AAHSA Board Member Takes on LTC Financing in New York Times Blog

August 28, 2008 by Sarah Mashburn
excerpted from AAHSA

I’ve written before about The New York Times “New Old Age” blog. This new publication features a variety of perspectives on the issues facing our aging population and those who care for them. Today, that included a commentary from AAHSA board member Kathryn Roberts. Kathryn is the CEO of Ecumen, one of the country’s largest not-for-profit providers. She’s also a passionate advocate and is working hard to help us advance our Long-term Care Solution. Check out her take on why the presidential candidates aren’t addressing long-term care, and why these leaders are missing out on an important opportunity:

Why Are the Candidates (Mostly) Silent on Long-Term Care?

My generation put day care in workplaces, gave rise to pediatricians and drove minivans and hybrids to market. Could transforming how we pay for aging be the baby boomers’ next big act?
Today about 10 million Americans need long-term care; 12 million will need it in 2020.

Should our primary option be a Cold War-era nursing home for which we largely pay with personal bankruptcy? No. I believe most Americans desire living fully — and differently — to the very end of life.

Unfortunately, as the unprecedented age wave rises, America sits in a costly time warp. We’re flying a 1965 aircraft — the Great Society programs of Medicare and Medicaid — absent an overhauled engine. While other countries have coordinated home- and community-based services for young and old with physical challenges, our outdated way unnecessarily, and expensively, institutionalizes people.

Medicaid pays nearly half of long-term care expenditures in the United States, costing federal and state governments $116.8 billion every year, according to the Kaiser Commission on Medicaid and the Uninsured. American businesses lose as much as $33.6 billion in annual revenue because of employees’ need to care for family. That’s about $2,110 per full-time employee who is also a caregiver, according to the MetLife Caregiving Study. There is a better way.

So why are the candidates generally silent on these issues?

Though Senators Barack Obama and John McCain each authored books, they’ve penned and spoken few words on long-term care. I see several reasons for this silence.

One is language. When people hear “long-term care,” their mind typically sees an outdated nursing home they want to avoid. Not great fodder for a stump speech. But long-term care is becoming much more, from independence-enhancing technologies to intergenerational respite centers. At its best, it’s empowered living, and we need new language and images reflecting that.

Second, most policymakers, like most Americans, know little about long-term care. Last year we surveyed Minnesota baby boomers, asking them who pays for long-term care. About a third said Medicare. It might pay for 100 days of rehab, but not for the care of those with memory problems or other intensive needs.

Third, Senators McCain and Obama, unlike most Americans, are somewhat insulated from this issue. When the candidates need assistive services, their private dollars will likely afford them top home services or posh senior housing rather than Medicaid-funded options.

Fourth, policymakers separate long-term care and health care. But the two are tightly intertwined in the kind of preventive, integrated cradle-to-grave health care for which Americans yearn but haven’t delivered on. Long-term care, in fact, could be a doable door opener to overall financing reform.

Fifth, we volley care between either-or’s. As in: either government pays for care, or private long-term care insurance pays. Neither is working. About 5 percent of Americans have long-term care insurance, and even if everyone purchased the best policy he or she could afford, Medicaid costs would still triple. Like most good public policy, the sweet spot lies somewhere in the middle.

Finally, aging and care lobbies (which include every American, because we’re all aging) have not cohesively raised voices around solutions. That will change, because the stakes in terms of life quality and economics are too high and too interconnected to our collective success.
A tremendous opportunity sits before every candidate and citizen who wants to transform America for the 21st century. It’s called long-term care financing reform.

Kathryn’s right. Long-term care financing doesn’t have to be an obstacle for McCain or Obama. It can be an opportunity to attract potential voters, build a legacy, and most important, help make it affordable to care for millions of aging and disabled Americans.

Hospitals can appeal to patients via virtual worlds, says IT expert

Note from Editor:

If Hospitals are starting to use this technology, how long will it be before forward-thinking senior housing owner/operators start doing the same thing??



Palomar Pomerado Health of San Diego, Calif. , plans to open a new, high-tech hospital in 2011, but according to Palomar's chief technology officer, an IT-driven community outreach effort has already begun. "We want to 'break the mold' on leveraging technology in the new facility, so it made sense to build a virtual model of the hospital online," said Orlando Portale, Palomar's CTO.

Portale spoke here Thursday at the 2008 Physician-Computer Connection Symposium, an annual event put on by the Association of Medical Directors of Information Systems.
Palomar's proposed brick-and-mortar facility, called Palomar Medical Center West, will have 453 beds, cover approximately 1.2 million square feet and cost almost $800 million. Portale said the hospital would teem with state-of-the-art technology, including operating suites with robotics technology and patient rooms that could be quickly reconfigured to meet the needs of a patient's changing health status.
The new medical center's online equivalent, termed "Virtual Palomar West," has similar features, which anyone with Internet access can tour via the virtual world of Second Life.

A creation of San Francisco-based Linden Labs, Second Life has more than 14 million registered users, and Portale told his audience that creating a presence in the popular three-dimensional virtual world was an easy decision for the health system.
"Second Life is the leading metaverse platform," Portale said. "We can simulate a model of the new hospital and offer people in the community a chance to see it before it is built, and we can also begin to simulate potential events in the virtual world."

The "metaverse" is a term coined by writer Neal Stephenson in his 1992 novel Snow Crash. It refers to a virtual world where humans interact with each other via avatars in a three-dimensional "metaphor" of the real world.

Portale told the AMDIS audience that interaction with patients in public virtual worlds like Second Life - and in private virtual worlds and meeting spaces created by companies like Forterra Systems and Qwaq - would likely be a critical part of health systems' outreach efforts in the future.

"Conceptual and virtual simulation in healthcare is not going to go away, but will probably grow," he said

By Richard Pizzi, Associate Editor MedTech Publishing

A Powerful Partnership - Senior Housing and Telemedicine

ATA 2008 - Largest, Most Comprehensive Meeting Ever

The Thirteenth Annual Meeting and Exposition of the American Telemedicine Association (ATA) was held in Seattle, WA, April 6-8, 2008. The meeting was filled with presentations, exhibits, and networking among a diverse group of almost 2,500 attendees, a record attendance that included individuals from every state in the U.S. and 35 countries. The University of South Florida offered Continuing Education Credits for meeting attendees. Reflecting the growing and diverse interest in telemedicine, the meeting included over 462 peer-reviewed oral and poster presentations covering a wide range of topics. The exhibit hall covered more than 100,000 square feet and provided attendees with a view of over 2,000 products and services from 185 exhibitors.

The ATA Annual Meeting also served as a venue for other related meetings and activities among a wide range of organizations, including the Office for the Advancement of Telehealth (OAT), the Appalachian Regional Commission, the U. S. Department of Veterans Affairs, the Continua Healthcare Alliance, the Canadian Society for Telehealth, the Universal Services Administrative Corporation, the Four Corners Telehealth Consortium and the Northwest Regional Telehealth Resource Center. The Mobile Health Clinics Network held their Fourth Annual Mobile Health Clinics Forum in conjunction with ATA, attracting more than 200 attendees and occupying more than 1200 square feet of exhibit space. The Annual Telemedicine and Advanced Technology Research Center (TATRC) meeting focused on personal health monitoring, diverse training courses and federal agency workshops.

A complete summary of the meeting is available at http://www.americantelemed.org/conf/2008/overview.htm. Pictures from the meeting are available on the front page of ATA's web site at: www.americantelemed.org.

Planning for next year's annual meeting is already underway. ATA 2009 will be held April 26-28, 2009 in Las Vegas, Nevada. Nearly 75% of the exhibit floor has already been sold for the meeting. The Call for Presentations will be announced in June.

Savvy senior housing executives should put this conference on their "must attend" list. As the age-in-place trend continues, and many seniors choose to stay in their primary residence longer, the senior housing industry needs to more fully embrace the use of technology for remote monitoring, wellness management, and disease management.

It's time to forge some strong bonds between the top providers in telemedicine and senior housing. It just makes good business sense for both industries -- mainly because we both serve the same end customer.

BB

Experts Say Technology Can Help Seniors Remain Independent

Experts involved in two recent studies say that home health care technologies, such as electronic pill dispensers and systems that monitor patients' vital signs, offer benefits that outweigh their costs, MarketWatch reports.

Majd Alwan -- co-author of a Center for Aging Services Technologies' study, titled "State of Technology in Aging Services" -- said the cost of technology that allows seniors to remain independent might be a "couple hundred dollars" per month, while the cost of a nursing home could be $6,000 per month.

Linda Barnett -- author of an AARP study, titled "Healthy @ Home" -- said that once caregivers and seniors learn about the new technology, such as telemedicine, they become willing to try it. She added, "These technologies can help older adults stay independent longer, and [they] can give caregivers a greater sense of freedom."

Home Health Technology

MarketWatch highlights three categories of home health technology.

• Safety: Safety technologies, which are designed to detect or prevent falls, include user-activated push buttons or sensors that detect walking patterns, floor vibrations or motion. Safety technologies typically are not reimbursable through health plans.
• Health and Wellness: Health and wellness technologies include home telemedicine systems that can monitor glucose and blood pressure and transmit those data to providers.
• Social Connectedness: The devices can help seniors connect socially. However, there are some acceptance and usability issues, and cost can be a factor as well (Powell, MarketWatch, 3/17)

A Future-Proofed Facility

Cypress Gardens will be a multi-building, 170-unit campus providing both assisted living and Alzheimer’s care. The unusual thing about Cypress Gardens is that the owners are dedicated to incorporating a full range of cutting edge technology—hardware and software—in the building before they even break ground. The technology infrastructure will support the building’s day-to-day operations and also ensure complete broadband connectivity to every resident.

Two factors led to the conclusion that this project needed to incorporate all current "best-of-breed" technology;

· The increased demands for connectivity on the part of seniors and their family members, and the positive impact broadband “always-on” connectivity has on the health, well-being and satisfaction of seniors

· The operational advantages, cost savings, efficiencies and revenue-generating possibilities that come with wiring an entire building

Some of the many issues that the owners are reviewing before they make final decisions:

· What kind of hardware and software and in what quantities should be provided to support operations and marketing?

· What kind of hardware and clinical systems will support the care staff, including whether such devices should be wireless?

· Outfitting of an on-site telemedicine suite.

· The need for HIPAA compliant software, encryption, and training.

· The build-out into resident rooms, including always-on broadband, television, Internet access, phone lines, video-on-demand services, distance learning, etc.

· Remote monitoring of residents in the Alzheimer’s unit via web cams.

· The creation of an interactive web site that will market Cypress Gardens using video, virtual tours, and 360⁰ photos.

The owners hope to use Cypress Gardens as a template for creating a chain of senior communities, each of which uses a cutting edge technology platform to improve returns and also make life better and healthier for the residents.

The sections below describe information technology systems, infrastructures, and standards that are typical to assisted living and/or specialty care facilities.

Business Office Solution

1. Optical fiber access for high-speed data and video connections - if available via 100Mps or greater connections, or via multiple T1 trunk connections. Access equipment and building interconnect equipment will be located in the Equipment Closet and will require dedicated power with surge protection, and be isolated from other electrical systems.

2. Enterprise Network - Computer Room in a Box (CRIB) – to include Enterprise Information System (EIS) Server, Exchange (Email) Server, network switches, hubs, routers, and other specified equipment.

3. Equipment Closet – located near Telco vendor demarcations for network, EIS, and video servers, patch panels, backboards, head-end equipment, telephone/PBX system, and building interconnect equipment. Space must be air-conditioned, include dedicated power with surge protection, and be isolated from other electrical systems.

4. Desktop Computers – to include workstations, laptops and/or PDAs, monitors, keyboards, mice, cables, network interface cards, and desktop software, i.e. Microsoft Windows O/S, Office (word processing, spreadsheet, database), and utility software (i.e., virus protection). Both personal and group printers and scanners can be included.

5. Enterprise Software – Best of Breed Clinical Enterprise Information System (EIS) including Assessment, Medication Order Entry & Monitoring, Activity & Care Planning; and Best of Breed Financial EIS to include Billing, Accounts Payable, General Ledger, Budgeting, Fixed Asset Tracking, and other selected accounting modules. Customer Relationship Management (CRM) and Pharmacy modules might be included in the selected EIS.

6. Business Class Telephone System - PBX supporting voice, data, and IP services including: private lines with internal extensions, long distance, internet services, frame relay and VPN services, high-speed broadband access, voice messaging, 911 access, and value-added features such as call-waiting, call-forwarding, and caller-ID.

7. Automated Call Detail Recording (ACDR) System – Software system to capture daily business and resident telephone usage and provide summary and detail reporting, billing by dwelling unit, and other management features.

8. HIPAA compliance – All EIS, Intranet, Internet, and/or virtual private network (VPN) systems and infrastructures must meet these standards to insure privacy and security of resident information.

9. CCTV monitoring system for internal and external video monitoring and security.

10. Training and Support for the above software and hardware systems.

Telemedicine Suite

1. A four-station Video Conference platform.

2. A 32-inch or larger TV.

3. Diagnostic Medical Devices (list and specifications to follow).

4. Dedicated, secure line if IP or high-speed fiber connection not available.

5. Training and Support

Resident Solution – Assisted Living Building

1. Televisions (27-inch or larger) in each apartment with Internet/Intranet access features for web-browsing, community activity calendar, daily menu, and other resident-focused information, as well as enabled middleware that supports MPEG encoding for Video-on-Demand (VoD) in each room

2. Digital Cable Television access for broadcast and cable TV viewing.

3. Digital Music access for on-demand listening to resident-selected music choices.

4. Video-on-Demand (VoD) system for pay-per-view movie viewing and access to other video resources (wellness, travel, exercise, documentary, education, and other video library materials).

5. Web Cameras for in-room use enabling residents to videoconference with staff, family, healthcare providers, or friends.

6. A small, common-area computer lab for residents, with two or three workstations as well as flatbed scanners, fax machines, and printers.

7. In-room phones connected to central IP or PBX network with speed dialing, voice mail, and other advanced telephone features. Local and long distance call usage will be tracked and billed via the call capturing software system (ACDR).

8. Training and Support for all Residents on equipment and resident-focused applications, as well as an eight-week training curriculum for the activity directors or community directors to use with all new residents as a core activity.

Alzheimer’s Building

1. TV- set-top boxes (STBs) in all residents’ rooms for staff use only as a bedside data capture tool.

2. Point-of-Care (POC) Data Entry software and system integration to EIS.

3. Training for Staff to use the installed system and software.

4. Training for the cognitively functional residents so they can learn hardware interaction and web surfing skills.

5. “Granny-cam” for remote monitoring and web cams in common areas for family interaction with residents.

6. Remote diagnostic medical devices.

7. Support for staff.

Affinity (Customized) Portal and/or Community Intranet

1. Co-branded and customized portal faceplate and content that is specific to the building and local community.

2. Electronic distribution of activity schedules, menus, and newsletters for residents and family. A reduced paper-flow environment will result as more staff/resident communication occurs over the Intranet.

3. On-line meal selection to assist in ordering, procurement, dietary and nutrition planning, and resident satisfaction.

4. Condition and wellness management reminders and instruction.

5. Continuing education and in-service materials delivered to the staff and other healthcare workers, using distance learning and web-based training methodologies. These materials will be particularly helpful when new hires, or replacement workers, have to be trained quickly and efficiently.

6. Customer Relationship Management (CRM) software for lead generation, tracking, retention, and customer satisfaction functionality.

Pre-Construction and Pre-Leasing Marketing Communications Materials

1. Website Development for the entire property, as well as hosting if required.

2. Collateral Materials (brochures, flyers, other print materials) to support database-marketing efforts.

3. Advertising Campaign in appropriate local media.

4. Internet-based promotion of property via websites such as: www.aplaceformom.com, www.snapforseniors.com, www.seniorcenter.com and others.

5. Virtual Tour capabilities

This project will change the game for many existing providers; it is specified, and could be coming soon to a town near you

BB

Is the Future of Senior Housing @ Home?

Home As The Site of Care: Redesigning Health Care For the 21st Century

An emerging philosophy in senior care emphasizes the need for Home TeleHealth, and to be put simply – keeping health care recipients in their home and improving opportunities to heal chronic illness. The components to consider are:

1. Identifying changing demographics and characteristics of the chronic disease population
2. Defining the components and implementation strategies that centers care delivery at home
3. Advocating and evangelizing the importance of evidence-based research and evaluation of the Home TeleHealth industry, to provide safe and cost effective care in the home
4. Demonstrating how patient choice and patient satisfaction are fundamental to the success of all Home TeleHealth programs
5. Defining clinical, technical and business elements necessary to sustain a successful HomeTeleHealth program
6. Providing a unique opportunity to network with industry thought leaders, clinicians and technology providers

Twenty-first century health care redesign has been achieved by identifying changing demographics and characteristics of the chronic disease that makes the home the most appropriate place to deliver care. Centering patient care in the home has clearly impacted patients enrolled in the program and Community Care Coordination Services has changed the clinical course through care coordination in the home environment, illustrated in specific patient cases.

What does Community Care Coordination mean for seniors?

The mission of Community Care Coordination is: coordinating the right care, at the right place and at the right time. The vision is that the residence is the place of care. The target market is the senior population with chronic conditions, high users, frequent system users, high risk (clinically complex) users, and high cost (over $25,000 per year) users. The program seeks to understand cost effectiveness, efficiency of care, the quality impact to patients and care givers, patient / provider satisfaction and best practices.

With this approach, patients' empowerment can be achieved by allowing independence from caregivers and the hospital. As one patient put it – who wants to go to the hospital and be away from familiar surroundings in the home? When patients take responsibility for their care, they enjoy feelings of pride and security. It enhances their quality of life by bringing the caregiver to the home and builds a bridge between the patient and their caregiver. No longer are visits performed in a rush, and with strangers. Outcomes are improved, often with results that are superior and in shorter duration. In some cases, lives were actually saved by quicker and more accurate results. Reduced hospitalizations were achieved by improved care and attention to the chronic conditions. And even though some seniors have been characterized as resistant to change, there were high levels of satisfaction with the care and technology. Indeed, Home TeleHealth is improving the quality of life for seniors and in some cases, has saved lives by being available all the time!

Training is a critical element if the technology and care are to be successful. Clinicians must prepare an assessment of the needs and issues with the interest of the patient clearly emphasized. All the staff and patients must buy-in to the process. Early champions must be willing to think outside the box to overcome problems and obstacles and not be techno phobic. The first population must be respected by their peers and patients. Staff and patients must trust the technology and their ability to use it. Patient instructions must be clear, concise and include installation and orientation information. Of course there must be a patient instruction checklist for equipment maintenance, including such basic items as no food, liquids, cleaning materials on the equipment, keeping the equipment out of the reach of children and not adjusting the equipment unless instructed to do.

Some of the more typical equipment features include cameras, video monitors, speakerphones, an interface to a communication line and monitoring equipment. The technology should be evaluated in terms of Home TeleHealth priorities such as the patient's needs, provider's needs, the agency requirements and ease of technology implementation. The technology should not be invasive of the patient's needs and care, and in fact, if that is the case, it should be discontinued from use. However, with the success of the equipment, this is not the case with practitioner and patient attention and approval

It is clear that with the tremendous success of various pilot programs, this is a model which should be carefully evaluated and followed by other members of the private and public health care provider community. It has dramatically reduced the cost of providing care to the chronically ill and provided immediate quality of life benefits to the patients.

BB

Health Care Renewal: Putting on the Ritz?

Health Care Renewal: Putting on the Ritz?