Home-Centered Health Care

Our current health care system – reactive, interventional rather than preventive, constrained by time and space, and lacking family or community context – is ill-equipped to address the demands of a rapidly aging population. (Watch Health Politics programs titled "The Emergence of Home-Centered Health," Part 1: Setting the Stage, Part 2: Turning Visions into Reality, and Part 3: Women as Home Health Managers.")

What is needed is a completely new paradigm of health, one that places a much stronger emphasis on prevention and wellness over intervention.

We can refer to this new paradigm as "home-centered health care" – built on a system in which health management begins at home, connects to physicians and care teams, and circles back to home.

The good news is that many of the pieces we need to accomplish the social transformation to this new paradigm -- from intervention to prevention and wellness -- are already in place. A number of megatrends are developing to help the paradigm along, including health consumer empowerment, physician movement toward partnership and team approaches that include clinical care and educational support, expansion of the Internet and technology to the people and their caregivers, expanded understanding of the causes and treatments for the major chronic diseases, and a very public debate about the benefits and risks of the health choices we make.

Other important megatrends are contributing to the need for a home-centered health system. These include conversion of families from three to four and five generations and rejection of an insurance system that critically curtailed choices of access.

It’s the evolution of all these megatrends, which are now colliding, that will drive this necessary change in health care and bring it back home again, but there is one megatrend in particular that is a force to be reckoned with – the aging of our population en masse. According to the Alliance for Aging Research, the number of Americans over age 65 will double in number from approximately 35 million today to 70 million in 2030. And not only will the country be grayer than ever, but these older Americans, living longer but suffering from more chronic diseases and disabilities, will require more help than seniors in previous generations.

The shift to home-centered health care will certainly help alleviate the impending crisis of an older, increasingly dependent population. With reports from Forrester Research and the U.S. Administration on Aging that 81 percent of people over age 50 would prefer to avoid nursing home care even if they needed 24-hour care and 61 percent of Americans saying they feel uncomfortable in hospitals, home-centered health care will allow seniors to spend their "golden years" in the comfort and security of their own homes. This type of care will revolve around technology and improvements to the home beyond mounting handrails in showers and installing stair lifts. Home health care will include low-cost, non-invasive sensors, mechanisms for communicating with physicians, new medical devices designed for home use, and more robust connections to the Internet. According to Forrester Research, the home health industry is projected to be a $2 billion industry by 2008, skyrocketing to $28 billion by 2020. Forrester predicts that by 2015, 12 percent of all seniors, 40 percent of all chronically ill, and 60 percent of all patients discharged after a lengthy hospital stay will adopt the new health care innovations.

The Role of Technology

The rise and potential success of home-centered health care relies largely on the use of a specific technology called telemonitoring. Telemonitoring is a developing technology that enables caregivers to monitor and assess a patient’s condition from a remote location. Clinical data is sent to family members and trained practitioners, enabling them to intervene quickly at even the slightest change in a patient's vital signs, weight, oxygen saturation, or other statistics.

Telemonitoring will be based on tiny, portable, inexpensive devices like cell phones and PDAs. These technologies will become commonplace in the next 5-10 years. GE has already begun developing this technology by creating a system of motion sensors that collect and transmit data to a central server at GE. The GE system is called Home Assurance and allows caregivers to monitor whether seniors are moving normally around their home, and alerts caregivers of indications that the senior has fallen or not left their bed. Intel has set up a group called "Proactive Health" whose mission is to "Explore evidence-based technologies to help consumers be more proactive in managing their health and wellness needs at home, work, and play." Intel's Proactive Health lab employs both social scientists who study the needs of seniors dealing with cognitive decline, cancer, and cardiovascular disease, and engineers who build home health technology prototypes to test with real families. Other companies including Philips and Best Buy are also entering the marketplace.

At the White House Conference on Aging in December, we saw many, many examples of technology that’s moving in the right direction to make home-centered health care a reality. For example:

Carnegie Mellon and the University of Pittsburgh are advancing some stunning new ideas, including “Guido,” an intelligent walker that provides navigation assistance for people who need a mobility aid and has the capacity to adapt to the personal needs of the patient.

The Georgia Tech AwareHome Research Initiative includes a Memory Mirror system, which helps older individuals remember if they have taken their medications or if they have taken them too often. The Memory Mirror system uses RFID (Radio Frequency IDentification) technology to record how often medications are taken or returned to the medicine cabinet and provides an easy-to-read graphical display of medication frequency.

Medtronic has created a CareLink Network, a remote monitoring service for people with implantable cardiac devices. Patients with an implanted Medtronic device can “plug into” a standard phone line in order to send their device data to their physician from the comfort of their own home.

The University of Rochester’s Center for Future Health has created ‘‘Chester the Talking Pill,” a natural language conversational interface that acts as a single point of contact for an individual’s personal health system. This conversational interface can help seniors manage conditions, medications, activities, and decisions quickly and efficiently without the need for a keyboard or training.

As you can see, new technologies will outfit the home to help bring the home-centered health concept to life, but technological advances can help patients in other ways, too. One company, Synoptics Research, is using the latest in computer and video technology to explain messages about healing and health care. Click here to watch a video produced by this group. It’s called “Guided Visualization: Working with the Healing Power of Your Immune System.”

The Advantages of Home-Centered Health

For the aging population, home-centered health care and its accompanying technology will result in:

  • Improved informal care effectiveness without increasing intrusion
  • Reduced burdens on the informal caregiver, reducing stress and improving mental and physical health conditions
  • Extending a healthy, active and dignified life for the elderly
  • Delayed admittance to specialized institutions, thus reducing the cost of formal elder care
  • Ensuring safety and well-being by providing reports to the care team
  • Assessing cognitive impairment more accurately by monitoring for extended periods of time
  • Greater efficiency through technology
  • Shorter hospital visits
  • Better quality of life for patients
  • Raised standard of care as improved outcomes result from new technology
  • Growing empowerment of older adults to participate in decision-making regarding their own health care and treatment
  • Active participation in health care decisions for patients and their families

The Ideal Scenario

Beyond home health care for our aging population, the whole idea of home-centered health is a vision for the not-so-far-off future that would use technology, advanced information systems and a new, more team-oriented medical approach that would make it possible for more health care to take pace in the home than we ever imagined possible. Ten realities would be skillfully integrated into this calm and well-organized vision of a healthy home:

  1. A home health manager, previously the informal family caregiver, designated for each extended family.
  2. Health insurance that covers nearly all Americans, and a medical information highway that has been constructed primarily around the patient, with caregivers integrated in, rather than the other way around.
  3. The majority of prevention, behavioral modification, monitoring and treatment of chronic diseases takes place at home.
  4. Physician-led, nurse-directed virtual health networks of home health managers provide a community-based, 24/7, educational and emotional support team.
  5. Health care insurance premiums for families are lower due to expert performance of the home health manager, as reflected in outcome measures of family members.
  6. Basic diagnostics, including blood work, imaging, vital signs, and therapeutics are performed by the home health manager and transmitted electronically to the physician-led, nurse-directed educational network, which provides feedback, coaching, and treatment options as necessary.
  7. Sophisticated behavioral modification tools, age adjusted for each generation, present and utilized, and funded in part by diagnostic and therapeutic companies that have benefited from expansion of insurance coverage and health markets as early diagnosis and prevention takes hold.
  8. Physician office capacity sees growth as most care does not require a visit. Physician reimbursement increases in acknowledgement of their roles in managing clinical and educational teams and multigenerational complexity. Nursing school enrollment goes up as the critical role as educational director of home health manager networks becomes a major magnet for the profession.
  9. Family nutrition is carefully planned and executed; activity levels of all five generations rise; weight goes down; cognition goes up; mental and physical wellbeing are also up.
  10. Hospitals continue to right size – they’re more specialized and safer, with better outcomes. And scientific advances have allowed early diagnosis and more effective treatment, making the need for hospitalization increasingly rare.

Getting There

The greatest obstacle to the success of home health care is ensuring that the government, private investors and the public wholly embrace this concept. Home health care must also have the technology to enforce the ideas behind this system. Fundamental advances must be made, not just in terms of getting this technology into our homes, but also in terms of understanding how to design sensor networks that are reliable, secure, and easy to install and maintain. Assistive technology needs to be flexible and adaptive – “self-tuning” – to meet the needs of the elderly. Human-computer interaction also needs to be further developed, especially for people who are cognitively impaired and have other difficulties. Still, the potential benefit is enormous, and the building blocks are increasingly on hand for this exciting new paradigm of care.

For More Information

To learn more about home-centered health care and the technology necessary to turn the vision into a reality, visit the webpages of the groups below who are actively engaged in making it happen.

Center for Aging Services Technologies (CAST)
http://www.agingtech.org/index.aspx

Intel
http://www.intel.com/research/prohealth/

Philips
http://www.medical.philips.com/us/clinicalsegments/careeverywhere/

NASA
http://science.nasa.gov/headlines/y2004/28oct_nanosensors.htm

eq life (owned by Best Buy)
http://www.eq-life.com