Everything old is new again

I was at a meeting last week, called Caring for Aging Adults: The Future of Geriatric Care. It was hosted by HealthTech, a non-profit group founded by Molly Coye, MD, MPH, that develops technology forecasts, decision-making tools and facilitates a learning network of experts and health system leaders. They do this work for the exclusive benefit of its partner organizations, which include healthcare systems, hospitals, safety-net providers and government agencies.

For this meeting, HealthTech had convened a group of national experts in geriatrics to help them strengthen a scenario they are building about what the five- and 10-year future of geriatric care will look like in this country. The charge to the experts was to question, challenge, accept or reject a set of assertions on the basis of what they think is likely to happen, as opposed to what they think needs to happen. HealthTech had seven broad areas of focus to frame its scenario:

1. Clinical care
2. Care setting and facilities
3. IT & communications
4. Cost & coverage
5. Workforce
6. Patient experience; and
7. Regulations & standards

Given the proprietary nature of meeting, and the fact that I was there by invitation, I can’t get into exquisite details about the specific predictions. However, there were some themes that ran through the discussion that led me to want to pose four questions to our blog readers.

There was a lot of discussion about the role of social support as someone ages and the potential role for virtual social networks with this population. But in a discussion on robotics in care settings that touched briefly on whether you could use robots to regularly turn bed-ridden patients, one expert noted that the richness of human contact and conversation you could have while turning a patient was as important to long-term outcome as the physical turning. That led me to Question 1: Are there some social supports that cannot be delivered sufficiently through virtual networks or technological implements and need to be delivered in person?

The group agreed that geriatrics as a field of practice has a poor image. It’s not that providers have poor skills; rather, it’s that ‘geriatrics’ means you’re old, you’re on your way out, and we’re going to focus on all your illnesses. Who wants that? One consequence is that the field is under-staffed and under-reimbursed. But there are some unique aspects to caring for elderly patients that benefit from specialized training. So, Question 2: How might we re-brand ‘geriatrics’ so it conjures up more positive connotations?

A major emphasis in geriatric care is about preventing or forestalling, and then closing, the gap between a person’s internal abilities to manage their lives and the needs of their lives. There’s a lot of technology being explored to help with management—electronic medical records are expected to play a major role; more real-time personal monitoring with arrays of sensors will continue to be explored—but payment policies for prevention and specific services will be a significant barrier to innovation of all kinds. Question 3: Are there specific innovations in payment policies that could facilitate advances in geriatric care?

And speaking of the gap between someone’s abilities and the needs they have, one panelist noted that older adults will likely increasingly depend on community-based social service providers to help meet their needs. Given that, they felt that the current generation of electronic medical records and even personal health records would not be able to deliver on their promise to help integrate and coordinate care for seniors because they were focused mostly on clinical care and couldn’t document and track social services. Question 4: Has anyone seen a PHR that is able to document and track social services?

Comments

[Ateret Haselkorn]

According to many leaders in marketing, a brand is “an identifiable entity that makes specific promises of value.” Brand invokes certain associations in the mind of a consumer through insinuations or explicit statements of worth and consequence.

Thus, re-branding anything requires the initial question of, “Who is our consumer?” and, as follow-up, “What does the consumer want?” and “What value can we offer him or her?”

Geriatrics incurs complex answers. As a field, it involves a diverse set of clinicians, administrators, caregivers, patients, families, and friends. Are there a common characteristics or desires that these stakeholder groups share?

Every person ages, and every person wishes to age successfully, with physical, mental, social, and financial fitness, few hospital visits, and peace of mind. No stakeholder wishes to experience or to see an elderly patient, family-member, or friend suffer from the downward spiral of progressive frailty that is so common today. While many aspects of this trail cannot be brought to a halt entirely, it is the goal of many to slow and alleviate the process. The complexity and satisfaction of realizing such an objective draws clinicians to the field, and patients and caregivers to the table.

This calls for holistic, multidisciplinary, and preventive care for the aging. As a brand, “lifespan care management” is more clearly associated with a process and a goal that has broad appeal. It replaces “you’re old, you’re on your way out, and we’re going to focus on all your illnesses” with a route that we should all be fortunate enough to live through.

Will “lifespan care management” convey our intention to consumers, or be viewed as healthcare jargon?

[Susan Promislo]

more food for thought - there are a couple of new reports that are looking at the role of technology and aging services. Thanks to Vince Kuraitis at the ecaremanagement blog http://e-caremanagement.com/ and Jane Sarasohn-Kahn over at Health Populi http://www.healthpopuli.com/ for profiling these.

The first is commissioned by AARP and the Blue Shield of California Foundation. "Healthy at Home" http://www.aarp.org/research/housing-mobility/indliving/healthy_home.html suggests that many older adults and their caregivers are receptive to the idea that technologies can help them maintain social contact, gather information, be safe at home, and promote their personal health and wellness.

The Center for Aging Services Technologies also has released two related publications: "The State of Technology in Aging Services" and "The State of Technology in Aging Services According to Field Experts and Thought Leaders." http://www.agingtech.org/announcement.aspx?id=223

CAST's takeaway conclusion? "The upcoming dramatic surge in the aging population, the desire of those seniors to remain at home as long as possible, and the shrinking long-term care workforce should provide the U.S. with the necessary mandate to promote Aging in Place technologies. Now is the time to create awareness of these technologies and demonstrate their value."