happen. (“We shouldn’t need a sick care system!”)

And the other is about responding to people who are suffering, and need our help to feel better. No, this is not the hallowed work of preventing chronic diseases from emerging. But it is preventing – or at least delaying — further deteriorations in health and function. It is helping people make the best out of the situation they are now in.

If you are working with people who are already downstream, and are coping with the burdens of chronic illness, should your priority be #CultureofHealth? Or #CultureofCare?

Consider, for instance, the family described in Knocking on Heaven’s Door. If Katy Butler’s parents, struggling with cognitive impairment and progressive decline in the aftermath of a stroke – and this after a lifetime of “healthy living” – ask their primary care doctor for help, is he more likely to offer the right assistance by thinking “Promote Culture of Health”? Or “Promote Culture of Care”?

After all, one way leaders can test a guiding principle is to ask themselves: as people in my organization face their work challenges, will this help them know how to do it right, or better?

I don’t think #CultureofHealth helps me do my work better. Instead, it leaves me wondering how on earth I’m going to get help doing my work.

This is not to say, mind you, that I don’t have great respect and appreciation for the work and ideas of the Robert Wood Johnson Foundation. If you’re someone like me, who went to medical school planning to work on improving primary care, you can’t not love RWJF. (Nor can you avoid hoping that they’ll someday find you worthy of funding.)

Furthermore, as someone with a MPH degree, an interest in systems, a background in quality improvement, a focus on person-centered care, and unqualified admiration for Alex Drane’s work highlighting the Unmentionables that affect people’s lives, I absolutely believe in what RWJF is championing.

That is to say: I believe that we as a society must address the social determinants of health, help people feel well, and work within but especially outside of doctors’ offices, to prevent chronic health problems before they develop.

But I worry that #CultureofHealth isn’t quite right, as the guiding principle for certain aspects of health care.

So I’d like to respectfully propose we look for some complements to #CultureofHealth. It’s a great concept, but we likely need more if we are going to find a way to offer all our citizens – including the aged and the chronically ill – the care they need and deserve.

(Are you a data junkie? For data on the scope of multimorbidity and associated utilization in the healthcare system, see the figures in the Medicare Chronic Conditions Chartbook. For data on how many older adults have difficulty walking, doing errands, etc, see Figure 2-14 of the Census Bureau report on seniors.)

ISO a meme for the primary care of the medically complex

We need a meme that speaks to better primary care for people with chronic health problems, and that helps us – as healthcare providers – do our job better. Specifically, we need a phrase that reminds us to be better at:

  • Seeing our patients for who they are, and not focusing excessively on their diseases;
  • Recognizing the many unmentionables – financial problems, caregiving burdens, relationship stressors, depression, substance use – that often underlie people’s difficulty in addressing other health issues;
  • Respecting – and facilitating — the involvement of our patients’ families, peer communities, and other sources of support and influence;
  • Helping our patients try behavioral interventions (such as exercise, stress reduction, social activities, diet changes, therapy, and even “activities that create a sense of purpose”) for the many complaints for which these help, instead of quickly defaulting to pills and procedures;
  • Discussing advance care planning, and addressing people’s fear and anxieties about death and declines in health;
  • Delivering the right care, at the right time, in order to help relieve suffering and optimize management of chronic diseases, so as to help our patients move towards whatever goal is a good fit for their preferences, values, and health situation. 

For those of caring for Medicare patients, we need a meme like this because aging adults – and their families — are coming to us for help, but in most practice situations, we’re having a lot of trouble providing the right help. It’s even, I’m sorry to say, common for us to inadvertently make things worse.

#Cultureofhealth is great for the population at large, and will likely have a profound impact on the health and wellbeing of older Americans in the future.

But let’s also promote some complementary memes, to help inspire the work we’ll be doing helping those with aging, and with multiple chronic health problems. Let’s not just bash the “sick care” system; let’s inspire ourselves to take better care of those who are sick and suffering.

So. I want to end this post by asking for your ideas. What meme resonates with you, when it comes to the clinician’s – or even the innovator’s — work of helping medically complex patients, and their caregivers? What phrases might serve as a touchstone?

By the way, #Cultureofcare was recently used to rally support for family caregivers. I do like it as a guiding principle for our work as doctors, but would love to know what others – clinicians, patients, family caregivers – think.

Recap on Caregiving & Technology at Health 2.0

Last week I attended the Annual Fall Health 2.0 conference in Silicon Valley. It’s a big event and there was lots to see and think about.

Of particular interest to me was a set of pre-sessions titled “Future Technologies for Caregiving” and “Easing the Burden: Connected Caregiving Tools.”

The first session was based on the “Catalyzing Technology to Support Family Caregiving” report which came out this past summer; the report itself was based on an expert roundtable convened in April. That group identified three types of tech solutions as especially interesting to them:

  • An “Intelligent Family Care Assistant” to help with day-to-day caregiving by helping to coordinate the family’s tasks in the context of the family’s other activities.
  • “Wearable technologies”—devices worn on or placed in the body, with sensors and/or human interfaces—to help monitor a person’s health and overall condition.
  • Technologies that provide better connections between family caregivers and health professionals, enabling them to work more effectively as a team in providing care.
(Clinicians, how do these sound to you? Post a comment below!)
The report’s core recommendations included:
  • Create better “concept maps” and find more appropriate language to describe the varied and complex caregiving landscape. 
    • LK’s note: the report doesn’t cite much academic literature, but caregiving scholars have been working on this for a while. Some, like Professor Rhonda Montgomery at the University of Wisconsin, have even developed really nifty practical caregiver assessment tools, like this “Tailored Caregiver Assessment & Referral” tool, which improved outcomes in this preliminary randomized study.)
  • Continue to collect extensive data about the prevalence, burden, and impact of caregiving and the role of technology.
  • Spur a broad national conversation on caregiving.
  • Develop compelling business cases for employers and healthcare providers to support caregiving.
  • Provide caregiving coaching as an integral component of all solutions.
  • Inspire social conversations about caregiving to encourage more learning and support within families and communities.

(All main bullet points above are verbatim from the executive summary of the report.)

In the “Connected Caregiving Tools” follow-up session, four companies demoed their products, and then their executives took questions from the crowd, and from the moderator, RWJF Senior Program Officer Michael Painter.
The four companies were CareSync, CareTicker, Independa, and GrandCare.
Below is a Storify with my tweets related to these sessions, and to a few other Health 2.0 moments related to innovation and caregiving.
What I was most excited about: Kaiser Permanente’s exhibit on Imagining Care Anywhere. Although KP’s website for this model doesn’t seem aging-specific, the exhibit at Health 2.0 centered around — get this — a Medicare patient who is diagnosed with early dementia.

The exhibit modeled a comprehensive family-centered care plan, which included safety sensors in the home. And there was a whole panel on how employers and health providers can support the patient’s wife, a working caregiver. It was really nice, and I hope to see more similar things at Health 2.0 in the future.