I’m pleased to welcome Jane Niederberger as My Health Care Manager’s new President.  With over 25 years of experience in the health care industry, Jane is a great addition to our team.  Most recently, Jane founded Niederberger Ventures LLC and has been active in HALO, an Indiana angel investment group.  From 2004 – 2006, Jane was Vice President and General Manager of Operations for Anthem Blue Cross and Blue Shield’s Central Region, a $16 billion subsidiary of WellPoint.  Prior to leading the consolidation of operations, Jane was Anthem’s Senior Vice President and Chief Information Officer (1997-2004). 

To read the Indy Star article 'Ex-WellPoint exec to lead elder-care services startup' visit the Star's website:   www.indystar.com/apps/pbcs.dll/article?AID=2009910050305

To learn more about Jane, please visit our website: www.myhealthcaremanager.com/aboutUs_manageteam.asp.

My last post covered some general vaccination information for seniors and caregivers.  Today, I’m going to provide you with some eldercare resources for flu season.  The best advice during this flu season is to talk to your health care provider about the seasonal flu vaccination and the “novel” H1N1 (Swine Flu) vaccination.

According to the Center for Disease Control (CDC), “One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of novel H1N1-related complications thus far.”  To keep up with the latest information, visit the CDC (http://www.cdc.gov/h1n1flu/).

Remember to take everyday flu-prevention and well-being precautions such as:

• Wash your hands often with soap and water   You can also use alcohol based hand cleaners
• Throw away your tissue after use
• Avoid touching your eyes, nose or mouth
• Avoid close contact with people who have flu type symptoms if at all possible
• Listen for your local public health advice especially regarding closing and crowds
• When you are sick (or have flu symptoms), stay at home and have the supplies in need in your home for a week or so. 

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.  If you have additional questions, please speak with your health care provider.  Your physician can also advise you on prevention measures, such as the flu vaccination.

For seniors and caregivers: if you would like to locate a flu center by zip code, visit http://www.lungusa.org/site/pp.aspx?c=aqKGLXOAIlH&b=1015035.

According the America Geriatrics Society,  a person is expected to live another 16 years after turning 65, a person who is 75 can be expected to live another 10 years and person 85 can expect to live another 6 years.  So even though vaccinations are focused more toward children, it is important to prevent disease as you age and practice prevention.    A recent post contained information about special vaccinations that you may need to travel to certain areas of the world, but vaccines are also an important consideration for everyday life.  Caregivers and seniors should make sure to stay on top of their preventative health plans.

A great eldercare resource is the American Geriatrics Society.  Through their site and publications you can know the latest recommendations not only for flu shots and the older adult, but also the recommendations for vaccinations and prevention tests.  Medicare does pay for some of vaccinations such as the costs of flu, pneumonia, and tetanus immunizations.


Some vaccine recommendations for seniors are:

• Influenza Vaccine - yearly
• Pneumococcal Vaccine - 1 dose at age 65
• Tetanus Vaccine - 1 booster dose every 10 years
• Shingles Vaccine - 1 dose in immunocompetent people

Always remember to discuss a preventative health plan with your health care provider.   
 

My last blog focused on a great eldercare resource for travel planning, the CDC travel site (www.cdc.gov/travel), where you can get information on recommended vaccinations and precautions.  I also gave you some preparation to do with your health care provider, including creating lists of your medical conditions and obtaining documentation of any special conditions for airport security (e.g. pacemakers, steel plates, etc).  Now you’re ready to pack – what do you need to take in terms of health care information?

Don’t forget

• a complete medication list
• enough of your medications for the duration of your trip
• a list of medical conditions (and treatments) created by your health care provider
• documentation of any conditions that airport security needs to be aware of
• alcohol-based hand sanitizer (for times when you can’t wash your hands

The medication list (including any over the counter drugs you’re taking) should include the drug names, doses, when you take them, any special instructions, and the amount of each drug you should take on the trip. 

Having all your medical information on paper (including the medication list described above) will assist you on getting through customs easier and help you if you need emergency medications.  Keep a copy on your person and copy in your luggage.

As always, protect yourself from infection by washing your hands and/or using an alcohol-based hand sanitizer prior to eating or after spending time in crowds such as on plane, bus or train.  Watch what you drink and eat.  

Plan ahead and enjoy!

We’re pleased to announce an agreement with Anthem and Wellpoint, which was covered in the August 24 – 30 issue of the Indianapolis Business Journal.  My Health Care Manager’s Eldercare benefit (which provides senior care management and caregiver support services to covered employees) will be offered in Indiana through the Anthem 360 Health program.  After the Indiana pilot, My Health Care Manager’s benefit will be rolled out by Wellpoint to all 14 states in which they operate. 

The benefit will help working caregivers balance the challenge of providing care to a loved one with work responsibilities, and also help improve the care and quality of life for the senior.  Employers assisting their employees by offering the Eldercare benefit look to reduced costs associated with working caregivers such as absenteeism, workday distractions, and time taken off to provide care.  My Health Care Manager provides an experienced nurse, a Health Care Manager, to guide the caregiver through their personal situation – and can assess a senior in the home anywhere in the U.S.

To learn more about Eldercare benefits for your business, or geriatric care management services for your family, please contact us at (800) 499-8020.

 

My Health Care Manager was honored as one of the Indiana Companies to Watch for 2009.  To see the full list of 2009 winners or to learn more about the honor, please visit their website at http://indiana.companiestowatch.org.  To learn more about us and the eldercare services that we provide, visit us on the web at www.MyHealthCareManager.com or call us at (800) 499-8020.

In earlier blogs, I've mentioned a variety of in home technology advances to assist people caring for aging parents who hope to remain living independently.  Among these are safety tools for monitoring the home environment intended to help seniors who are "aging in place". 

One thing that doesn't come up enough in the discussion of these tools is the question of ethics.  How invasive should family members, or monitoring services, be allowed to be?  There are people looking at both the technology and the surrounding ethical issues.  One such group is the Ethical Technology in the Homes of Seniors (ETHOS) effort underway at Indiana University.  The focus of the ETHOS team is developing tools and guidelines to protect the privacy of senors living at home.  According to the team, seniors often underestimate the risks to privacy involved with technology use.

You can read more about there efforts by clicking on this link http://ethos.indiana.edu/. 

The final installment of the SCANS 1.3 rolling release is complete.  The July release includes some 22 new and revised tools and resources.  The list includes:

• Medicare Summary
• Medicare A Information
• Medicare B
• Insurance Resource
• SHIP
• Medigap
• Medicare C and Advantage Plans
• Earwax
• Visual Impairment Websites
• Hearing Impairment Websites
• Visual Impairment Devices
• Optometrist vs. Ophthalmologist
• Bladder Training
• Foley Catheter Care
• Urinary Continence Education
• Incontinence Supplies
• Catheter Education and Support
• Brain vs. Bladder
• Incontinence – Foods to Avoid
• Tips to manage Incontinence with dementia
• Continence Bladder Diary
• Modify Environment to Assist with Continence

Thanks to the SCANS research team for this successful (and popular) release which included some 74 new tools!  You can read more about these topics from a caregiver's perspective directly from one of our researchers Karen Witt Kelsey.  Click here to read more in her Caregiver Support blog.  Karen is a key member of the research team as well a caregiver for her own mother.  You'll enjoy her unique perspective on senior health care.

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.

A colleague handed me a flyer today from a local cardiac physician group for cool little wallet sized CD they provide their patients with key medical information on it. 

The idea is that you carry this card in your wallet and in an emergency situation you can hand the card to a provider who can then view it on a computer capable of reading a data CD.  Even if you are unconscious, medical personnel can find the card style CD and view it.

The CD contains things like:

• medication lists
• current diagnosis
• current allergies
• discharge summaries
• diagnostic test results
• and even educational materials

All in all this is a good thing.  It also points out some of problems with "high tech" solutions to emergency information. 

• First, not all emergencies will allow time for medical staff to leave the patient in order to find a PC with a CD drive and review a set of unfamiliar computer documents.   
• Second, in order for this information to be easily read in an emergency situation, it is also easily read by anyone who steals or even simply has access to a person's wallet.  Because it's a CD, it's also not clear exactly what data is on the record; leaving seniors and families caring for aging parents to wonder what information is potentially disclosed.
• Additionally, the currency of the data may be questionable.  Frequent health and medication changes are common in older adults and this approach requires notification back to the provider, payment of an update fee, and the reissuing of the wallet CD.  Allowing reasonable times for such activity, it could be very difficult to keep this up to date.
• Even small scratches from "wallet wear" on the CD can render it unreadable.  Something that wouldn't be readily apparent until the CD was checked in a computer drive.  Often, I fear, at the time the information is most needed. 
• Lastly, the completeness of the data may be in question as it relies on the patient, often a senior with depression or memory loss, to report the activities of the disjoint senior health care system.

My Health Care Manager approaches this problem differently.  Our geriatric care managers collect, review, and update information across all of a client's health providers.  This Personal Health information (PHI) is then used to inform all providers engaged in the client's health.  For example, each of the client's physicians receives the medication list initially and then again for every medication update. 

For emergency situations, clients are given a Ready Reference Card which contains all the key medical information and alerts.  This PHI easily folds to the size of credit card for wallet use and multiple copies can be kept in other key areas, for example in a specially identified pocket on the client's refrigerator where emergency personnel are trained to look. 

Because the Ready Reference is a paper record it is immediately available to emergency personnel in settings where a CD reader may not be at hand such as the senior's home, as shopping center, and so on.  It is also quick and very inexpensive to reprint when updates are needed.

The point here is not that technology is bad.  On the contrary, technology enables both of these solutions.  We should put it to work in the most effective ways we can devise for seniors and their families.

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.

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.

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.

The Indiana Geriatrics Society hosted its annual conference in Nashville, Indiana a couple weeks ago.  It was a great day where colleagues met to network and learn about initiatives that will enhance the provision of eldercare services. The focus of the conference was on providing quality of care for older adults transitioning from one setting to another.  Latest evidence-based practices were shared formally and informally throughout the day.  Topics included a great review of psychotropic medications, a quality initiative for early screening of depression in primary care, and how to address wound care issues and fall prevention concerns.   The day ended with the vision for the future and the key role that informatics will play in assisting care providers.  Eric Tinsley summarized the day’s event explaining “caregiving” through life stages and how technology will assist older adults and their caregivers in coping with the transitions of care. Visit Eric’s blog for more information on tools for eldercare.

As a state affiliate of the American Geriatrics Society, IGS was created to enhance the visibility of geriatric medicine in Indiana, to provide local educational programs in geriatrics, and to provide input to the national organization on policy issues. This all-day conference demonstrated the intent of the organization. For more information on Indiana Geriatric Society, contact Kathy Frank RN, DNS, Geriatrics Program Administrator and the IGS COSAR representative for AGS at katfrank@iupui.edu.