Transcript The U.S. Caregiving Challenge

Computer-Based Technology
& Caregiving for Older Adults
National Conference
Natcher Center
NIH Campus
Bethesda, Maryland
October 2-3, 2003
Computer-Based Technology
& Caregiving for Older Adults
John Rother
Director
Policy & Strategy
U.S. Caregiving Challenge

Give more people

Better care

For less cost
U.S. Caregiving Challenge
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More people
Number of Medicare eligibles
Percentage of Total Population Age 65+
25%
% Age 65+
20%
% Age 85+
15%
2003
10%
5%
% Age
65+
Ye
ar
19
00
19
10
19
20
19
30
19
40
19
50
19
60
19
70
19
90
20
00
20
10
20
20
20
30
20
40
0%
% Age
85+
Source: U.S. Census Bureau, middle series projections and historical data, U.S.
The shrinking pool of caregivers
Caregivers available
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-- -
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^
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For each sick person
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^
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-
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-
-
-
-
11 for
10 for
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1990
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2010
6
for
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2030
4
for
-
2050
U.S. Caregiving Challenge

Give more people

Better care
Some results of AARP’s first-ever
poll of 50+ with disabilities
Of majority who receive help, it is
from an unpaid family member
(spouse or child)
Figure 37
Q. Is the person who provides the
help to this person with a disability
or health condition paid or unpaid?
Base: Those who receive help.
Q. Is the person a family member or
friend or some other type of
relationship? Base: Those who
receive care.
Q. What type of family member
provides you with this help? Base:
People who receive care from a
family member.
Source: AARP/Harris Interactive
Survey of Persons 50 and Older
with Disabilities, September
2002Disabilities, September 2002
Most caregivers LIVE WITH person
helped
Figure 38: Living
Arrangements of
Persons 50 and Older
Who Receive Help
with Daily Activities
Q. Does this person live with you?
Base: People who receive help on a
regular basis.
Source: AARP/Harris Interactive
Survey of Persons 50 and Older
with Disabilities, September 2002
Family caregivers
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Where will they get
information?
How can they partner
efficiently with
professional providers?
How can they continue
their own employment?
Poll asked those with disabilities
about their worries & concerns,
No. 1 answer: LOSS of
INDEPENDENCE and MOBILITY
Table 18
Q. Looking to the future, what are
your biggest worries or concerns
about having a disability or
health condition?
Source: AARP/Harris Interactive
Survey of Persons 50 and Older
with Disabilities, September 2002
Note: Percentages do not total
100% because of “other” responses.
If home care services are needed, 50+
with disabilities prefer own control over
money and management of
home care workers (vs agency control)
Table 26
53
53
53
25
27
24
Q. Home care services paid for by the government could be provided in several different ways. I’m going to describe three possible ways that the government
could pay for home care services. Then I will ask you the option you would prefer if you needed these services. If you needed these services, which of these
three options would you prefer? Source: AARP/Harris Interactive Survey of Persons 50 and Older with Disabilities,
September 2002
The recipients of care
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
How can they get
information?
How can they stay in
touch with the world
outside?
How can they manage
their own affairs?
The recipients of care

How can we design
technology to promote
better partnership among
physicians,
the caregiving team,
the patient,
and her family?
Large numbers of 50+ with
disabilities are computer users
Figure 53
Q. Do you personally use a
computer at home, work, or in some
other place such as a computer
terminal at school, a library, a post
office, or someplace else?
Source: AARP/Harris Interactive
Survey of Persons 50 and Older
with Disabilities, September 2002
65+
30%
20%
10%
0%
50-64
60%
50%
40%
By Age
SLIGHT/MODERATE
70%
VER/SOMEWHAT SEVERE
90%
80%
By severity
How about
those in the
formal
caregiving
settings?
Today’s nursing home residents
have MORE SEVERE limitations
Figure 20: Percent of
Nursing Home
Residents Age 65 and
Older at Various Levels
of Disability, 1984-1999
Source: Urban Institute analysis of the
National Long-Term Care Survey for
AARP Public Policy Institute
Which requires more monitoring
and attention
Problems with QUALITY OF CARE
persist in U.S. nursing homes
Figure 21: Selected
Quality Measures for
Long-Stay Nursing
Home Residents, 2002
Source: Centers for Medicare and
Medicaid Services, Nursing Home
Compare
Web site www.medicare.gov
Better care
Computer technology a key to
improved QUALITY
• Better record-keeping, record access
• Better-informed medical practitioners
and “hands-on” caregivers
• More accurate transfer of information
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
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Prescribing
Diagnostic tests
Concurrent treatments
• Auto-reminders of tests, procedures,
medications, turning due patients
Better care
Computer technology a key to
improved QUALITY
•Not only in long-term care,
but in hospital settings and
outpatient care
Better care
Bring computer technology into
the exam room
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Diagnostic checklists
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Data bases of best practices
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Computerized prescriptions, lab orders
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Automated patient records (AMR)
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All easy-to-use by stressed professionals
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Plus, ability to track outcomes
economically
Better care
Extent & cost of medical errors
widespread


Recent IOM Report suggested that
as many as 98,000 unnecessary
deaths a year occur in hospitals
due to medical errors
Many of these could be prevented
with well-designed computer
technology
U.S. Caregiving Challenge

Give more people

Better care

For less cost
Health spending has taken off
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
7.5%
6.3%
3.8%
6 years
1 year
1 year
1994-2000
2001
2002
Real average annual growth in health spending
Less cost
Chronic care management key to
a large segment of cost
80
60
40
20
0%
% Health Care Dollars Spent
100%
30% of costs
for 1% of people
10% of costs
for 70% of people
20%
40%
60%
Percent of Population
80%
100%
Less cost
Inappropriate care adds risk and
expense

Study done by the Chicago
Midwest Business Group on
Health estimated 30% of
healthcare dollars are spent
on inappropriate care
Reducing the Costs of Poor Quality Health Care
Through Responsible Purchasing Leadership
June 2003
Less cost
Inappropriate care adds risk and
expense
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Tracking and publishing
outcomes improves care
Measuring outcomes at
reasonable cost requires
computerized data
systems, patient records
A HEALTH
INFORMATION
SYSTEM
Envision an adequate
health information system
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Giving consumers and
providers the latest
information to make
informed decisions
Expanding consumers’
ability to participate in their
own care
Facilitating patient-toprovider interaction
Envision an adequate
health information system
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Speeding and adding
accuracy to professional-toprofessional consultation
Reminding us when to take
our meds, report for tests,
renew Rx’s
Storing for easy retrieval all
the medical information in
the world
Concerns:
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Privacy issues
Cost to individual to
participate
Will technology
promote or impede
patient-caregiver trust?
Four policy recommendations:
1. Need for national health
infrastructure standards
2. Must create funding
mechanism
Four policy recommendations:
3. Must create a system that
involves patients more
fully in their own care
4. Formulated in a way that
will support appropriate
decisions
Computer-Based Technology
& Caregiving for Older Adults
National Conference
Natcher Center
NIH Campus
Bethesda, Maryland
October 2-3, 2003