National Committee Quality Long-Term Care: Application to Technology

Mike Magee MD

Chair, Technology Sub-Committee, Washington, DC

National Commission for Quality Long Term Care (NCQLTC)

November 7, 2006

In the lead up to the 2005 White House Conference on Aging, considerable focus was placed on the interface of aging and technology. Traditionally the area of greatest interest had been in the application of technology for the management of disease and disability to assist older Americans in their ability “to age in place”. But as the Conference approached, and an analysis of aging Boomers with high functionality and high expectations came front and center, the vision expanded and raised the question, “How might technology extend independence, productivity and quality of life for our nation’s oldest citizens?” Since the Conference, and as part of the work of the National Commission for Quality in Long-Term Care, the exploration has both broadened and sharpened its focus. The question today is “How might technology be applied to re-engineer homes for health and assure maximum connectivity to support aging citizens as part of the multigenerational family, the community and a preventive oriented health delivery system?”

This insight, that the technology should not be limited only to fourth and fifth generation Americans, but rather, in an integral way, be applied to assist as well the three generations below them – their children, grandchildren, and great-grandchildren – reinforces the concept of technology applications as both assistive and transformational. In supporting our most senior citizens in home design, care team connectivity, mobility, cognition, entertainment, learning and employment, might we reorient our support for citizens and their families around a more home centered approach that reinforces independence, productivity, connectivity and efficient application of limited resources?

As connectivity reaches a critical mass, with the expansion of the Internet, broadband networks and wireless WiMax technology, multiple innovative applications from corporate and academic centers of excellence are progressing in mass toward market introduction. Predicted to arrive in full force by 2010, smart appliances, sensors, home diagnostics, lifespan planning tools, and converging,image-rich human interfaces are each seeking out their appropriate place in a different type of society where health is about reaching your full human potential regardless of age and disability, and where disease is something to avoid rather than something to treat.

Such a vision focuses on healthy bodies and healthy minds. It assists memory as well as mobility. It harnesses software and hardware to not only improve individual quality of life, but to also advantage family, community and societal goals. For example, extending workplace involvement can be extraordinarily beneficial to the overall health of an elder citizen. Coincidentally, harnessing the knowledge, skills and experience of these citizens can positively impact the success of a community and all of its citizens.

Independence also implies responsibility centered on individuals and their networks of support including family, friends and caring professionals. As citizens we have differing capabilities and needs, and these change as we age. We must help each other. But to do so efficiently, we must advantage virtual connectivity and a full range of technologic applications that unlock our fullest individual and collective human potential.

The technologic challenges are being addressed in real time, just as a vision of a truly preventive, holistic, and home-centered health care system is beginning to emerge. But to realize the full benefit of this vision, we must also proactively address a range of policy issues, including privacy, security, ethical applications, discrimination, sustainability, rights and responsibilities. At the core of these complex deliberations is the realization that our fears about technology – that it will dehumanize, limit employment opportunities, and in a myriad of ways, somehow replace us – are not only outdated, but self-defeating. Rather we must embrace technology and harness its potential to connect us to each other, reinforce relationships, and reorder our processes and systems so that they are properly centered and most efficiently deliver customizable and personalized care and support.

The revolutionary strength of modern information and scientific technologies is that “they ignore geography.” In so doing they allow us to reorient and connect beyond the limits of a range of barriers whether they be physical, social, financial or political. The danger is not in over-reaching but in under-reaching. Our vision must be sufficiently forward looking and expansive to challenge technology innovators. Where are the “killer applications” that would allow lifespan planning to move us ahead of the disease curve? How can we target technologic advantages in health to first reach our citizens most at risk? How do we, in powering the health technology revolution, broaden our social contract to include universal health insurance? How do we unite the technology, entertainment, and financial sectors (traditionally locked out of the health care space) with the traditional health care power players, and incentivize them to work together to create a truly preventive and holistic health delivery system that is equitable, just, efficient, and uniformly reliable? How can each citizen play a role in ongoing research and innovation, and help define lifelong learning and behavioral modification as part of good citizenship? What can corporate America do to advance health in the broadest sense of the word, and in “doing good,” do well financially, serving Main Street as it serves Wall Street?

Individuals, families, corporations, universities, health caregivers, and government entities all have a role to play. Technologies can enable, operate, connect, instruct and assist. But to do so logically and efficiently they must conform to a vision that is both generalizable and customizable. Technology offers the flexibility and fluidity to pursue health, independence, mobility, financial security, social engagement and cognition in hundreds of thousands of uniquely different environments simultaneously, while also pursuing a single unified and collectively committed vision for our nation.

The vision for technology must be integrated into a broader and more transformational quality of life model. It must equally serve 4^th and 5^th generation Americans as it addresses the needs of 1^st, 2^nd, and 3^rd generation Americans. It must address variability of services, and be broadly inclusive, and universal in coverage. It is not so much about Aging as it is about Living, and doing so to our fullest human extent. Technology has the power to assist us in healing, providing health and keeping our nation and global family whole. But the vision must be ours, and that vision must determine our future.