I'm Eric Tinsley, the VP of Research & Development and Chief Technology Officer at My Health Care Manager.

My role here is to build systems and tools to make caring for seniors easier, more predictable, and help everyone involved in eldercare make the most informed decisions possible.

If you'd like to read more on my background click this about us link .

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

My Health Care Manager's care management system (Navigator) has just been updated to version 1.9.  This is the core system that geriatric care managers use to assist families caring for aging parents.  From past blogs you may know that this includes the assessment, care planning, implementation, and tracking support for seniors and their families.

Navigator 1.9 includes:

• Key changes for work flow
• Assessment and tracking improvements in the following dimensions:
  • Client Designees
  • Financial
  • Advance Directives
  • Engagement – Social Support
  • Provider Information
  • Medication History
  • Family Medical Health History
  • Functional Status
  • Assistive & DME Devices
  • Sensory Status
  • Nutritional Status
  • Anxiety
  • Environmental
• Reporting enhancements in areas like legal and Insurance, personal health record outputs, services listing, and more

This system is available to our clients and clients of our affiliates and partners.  We also provide much of this information in our Guide for Senior Well-being and Eldercare.  This is a self help guide is available at http://www.myhealthcaremanager.com/guide/product.asp.

I've been seeing several ads for voice recognition phones, lately .  The idea is to provide both the sound through the ear piece and a text display of what's being said.  This can be a terrific tool for older adults with hearing problems. One example can be found at the CapTel web site.

This service can have impact on senior well-being in several ways.  The example shown by most of the advertisers is reducing feelings of isolation by making it easier for grandparents to speak with grand kids and other friends and family.  It can also play a very practical role in caring for aging parents, as well.  Caregivers can communicate more frequently by adding phone conversations to face to face interaction.  The text can also help assure that advice or instructions are more accurately understood.

These phones are another tool in the emerging market to help seniors who are  living independently. 

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

Our Senior CAre Navigation System (SCANS) has released in a new edition - Version 1.2!
 
This version includes major extensions of the search functionality to make it easier for geriatric care managers to find specific tools and solutions.  This provides quicker access to hands on practical solutions for families caring for aging parents.  Of course, the structure and caregiver advice in each of the 25 Care Categories remains in place to assist the geriatric care manager overall care planning.

Also including in the 1.2 release are a variety new solutions, actions, resources and other content for helping with senior well-being and senior health care.

One of most touted areas of the Federal government's stimulus initiatives has been investment in Health Information Technology.  Unfortunately this has been focused heavily on infrastructure not caregiving tools (and certainly not tools for eldercare specifically).  Proponents of this investment believe that it will save billions of dollars in the long run on health care costs.  Typically they site things like the elimination duplicate tests, administrative efficiencies of an Electronic Medical Record (EMR) and other "back office" improvements.

Well, I'm skeptical.

I'm not alone,  the New York Times published an article a little while back raising some of the same concerns.  Titled "Doctors Raise Doubts on Digital Health Data" the article discusses how difficult a problem this really is.  Two significant issues surface.  First, how frequently these systems are used and second, do they actually make a difference in the quality of care and coordination between health care providers.

Read the full article at www.nytimes.com/2009/03/26/business/26health.html. 

Not surprising the use is very low - 9% of the nation's 3000 hospitals according to the article.  Data on quality or efficiencies really isn't even available.

For people caring for aging parents and the cost associated with senior health care.  I'm even more skeptical.  In reality the health situation for a senior really can change over night and repeat tests are necessary.  A senior with congestive heat failure or chronic obstructive pulmonary disease may require duplicate tests in very short time frames.

Transfer of information could provide some efficiencies, but often competitive hospitals, physician practices, and other competitive health providers are being asked to collaborate with no financial incentive. 

A number of people have been asking me about starting a Personal Health Record(PHR) with Google Health, Microsoft Vault, or other free tools.  The question eventually cycles around to, "Why would I pay for a PHR when I can get one for free?"

Good question.

Of course, the answer is as old as the health care business itself.  "There's no such thing as a free lunch" ... or even a free PHR.  It's simply a matter of what you are willing to trade for the service. 

If you build your own PHR you have to take extra time to build, maintain, and even think through all the necessary information to collect.  Likely you have to type everything by hand rather than pulling from medical records, pharmacy records, or other sources of ready data.  What you are "paying" is your time and what tools you decide to use.

I the case of Google Health of Vault you are "paying" with your personal information.  In particular, detailed information about your medical conditions, treatments, and health situation.  If you are caring for aging parents you are trading their information.  What you get in return is the result of hundreds of thousands of dollars of development and though.

But, where did all the development money come from?  Where does the money come from to pay for the computers, bandwidth, and support staff?  It comes from advertising dollars aimed directly at you, your parents, or you as a caregiver.  These advertisers love the idea of being able to get directly at you and the health problems you or your parents face.  Not all bad, really... but no so good either.

The other model of course is to pay for a PHR application yourself and eliminate the need for a "third party payer".  In this case, of course, you are paying with an annual or monthly access fee.  This is also true if you are using a geriatric care manager or other provider of eldercare services who is using a system on your behalf.

There isn't a right answer.  You simply have to evaluate the trade off between your time, your private health information, or your money.

A friend forwarded an email recently about something called the "Wellness Wizard".  This is system for automated reminders.  The caregiver records messages to be played at specific times and dates.  The idea is to provide reminders about medications or important appointments.  It also provides a mechanism for the senior ask for help from caregivers.

All-in-all this tool probably has some utility.   It's relatively inexpensive and could help people caring for aging parents who live independently feel more comfortable about their parent's situation.   

The only part of this that really bothered me was the claims about this product.  The company claimed it would:

• decrease avoidable readmissions
• maximize the well-being of their loved one
• reduce caregiver stress
• and more

The product can contribute to these, but it's really a stretch.

The truth is, it takes a coordinated effort.  Eldercare is not a tool.  Tools can only help.  Be wary of "over sell".  There's nothing that can replace a caregiver's involvement.  Even a geriatric care manager still needs the connection with family. 

Care managers and tools for eldercare can save time, improve situations and even well-being, but they are aides not replacements.

Natalie, one of your key researchers, just let me know about a long list of materials released to SCANS.  In previous blogs I mentioned the development that is underway for SCANS, but we are also improving the Knowledgebase of the current production release. 

Here is a sampling of some of the new material available to geriatric care managers and the families they are helping:

My Medicare Matters	Insurance – Resources
On-line Services at the Social Security’s Website	Financial – Resources
Food Pyramid for Older Adults	Nutrition
How to Find a Geriatric Physician – updated	Provider Coordination  - Protocols
How to Locate a Neurologist	Provider Coordination - Protocols
How to Locate a Speech Therapist	Service Coordination - Protocols
DME Resource – Updated	Communications, Continence, Environmental, Functional health, Physical Health, Sensory
Caregiver Support Resources – Updated
Pet Plan	Social
Tips on getting an older adult to the doctor when they refuse	Provider Coordination
How to locate a Urologist	Provider Coordination – Protocols
How to locate a Audiologist	Provider Coordination – Protocols
Medical Transport Services	Service Coordination - Protocols
Home Modification Resources	Environment
Tips to a Successful ER Visit	Service Coordination
Veterans Benefits Information	Financial

Continuing to explore the technology to help with aging parents, in home monitoring is becoming more and more visible. 

One of my blog readers recently called my attention to this article from the University of Missouri titled "Health-Monitoring Technology Helps Seniors Live at Home Longer, MU Researchers Find".  Click here to read the article.  Articles like this one are appearing more and more, and research in these areas is on the rise.

That's not a surprising trend given the demographic shifts and the desire for seniors to continue living independently.  The article, in fact, leads off with this premise.

Using sensors, video, and other tools researchers at MU have built an early warning system to help identify problems and alert health care providers before problems escalate to full blown emergencies.  The study examined data collect of two years at an affliated retirement community to identify patterns leading up to adverse events.  Real time data can then be monitored - watching for these patterns.

Systems like this can help to provide peace of mind to families who are caring for aging parents and provide meaningful data to senior health care providers.

I got several comments on my caregiver blog about Therapeutic robots.  Several people were intrigued and others where "cautionary".  The cautions are well founded.  If you are caring for aging parents, you have to view technology as a tool, not a pat answer.  Some dementia patients might find a robot a cause for paranoia or even an object of anger.  So instead of enhancing a sense of well-being it could actually damage it.

A professional geriatric care manager can help with these kinds of decisions along with other health professionals.

Here is another article about Paro which you may find interesting titled, Robot baby seals to replace cats and dogs as pets in hospitals, nursing homes. This article explores the artificial intelligence capabilities in a little more depth.

Just in case you thought the robot dog was too silly, I wanted to share this article from the Washington Post.  "Dementia Patients Find Comfort in Robot' discusses the use of a robot to provide comfort and companionship to dementia patients living in a retirement community.

This is not a whim, the National Institute of Advanced Industrial Science and Technology developed the robot called "Paro" over 12 years.  These same kinds of research are being explored at IUPUI in the schools of Informatics and Computer Science.  Creating animal like or child like responses in a robot seems to have significant impact in treating cases of dementia.  Sights, sounds, tactile sensation, and responsiveness all appear to be important influences.  This make a robot an ideal tool.

It's exciting to hear of real help with senior health care that doesn't involve extensive medication and actually enhances well-being.

Perhaps the most difficult thing for a senior to do is give up the car keys.  Eventually nearly everyone has to, but driving is a major key to living independently and person's sense of well-being. 

Consumer side technology is being developed to help improve safety issues with seniors.  GM is developing a car windshield that uses infrared sensors, cameras, and lasers to enhance sharpness of items on the road.  The idea is to make lane marks or objects in the path of the vehicle more distinct.  See this article General Motors designs windshield that enhances objects to help seniors for more details on the development.

This is a example of a home (car) safety product targeted specifically at older adults.

Just to begin to get a feel for the amount of products hitting the consumer market, consider this site a friend emailed me http://www.epill.com/.  That's right, an entire site dedicated to pill reminders.  They have reminder watches, reminder pill trays, pager systems, locking dispensers, and you guessed it an automated robotic pill reminding dog (see it here http://www.epill.com/pillpets.html).  

All of these devices probably have their place, but it's no wonder families and caregivers end up confused.  Pill reminders can sometimes even be more of a hindrance than help.  I touched on some of these problems in a earlier blog titled, Can Technology Help with Memory Loss.  The advice of a geriatric care manager can be a big help in determining what might work best.  In fact, if the care manager has a consistent relationship with the family, their advice is likely to be more tailored to the specific circumstances than recommendations of senior health care providers like doctors, hospitals, or retirement community staff.

Technology is pervasive in the provider community, but still relatively undeveloped in the areas of patient communication and knowledge management.  We've all seen the amazing technical devices to assist providers in diagnosing and treating diseases.  Likely, you're familiar too with the use of technology in claims processing, billing, and so on.

In the area of informatics and knowledge management the use of systems is still very new.  Some of the key initiatives in this area include:

• Electronic Medical Records (EMR)
• Health Information Exchange
• Disease Management
• Patient Information Portals

For Geriatric Care Management, specifically, we could add Case Management and Decision Support Systems.  Case Management has been used for some time by payers to control costs, but recently have been used to improve and coordinate care.  There are a handful of case management systems emerging for the non-clinical dimension of Geriatric Care. 

Decision Support is very new.  SCANS, mentioned in earlier blogs, is an example of such a system.  This is unique in the class in that it focuses on care rather than improving reimbursement.

Technology is being developed in a variety of areas to assist in geriatric care.  Significant efforts are underway in both the consumer and professional markets.  Already these efforts are bearing fruit.  You can read about some in my earlier blogs and I'll be highlighting others in the coming weeks.

Let's start the discussion with some categories.  Technology is entering the the consumer side of eldercare both in the home and on the Internet.  This work could be grouped as follows:

In Home:

Consumer Products 
- Family Communication 
- Wellness and Assistance
Health Products 
- Services 
- Diagnostics Reporting
Safety 
- Monitoring Services 
- Products
Research Initiatives 
- Continuous Monitoring – Automatic Detection 
- Decision Support

On the Internet:

Person Health Records
- Microsoft Vault 
- Google Health
- Hundreds of Others
Medical and Non-Medical Information
- Health Sites
- Support Group Sites
- Commercial Sites

Just to give you a feel for size and scope of the eldercare problem, I thought I'd share a few dramatic numbers. 

• By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years - Department of Health and Human Services, Administration on Aging, 2006.
• 24 billion hours were spent in caregiving in 1997. - Arno PS, Levine C, Memmott MM. The economic value of informal caregiving. Health Affairs. 1999
• In 2006, productivity loses to U.S. business were estimated at $33.6 billion. Nearly 80% of these caregivers, were caring for someone over the age of 50 - The MetLife Caregiving Cost Study: Productivity Loses to U.S. Business. MetLife Mature Market Institute and National Alliance for Caregiving. 2006.

You can see from these statistics caring for aging parents is big and growing problem.  It also too big to expect health care providers to provide the solutions.  Caregivers themselves are going to be overwhelmed, as well.  On a personal scale many are already.

Technology can help and may be the only way to cope with the growing issues.

In addition to caregivers having to shoulder the work load of the growing senior population, they are also naturally more engaged in caring for aging parents than health providers for most time their parents face the challenges of aging.  

If you create a "smoothed" picture of the health challenges faced by older adults, you get a continuum like the one shown below.

Each of the "humps" corresponds to major health incidents or living circumstance changes.  In the early part of the continuum, the senior is aging at home and later may require assistive care at a retirement, assisted living, or long term care community.

The health care providers only intersect with the caregiving need at the green arrows for acute or assistive care.  The vast majority of the continuum is addressed by family caregivers who are typically not trained health professionals.  These caregivers need support tools and services to provide the best quality of life for their parents and themselves.

Last week's Indiana Geriatric Society's Fall Conference was a terrific meeting.  Special thanks go to the speakers, the current Presidents Drs. Diane and Pat Healey, and conference organizer Kathy Frank and her team of volunteers for carrying off a great program. 

I wanted to share a few thoughts from the conference.  We are facing a serious problem in our Heath System.  The growing population of seniors, their expected longevity, and the small number of health care professionals entering geriatrics or even primary care make for an alarming future.  Health care providers simply won't be able to keep up.

This means that families will need help with aging parents.  That help will come from caregivers.  Most will be family members and some will be professionals such as Geriatric Care Managers, companions, and other eldercare service providers.

These caregivers (especially the family members) need more tools, more resources, and more expertise.  Most will not be trained health professionals and many will be caring for an senior for the first time.