Transcript Better care
Aging by Design BENTLEY COLLEGE Waltham, MA September 27 & 28, 2004 Technology & Caregiving Aging by Design John Rother Director Policy & Strategy U.S. Caregiving Challenge MORE PEOPLE Better care For less cost Number of Medicare eligibles Percentage of Total Population Age 65+ 25% % Age 65+ 20% % Age 85+ 15% 2004 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 ratio of caregivers Caregivers available - - - - - - -- - - ^ - - - - - For each sick person - - - - ^ - - - - - - - - - - - 11 for 10 for - 1990 - 2010 6 for - 2030 4 for - 2050 U.S. Caregiving Challenge More people BETTER CARE Some results of AARP’s first-ever poll of people with disabilities 50 and older Of majority who receive care, it is from an unpaid FAMILY MEMBER 100% 80% Data from Figure 37 50.3 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 60% 100% 40% 80% 20% 60% 0% PAID 40% 20% 0% FAMILY FRIEND OTHER UNPAID Of majority who receive help, it is from an unpaid family member who is a SPOUSE or CHILD MOTHER/FATHER IN LAW Data from Figure 37 50.3 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 DAUGHTER/SON-LAW SIBLING CHILD SPOUSE/PARTNER 0% 20% 40% 60% 80% 100% Most caregivers LIVE WITH person helped 100% Figure 38: Living Arrangements of Persons 50 and Older Who Receive Help with Daily Activities 80% 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 60% 40% 20% 0% Caregiver lives with person Caregiver does not live with person Family caregivers Where will they get information? How can they partner efficiently with professional providers? How can they continue their own employment? Poll asked about worries & concerns People with disabilities’ No. 1 answer: LOSS of INDEPENDENCE and Becoming MOBILITY housebound Decrease/loss of assets 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. Unable to pay Loss of Mobility 65+ 50-64 Loss of Independence 0% 10% 20% 30% 40% If home care services are needed, 50+ with disabilities prefer their OWN CONTROL over money and management of home care workers (vs agency control) 78% 53 Table 26 25 The recipients of care 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 65+ 30% 20% 10% 0% 50-64 60% 50% 40% By Age SLIGHT/MODERATE 70% VERY/SOMEWHAT SEVERE 90% 80% By severity 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 Can technology help those in institutional caregiving settings? Today’s nursing home residents have MORE SEVERE limitations 50% Figure 20: Percent of Nursing Home Residents Age 65 and Older at Various Levels of Disability, 1984-1999 40% Source: Urban Institute analysis of the National Long-Term Care Survey for AARP Public Policy Institute 30% .20% . .which require more monitoring 1984 1989 and attention 10% 1994 1999 0% 1 2 3 4 5 6 ADL ADLs ADLs ADLs ADLs ADLs 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 20% 15% With infections 10% With pain 5% With pressure sores In restraints 0% Residents of Nursing Homes Better care Computer technology a key to improved QUALITY Better record-keeping, record access • Better-informed medical practitioners and “hands-on” caregivers • Auto-reminders of tests, procedures, medications, “turning” due patients Better care Computer technology a key to improved QUALITY Better record-keeping, record access • More accurate transfer of information Prescribing Diagnostic tests Concurrent treatments 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 Diagnostic checklists Data bases of best practices Computerized prescriptions, lab orders Automated patient records (AMR) Easy-to-use by stressed professionals Ability to track outcomes economically Better care Extent & cost of medical errors widespread The IOM found that as many as 98,000 preventable deaths a year occur in hospitals due to medical errors Many of these could be eliminated with well-designed information systems U.S. Caregiving Challenge More people Better care For LESS COST Health spending has taken off 10% Real Average Annual Growth in Health Spending 8.1% 8% 5.2% 6% 4% 3.4% 1 6.2% year 1 year 4 years 2% 6 years 0% 19931998 19992001 20012002 20022003 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 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 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 Speeding and adding accuracy to professional-toprofessional consultation Reminding patients when to take meds, report for tests, renew Rx’s Better provider-patient communications Concerns: Privacy issues Cost to individuals & providers to participate Will technology promote or impede patient-caregiver trust? Four Policy Recommendations: 1. Need for national health infrastructure standards 2. Must create a 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 healthcare decisions Technology & Caregiving Aging by Design