3 Days in the Life of a Home Care Futurist

Merrily Orsini, Home Care Futurist
Home Care Futurists Merrily Orsini

It took a Facebook posting by an old high school friend to remind me what a full and exciting life I lead. You see, I have a passion for aging care and that passion takes me to some very interesting places and includes me in some futuristic planning meetings. The upshot of all this is a professional life that is action packed and that allows me unusual insight into where we are headed as we boomers age. The home care and health care world is struggling to figure out how to handle the onslaught of aging people that are soon to be not only on the horizon, but upon us, After all, we are in to the boomers (those born between 1946 and 1964) era of turning that magical number of 65, and as the years move on, so do those aging boomers.

I’ll just cover a week in time, but, this week will showcase a trend for us as we age in place. First, the Saturday all day meeting with the University of Maryland, Baltimore Campus (UMBC) was a workshop on home health and hospice technology (H3IT). There are actually many folks that are focusing on how to leverage technology to assist in our aging dilemmas. And, not only telehealth or eHealth or telehomecare, but also communication, and standardized processes for interdisciplinary teams to keep the patient and his or her needs at the center of the care. Telehomecare (or whatever you want to call using devices, even smart phones, to communicate on care issues) are seen, not only as monitoring or data collection devices, but also as a way to extend the care. Currently care delivered at home is one-on-one care. Telehome care should allow less one-on-one care so that less staffing can accomplish what we do now with people. Less staffing, but not less caring is the idea. Extending the care through technology, communication with the patient and the care team, and intervening when necessary and appropriate. After all, it is the disparity in available caregivers and the need for them that poses the greatest risk for a focus on in-home care. This is a subject for a sales webinar today, if you are interested.

The issues of caring for frail folks at home seems simple. However, think of the workforce- it is distributed (not provided at one location like a hospital, but rather in a location that someone calls home), and it is largely unsupervised. The practicality of having the right person at the right time at the right place is hard enough without another person needed to supervise the sole care provider in the home. Technology can help. The location and time that care is delivered can be verified. The care given or provided can be monitored, and the tasks can be verified, with all accomplished remotely through current technology. Soon we may also have affordable video monitoring for all agencies to allow for sporadic checks on the tasks provided and some quality checks on the caring and kindness provided as well. After all, the way care is delivered should also be an integral part of the job.

What happens if the designated caregiver cannot get to the patient? Or if there is an emergency that keeps anyone from coming? Technology can at least proved some communication and assurance, and a check that meds are taken and food is consumed. Technology can also be used to monitor the effects of new meds or to check on a patient just home from the hospital or nursing home. Just having someone who knows what should be done for care and what events are outside the norm for that health situation will help a newly frail person to start regaining independence. Telehomecare can also provide some safety checks that may not be present currently.

Some of the issues with current technology systems stem from accumulating too much non-prioritized data. What is most important from a care standpoint oftentimes gets lost in the reimbursement and documentation regulations. Critical to care is determining what needs to be checked, with some alert for any changes in condition that would be an alarm for potential health or safety dangers. Right now we are trying to get every system talking to each other in the same terms, and until that happens there is little chance of getting meaningful, summarized data. We do need to decide on standards and adopt some common language that spans the clinical and the non-clinical.

The H3IT conference had attendees from Jordan, Ireland, Russia, Canada, and Mexico as well as almost every aging focused university in the country. It certainly is a great way to identify what is important in development of systems that will assist in our world’s efforts to solve some of our troubles before they become overwhelming. The side conversations at the breaks were almost as meaningful as the presentations and poster papers presented.

Monday brought a meeting at CHAP that also was focused on technology. How do we assist the agencies that seek to achieve quality and maintain it? How can we assist the surveyors tasked with pulling random records and assessing processes do their job better? Can the in- home technology be leveraged to expand on providing better patient care? Can we identify best practices by analyzing processes used by home health agencies that are at the top of the quality curve? What role does technology play in quality care, and how can that be proven? There are several accrediting bodies that service the in-home care industry, and quality is definitely one of the keys for future success. State regulations vary and there are few national regulations that govern in-home care, so the wise agency will focus on quality improvement and ways to maintain and improve quality with some way to verify that. Technology should play an important role in verifying that quality measures are, in face, in place.

For years the physicians were at the low end of adopting technology to do their job better. Now that EHR is a mandate for physicians, it is the home health agencies that are lagging. Many of the programs used by the larger established systems are legacy (programmed on old code) and not equipped to be as flexible as needed in today’s world of global interoperability. Early telehealth equipment is large, cumbersome, complicated and not very user friendly. Technology needs to be easy to use, integrated into the home environmental and easily converted to monitoring as needed. And, once again, a summary of important data is needed. All of that monitoring and all of that data collected is not important if it is not analyzed for actions. Is the patient out of normal functions for some readings? Has behavior changed? Have sleep or eating patterns changed? Has there been rapid weight gain or loss? And what does that all mean? Then, take this back to providing quality care and how can we assure that, with all this intervention and care at home that the patient is getting the best quality? Lots of unanswered questions, but good questions to create a path for success for the future.

On to a meeting at the FDA to showcase how GPS can be used to verify visits in home care. Because there are no diagnoses stemming from the information transmitted from the home to the office for electronic visit verifications (EVV), the EVV systems are not FDA regulated. However, they are very interested in the technology as a platform for the future. The API interfaces available and at the fingertips of the home care aide or nurse while in the home, opens up a whole new world for the patient in the home. Verifying that a visit takes place and having the patient sign off that the nurse or aide was there is just ones component of technology used in the home. Access to teaching guides in many languages makes the interaction meaningful if the patient needs to know how to treat a wound, or how to best exercise following a stroke. Access to resources for making life at home easier is available through technology. With the right technology, one can even order and schedule any equipment needed in the home.

Just entering into the FDA building was an adventure. It seems that Clinton made requirements for every federal building to be ultra secure following the Oklahoma disaster where access to a federal building was easy. Photo IDs were scanned, questions asked about the info on the ID and the collection of those visitor passes post visit assure that no one could represent anyone else, remain in the building undetected or enter with any weapon, pretty impressive system itself.

All in all, the action packed three days in the life of a home care futurist is not a typical three days. However, it does showcase the variety and interoperability needed for a successful future in home care. That future will have technology at its core, and quality as its mantra. I have to say thank you to my friends at AXXESS for allowing me the flexibility to travel to the important agency meetings and then to listen to my suggestions for how their technology can continue to be state of the art.