Home-Centered Health Care

(Note: Dr. Magee covered this topic in depth during his time as host of the Internet program "Health Politics." Check out his special video series on Home-Centered Health Care: "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.")

The current health care system—reactive and interventional rather than preventive, constrained by time and space, and lacking family or community context—is ill-equipped to address our growing population's future health care needs and the more immediate demands of a rapidly aging population.

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.

The evolution of all these megatrends, which are now colliding, 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 theU.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-centered 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.

These technologies will become commonplace in the next 5-10 years. Intel's Proactive Health group, for example, is developing solutions including "Activity Detection Technology," which involves equipping homes with a network of sensors that track and monitor everything from cooking habits to purchasing activities to level and quality of physical movement. One potential outcome of this solution is the early detection of the onset of dementia by monitoring changes in activity patterns and levels. A broader goal is to use the sensor data to build assistive technologies that support and enhance people's abilities to conduct normal daily activities, by providing an appropriate level of support without making people prematurely dependent on technology-based assistance.

Other companies including General Electric, Philips and Best Buy are also entering the home health technology marketplace.

Among the examples of how home health technology is advancing:

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. A wide variety of other medical monitoring devices are also increasingly used; one example is ResponseLink, an inexpensive monitoring system that provides 24-hour emergency medical service.
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.

The Advantages of Home-Centered Health

Home-centered health care would be beneficial for all generations, but will most dramatically and immediate affect the aging population with:

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 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:

A home health manager, previously the informal family caregiver, is designated for each extended family.
Health insurance covers nearly all Americans, and a medical information highway is constructed primarily around the patient, with caregivers integrated in, rather than the other way around.
The majority of prevention, behavioral modification, monitoring and treatment of chronic diseases takes place at home.
Physician-led, nurse-directed virtual health networks of home health managers provide a community-based, 24/7, educational and emotional support team.
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.
Basic diagnostics, including blood work, imaging, vital signs, and therapeutics performed by the home health manager are transmitted electronically to the physician-led, nurse-directed educational network, which provides feedback, coaching, and treatment options as necessary.
Sophisticated behavioral modification tools, age adjusted for each generation, are 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.
Physician office capacity grows, as most care does not require a visit. An increase in physician reimbursement occurs as acknowledgement of their roles in managing clinical and educational teams and multigenerational complexity. Nursing school enrollment rises as the critical role of education director of home health manager networks becomes a major magnet for the profession.
Family nutrition is carefully planned and executed; activity levels of all five generations rise; weights go down; cognition goes up; mental and physical wellbeing goes up.
Hospitals continue to right size—they're more specialized and safer, with better outcomes. And scientific advances allow early diagnosis and more effective treatment, making the need for hospitalization increasingly rare.

Getting There

The greatest obstacle to the success of home-centered 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 HealthPolitics.org. The online health news and information site has covered home-centered health care from a variety of perspectives.

Other informational resources include:

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/products/telemonitoring/

Center for Future Health
http://www.futurehealth.rochester.edu/

Medtronic CareLink Network
http://www.medtronic.com/carelink/

ResponseLink Medical Alert Services www.responselink.com

For more information about caregiving:

National Alliance for Caregiving. This organization provides a clearninghouse for individuals facing the challenge of caregiving.

http://www.caregiving.org/

Care.com. Care.com provides a tools and resources for families seeking caregiving assistance for seniors.

https://www.care.com/senior-care-p1023-articles-resources.html