GeriTech

In Search of Technology that Improves Geriatric Care

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

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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

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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 GeriatricsForCaregivers.net 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:

Almost all aging problems that cause worry in families track back to underlying health problems.

 

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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: [Read more…] about My Process for Meaningful Use & Chronic Care Management

Aging in Place Safely: Dr. K vs APS vs the latest start-up

This week, I did a lot of thinking about aging in place and safety.

That’s in part because I ended up going to head-to-head with a local Adult Protective Services agency (APS), who was worried that my 91 year old fiercely independent patient with dementia was not safe to keep living in her own home as she’s doing.

Also, my Twitter friends brought my attention to the latest darling of the aging innovation press: a new start-up called Honor, promising “Home Care Built For Our Parents, and For You.” (Founded by an ex-Googler! Raised $20 million!)

So, seems like as a good a moment as any to write about what it can take, to support an older person in aging in place, and what might get in the way.

(Note: I haven’t read it but I’d be remiss if I didn’t mention that gerontology professor Stephen Golant has recently published a book arguing that the aging in place model is being oversold; see this good article about the book “Aging in the Right Place” for more.)

Betty, a 91 year old woman who wants to age in place

“Should she still be living at home?”

I get asked a variant of this question all the time. It’s what families worry about and why geriatric care managers sometimes consult me.
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