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.

I have the privilege of speaking tomorrow (October 10, 2008) at the Indiana Geriatrics Society Fall Conference. My topic is:

Vision for the Future: Impact of Informatics on the Continuum of Caregiving

At the core of the material I'll be covering I want to share ideas about how technology can improve the lives of seniors and the caregivers around them. 

This in not only a desirable thing; it is a necessary thing.  By 2030 the population of seniors in the United States will be 71.5 million, more than doubling in just 30 years according the Department of Health and Human Services, Administration on Aging, (2006). 

The truth is that there are not enough senior health care professionals, continuous care retirement communities, or even professional geriatric care managers to provide complete and meaningful support for all these seniors.  Caregivers dealing with aging parents or other loved ones must have tools that do not rely exclusively on the individual people from provider community.

After the conference tomorrow, I'll share more on these ideas. 

For a complete program on the IGS Fall Conference follow this link http://iucar.iu.edu/igsfall2008.pdf

Just a quick note to announce the production release of SCANS V1.1.  The key enhancements include:

1. Search Capability for Issues, Solutions, and Resources
2. New Resources and Tools for the following:
   • Alcoholism
   • Suicide
   • Pressure Ulcers
   • Falls
   • Confusion and Alzheimer’s disease
   • Hoarding behavior and Alzheimer’s disease
   • Sun-downing and Alzheimer’s disease
   • Wandering
   • Prescription Drug Abuse
   • Transportation resources for both FL and IN
   • Resources by state
   • Alzheimer’s disease resources
   • Malnutrition info
   • Cultural
   • Spirituality
   • Long Term Care Insurance
   • Nutrition and Osteoporosis
   • Nutrition and Cancer
   • Nutrition and COPD
   • Dehydration
   • Oral Health for Older Adults
   • Nutrition and Vitamin B-12 deficiency
   • Beliefs and Practices
   
   

I've had several people ask me how SCANS (our Senior Care Navigation System) will develop over the life of the Indiana 21st Century Research and Technology Fund grant and beyond.

Version 1.0 of SCANS has just gone live, as active blog readers will know.  Training was completed yesterday and the system is already in the hands of Health Care Managers to improve geriatric care.

Over the next few months we are developing and deploying a series of "point" releases to and features and functionality of the system.  V1.1, for example, will improve the search capabilities of the application to provide easier access to solutions and tools for specific senior health care issues  (e.g. dementia information, well-being concerns, depression, and so on).  The plan includes the following releases:

SCANS    V1.0    Knowledge Repository 
               V1.1    Expanded Search
               V1.2    Enhanced Navigator Integration 
               V1.3    Localization and Enhanced Branding Support

Next, there are a series of major releases planned.  These provide dramatic advances in application capability and can even result in fundamental changes in the geriatric care profession.  The release plan is as follows:

SCANS  V2.0  Reasoning Engine 
SCANS  V3.0  Automated Knowledge Collection  
SCANS  V4.0  Outcomes Validation

Great news for families caring for aging parents!

My colleague Jennifer brought another in home communication device/service to my attention recently.  It's called Celery. 

You may remember a previous blog (click here) on the Presto Printer; a great way to communicate with parents living independently at home of in a retirement community. 
Celery is a service which combines FAX and Email capability.  It allows a caregiver or remote family member to send an email to a FAX machine in their loved one's home.  This can include a text message and even pictures.  The FAX is hooked up to a standard phone line so you don't have to obtain Internet service or have a computer.  The exciting part is that the receiver can hand write a reply and FAX it back to a special Email service that will match it to a preset list of authorized email accounts and send the message on as an image.  This makes the communication two-way.  For more on Celery see their web site http://www.mycelery.com/. 

This could be used to reduce social isolation, provide reminders about heath care, improve medication management, and just keep in touch with distant and busy family members.

SCANS (Senior Care Navigation System) goes live today with the first Health Care Manager training session.  A second session will be held this Thursday.  Our Training Manager, Katie Eller, has put together an exceptional train module for the introduction of this exciting new product.

In just a few short days all of My Health Care Manager's and our Affiliates' geriatric care managers will be using this knowledge base to provide eldercare services.

The system is directly integrated with our case management system called Navigator.  Navigator has been in use for well over two years.  The two systems together provide a comprehensive package for Health Care Managers to help with aging parents.

Technology is helping seniors with their health, safety, and overall well-being.

I'm going to cheat just a little bit and pre-announce to my blog readers that SCANS Version 1.0 is about to go into production release. 

This is the Knowledge Repository Edition of SCANS.  It provides Health Care Managers at My Health Care Manager and our Affiliates with a comprehensive knowledge base of best practices in geriatric care. 

It contains information on all of the most common problem areas encountered when caring for aging parents.  More importantly it provides concrete geriatric care solutions, step by step actions, and powerful, practical tools for implementation.    Some examples of the issues addressed by SCANS include:

• Behavioral Issues
• Caregiver Support
• Cognitive Issues
• Family Communications
• Continence Problems
• Emotional Concerns
• Environmental Issues
• Information Management
• Intellectual Engagement
• Medication Management
• Nutritional Needs
• Pain Management
• Prevention/Wellness
• Provider Coordination
• Service Coordination
• Social Support
• Spiritual Well-being
• and many more

Our Director or Research, Jean Bandos, puts it this way:

"My Health Care Manager is in the process of developing an advanced technology Knowledge Management and Decision Support System that will change the way geriatric care management is delivered. This system is directly concerned with the caregiving challenges of the senior and their family ...  (this) Knowledge  management and Decision Support System will assist the Health Care Managers in delivering complete, comprehensive, and predictable services."

Our Research and Development team is particularly proud of delivering this first version to commercial use in less the 4 months of receiving a major grant from the Indiana 21st Century Research and Technology Fund of the Indiana Economic Development Corporation.

More advances are in the works...

The My Health Care Manager's Client Portal serves as a communication platform for families caring for aging parents. It provides easy access to information like:

• Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
• Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
• Health provider contact information and specialties
• Medication list including dosage, frequency, prescribing physician, and other specifics
• Recent Hospitalizations
• Client contact information
• Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
• Resources
• and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.

In addition to general communication sites like those mentioned in my previous post, family communications can be aided by a geriatric care manager.  The geriatric care manager is actively involved in the day to day care.  As such they often serve as a communication bridge between a variety of caregivers (such as home health providers, companion services, or home aids) and the family.

At My Health Care Manager our Health Care Managers use technology to help with this communication.  Some of this is done with simple reports or other outputs from our case management system that help to plan and organize the activities of the visiting agencies helping with eldercare.

A more advanced tool used by our Health Care Managers is the client portal.  This is a special purpose portal that allows authorized family members to view key data about their loved one.  It also provides a discussion board and other communication capabilities between the Health Care Manager and all the family members authorized to view information.  Caregivers can also provide updates regarding upcoming appointments or other events and even updates to the Personal Health Record such as prescription drug changes.    One of the favorite features for families is the posting of Contract Logs showing the most recent direct activities with the Health Care Manager and their loved one.  Instead of wondering what went on the doctors visit yesterday or relying on sketchy details from mom or dad the portal user can read the Health Care Manager's firsthand account.

My friend recently asked me about recommendations for improving family communications about their aging parents through the use of technology.  Their family is struggling with keeping everyone current on their parent's situation and having a more even view of care required to keep them living independently. 

No surprise to most of you, this is a very common problem.  Typically the family member living nearby and providing help with aging parents every week has to convince the distant relatives that problem is emerging.  Occasionally, it even works the other way.  A visiting family member who hasn't seen mom or dad in a while can sometimes be struck by the a dramatic decline in cognitive ability, memory loss, or even overall health that has crept up on the local caregiver.

There are several good free tools for sharing information with your family.  Many people use Yahoo Groups  for this (to learn more click here).  It's free and easy to use, but to take full advantage of the portal family members must have a My Yahoo ID.  The Id is free, as well, but it's extra steps.  These groups can have restricted membership and other monitoring controls.  Without a Yahoo ID people can still participate in email communication through the group much like a classic list-serve.

Google has a similar tool (click here).  There are also a large variety of these with a more specific medical focus.

Lots of questions are coming in about our latest major technology initiative - SCANS.  SCANS stands for Senior CAre Navigation System.  This is a development effort that has been underway for some time at My Health Care Manager.  The first full production release is due out in August.

We already use a complete set of Informatics tools to track, manage, and communicate with families regarding the issues faced by our senior clients and their caregivers.  SCANS goes to a whole new generation of support for our health care managers. 

The system provides a comprehensive set of geriatric care knowledge and decision support to our team in the field.  This includes a holistic, consumer-side view of the many issues faced by families grouped into 25 Care Categories.  All of the primary issues in each category are explored and specific solutions are recommend along with practical tools and actions steps for the caregiver.

This puts the best practices of the industry and a full time research team at the fingertips of health care managers and the families they help.

Laurie recently posted a comment about her mom having problems mixing up her medications.  This is a very common problem.  The average person over age 65 is taking 8 prescription medications.  Someone who is battling chronic diseases may be taking many more. 

The number of medications is confusing in the best of circumstances, but clearly other challenges like declining vision, cognitive issues, or problems with manual dexterity make medication management a daunting task. 

Some of the posts in my blog can help.  See Technology in Day-to-Day Medication Management and Create Your Medication List Now.  You can also click here for our full blog list on Medication Management where you will find lots of additional advice and insight.

You can also ask question directly of a Health Care Manager by joining our Caregiving community.  Click here for that link.

To make effective use of any set of tools you need to combine them with process.  In the case of caring for aging parents, the process is something you have to repeat over and over.  The situation changes, health conditions like diabetes or cognitive concerns change, needs and desires change, and all of these play in to the decisions about the next course of action.

At My Health Care Manager we have defined, detailed and implemented processes at all levels of service delivery - over 100 in all.  These include detailed flows, processing narratives, measures, entry and exit criteria, responsibility identification, and more.  At the core, however, these processes all revolve around this simple cycle.

If you are caring for a senior, consider adopting a process like this one and implementing changes in the top 3 (or fewer) areas of concern in each iteration.  Clearly, trying to change too many things at once can actually be counterproductive.  Any of us, especially if we're sick, depressed, or struggling with cognitive decline, can only impact a small number or areas at one time.

Understanding that this is a cycle with re-evaluation can help manage the sometimes overwhelmingly long list of things needing attention.

My Health Care Manager has introduced a new FREE service that uses a little bit of technology to connect you to a lot of geriatric care research and experience. 

If you look in the upper right hand corner of this page you will see a "sunburst" linking you to a free service called the Caregiving Community.  By joining the Caregiving Community you can ask a question of our geriatric care management team and get an answer by the next business day.  Ask as many questions as you want, whenever you want.  In addition, once a month you will receive another Caregiving Community solution selected from best questions and answers we've tackled that month.  There is no cost for the service; all you need to provide is a name and email address.  We will not share or sell your name with others and we will not inundate you with any kind of high pressure sales.

So what's the catch?  Well, we do have a company interest here.  We believe that by providing valuable information to people caring for a senior in their life those caregivers will turn to us if they ever need help.  No tricks.  We know that if we can help families with the complex issues of aging everyone wins.