Prepare for Aging Epidemic by Extending Your Virtual Care Strategy to Support Ag
Governments and private organizations globally are positioning virtual care as a key solution to the increasing healthcare demand associated with the aging population. Healthcare provider CIOs should use this research to extend their virtual care programs to support aging in place.
Overview
Key Challenges
The growing and aging population globally is straining healthcare systems to the point of breaking. Healthcare providers are struggling to develop and implement sustainable and scalable strategies to reduce both the demand for and cost of healthcare for the aging population.
Virtual care for aging in place requires organizations to focus not only on specific health conditions but also an individual’s overall functional ability and thus their independence. The capabilities delivered through existing virtual care programs typically fall short for this population group.
Older people have unique barriers, such as cognitive impairment and poor technology literacy, which suppress their adoption of virtual care services, creating ethical and technical challenges for implementation.
Recommendations
Healthcare provider CIOs supporting aging in place as a component of their electronic health record and digital care delivery optimization program:
Extend your organization’s virtual care strategy to support aging in place by integrating home-based services that focus on maximizing the individual’s functional ability and independence. Build strong partnerships with other service providers to ensure effective delivery of the strategy.
Implement the required capabilities by identifying and investing in enabling technologies such as sensors, robots, virtual reality and artificial intelligence (AI). As these technologies are evolving at pace, ensure your planning includes both short- and long-term requirements.
Increase end-user adoption and value by identifying and addressing the specific barriers. Barriers relate not only to challenges associated with the aging process (such as cognitive impairment or physical limitations) but also to the specific applications of the technology in this context (such as privacy concerns related to “always-on” home monitoring).
Strategic Planning Assumption
By 2025, 50% of healthcare providers will be unable to fulfill the care requirements of their aged population due to staff shortages and insufficient supported accommodation beds.
Introduction
The Aging Trend Will Test CIOs Core Values
Healthcare providers are facing an aging epidemic and are, as yet, largely unprepared to deal with the associated onslaught in demand and rising costs.
Now is the time for healthcare providers to double down on their virtual care investments, extending them deeply into consumer’s homes to maximize the older person’s independence and prevent expensive episodes of care. The CIO must lead this charge with enabling technologies and smart partnering strategies.
The U.S. Centers for Disease Control and Prevention defines aging in place is “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income or ability level.” It is about ensuring citizens can continue living in the home of their choice as they age, for as long as possible.
As people age, many acquire chronic medical conditions, these conditions are often associated with physical and cognitive impairments. For the older person, this causes a decline in functional ability and independence, and is associated with increasing social isolation and loneliness. Compromising their ability to continue living safely within their own home.
In addition to supporting a high quality of life for the older person, aging in place addresses some of the challenges faced by the health system by reducing:
Demand on institutional care
Burden on the healthcare system
Cost of delivering care
For example, in the U.K. demand for residential care beds is predicted to outstrip supply by 2022.
There are, however, challenges to implementing sustainable support and infrastructure that enable independent living through to advanced age. In the U.S., demand for personal care workers for home care already exceeds supply. Recently, Australia published its interim report on the findings from their Royal Commission Into Aged Care Quality and Safety. Titled “Neglect,” the report highlights significant issues with Australia’s home care support program, including inappropriate hospitalization and caregiver burnout due to a lack of appropriate service provision for older people requiring support to remain at home.
Virtual Care Is Essential to Enabling Aging in Place
New and emerging technologies, including sensors, robotics, virtual reality and AI that underpin organizations’ comprehensive provision of virtual care hold great promise in being able resolve some of these issues by:
Supporting sustainable and scalable aging-in-place service models
Improving the quality and safety of care
Reducing the demand on caregiver support and hospital beds
To extend the healthcare delivery organization’s (HDO’s) virtual care model to address the unique needs of this population, CIOs must develop an approach that builds strategic partnerships focusing on increasing and maintaining the older person’s functional ability and independence. The winning formula demands not only directly addressing the management and cure of older people’s health conditions but also wellness and prevention, early detection and the use of technology to compensate for their loss of internal capacity.
Analysis
Focus Your Strategy on Maximizing Functional Ability and Building Partnerships for Effective Delivery
Traditional virtual care models are focused on predicting or responding to specific health conditions. The virtual care model for aging in place must be extended beyond this scope to focus on maximizing the individual’s functional ability and independence. Healthcare providers must achieve this through provision of personalized, proactive interventions aimed at increasing the older person’s internal capacity and optimizing their supporting environment.
An older person’s ability to live at home is dependent on their capacity to carry out the tasks required for safe, independent living — their functional ability. An individual’s functional ability is a product of their internal capacity (including their health status), their external environment and the interplay between the two.
Internal capacity is the composite of the physical and mental capacities of an individual. Individual trajectories of internal capacity vary widely. Some individuals experience a steady decline over time, for others capacity may fluctuate vastly over time. For example, a temporary decline in internal capacity after a total knee joint replacement for arthritis, can be followed by an increase in internal capacity to levels higher than those presurgery. Some may experience relatively high and stable capacity before an event (e.g., stroke) that causes a sudden and rapid decline.
The external environment includes a range of factors such as the physical environment and infrastructure, social networks, and health and social policies, systems and services. The external environment has an important role to play in enhancing an individual’s functional ability by compensating for losses in internal capacity. For example, use of a medication management system for an older person with cognitive decline.
Thus, as individuals age their physical health is only one of the factors required to maintain the level of functional ability to sustain aging in place. Virtual care strategies must be sympathetic to the range of factors that impact functional ability and independence, including:
Active self-management of health and wellness (e.g., wearables to encourage increased physical activity)
Early diagnosis and treatment of disease
Identification of early indicators of declining internal capacity (e.g., changes in gait, cognition, fatigue, metabolic measures)
Supporting communication and social connectedness (e.g., telepresence robots)
Training and education for the older person and their caregivers
Effective and safe care delivery in the community (e.g., remote condition monitoring)
Compensating for a loss of internal capacity (e.g., voice reminders to take medication)
Increasing safety (e.g., fall detection systems, wandering management systems)
To extend their strategy in this way healthcare providers need to develop new IT capabilities and service models to enable effective delivery. CIOs must objectively review what capabilities they will deliver in house versus those that partner organizations will deliver. Choosing to partner with organizations that have already built strong capabilities in specific areas, rather than building them internally, will be more efficient and effective in both the short and long terms.
These partnerships will typically include traditional service providers, such primary care physicians, community allied health service providers and home care support services. CIOs should also consider other nontraditional partners who are increasingly penetrating the health and wellness markets, such as the digital giants or retail industry. For example, Amazon and its virtual pharmacy service, PillPack or Best Buy, a U.S.- based electronics retailer and its Assured Living service, a remote monitoring service specifically designed to support the needs of aging in place.
Actions:
Work with your C-suite peers and senior clinical leaders to review your current virtual care strategy, identifying what will be required to extend the focus beyond specific health conditions to support aging in place.
Accommodate differing levels of internal capacity, and changes in the older person’s internal capacity over time, by ensuring your virtual care program is adaptable to individuals’ needs.
Review the capabilities of your current and the broader healthcare ecosystem to determine who will be your critical partners to enable effective delivery of the strategy.
Identify and Invest in the Enabling Technologies Required to Support Virtual Care for Aging in Place
Choosing the right technology to support older people’s physical, medical and social needs is critical to ensuring that your aging-in-place virtual care program is both sustainable and scalable into the future. Focus your efforts on deploying technologies that:
1. Maximize an individual’s functional ability and independence through maintenance of internal capacity (including health status).
2. Optimize the individual’s environment given their inherent internal capacity. For example, as an individual’s internal capacity declines implement changes in the environment to compensate for the loss of capacity.
Internet of Things (IoT) and Sensors
IoT is the network of dedicated physical objects that contains embedded technology to communicate and sense or interact with their internal states and/or the external environment. IoT comprises an ecosystem that includes assets and products, communication protocols, applications, and data and analytics.
Providers themselves and many specialized vendors use sensor technology to increase safety, identify issues that require intervention and enable early detection of changes in either health condition (e.g., changes in blood pressure and heart rate) and internal capacity (e.g., mobility). Sensors are divided into two main groups:
1. Ambient sensors — used for monitoring the environment, they include infrared, RFID, cameras and microphones.
2. Mobile and wearable sensors — used for monitoring the person, they include accelerometers, gyroscopes, pulses and electrocardiograms (ECGs). These can be attached to the individual or embedded in other technology, such as mobile phones and smartwatches.
Within the context of aging in place, ambient assisted living (AAL) refers to the integration of sensors, actuators, smart interfaces platform and AI to support the older person remaining independent in their home for longer. Three generations of AAL technology are described in the literature:
First generation: wearable alarm devices, activated by the user to raise an alarm in an emergency (e.g., fall), triggering a response, such as alerting a 24-hour call center for action.
Second generation: home sensors that detect potential emergencies and, triggering an automatic response. Thus, they do not rely on human intervention to initiate the alarm.
Third generation: integrated home sensors and wearable devices to actively monitor the home environment and the older person. For example, these devices monitor vital signs, changes in mobility levels and changes in activity patterns.
Sensor technologies have a broad range of applications that support internal capacity as well as enhancing the environment. These include:
Emergency monitoring
Remote health monitoring
Falls detection and prevention
Activities of daily living
Wandering
Robots and Automation
Robots are programmable machines that interact with the physical world via sensors and actuators, and often employ AI technology. They operate autonomously or semiautonomously and can be used to automate physical tasks and processes.
HDOs can apply robotics and automation in several ways to improve the older person’s functional ability and quality of life. Robots can automate and monitor activities (e.g., medication management), provide cognitive stimulation and companionship, provide reminders and detect emergency situations.
There are several different categories of robots the HDO can deploy to support aging in place. These include:
Companion robots — interact independently with people, reducing negative emotions and behavioral symptoms, enhance social interaction and promote a positive mood.
Eldercare assistive robots — assist the older person with daily activities such as mobility, household tasks and monitoring safety.
Telepresence robots — combine robots with videoconferencing capabilities that enable caregivers and family to virtually visit the older person in their home.
Drones — although not yet mainstream, drones will have future applications through their transportation and location capabilities.
Immersive Technology (Virtual Reality)
Virtual reality (VR) delivers a computer-generated 3D environment that surrounds a user and responds to an individual’s actions in a natural way, usually through immersive head-mounted displays. Gesture recognition or handheld controllers provide hand and body tracking, and haptic (or touch-sensitive) feedback may be incorporated. VR interventions can improve key outcomes including physical fitness, and cognition and emotion in people with cognitive impairment, particularly when used in the community setting.
Voice-Enabled User Interfaces
“Voice-first” technologies, also known as conversational user interface (CUI), use AI technologies such as deep neural networks and natural language processing provide a voice input and output user interface. Interfaces are reactive, initiated by the user through a question or command (e.g., “What will the temperature be today?” “Turn on the lights.”) and/or proactive, initiated by the device/application (e.g., “It’s 5 p.m. and time to take your medication”).
Technologies that deploy voice-enabled user interfaces overcome many of the physical and cognitive barriers experienced by the older person in interfacing with technology. As a result, voice-first technology reduces social isolation, increases independence in older people and reduces caregiver burden.
It supports:
Task automation — through integration with smart home devices, like Google Home and Amazon Echo, the older person can use their voice to initiate tasks such as turning on lights, opening blinds, turning on the TV and controlling the heating/cooling.
Caregiving — from setting alerts and reminders to providing activities and games to improve cognitive function and exercise programs for physical functioning. The older person can also use voice enabled technology to alert caregivers and family members of emergency situations and call for assistance or help.
Voice personal assistants — to assist with daily activities, such as booking and rescheduling appointments, as well as providing information and entertainment.
Artificial Intelligence
AI is now ubiquitous in sensor, IoT, robotics, voice-assisted, and augmented and VR technologies. AI technologies, including machine learning and natural language processing, also underpin emerging capabilities for virtual health assistants (VHA) and speech analysis for clinical diagnoses. Over the coming years both technologies will play an increasingly important role in supporting aging in place.
Actions:
Familiarize yourself with and actively monitor technologies that can currently support virtual care for aging in place and will evolve rapidly in the future.
Identify what capabilities will be required to support your aging-in-place virtual care strategy and perform a gap analysis against your current technologies.
Build your technology roadmap to include not only those technologies that are ubiquitous today, but also emerging technologies, like drones and VHAs, that will provide additional capabilities for supporting aging in place in the near future.
Overcome the Specific Barriers to End-User Adoption of Virtual Care Technologies Used in Aging in Place
Success of a virtual care program to support aging in place depends on its ability to empower the older person to shift from being a passive recipient of care to an active participant in their care through self-monitoring and management. Older people will only realize the benefits of technology to support and improve their functional ability if they apply and use the technology in the way it was intended over a sustained period. Factors including changes in health status, personal goals, life events (such as the death of a partner) and social influences may all impact the older person’s engagement with technology over time.
We have previously identified that, although older people are the highest users of healthcare services, they are the least represented in the use of digital services. To increase digital consumer engagement of the older person in their healthcare requires a personalized digital design that reflects the limitations, preferences and needs of the individual.
End-user acceptance of technologies used for aging-in-place virtual care services is influenced by many factors — living arrangements, availability of support networks, alignment to current health status, anticipated utility, ease of use and social desirability. You must consider and address the barriers associated with adoption of technologies as you introduce them and as individuals’ personal circumstances change over time. Barriers relate not only to challenges associated with the aging process (such as cognitive impairment and physical limitations) but also to the specific applications of the technology in this context (such as privacy concerns related to “always-on” home monitoring).
Ultimately, the older person’s acceptance and adoption of the digital solutions will depend on the realization of the right balance between:
Perceived costs — reduced privacy, loss of autonomy, ease of use and financial cost
Delivered benefits — increased safety, health improvements and negating the need for higher level care
You must implement strategies to address identified adoption barriers to reduce perceived costs, tipping the scale to the point where benefits outweigh costs.
Actions:
Multimodal adaptive education, training and ongoing support
Provide education to the older person and their family/caregivers regarding the scope and benefits of the technology, dispelling any false perceptions with regards to impact on face-to-face interactions, loss of autonomy and loss of independence.
Use static printed training material in addition to online instructional and troubleshooting information. Ensure all printed material is available in appropriate font sizes and uses appropriate language (i.e., no technical jargon).
Deploy face-to-face training with the technology over video and phone tutorials whenever possible.
Adopt continual learning and training programs to support changes introduced with technology updates and new technology.
Make technology support available both during implementation and in an ongoing capacity.
Adapt education, training and support approaches based on the individual needs of the end user. Accommodate for differences in technology experience, cognitive and physical capacity and the availability of a support network.
Multiexperience user interfaces
Accommodate different end-user needs and preferences for interfacing with the technology. For example, voice is a powerful user interface but not for those with verbal communication deficits (e.g., post-stroke dysarthria) or poor hearing.
Enable personalization of the user interface to accommodate for individual deficits through the ability to configure font size, color and contrast settings.
Where possible, provide a consistent user interface experience across different technologies.
User-centered technology design
Maximize the fit between capabilities of the technology and its required use by adopting user-centered design principles during the design process. This should include extensive assessment of the user needs, preferences and values, and usability analysis.
Include a representative sample of the target population — for example, physical and cognitive capacity, socioeconomic backgrounds and prior experience with technology — as well as family, friends, caregivers and clinicians during the user assessment process.
Ensure the development team includes expertise in design of solutions that accommodate for the specific changes in sensory function, cognition and physical capacity that occur with aging.
As appropriate, adopt standards for accessibility such as the Web Content Accessibility Guidelines (WCAG) and the Telecommunication Act Accessibility Guidelines (TAAG).
Flexible funding models
Address the issues of who will fund the purchase, implementation and ongoing support and maintenance of required technologies in your virtual care business case for aging in place.
Identify opportunities to shift technology costs away from the consumer through deployment of HDO-owned devices, incorporation into payer funding and implementation of solutions that support bring your own device (BYOD) of consumer owned devices.
Provide multiple payment options — for example, single upfront payment, monthly payment plan or weekly/monthly subscription fees — for situations where costs must be incurred by the consumer.
Legal and ethical framework
Develop a comprehensive framework that addresses the legal and ethical requirements, such as privacy, security, identification and consent, to underpin all initiatives.
Implement technology that is personalized to older people’s needs, finding the right balance between benefits of monitoring with privacy intrusion.
Complete a privacy impact assessment for all new capabilities introduced. Ensure collection, use, storage and sharing of data complies with applicable privacy legislation like the U.S.’s Health Insurance Portability and Accountability Act or EU’s General Data Protection Regulation.
Simplify consent processes by choosing the right time and location (e.g., away from distracting noise). Use multimodal methods and simplify and adapt consent forms, through the use of graphics, multiple presentations of the information and summaries.
Embed identification processes into all digital solutions to enable accurate patient identification and avoid inadvertent monitoring of nonconsenting individuals.
