Sunday, May 31, 2020

Six Covid-19 Aging and Health Technology blog posts from May 2020

May was an unmerry month of angst and abject failure. All around, we have been locked down beginning in March. We have been incredulous, watching older adults die alone in a nursing home, and then dying in many nursing homes. Then half of the 30 million small businesses shut down temporarily. Then hospitals limited admissions in anticipation of an onslaught – and limiting their revenue-generating business – and some shut down completely. And on and on. In May came the trickling of re-openings and beginning of renewed life, though very different from that previous life.  We wait and watch to see what will be different, especially for older adults and their access to technology, moving forward. Here are six blog posts from a May unlike any previous:

Could technology improve nursing homes? Nursing homes – consternation, condemnation are words that rule the day. It must be tough to be focal points for nursing home policy these days. Even as a task force is being set up to focus on nursing homes, on the one hand, that seems positive. On the other hand, Leading Age CEO was 'enraged' about shortages of PPE. And seniors (AARP) who are most likely NOT in nursing homes, demand that workers have adequate PPE, that the public be notified which nursing homes have cases of Covid-19, workers are striking at nursing homes, and so on. Go back to 2019, for just a moment. What were the top issues early in the year? "Challenges facing nursing homes serving primarily long-stay residents covered by Medicaid; workforce challenges, which are unlikely to dissipate; nursing home regulations; and the growing popularity of Medicare Advantage." Read more.

65 is the new 85 – Covid-19 cultivates elements of ageism. Note the interesting behavior of ‘leaders’ during the time of Covid-19. Consider the EU guidance: "The chief of the European Union's executive has warned the block's elderly that they may have to stay in lockdown till 2021 due to the new coronavirus." And in California, as seniors use more technology to communicate with others, the executive director of the Village Movement California, Charlotte Dickson, observed that EU guidance is consistent with Governor Gavin Newsom’s thinking for California and his March 15 order telling the 65+ to isolate at home: "You’re basically disappearing almost 30% of the state of California, and ageism is all about disappearing people … once you retire, you’re done. If seniors are being asked to continue physical distancing for the better part of the next year or two, divisions between generations may calcify." Read more.

How essential has the Internet been during this pandemic? Rant on. Read down the April Pew report with the moniker, “53% of Americans say the Internet has been essential during the Covid-19 pandemic. Go past the concerns about whether students can complete work, past the political debate about whether the government should provide Internet access -- there are some interesting nuggets and puzzling findings. During the Covid-19 outbreak, only 31% of the 65+ said the Internet was essential; 49% said it was important but not essential, and 20% said it was not too/not at all important, with likely those with more education believing it to be essential. Given that response, it also followed that those over age 65 were not too worried about being able to pay the bill for smartphone or broadband use. Read more.

Five older adult offerings in the time of Covid-19. Companies continue to invent and introduce technology. In the face of the devastation and economic collapse precipitated by the pandemic, many tech firms soldier on, finding opportunity, re-spinning products, and announcing new capability. It is encouraging to see this sheer quantity of free offerings, accelerated interest in telehealth, and other innovations in smart homes, healthcare and robotics that have emerged in the past few months of the Covid-19 pandemic. Here are just five focused on older adults: Read more.

About those Covid-19 nursing home deaths. Try staring at the NY Times list and its murky map. The NY Times decided that tracking down and mapping the list of nursing home deaths nationwide required more than 30 contributing writers for the story. The ‘Nursing Homes in Crisis’ collection is about Covid-19 in 2020. Actually in each recent year, the New York Times has looked at nursing homes and found them to be a problem in 2017, wanting for a great deal in 2018, just a bit in 2019, then an onslaught of investigation most recently. Amid the outcry, the negative comments about bad management, bad physical design of the buildings, bad for-profit ownership, bad Covid-19 testing, etc., etc. -- very little deep thought about why people live there and what change is likely. Read more.

After Covid-19, When the care recipient is elsewhere, what’s next for technology? Technology usage has climbed sharply during Covid-19. Pew Research notes 53% of responders in April consider the Internet as ‘Essential’– although, no surprise, the oldest did not.  And Nielsen observed that the pandemic was a catalyst for the rise of tech use for working at home and shopping, among other uses. In addition, telehealth usage has skyrocketed, with virtual doctor visits expected by Forrester Research to top 1 billion by years end. The spike has been attributed to a) the declaration of a state of emergency in March; b) introduction of Medicare/Medicaid coverage matching in-person visits; and c) encouragement from hospitals and medical practitioners. Read more.



from Tips For Aging In Place https://www.ageinplacetech.com/blog/six-covid-19-aging-and-health-technology-blog-posts-may-2020

Thursday, May 28, 2020

InnovAge Pace In Action

InnovAge Pace In Action
In some communities, like Philadelphia, PACE is known as Living Independently for Elders (LIFE). To watch the InnovAge LIFE in Action video, click here: https://youtu.be/X2DARBK7tM8

from Tips For Aging In Place https://www.youtube.com/watch?v=bzs5H3cQE40

Wednesday, May 27, 2020

After Covid-19, When the Care Recipient is Elsewhere, What’s Next for Technology?

Technology usage has climbed sharply during Covid-19.  Pew Research notes 53% of responders in April consider the Internet as ‘Essential’ although, no surprise, the oldest did not. And Nielsen observed that the pandemic was a catalyst for the rise of tech use for working at home and shopping, among other uses. In addition, telehealth usage has skyrocketed, with virtual doctor visits expected by Forrester Research to top 1 billion by years end. The spike has been attributed to a) the declaration of a state of emergency in March; b) introduction of Medicare/Medicaid coverage matching in-person visits; and c) encouragement from hospitals and medical practitioners.  

A technology transformation is underway, greater than the sum of its parts. First the confusion. One article author cites the growth of digital health but swaps in terms like “remote services” and “virtual consultations.” After decades of pushing the telehealth rock uphill, the market value of individual firms, like Livongo, has skyrocketed. But other categories of usage and their user groups are coming into focus – consider the multiple examples in senior living during the visitation lockdown. Not just telehealth, but robots for cleaning or engagement technologies to mitigate isolation are ramping up. Up next, more experimentation and usage of what is available today and in-house. Further, the home care and home health companies see the opportunity to boost deployment of technology – and they’re moving aggressively forward – with engagement tools, remote patient monitoring (RPM), analytics and AI, sensors in the home.   

Consider the components of next generation remote technology to deliver care.  As the world settles into a post-pandemic phase, what will matter most for the care of and benefit for older adults? Of course, ramping up access to technology using what’s available today is a good start. Organizations everywhere are rallying to the need to fix or solidify connectivity, whether as part of national policy directive, care delivery, family pressure, staff retention, or maintaining service delivery.  These include senior housing, skilled nursing facilities, home care, home healthcare, or healthcare providers.  What technology considerations will need to be next, moving from a desperate to a more measured pace?

Next generation: What are the dimensions of remote care technology?  After the re-opening and stabilization phase of businesses in 2020 and beyond, delivery organizations will want to do a better job of delivering care in its many forms -- when the care recipient is elsewhere. What will be the priority?  Telehealth demands continued investment -- phone, video  remote patient and/or device monitoring. Along with telehealth, will wearables for health and wellbeing be a priority post Covid-19? What about Voice First engagement technologies – or other tools for caregiver teams and family connection?  And for home care – is there a better way to engage and retain the worker? What changes will be wrought in smart home categories – sensors, robotics, predictive analytics in a post-Covid world? And not least, with the pandemic at some point behind them, how will senior-focused organizations change their usage of technologies in the coming years?  

[NOTE: This is a first in a series of blog posts about the Future of Remote Care Technology After Covid-19 – a proposed Q4 Research Report -- thoughts welcome]



from Tips For Aging In Place https://www.ageinplacetech.com/blog/after-covid-19-when-care-recipient-elsewhere-what-s-next-technology

Thursday, May 21, 2020

Nursing home Covid-19 deaths – the NY Times data shouts – but what is it saying?

 Try staring at the NY Times list and its murky map.  The NY Times decided that tracking down and mapping the list of nursing home deaths nationwide required more than 30 contributing writers for the story. The ‘Nursing Homes in Crisis’ collection is about Covid-19 in 2020. Actually in each recent year, the New York Times has looked at nursing homes and found them to be a problem in 2017wanting for a great deal in 2018, just a bit in 2019, then an onslaught of investigation most recently.  Amid the outcry, the negative comments about bad management, bad physical design of the buildings, bad for-profit ownership, bad Covid-19 testing, etc., etc. -- very little deep thought about why people live there and what change is likely.

Why are people in nursing homes?  You probably know the reasons -- but let us recap. Women make up the majority of nursing home residents. Past age 75 single women are likely to rely on Social Security for income, not enough to afford assisted living, now north of $48K per year. If they live in assisted living, at some point they can’t pay the bill or are a problem for staff, so they can be ejected – sometimes to a family member, but typically to a nursing home, where the average duration of stay is 2.5 years.  So up to 70% of nursing home residents are women, either widowed, single, or having spent down assets with the assistance of attorneys to qualify for Medicaid, the primary payer for nursing homes. Half of these women have no close relatives. They may be disabled or have significant chronic conditions, including dementia.

When the customer does not advocate for self... Despite years of media rage about conditions in nursing homes (see 2018, above), nothing is really done about those that provide poor care.  In the well-run nursing homes during non-pandemic times, family visitors are often seen, as well as volunteers from religious organizations, local high schools, charities, and pet therapists to visit those without families. On the other hand, as the Covid-19 pandemic began, nursing homes were generally in poor shape – and those with low-star ratings were in worse shape.  Keep in mind that the inspection process that produced those ratings is typically annual. There are new attempts to inspect more frequently to look for contributors that led to the incidence of Covid-19 (following the Kirkland, WA disaster). But realistically how will that process change, given that it is typically done by state health agencies, which are not likely to be overstaffed?

…Lawyers are at the ready. Note that the nursing home 'industry' is pushing for immunity from liability for the recent deaths – an immunity that seems to have made it into the New York State budget, but may be repealed. In New Jersey, though, a class action lawsuit has already been filed for the nursing home that had the makeshift morgue. Note that wrongful death lawsuits have the biggest (up to $43 million) payout.  So let's ask -- when the dust settles on the nursing home disasters of 2020, what will have fundamentally changed, either in the composition of residents, the payment mechanics, the corporate structure of the industry, the role of lawyers, the public’s interest, or the media outrage? 



from Tips For Aging In Place https://www.ageinplacetech.com/blog/nursing-home-covid-19-deaths-ny-times-data-shouts-what-it-saying

Wednesday, May 20, 2020

Nursing home deaths – the NY Times data shouts – but what is it saying?

 Try staring at the NY Times list and its murky map.  The NY Times decided that tracking down the list and mapping nursing home deaths nationwide merited more than 30 contributing writers for the story.   The ‘Nursing Homes in Crisis’ collection is about Covid-19 in 2020. Actually in each recent year, the New York Times has looked at nursing homes and found them to be a problem in 2017wanting for a great deal in 2018, just a bit in 2019, then an onslaught of investigation most recently.  Amid the outcry, the negative comments about bad management, bad physical design of the buildings, bad for-profit ownership, bad Covid-19 testing, etc., etc. -- very little deep thought about why people live there and what change is likely.

Why are people in nursing homes?  You probably know the reasons -- but let us recap. A single woman at age 75 has saved very little money, not enough to afford assisted living, now north of $48K per year. If  they live in assisted living, at some point they can’t pay the bill or are a problem for staff, so they can be ejected – sometimes to a family member, but typically to a nursing home, where they average duration of stay is 2.5 years.  So up to 70% of nursing home residents are women, either widowed, single, or otherwise having spent down assets with the assistance of attorneys to qualify for Medicaid, the primary payer for nursing homes. Half of these women have no close relatives.   They may be disabled or have significant chronic conditions, including dementia.

When the customer does not advocate for self...  Despite years of rage about conditions in nursing homes (see 2018, above), typically nothing is ever done about those that provide poor care.  In the well-run nursing homes during non-pandemic times, family visitors are often seen, as well as volunteers from religious organizations, local high schools, charities, pet therapists, who visit those without families. On the other hand, as the Covid-19 pandemic began, nursing homes were in poor shape – and those with those low-star ratings were in worse shape.  Keep in mind that the inspection process that produced those ratings is typically annual. There are new attempts to inspect more frequently and for contributors to the factors that led to the incidence of Covid-19  (following the Kirkland, WA disaster). But realistically how will that process change, given that it is typically done by state health agencies, likely not overstaffed?

…Lawyers are at the ready. Note that the nursing home ‘industry’ in the time of Covid-19 is pushing for immunity from liability – an immunity that seems to have made it into the New York State budget but may be repealed.  In New Jersey, though, a class action lawsuit has already been filed for the nursing home with the makeshift morgue  -- and wouldn’t you know, wrongful death lawsuits have the biggest (up to $43 million) payout. But when the dust settles on the nursing home disasters of 2020, what will have fundamentally changed, either in the composition of residents, the payment structure, the corporate structure of the industry, the role of lawyers, or the public’s outrage? 



from Tips For Aging In Place https://www.ageinplacetech.com/blog/nursing-home-deaths-ny-times-data-shouts-what-it-saying

Monday, May 18, 2020

Five older adult new offerings in the time of Covid-19

Companies continue to invent and introduce technology. In the face of the devastation and economic collapse precipitated by the pandemic, many tech firms soldier on, finding opportunity, re-spinning products, and announcing new capability. It is encouraging to see this sheer quantity of free offerings, accelerated interest in telehealth, and other innovations in smart homes, healthcare and robotics that have emerged in the past few months of the Covid-19 pandemic. Here are just five focused on older adults:

Megilla. "Megilla, the video-storytelling platform designed to bridge generations and record treasured stories, announces they are making an early version of its platform free for everyone to connect with family and friends, in a deep and meaningful way, during the quarantine. “"The COVID-19 pandemic has exacerbated the loneliness of millions of older people,” said Dr. Scott A. Kaiser, Director of Geriatric Cognitive Health at the Pacific Brain Health Center and CIO for the Motion Picture & Television Fund. 'The risks of isolation have negative impacts on physical and mental health. The benefits of social connection—the antidote—are clear. Solutions, like Megilla, provide social connections and purpose are needed now more than ever.'" Learn more at Megilla.

Sanvis Health Care Hero. "Sanvis Health announced today the release of CareHero™, a cloud-based virtual care offering tailored for the exceptional challenges that senior living communities are facing during the COVID-19 pandemic. CareHero™ helps community operators of Assisted Living, Independent Living and Memory Care facilities navigate the multitude of primary care and specialty physicians that their residents rely on to manage their chronic conditions. By further minimizing even essential visitors to these facilities, community operators can protect their seniors and reduce the risk of exposure from external carriers of the Coronavirus." Learn more at SanvisHealth.

Caspar Smart homes. "Caspar’s artificial intelligence technology helps residents adjust their home environment – automatically modifying climate, lighting, and shades. For example, shades that automatically open in the morning lets natural light through to improve the well-being and morale of residents. Caspar smart homes are acting as a personal assistant to motivate residents to maintain a healthy lifestyle during times of isolation. For example, Caspar adapts the home by turning on soft white lights and playing motivational music to create a suitable home environment for exercising." Learn more at Caspar.ai.

Safety Labs Sirona TV. "Safety Labs the leader in TV based connected health for active aging seniors, today announced the Sirona.TV App which brings our simple to use connectivity solution designed for 75+ seniors to any Android and iOS smart phone. This further enables seniors to be independent, connected and safe in and outside their homes. Sirona.TV easy to use TV, remote control and smart speaker interface designed exclusively for seniors 75+ is now extended to the smart phones." Learn more at Safety Labs.

NurseCaller. "Originally developed and pioneered by Homestead Health, the NurseCaller™ is a revolutionary wearable device designed to give home health patients the means to directly call and/or text their visiting nurse, home health provider or a 24/7 nurse assist hotline anytime with the simple press of a button. Additionally, the 4G LTE-powered NurseCaller™ empowers home health patients to directly contact their home health caregivers anywhere, anytime." Learn more at NurseCaller.
 



from Tips For Aging In Place https://www.ageinplacetech.com/blog/five-older-adult-new-offerings-time-covid-19

Monday, May 11, 2020

Pew's simplistic survey of Internet importance during Covid-19

How essential has the Internet been during this pandemic? Read down the April Pew report with the moniker, “53% of Americans say the Internet has been essential during the Covid-19 pandemic. Past the concerns about whether students can complete work, past the political debate about whether the government should provide Internet access, there are some interesting nuggets and puzzling findings. During the Covid-19 outbreak, only 31% of the 65+ said the Internet was essential; 49% said it was important but not essential, and 20% said it was not too/not at all important, with likely those with more education believing it to be essential.   Given that response, it also followed that those over age 65 were not too worried about being able to pay the bill for smartphone or broadband use. 

It may help to place this view in the tech context of social isolation and telehealth.  The Pew response on whether tech was ‘essential’ is intriguing. Perhaps a follow-up question about ‘essential for what’ would have clarified.  Streaming video?  Searching for a good restaurant? Consider the hand-wringing that surfaced recently in that same time period about lack of access among the oldest that has contributed to social isolation during the Covid-19 pandemic.   Nursing homes struggled to link residents to remote care telehealth services. A plethora of tech providers offered free or low-cost tech for seniors. And senior living organizations were caught short and hurried to deploy tech for telehealth and engagement.

Also asked without context – should the government play a role in extending access?  Again, no specific purposes for determining ‘essential’ were outlined. The general answer, divided by party, was that it was not the responsibility of the government to provide either Internet or cellphone connectivity.  That was likely before unemployment in the US reached its highest level since the Great Depression -- with 20.5 million jobs lost.  A few other relevant details: prior to the pandemic layoffs, 20% of the 65+ population was working – not so likely any more.  Job seekers’ primary first stop has been online. If the government doesn’t pay or subsidize, smartphone access averages $60-95/month for one person and broadband access is around $65/month. At $125 lowest level of both for just one person per month, that adds up.

AARP’s 2020 survey provides more context.   In their most recent tech survey, 81% of those 60-69 and 62% of those aged 70+ owned smartphones, with the vast majority in both age groups using them daily for a wide variety of purposes, leading with connecting to others via messaging or email. Now place this usage in the context of a pandemic in which older adults are not only isolated into solely depending on the Internet, depending on where they live, but they are at some risk of being ignored completely simply based on their age – just as the country begins to open up.  How essential (and perhaps unavailable) is the Internet during a pandemic? Perhaps, as the IEEE observes, broadband access is a human right.



from Tips For Aging In Place https://www.ageinplacetech.com/blog/pews-simplistic-survey-internet-importance-during-covid-19

Tuesday, May 5, 2020

Nursing homes and Covid-19 – defensiveness persists 

Nursing homes – consternation, condemnation are words that rule the day. Rant on. It must be tough to be focal points for nursing home policy these days. Even as a task force is being set up to focus on nursing homes, on the one hand, that seems positive. On the other hand, Leading Age CEO was 'enraged' about shortages of PPE.  And seniors (AARP) who are most likely NOT in nursing homes, demand that workers have adequate PPE, that the public be notified which nursing homes have cases of Covid-19, workers are striking at nursing homes, and so on. Go back to 2019, for just a moment. What were the top issues early in the year?  "Challenges facing nursing homes serving primarily long-stay residents covered by Medicaid; workforce challenges, which are unlikely to dissipate; nursing home regulations; and the growing popularity of Medicare Advantage."

Times change – staffing turnover and low pay have been issues forever.  It used to be that CNA (certified nursing assistant) pay at an average of $12.52/hour was as low as that of Walmart workers. Scratch that. Walmart workers, say the company, average $14.26/hour in 2019.  Whatever. The CNA job is in a different league of difficulty from the Walmart job. The staffing requirements (minimum guidelines from the federal government, interpreted by states) and actual staffing in nursing homes, given the level of care required, have been issues long before the emergence of Covid-19.   

Can a commission open up its lens to view overall care? It could be a good thing that CMS has announced formation of a commission to address 'Safety and Quality in Nursing Homes.' Consider, for example, what nurses describe as the safety issues of their jobs. It would be great if they looked at the broader picture – not just Covid-19, but the care ratios and oversight processes. Also, who will validate compliance with whatever the commission recommended? Will that be a new organization – and who will be in it? It would be great if the response of association lobbyists like LeadingAge and AHCA/NCAL would broaden their near-term advocacy to focus on the long-standing issues of staffing and worker turnover.  Perhaps even taking a close look at a recent disaster – what can it mean for families and residents when most of the staff calls in sick and residents need to be moved elsewhere?

What role can technology play in new initiatives? Measurement of progress should be key – and not just squirreled away in out-of-date, potentially irrelevant inspection reports.  A new tracking system should accompany implementation of commission recommendations – looking at a few resident safety metrics prior to implementing commission guidelines.  [Note the item already in the current reporting process: "Have a program that investigates, controls and keeps infection from spreading."] Then add in the guideline assessment elements – hopefully these staff-to-resident ratios. Note what the status was in each nursing home of those elements, the date, and comparison to prior period. Hopefully the big changes will be improvements in staffing/pay/retention to match the expectations of the commission. Ultimately, the real transformation could be the analytics (who would look at this data?) about performance over time, by state, county, nursing home, and placing the results onto maps for viewing by anyone interested.  Pipe dream?  Rant off.

 

category tags: 


from Tips For Aging In Place https://www.ageinplacetech.com/blog/nursing-homes-and-covid-19-defensiveness-persists

Nursing homes and Covid-19 – defensiveness and obfuscation persist 

Nursing homes – consternation, condemnation are words that rule the day. Rant on. It must be tough to be focal points for nursing home policy these days. Even as a task force is being set up to focus on nursing homes, on the one hand, that seems positive. On the other hand, Leading Age CEO was 'enraged' about shortages of PPE.  And seniors (AARP) who are most likely NOT in nursing homes, demand that workers have adequate PPE, that the public be notified which nursing homes have cases of Covid-19, workers are striking at nursing homes, and so on. Go back to 2019, for just a moment. What were the top issues early in the year?  "Challenges facing nursing homes serving primarily long-stay residents covered by Medicaid; workforce challenges, which are unlikely to dissipate; nursing home regulations; and the growing popularity of Medicare Advantage."

Times change – staffing turnover and low pay have been issues forever.  It used to be that CNA (certified nursing assistant) pay at an average of $12.52/hour was as low as that of Walmart workers. Scratch that.  Walmart workers, say the company, average $14.26/hour in 2019.  Whatever.  The CNA job is in a different league of difficulty from the Walmart job.  The staffing requirements (minimum guidelines from the federal government, interpreted by states) in nursing homes -- given the level of care required -- have been inadequate long before the emergence of Covid-19.   

Can a commission open up its lens to view overall care? It could be a good thing that CMS has announced formation of a commission to address 'Safety and Quality in Nursing Homes.'  Consider, for example, what nurses describe as the safety issues of their jobs. It would be great if they looked at the broader picture – not just Covid-19, but the care ratios and oversight overall.  Also, who will validate compliance with whatever the commission recommended? Will that be a new organization – and who will be in it? It would be great if the response of associations (lobbyists) like LeadingAge and AHCA/NCAL would broaden their advocacy to focus on the long-standing issues of staffing and worker turnover.  Perhaps even taking a look at a recent disaster – what can it mean overall when most of the staff calls in sick and residents need to be moved elsewhere?

What role can technology play in new initiatives?  Measurement of progress should be key – and not just squirreled away in out-of-date, potentially irrelevant inspection reports.  A new tracking system should accompany implementation of commission recommendations – looking at a few resident safety metrics prior to implementing commission guidelines.  [Note the item already in the current reporting process: "Have a program that investigates, controls and keeps infection from spreading." Then adding in the guideline assessment elements – hopefully including staff-to-resident ratios. Note what the status was in each nursing home of those elements, the date, and comparison to prior period. Hopefully the big changes will be improvements in staffing/pay/retention to match the expectations of the commission. Ultimately, the real transformation could be the analytics (who would look at this?) about performance over time, by state, county, nursing home, and placing the results onto maps for viewing by anyone interested.  Pipe dream?  Rant off.

 

category tags: 


from Tips For Aging In Place https://www.ageinplacetech.com/blog/nursing-homes-and-covid-19-defensiveness-and-obfuscation-persist