The aging population is forcing tech evaluation and growth
by Dr. John R. Patrick

Between 2010 and 2050, the senior population is expected to reach 88.5 million, or 20 percent of the U.S. population, greatly increasing the need for senior care. Home health care will then become an even more significant element of the continuum of care. As our elderly population increases, it will require higher levels of health care that are more affordable and can be delivered at home. Many seniors have a strong preference for where they want to receive care. Multiple studies and surveys have shown 80–90 percent of seniors prefer to age at home.

Fernand Sarrat is the owner of Home Helpers & Direct Link, a home health care service in Austin, Texas. He said senior citizens not only prefer a more comfortable, familiar environment, but also want to retain as much independence as they can. Sarrat said, “Facilities such as nursing homes and, increasingly, assisted living facilities, tend to require adherence to schedules and usually offer less privacy. Patients’ contact with caregivers like nurses is limited. Financially, home health care is less expensive than live-in facilities for similar one-to-one service levels.”

For these reasons, home health care will play an increasingly larger role in health care at large. Hospitals will benefit from reduced readmissions and the government penalties that result. Family members who care for their elders often experience a burden from caregiving—home health care can provide much needed respite. For elderly people limited in their daily activities, home care offers benefits. Toileting and bathing are easier, they have better mobility and they can enjoy cooking and companionship. They can live in a familiar environment where they feel independent, relaxed and secure.

Medicare’s coverage for home health care does not currently match the demand. Non-medical home care is largely not covered. Coverage for medical home care is quite limited. Medicare should review policies in this area in light of the lower cost of home health care, its favorable impact on recovery and the preference seniors are expressing for it. For many, home health care may be an interim step to home medical care and then nursing homes. But if the elderly have their way, they want to stay home.

New technologies will make it easier for seniors to do so. An April 2012 Pew Research Center survey found for the first time more than half of older adults (defined as those ages 65 or older) were Internet users. As of 2013, the number had grown to 59 percent, a six percent growth in one year. In addition, 77 percent of older adults have a cell phone, up from 69 percent in April 2012. Seniors are adopting tools that help them develop a positive attitude about their health, and serve as a means to deliver new approaches to safety, socialization and more.

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Robots in Home Health Care

Robots will take on a wide and significant role in home health care in the years ahead. There is a shortage of nurses in health care. The number of elderly is climbing and so is the number of retiring nurses. An even larger shortage may develop for home health care aides. The demand is growing because one percent of chronically ill patients consume 22 percent of health care expenditures. Elderly patients get shuttled back and forth to multiple providers often resulting in a poor quality of life for them and their families. Telehealth shows promise as a method to provide a larger share of the care in the patients’ home or residence, potentially reducing the demand for nurses and aides.

In theory, robots could take on a much greater role in home health care. They could help people recovering from a stroke re-learn how to perform basic functions. Therapists and aides can perform the task, but such therapy can be expensive and not pleasant to administer. Robots, on the other hand can work around the clock, and they never get bored with repetitive tasks. The question about robots is whether people will accept them and not be intimidated by them. A reason to be hopeful is while the technology is gaining more and more capabilities, it is also becoming more human-like. As human perception of robots becomes more positive, they become allies for our health care.

A European project called Giraff Plus offers a glimpse of the future. Giraff Plus aims to combine social interaction and long-term monitoring to help people live independently. The Giraff is a home-resident robot specifically designed to take care of the elderly. The robot looks like a giraffe, with four wheels and a long neck with a camera and video display. It enables a caregiver to provide a remote online consultation with a person in his or her home and record the results in the person’s electronic health record.

Giraff Plus is a complex system that can monitor activities in the home using a network of sensors in and around the home as well as on the body. The sensors can measure blood pressure, weight, heart rate and oxygenation of the blood. Sensors can tell if a refrigerator door has not opened or has remained open for a protracted time. Motion and activity sensors can detect if someone falls down. Different services, depending on the individual’s needs, can be pre-selected and tailored to the requirements of older adults and health care professionals. At the heart of the system is the Giraff, a unique telepresence robot that uses a Skype-like interface to allow caregivers or relatives to virtually visit an elderly person in their home from thousands of miles away. The video capabilities enable care providers to see and converse with the patient, providing him or her advice and answering questions. The European Union has 15 trials of Giraff Plus underway in Sweden, Italy and Spain, and is hopeful that the technology will result in fewer hospital admissions and readmissions.

The Role of mHealth

A key part of home health care is the patient taking an active role in monitoring their health. Part of the shift in consumer attitudes toward taking care of themselves involves collecting data related to their activities and conditions. More than half of Americans track their weight, diet, or exercise as a way of improving their health. Innovators are developing new mobile health (mHealth) apps and devices at a frenetic pace, and consumers have a healthy attitude about adopting them. According to industry estimates cited by the FDA, 500 million smartphone users worldwide will be using a health care application in 2015, and by 2018, 50 percent of the more than 3.4 billion smartphone and tablet users, including health care professionals, consumers and patients, will have downloaded mobile-health applications.

A new app called Isabel can instantly and accurately compare data input, such as age, gender, location and numerous medical symptoms, with a database of more than 6,000 diseases and conditions and produce a diagnosis. A study of thousands of users showed accuracy to be 96 percent. While some health care providers balk at consumer self-diagnosis, these new technologies are pushing the boundaries of doctor-patient relationships in ways that can be beneficial to both parties. Increasingly, seniors and physicians will be able to collaborate on diagnoses and treatments rather than just doing what the doctor ordered.

AliveCor is an FDA-approved heart monitor that attaches to the back of an iPhone. The consumer simply holds two fingers from each hand on the back of the iPhone, and in 30 seconds, the AliveCor device takes the equivalent of a single-lead electrocardiogram (ECG). The device saves the ECG data in the iPhone and the app allows the consumer to annotate, store, display and share the ECG data with a doctor. AliveCor claims clinical studies demonstrated the AliveCor Heart Monitor’s accuracy to be comparable to readings from Lead 1 of standard ECG machines, but at a fraction of the cost. The ease of use and lack of potentially irritating sensors attached to the skin will be appealing to consumers. AliveCor received FDA approval in September 2014 to extend the basic ECG to detect atrial fibrillation, a condition presenting a major risk for stroke.

As consumers adopt mHealth apps and devices, they will be performing tests at a much lower cost than traditional laboratories. The FDA sees the widespread adoption and use of mHealth as a way to improve health and the delivery of health care services. To date, the agency has approved more than 150 apps and devices.