the state of technology in aging services in pennsylvania · 2016-07-22 · 5.1.3 keystone home...
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The State of Technology in Aging Services in Pennsylvania
Primary Author: Scott Peifer,Center for Aging Services Technologies (CAST)American Association of Homes and Services for the Aging (AAHSA)
in partnership withPennsylvania Association of Nonprofit Homes for the Aging (PANPHA)
October 2008
A program of theAmerican Association of Homesand Services for the Aging (AAHSA)
2519 Connecticut Ave., NWWashington, DC 20008-1520Phone (202) 508-9416Fax (202) 220-0032
Web site: www.agingtech.org
© Copyright 2008 AAHSA
The State of Technology in Aging Services in Pennsylvania
Table of ConTenTs Page
1. Introduction .............................................................................................................................................2
2. Executive Summary .................................................................................................................................3
3. Current Technology Adoption Rates in Aging Services .......................................................................4
4. Policy & Legislative Context ...................................................................................................................7
4.1 ExecutiveBranchInitiatives................................................................................................................ 7
4.1.1 PennsylvaniaHealthInformationExchange(PHIX)............................................................. 8
4.1.2 MedicaidAgingWaiverTelecareReimbursementProgram.................................................. 8
4.1.3 Long-TermLivingTrainingInstituteandVideoconferenceInitiative................................ 11
4.1.4 DepartmentofAgingVirtualCareManagementPilot......................................................... 11
4.2PendingLegislation............................................................................................................................ 13
5. Early Adopters of Aging Services Technologies (ASTs) ......................................................................16
5.1AgingServiceProviders..................................................................................................................... 16
5.1.1 ActsRetirementCommunities............................................................................................... 16
5.1.2 DiakonLutheranMinistries.................................................................................................... 17
5.1.3 KeystoneHomeHealth&Hospice........................................................................................ 21
5.1.4 NewCourtlandElderServices................................................................................................. 24
5.1.5 VNAofWesternPennsylvania............................................................................................... 30
5.1.6 ProviderRecordSystemsIntegration:PHI,PhoebeMinistries,WesleyEnhancedLiving.... 33
5.2PublicAgingServicesPrograms........................................................................................................ 35
5.2.1 AlleghenyCountyAreaAgencyonAging.............................................................................. 35
5.2.2 Bradford,Sullivan,SusquehannaandTiogaAreaAgencyonAging................................... 38
5.2.3 ClearfieldCountyAreaAgencyonAging.............................................................................. 39
6. University Aging Services Technology Research Initiatives and Provider Partnerships .................40
6.1CarnegieMellonandUniversityofPittsburgh................................................................................ 40
6.2UniversityofPennsylvania................................................................................................................ 45
7. Opportunities and Resources in Pennsylvania ...................................................................................48
8. Call for Action ........................................................................................................................................50
8.1Providers............................................................................................................................................. 51
8.2GovernmentandPrivatePayers........................................................................................................ 51
8.3TechnologyCompanies..................................................................................................................... 52
9. Conclusion .............................................................................................................................................53
Center for Aging Services Technologies (CAST)
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1. InTroduCTIon
Thepurposeofthispaperistodescribethecurrentstateofaffairsoftechnologyinagingservices
andrelatedpolicyintheCommonwealthofPennsylvania,particularlywithregardtothe
advancementoftechnology-enabledservicesinlong-termcareandindividualhomesettings.
Thispaperseekstohighlightinnovativepracticesofstategovernment,agingservicesorganizations,
universitiesandothersandidentifyopportunitiestofurtheradvancetheuseofagingservices
technologiesinPennsylvania.Itservesasafoundationforacalltoactionforproviders,technology
companies,andgovernmentandprivatepayerstoadvancetechnologydevelopmentandapplication.
Thispaperispartofaseriesofpapersthatfocusonindividualstates’progresstodateandpotential
opportunitiesforadvancementintheuseofagingservicestechnologies.Itisalsointendedthatthiseffort
willserveasapracticeandadvocacyguideforuseinstatesnationwide.
ThispaperwascompletedinpartnershipwithPANPHAandbenefitedfromtheinsightsand
experienceofitsmembersandstaff.
ItalsobenefitedgreatlyfromtheassistanceofthePennsylvaniaHomecareAssociation,the
PennsylvaniaAssociationofAreaAgenciesonAgingandseveralAreaAgenciesthroughoutthestate.The
contributionsofCASTmembersandallthoseinterviewedwereinvaluableandaregreatlyappreciated.
defInITIons
TheNationalAllianceforHealthInformationTechnology,whichmanagedafederallyfundedinitiative
toseekindustryconsensusontheuseanddefinitionsofspecificinformationtechnologyterms,has
publishedthefollowingdefinitionswhichmaybereferredtointhispaper.
Electronic Health Record: Anelectronicrecordofhealth-relatedinformationonanindividualthat
conformstonationallyrecognizedinteroperabilitystandardsandthatcanbecreated,managedand
consultedbyauthorizedcliniciansandstaffacrossmorethanonehealthcareorganization.
Electronic Medical Record:Anelectronicrecordofhealth-relatedinformationonanindividualthatcan
becreated,gathered,managedandconsultedbyauthorizedcliniciansandstaffwithinonehealthcare
organization.
Health Information Exchange:Theelectronicmovementofhealth-relatedinformationamong
organizationsaccordingtonationallyrecognizedstandards.
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The State of Technology in Aging Services in California
Health Information Organization:Anorganizationthatoverseesandgovernstheexchangeofhealth-
relatedinformationamongorganizationsaccordingtonationallyrecognizedstandards.
Personal Health Record: Anelectronicrecordofhealth-relatedinformationonanindividualthat
conformstonationallyrecognizedinteroperabilitystandardsandthatcanbedrawnfrommultiple
sourceswhilebeingmanaged,sharedandcontrolledbytheindividual.
Regional Health Information Organization: Ahealthinformationorganizationthatbringstogether
healthcarestakeholderswithinadefinedgeographicareaandgovernshealthinformationexchange
amongthemforthepurposeofimprovinghealthandcareinthatcommunity.
Inaddition,thefollowingaredefinitionsofkeytermsusedinthispaper:
Aging services technologies (ASTs): Technologiesthatcanbeusedbyolderadults,caregivers(both
professionalandinformal),healthcareprovidersandagingservicesproviderstoimprovethequalityof
care,enhancethecaregivers’experience,efficienciesandcost-effectiveness.Thesetechnologiesbroadly
includeassistive,telemonitoring,telehealth,telemedicine,information,andcommunicationtechnologies
thatintendtoimprovetheagingorcareexperience.Agingservicestechnologiescanbecategorizedinto
threebroadareasbasedontherelationshipthesetechnologiesaddressbetweentheolderadultandhis/
herenvironment(safety),oneself(physicalandmentalhealth/wellbeing),andothers(socialinteraction).
Formoreinformationonspecifictypesofagingservicestechnologiesseewww.agingtech.org.
Health information technology (HIT):Hardwareandsoftwareusedtostore,retrieve,shareanduse
healthinformationtotreatpatientseffectively.
2. exeCuTIve summary
TheCenterforAgingServicesTechnologies(CAST)developedthispapertodescribethecurrent
stateofaffairsoftechnologyinagingservicesandrelatedpolicyintheCommonwealthofPennsylvania,
particularlywithregardtoadvancingtechnology-enabledservicesinlong-termcaresettings,including
thehomesofindividualsinthecommunity.Italsoservesasafoundationforacalltoactionfor
providers,technologycompanies,andgovernmentandprivatepayerstofurtheradvancetechnology
developmentandapplication.
Currentratesofagingservicestechnologyadoption,primarilybyhomecareorganizationsbased
onexistingsurveyresearch,werereviewedtoprovideanoverallbaseline.Severalexamplesofearly
adoptersarediscussedindetail.Theinvestmentsofbothprivatenon-profitprovidersandpublichome
andcommunitybasedservicesproviderswerehighlighted.Examplesrangefromwirelesspointofcare
Center for Aging Services Technologies (CAST)
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systemstocognitivefitness,totelehealthmonitoringandvideoconferencingforsocializationandcare
coordination.Theseearlyachievementscanserveasapointofreferenceforotherprovidersinthefield,
aswellasafoundationtoevaluateandimprovetheapplicationofspecificemergingtechnologies.
ThepolicyandlegislativecontextforHITandagingservicestechnologiesinPennsylvaniais
presentedtocapturesubstantialpolicyadvancestodate,pendinglegislationtoaddressdeficienciesin
currentpractice,andremaininggaps.GovernorEdRendell’sadministrationhasbegunseveralmajor
agingservicesinitiativesoverthepastfewyearsthataretobecommended,includingaMedicaid
reimbursementprogramforagingservicestechnologiesthatisamongtheveryfirstandmost
comprehensiveinthenation.Theseeffortsrequirecontinuedfocusanddevelopment.
Inaddition,animportantcomponentofthispaperisareviewofrecentandcurrenteffortsbyresearch
universities.CASTbelievesthatrobustresearchinpartnershipwithagingservicesprovidersina“living
testbed”approachiscrucialtothedevelopment,validationandevaluationoftechnology,andhencethe
effectiveproliferationofthesetechnologies.Followingthisreviewisasamplingofopportunitiesand
resourcesforproviders,technologycompaniesandconsumers.
Finally,acalltoactionisgiventoproviders,governmentandprivatepayers,andtechnology
companies.Pennsylvaniaissignificantlyfurtheradvancedinagingservicesinitiativesthanmanystates.
Thereareabundantopportunitiestobuilduponexistingeffortsandfurthersuccesseswillrequireall
partiesinvolvedtotakeaction.CASThopestohelpbringaboutfurtheradvancements.
3. CurrenT TeChnology adoPTIon raTes In agIng servICes
PresidentBushin2004issuedanExecutiveOrdertoestablishthegoalofnationwideadoptionof
interoperablehealthinformationtechnologyinfrastructure,includingelectronichealthrecordsystems
(EHRs),by2014.HecreatedthepositionofNationalHealthInformationTechnologyCoordinatorin
theU.S.DepartmentofHealthandHumanServicestoleadthecountryinachievingthisgoal.Ifthat
goaliseventuallytranslatedintofirmmandates,allhealthfacilities,includingnursingfacilities,could
berequiredtoimplementelectronicrecordsystemsbythatdate.PennsylvaniaGovernorEdRendellin
MarchofthisyearsignedanexecutiveordertocreatethePennsylvaniaHealthInformationExchange,
whichisintendedtodeveloptheinformationtechnologyarchitecturenecessarytosupportinteroperable
electronichealthrecordsandelectronicprescribingstatewideby2012(seesection4.1.5).
WiththeexceptionofmandatedMinimumDataSet(MDS)electronicreportingandelectronic
billingbyMedicare-andMedicaid-certifiednursinghomes,adoptionratesofelectronichealthrecords
amongagingservicesprovidersinPennsylvaniaistodatelargelyunexamined.Currentresearchinthis
The State of Technology in Aging Services in Pennsylvania
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areawillprovidegreaterclarity.Adoptionratesoftechnologiesotherthanelectronichealthrecordsby
Pennsylvaniaprovidersiswelldocumentedforhomecareproviders,showingextensiveuseofmultiple
technologies(seebelow),butnorecentsurveyshavebeenconductedofotheragingservicesprovider’s
adoptionoftechnology.
Furtherresearchisneededtodevelopabaselineoftechnologyadoptionbythefullrangeofaging
servicesproviders.Inadditiontohomecare,settingsthatshouldbescientificallysurveyedinclude
nursinghomes,assistedliving,independentliving,andaffordableseniorhousing.Sectionfiveofthis
paperhighlightsseveralexamplesofagingservicesprovidersemployingvarioustechnologies,including
EHR-likesystems,andoneexampleofalong-termcareproviderparticipatinginaregionalhealth
informationexchangetodeveloparobustEHRsystem.
Pennsylvania Home Care Providers’ Use of In-home Technologies
Pennsylvaniahomecareprovidersareregardedasnationalleadersinusingtechnologyinconsumers’
homesasdemonstratedinresearchfindingsbelow.Thisisdue,inpart,tothreeCongressional
AppropriationsawardedinrecentyearstothePennsylvaniaHomecareAssociation(PHA),totaling
$800,000,whichprovidedagencieswithseedfundingtopurchasetelehealthequipment.PHAhasbeena
strongadvocateofincreasedadoptionofagingservicestechnologiesandwasinstrumentalindeveloping
thePennsylvaniaMedicaidTeleCarereimbursementpolicy(seesection4.1.6).
Datafroma2006surveyconducted
byresearchersattheUniversityof
PittsburghDepartmentofHealthPolicy
andManagementonbehalfofPHAshows
extensiveuseofin-hometechnologiesby
Pennsylvaniahomecareproviderstoalargely
olderadultpopulation.1Surveysweresent
toallhomecareprovidersinPennsylvania,
includingMedicare-certifiedhomehealth
agencies(HHAs),privatedutyagencies
andhospiceproviders.Atotalof167completedquestionnaireswerereceivedfromHHAs,67from
hospiceagencies,and121fromprivatedutyagencies,resultinginanoverallresponserateof53percent.
ThesampleisrepresentativeofallhomecareprovidesinPennsylvania.In-hometechnologyadoption
ratesexaminedinthesurveywerefortelehealthremotevitalsignsmonitoring,electronicmedication
� Pennsylvania Home Care Association and University of Pittsburgh, N. Castle and J. Engberg, “The State of the Homecare Industry in Pennsylvania: Bringing Care Home”, 2007
Use of Telehealth Vitals Monitoring
05
10152025303540
HHAs Private Duty Hospice
Provider Type
Perc
ent
Currently UseConsidering
Center for Aging Services Technologies (CAST)
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dispensers,activitysensors,andpersonalemergencyresponsesystems(PERS),aswellaselectroniccare
documentationandschedulingsoftware.
Whenaskedabouttheusetelehealthforremotevitalsignsmonitoring,38percentofHHAs,24percent
ofhospiceand17percentofprivatedutynursesindicatedtheyareusingremotevitalsignsmonitoringin
deliveringcare.Anestimated6,336certifiedhomehealthagencyclientsinPennsylvaniauseremotevital
signsmonitoringtechnologies.Another19percentofcertifiedhomehealthagencies,fourpercentof
hospiceagencies,andfivepercentofprivatedutynurseagenciesindicatedtheywereactivelyconsidering
usingremotevitalsignsmonitoring.
Electronicmedicationdispensersareusedby19
percentofHHAs,12percentofprivatedutynurse
agenciesandfivepercentofhospiceproviders.
“Smarthouse”oractivitysensortechnologiesare
usedbysevenpercent,fourpercentandtwopercent
ofagencies,respectively.Personalemergency
responsesystems(PERS)havehigherutilization
ratesat17percentofHHAs,29percentofprivate
dutyagenciesand32percentofhospiceagencies.
Interestingly,manymorehospiceproviders
useelectroniccaredocumentation(71percent)thandoHHAs(36percent)andprivatedutyagencies
(fourpercent).However,adoptionratesoftelephonysystems(i.e.,timeandattendanceverification)is
virtuallyevenacrosshomecareprovidertypesat23percentofHHAs,21percentofprivatedutyand24
percentofhospiceagencies.
Itshouldbenotedthatprivatedutyhomecare
agenciesandregistriesmostlyprovidenon-medical
servicessuchashelpwithactivitiesofdailyliving
(ADLs),includingassistancewithbathing,grooming,
transportationandmealpreparation.Recently,
Pennsylvaniapassedalawrequiringtheseagencies
andregistriestobelicensed.Also,whilemosthospice
agenciesprovideend-of-lifecaretoindividualsin
privatehomes,hospicecarealsoisprovidedinnursing
homes,hospicehousesandinpatienthospicefacilities.
Use of Remote Technologies
05
101520253035
HHAs PrivateDuty
Hospice
Provider Type
Perc
ent Medication Dispenser
Activity SensorsPERS
Use of Staff Efficiency Systems
01020304050607080
HHAs Private Duty Hospice
Provider Type
Perc
ent
Electronic Care DocTelephony
The State of Technology in Aging Services in Pennsylvania
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4. PolICy and legIslaTIve ConTexT
ThisoverviewofpolicyandlegislativeactivityrelatedtoHITandagingservicestechnologiesprovides
acriticalcontextfortheproliferationofthesetechnologiesinPennsylvania.Significantexecutivebranch
initiativeshavebeenimplementedandmajorlegislationhasbeenproposedinrecentyears.
4.1 Governor’s Policy Initiatives
GovernorRendellandhisAdministrationhavebeenactivelypromotingeffectiveutilizationof
technologyinthecontextofhealthcareandlong-termcare(or“Long-termLiving”)reformin
Pennsylvania.WhenGovernorRendellfirsttookofficein2003,heestablishedtheGovernor’s
OfficeofHealthCareReform(GOHCR)byexecutiveorderwiththegoalofimprovingaccessibility,
affordabilityandqualityofhealthandlong-termlivingservicesinPennsylvania.Hisfirstpriority
fortheOfficewascreatingmeaningfullong-termcarereform.Severalreforminitiativesensued,
including“rebalancing”ofstatetraditionalandcommunity-basedlong-termcareresources.
Pennsylvaniaismakingasignificantfinancialinvestmentinhomeandcommunitybasedservices:
between2002and2007,theamountofmoneyspentontheseservicesmorethandoubled.The
numberofolderPennsylvaniansserved
athomegrewfrom12,000in2002-03to
morethan18,300*inFY2006-07(*number
representsconsumersage60andolderinfour
ofthestate’sMedicaidwaivers).
Asagovernmentalmanifestationofthis
reformagenda,theOfficeofLong-termLiving
(OLTL)wascreated.Itiscomprisedofstaff
fromtwostatedepartments–theDepartment
ofPublicWelfare,thestate’sMedicaidagency,
andtheDepartmentofAging.Consistentwithitsgoalstoremovebarrierstoprovidingcarein
homesandcommunitiesandtoserveasmanyconsumersaspossiblewithhigh-qualitycareand
services,theOLTLhaslaunchedtworecentmajortechnologyinitiativesforpubliclong-termliving
providers(see4.1.6and4.1.7below).Additionally,anewPennsylvanialong-termlivingwebsite
wasrecentlylaunched(www.Ltlinpa.com)andwhileitisnotspecifictotechnology,technologywill
playanimportantroleinfutureOLTLefforts.TheOfficeispartneringwiththeHousingFinance
Authoritytocoordinate,expandandimproveusinghomemodifications,includingpilotingsmart
homeandothertechnologies.
Number of Older Pennsylvanians Served at Home*
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
2002-03 2003-04 2004-05 2005-06 2006-07
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Center for Aging Services Technologies (CAST)
EffectiveDecember1,2007,theDepartmentofPublicWelfaremodifiedtheMedicalAssistance
(MA)ProgrambyaddingatelehealthtechnologyprocedurecodeandtotheMAProgramFee
Schedule.Theproceduralchangeisforconsultationsrelatedtohigh-riskobstetricalcareand
psychopharmacologyperformedusingtelecommunicationtechnology,includingvideoconferencing
andtelephone.TheDepartmentofAginghasembarkeduponapilotprojectusingtechnologyto
delivercaremanagementinaruralcounty(see4.1.8below).
4.1.1 Pennsylvania Health Information Exchange (PHIX)
OnMarch27,2008GovernorRendellbyexecutiveordercreatedthePennsylvaniaHealth
InformationExchange,or“PHIX”–toprovidetheinformationtechnologyarchitectureto
supportstatewideinteroperableehlectronichealthrecordsbysharingdatathatiscapturedatthe
pointofcareinaphysician’sofficeorhospital.ThePHIXwilleventuallyallowmostdoctors’
offices,hospitals,laboratoriesandpharmaciestoshareinformation
withvarioushealthcareprovidersandotherauthorizedcare
providers,includinglong-termcareproviderssuchasnursing
homes,assistedlivingandhomecareprovidersfortreatment
purposesby2012.TheinitiativealsowillpromoteElectronic
MedicalRecords(EMRs)andElectronicPrescribing(eRx)by
workingwithlocalcollaboratives,leveragingfederalactions,and
findingwaystoprovideseedmoneytoregionalefforts.Achronic
careinitiativeofPHIXistoprovidephysicianswithafreeweb-
basedpatientregistryandprovideapooled-claimsdatabaseformeasuringperformance.
ThePHIXprogramreceived$4,483,000inthe2008/09statebudget.Thesefundswillallowthe
programtohirestaffandsecureaconnectivitypartner.TheGovernor’sOfficeofHealthCare
Reform(GOHCR)willoverseethePHIXinitiative.
4.1.2 Medicaid Aging Waiver TeleCare Reimbursement Program
Pennsylvaniaisoneofthefirststatesinthenationtoprovidereimbursementforhome
“TeleCare”throughaMedicaidwaiverforolderadultsages60andolderunderapprovalfrom
theCentersforMedicareandMedicaidServices(CMS).OnSeptember1,2007theOfficeof
Long-termLivingbeganademonstrationTeleCarereimbursementpolicytocoverarangeof
servicesprovidedbyhomehealth,durablemedicalequipmentproviders,pharmaciesorhospitals
throughcontractswithlocalcountyAreaAgenciesonAging(AAAs).
AnewMedicaidagingwaiver(“PDA60+Waiver”)beganinJuly2008thatincludesplace-
holderlanguageforapermanentTeleCarereimbursementprogram.ThedraftTeleCarepolicy
wasrevisedandsubmittedforapprovaltoCMSforfinalinclusioninthenewfive-yearwaiver
program.Finalprovisionsareexpectedtobesubstantiallysimilartothedraftpolicy,with
improvementsinclarityofprotocolsandrespectiveresponsibilitiesforAAAsandproviders.
Underthedraftpolicy,reimbursementforTeleCarenotonlycoversuseofequipmentthat
performsremotevitalsignmonitoring(telehealth)
butalsocoverstelemonitoringwithactivitysensors
bywhichafamilymembercanaccessawebsite
anddetermineactivitystatussuchaswhenthe
consumerawakesinthemorning,thefrequency
ofrefrigeratoropenings,howmanytimesthe
bathroomisused,ifmedicationsweretakenand
whetheraconsumersuffersapossiblefall.State
officialsexpecttheTeleCareprogramtohelpwith
aworkforceshortagebyincreasingthenumberofpersonsthatcanbeservedbyhomecarestaff,
whileenablingstateMedicaidsavingsbyallowingmoreconsumerstoremainsafelyintheir
homesanddelaymovestomoreexpensiveskillednursingcare.Whileitisoftennotfeasibleto
provideanin-homeaide24hoursaday,thetechnologiescanmonitorconsumers’wellbeing24
hoursaday,sevendaysaweek.
TeleCare Demonstration Reimbursement Policy Requirements:
• Demonstratedmedicalneed(physician’sorder)fortheservicesandevidencethatservicesare
notcoveredunderMedicare,StatePlanorotherthirdpartyresources
• Participant’shomemustbeevaluatedforsuitabilityforthetechnologyapplication
• Participantsmust:
– Meetnursingfacilityclinicallyeligible(NFCE)determination
– Meetatleastthreeofthefollowingneedscriteria:
• Three(3)ormorehospitalizationsinthepastyear
• Frequent,recurrent,repeatedorregularuseoftheemergencyroom
• Pooradherencewithphysicianordersormedications
• Formalorinformalsupportsystemsarelimitedorabsent
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The State of Technology in Aging Services in California
PA TeleCare Medicaid Waiver Demonstration Reimbursement Rates
Health Status Measuring & Monitoring: $10/ day Activity & Sensor Monitoring: $200/ install
$79.95/ mo. Medication Dispensing & Monitoring: $50/ mo. PERS: $30/ mo.
Center for Aging Services Technologies (CAST)
10
• Documentedhistoryoffallswithinthelastsixmonthsthatresultedinaninjurythat
requiredmedicaloremergencycare
• Livesaloneorisathomealoneforextendedperiodsoftimeorcareaccesschallenges
exist(forexample,RNshortage,ruralaccessissues,etc.)
• Becognitivelyabletooperateequipmentifneededorhaveacaregiveroperate
equipment.
Thepolicychangeisexpectedtospuranincreasingnumberofagenciestoadoptthetechnology.
BecauseadministrationofthepolicyrequiresAAAstodevelopcontractsforTeleCareservices
intheircounty(s),ramp-upoftheprogramwilllikely
takeacoupleofyears.AAAsneedtocollectivelybecome
morefamiliarwiththeparametersoftheprogramand
developstandardsofpracticeforenteringintocontracts
within-homeprovidersandtechnologycompanies.Itwill
alsorequirerevisingexistingmodelsofcaremanagement
anddevelopingnewwaysofinteractingwithproviders
regardingtrackingthewellbeingofolderadultsreceiving
careathomeundertheMedicaidwaiver.TheOfficeofLong-termLivingplanstocomparepre
andpost-TeleCareuseandclientassessmentdatatorevealanyrelevantcareoutcomes.
Early Demonstration of Value Fostered State Policy Change:
ThePennsylvaniaHomecareAssociation(PHA),representingthestate’svisitingnurse
associations,homehealthagencies,hospicesandprivatedutyagencieshaslongadvocatedforthe
advancementoftechnologytoimprovecareandefficiencyoflimitedhealthcaredollars.Through
testimonyatadvisoryandlegislativebodies,PHAcitednationalandlocalresearchfindingsto
makethevaluecaseforusingtechnologyandforstatereimbursement.Asdiscussedabove,PHA
alsocommissionedrecentresearchonthecurrentproliferationoftechnologyadoptionamong
homecareproviders.
InadditiontoPHA’sgroundwork,KeystoneHomeHealth&HospiceandtheLiving
IndependentlyGroupInc.,themakerofthe“QuietCare”remotemonitoringsystem(www.
quietcare.com),wereintegralinthedevelopmentofthePennsylvaniaTeleCarereimbursement
programbydemonstratingvalueoftelecaretechnologiesinlocalcaredeliverymodels.Thehome
healthproviderandthetechnologycompanypartneredtodemonstratetheuseofthistechnology
forcomparablestateclientpopulationsandtocultivateawarenessandpositiveregardamong
stateofficials.Theysuccessfullyshowedthepotentialtoimprovebestpracticesandmaximizethe
PA Telecare Medicaid Waiver Demonstration Use DataSeptember 1, 2007 to June 30, 2008
18 Counties Authorizing TeleCare Services105 Consumers Authorized to Receive TeleCare
Services
33 Providers of Service
The State of Technology in Aging Services in Pennsylvania
11
abilityforthosewithchronicconditionstostayathomeforaslongaspossible,whileminimizing
cost(seesection5.1.3forfurtherdetails).
Workgroup Approach Used to Craft TeleCare Policy
Afterstateofficialswereconvincedofthevalueofusingtelecaretechnologiesanditspotential
forcostefficiencieswiththestate’sburgeoningolderMedicaidpopulation,theDepartmentof
PublicWelfareandDepartmentofAging(whichtogetherformedanewOfficeofLong-Term
Living)convenedaworkgrouptodevelopvariouscomponentsofanewtelecareprogram
andcraftreimbursementpolicyforMedicaid60+Waiverconsumers.Representedonthe
workgroupwerehomecareproviders,AreaAgenciesonAging,seniorserviceproviders,andstaff
fromthedepartmentsofPublicWelfareandAging.Theworkgroup’smissionwasto:Develop
an infrastructure for a TeleCare program for older Pennsylvanians that helps them to remain
independent in the community.UponcompletionofthedraftTeleCarepolicydiscussedabove,
stateofficialsheldthreeregionaltrainingsessionsforAAAstaffandproviders.
4.1.3 Long-Term Living Training Institute and Videoconference Initiative
ThisyearthePennsylvaniaOfficeofLong-termLivingcreatedaLong-termLivingTraining
Instituteforthestate’saginganddisabilityserviceprovidernetworks.Atotalof$3millionwas
allocatedfortheefforttoincreasepreparationofthestate’sworkforcetocareforanincreasing
populationofolderanddisabledindividualswithongoingcareneeds.Approximately$1million
hasbeendesignatedforvideoconferencingequipmentforall52AAAsand25disabilityproviders
throughouttheCommonwealth.Itisintendedtoprovideubiquitouscapacitytoprovide
trainingandcommunicationsinallagenciesandbuildcriticalstaffskillswithoutburdening
agencieswithtravelcostsandlostworktime.Itispossiblethetwo-wayvideoequipmentcould
beusedforotherpurposes,suchasmulti-disciplinarycareteams,formoreefficientcomplex-
careplanning.
4.1.4 Department of Aging Virtual Care Management Pilot
ThePennsylvaniaDepartmentofAgingispiloting“PDAVirtual,”avirtualnetworkof
informationoutreachandtele-caremanagementservicestobettermeettheneedsof
Pennsylvania’sexpandingseniorpopulation.Thepilotwillbeconductedatfivelocationsina
verylargefour-countyruralareainwesternPennsylvania.ThepilotwillusetheFamilyVirtual
VisitstechnologybyAgeServeCommunications(www.familyvirtualvisits.com).
InthePDAVirtualmodel,virtualcenterswillbeestablishedinselectedSeniorCentersand
inselectedaffordableseniorhousing(i.e.,HUDSection202)communitiestolinkAAAstaff,
caremanagersandresourcesdirectlytoseniors.OlderadultswillaccessAAAcaremanagers
Center for Aging Services Technologies (CAST)
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remotely–yetface-to-face–fromtheirhousingcommunityoranear-bySeniorCenterinstead
ofhavingtotraveltoAAAofficesorhavecaremanagerstraveltomeetthem.Thepilotalsoaims
toempowerseniorswhoarenotcurrentlyutilizingpublicresourcesthatareavailabletothem.
Eliminationoftravelexpenseandtraveltimewillenablecaremanagerstoreachmoreseniors
thancurrentlypossiblebyreducing“windshieldtime,”withoutimpactingproviderincomesor
exceedingserviceexpensecapsforanyonesenior.Inaddition,morepersonalizedsessionsby
trainedpersonnelwillpotentiallyprovideolderadultswithahigherlevelofcaremanagementfor
thesamecaredollars.
ThePDAVirtualnetworktechnologycomponentsinclude:
1) ThePDAVirtualCenter:videoconferencingequipmentthatiscompletelyhands-freefor
seniors.
2) Webcam-enabledserviceproviderresourcescontractedbytheAAA’stodeliversenior
services,includingcasemanagement.
3) AdirectphonelinkfromthePDAVirtualCentertotheappropriateAAAofficeservicingthe
locations’seniors.Thiswillenableseniorstocallandscheduleservice.
4) Afaxmachinetotransmitdocumentsandauthorizationsignaturestoandfromthesenior’s
location.
ThevideolinkagewillbebetweentheAAAserviceprovidersandthePDAVirtualCenterlocation.
SomeprovidersmayinfactbeAAAstaff,whileotherswillberemotelylocated,contractedservice
agencies.Asenior’sphonecallrequestwillbeprocessed/triagedbytheAAAreceptiondeskto
anavailablevideo-enabledresourcepersonwhocanthendirect(video)dialintothePDAVirtual
Centerwheretheseniorislocated.Thisenablesaliveperson-to-personvideoconferenceto
addresstherequest.Featuresoftheprograminclude:
• Onecaremanagercanserveolderadultsinseverallocations,and/ortriagetospecialized
providerviavideoconference(mentalandbehavioralhealth,legalaid)
• Providescapacityfor“walk-in”AAAservicesatseniorcentersandincreasedutilizationof
centerprograms
• Follow-upconferencescanbeconductedbyappointmentwiththeresourcepersonas
needed,withoutneedingtoroutethroughthetriagephonelink
• HUDNeighborhoodNetworksfundingisavailableforvideoconferencetechnology
installationcostsandmonthlyfeeataffordableseniorhousingcommunities
• Freevideovisitswithseniors’families
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4.2 Pending Legislation
PendinglegislationinboththePennsylvaniaStateSenateandHousewouldenablesubstantial
advancementsinutilizingagingservicestechnologiesintheCommonwealth.Advocatesand
legislatorshaveinvestedsignificanttimeandenergytodevelopandconsiderthebillsdiscussed
below.However,nonecurrentlyhaveaclearpathtoenactmentthislegislativeyear.
SB 8 (Wonderling) Medical Safety Automation Program for EHRs
IntroducedbySenatorRobertWonderlingandsubsequentlyintroducedintheHouseby
RepresentativeMarkCohenasHB2564(printer’s#3415),SB8wouldestablishamedicalsafety
automationprogramandgrantsforregionalhealthinformationorganizations.Amedicalsafety
automationsystemisdefinedbythebillasaninteroperablesystemthatutilizeshealthinformation
technologytointegratehealthinformation,clinicalactivitiesanddatasharinginanyofthefollowing
areas:pharmacyorderingandtracking;laboratorytestingandresults;physicianordermanagement;
accessbyclinicians;accessbyconsumers;telemedicine;datasharingamonghealthcarefacilities,
physiciansandhealthinsurers;orothertransactionmonitoringorhealthinformationexchangethat
promotespatientsafetyandefficiencyindeliveringhealthcare.Grantsofupto$1millionwould
beprovidedtoregionalorganizationstopurchasethehealthinformationortelecommunications
technologynecessarytocreateaninteroperableandintegratedmedicalsafetyautomationsystem
andtocovertrainingphysiciansandpersonnelinusingthesystem.SB8iscurrentlypendinginits
firstcommitteeandissaidtobeassociatedwithconsiderationofphysicianmedicalliabilityfund
(“MCARE”)legislation.
AschairoftheSenateCommunicationsandTechnologyCommittee,SenatorWonderlingalso
hasformedthePennsylvaniaTechnologyinHealthcareWorkingGroup,whichbringstogether
stateleadersinacademia,technology,healthcareandgovernmenttofindwaysinwhichthe
Commonwealthcanbetterintegrateandpromotetechnologyinhealthcare.
SB 340 (Browne) Medicaid Rates for Telemedicine
IntroducedbySenatorPatrickBrowneandsubsequentlyintheHousebyRepresentativeMarkCohen
asHB2545(printer’s#3794),SB340wouldestablishthatanyratesestablishedbytheDepartmentof
PublicWelfarefortelemedicineservicestoMedicaidbeneficiariesshallbeequaltothoseforservices
providedin-person.ThebillhaspasseditsfirstpolicycommitteeandispendingbeforetheSenate
AppropriationsCommittee.
SB 1094 (Williams) – ePrescribing Requirement for Health Facilities
IntroducedbySenatorConnieWilliams,SB1094wouldrequireallhealthfacilities,includingskilled
nursingfacilitiesandhospiceproviders,todevelopafullimplementationplanwithin60daysto
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provideeasyandtimelyaccesstoane-prescribingsystemforusebyallmedicalstaffwhohave
prescriptionauthorityintheCommonwealth.Thesystemwouldneedtobeabletomonitorand
notifystaffofpotentiallyharmfuldruginteractions.ThebillalsowouldrequiretheStateBoard
ofMedicinetoestablishguidelinesforusinge-prescribingbyeveryphysicianthatchoosestowrite
prescriptionselectronically.SB1094wouldappropriate$25millioningrantstoassisthealthfacilities
inacquiringthesystems.Thegrantswouldbecappedatnomorethan50percentofthefacility’s
costsforthesystemandtheDepartmentofCommunityandEconomicDevelopmentwouldbe
requiredtoreviewthefiscalconditionofthehealthfacility.SB1094hasbeenreferredtocommittee
butisnotexpectedtobeacteduponthislegislativesession.
HB 1849 (Cohen) Requirement of Telemedicine/ Telehealth Coverage by Health Insurers
IntroducedbyRepresentativeMarkCohen,HB1849wouldrequireallhealthinsurersin
Pennsylvaniatoprovidecoveragefortelehealthifahealthcareprofessionalcertifiesthatcertain
conditionsaremet.Thebilldefinestelehealthastheremoteinteractionbetweenahealthcare
professionalandapatientthroughtheuseofvideocameraorcomputervideotransmission;an
electronichealthmonitoringdevice;oranothertelecommunicationsdevicethatdelivershealth
informationconcerningapatienttoahealthcareprofessional.Qualifyingconditionsincludethe
following(allmustbemet):
1) theuseoftelehealthisappropriateforthepatient;
2) thehealthcareprofessionalwillbeabletomaintainproperdirectexaminationofthepatient
orthatdirectexaminationofthepatientisnotnecessary;
3) andtheuseoftelehealthwillresultinlowerhealthcarecoststhanifitwerenotused.
HB1849ispendingbeforetheHouseInsuranceCommitteeandhasreceivedthemostpublicdebate
ofanyofthebillsabove.OnApril15,2008thecommittee,chairedbyRepresentativeAnthony
DeLuca,heldapublichearingonHB1849toreceivetestimonyfromrepresentativesoftheinsurance
industry,visitingnurseservicesandotherhomecareproviders,hospitals,andthePAMedicalSociety
todeterminewhetherornotinsurancereimbursementoftelemedicinemakessenseinPennsylvania.
Inhisopeningremarks,RepresentativeDeLucastatedthat“Astechnologyevolves,thepracticeof
medicinemustadvancealongwithit.Itisincumbentuponustoinvestigateandconsiderthese
technologiesandadvancesandhowtheycanbenefitourconstituents.”DeLucafurtherassertedthat
itappears“theuseoftelehealthmedicinewouldbemoreconvenientforboththeprovidersandthe
The State of Technology in Aging Services in Pennsylvania
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patients”andthatit“wouldreducethedemandsforhealthcareservicesandsavethepatientstime
andmoneygoingforthedoctors’visits.”2
Highmark,alargehealthinsurerinPennsylvania,testifiedthattheycurrentlyprovidelimited
coverageforclinicalapplicationsoftelemedicinethatdonotrequireface-to-faceencountersbetween
theclinicianandpatient.Suchusecasesarelimitedtoradiologyforthetransmissionofmedical
imagestoaradiologistforinterpretation,pathologyimagestransmittedthrough“storeandforward”
imagetechnology,andincertaincasespatientmonitoring–mostlyforcardiacmonitoringaswell
assomecasesoffetalandpulmonarymonitoring.Highmarkdoesnotprovidecoverageforclinical
applicationsnormallyinvolvingface-to-faceencountersthatwouldrequirecognitiveskillssuchas
visits,consultations,counseling,therapysessions,andon-linemedicalevaluationsorassessments
citingalackofscientificevidencedemonstratingthatcognitivetelemedicineservicesaremedically
anddiagnosticallyequivalenttoface-to-facecare.HighmarkopposesHB1849becausetheybelieve
ithasthepotentialtoexposehealthcareconsumerstoservicesthatcouldbeharmfulifnotprovided
duringdirect,face-to-facecontactwiththeirphysician.Theyalsocontendthatthebroadnatureof
thebillraisesquestionsaboutcostsandmedicalliability.
TheNorthPennVisitingNurseservicetestifiedonbehalfofhomecareprovidersinstrongsupport
ofthemeasure,citingresearchfindingsofcostefficienciesthroughdecreasedrehospitalizations,
particularlyforchronicheartfailurepatients.Theagency,whichbeganitstelehealthprogramin
2006andnowutilizes60remotevitalsignmonitoringunits,hasbeenabletoreducethenumberof
in-personvisitsper-patient(oneormoreperweek)whilesafelymonitoringpatientrecoveryand
avoidingunnecessaryrehospitalizations.Becausethereisnorequirementforinsurers,including
long-termcaremanagedcareplans,toreimbursefortheuseofsuchequipment,nearlyalldonot.
NorthPennassertedthatforaslittleas$10perdayapatientwithMedicareorMedicaidcanbe
evaluatedremotelybyanurse,receivequickresponsetoanimpendingmedicalemergencyandavoid
anunnecessaryvisittoanemergencyroomorhospitalization.
LargehospitalnetworkscoveringwesternandeasternPennsylvaniaandtheHospitalandHealth
SystemAssociationofPA(HAP)testifiedinsupportofHB1849.However,HAPcontendedthat
thelegislationcouldhaveasomewhatlimitedimpactbecauseitdoesnotcoverfederalprograms,
suchasMedicare,andmanyprivateinsurerswouldnotberequiredtofollowtherequirementssince
federallaw(ERISA)wouldexemptthemfromfollowingthisstatemandate.Therefore,HAPfurther
advocatedforthepassageofSB8andSB340,discussedabove,tofurtheradvancetheproliferationof
telehealth.ThePennsylvaniaMedicalSocietyalsotestifiedinsupportbutassertedthatthelegislation
2Transcript of PA House Insurance Committee Public Hearing on HB �849, April �5, 2008
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doesnotgofarenough,andsuggesteditbeexpandedtorequirereimbursementfortelemedicinefor
real-timeinteractivephysiciantreatmentinadditiontotelehealthservices.
5. early adoPTers of agIng servICes TeChnologIes
Severalprovidersandpublichomeandcommunity-basedserviceprovidershavebeen“earlyadopters”
inASTsbecauseoftheirearlycommitmenttotheuseoftechnologytoachievetheirservicemissionand
goals.ThefollowingisasnapshotoftheeffortsofafewearlyadoptersinPennsylvania.
5.1 Aging Services Providers
ThefollowingaredetailedexamplesofcareproviderstoolderPennsylvaniansthathavemade
strategicinvestmentsinagingservicestechnologyinfrastructureandtools.Itshouldbenotedthat
thissummarydoesnotpurporttocaptureallexamplesofearlyadopterproviders,butratherpresents
afewkeyexamples.Therearemanyotherproviderswhohavemadeinvestmentsintechnology,
someofwhicharereferencedinsection5.1.6andotherswhoarenotdiscussedinthispaper.
5.1.1 Acts Retirement-Life Communities
BasedinSoutheasternPennsylvania,ACTSRetirement-LifeCommunitiesisthelargestnot-for-
profitbuilder,ownerandmanagerofcontinuingcareretirementcommunities(CCRCs)inthe
UnitedStates.Begunin1972,ACTSnowhasmorethan7,800residentsand5,600employeesin
18ACTScommunitiesinseveralstates.ACTS’agingservicestechnologyadoptiontodatehas
beenfocusedonmakingimprovementsinquality,serviceandefficiencyintraditionalsettingsof
carewithintheCCRCmodel.Withregardtotechnologyadoption,seniorstaffrefertoACTSas
“conservativelyproactive,”meaningtheyarecontinuallyexploringthetechnologyhorizonbut
arerarelytheveryfirstadopter–butmaybethefirstevaluatorofthetechnology.Ithasexcelled
initsareasoftechnologyfocus.
Sincethelate1990s–early2000s,allofACTS’coreoperationalservicesareashavebeen
electronic,includingfront-linesystems.Forexample,forsevenyearsitsfoodmanagementand
maintenanceworkershavebeenusinghand-heldelectronictoolstomanagetheirday-to-day
operations.Securitysystems,hospitalityservices,andclinicalsystemsareallelectronic.
Foritsclinicalpointofcaresystem,ACTScurrentlyusesCareTrackerbyResourceSystems
(http://www.resourcesystems.net/caretracker.htm).WhatmakesACTS’implementationunique
isthatthesystemextendsacrossalllevelsofcare.ACTShaskiosksthroughoutitsCCRCs,even
infitnesscenterstodocumentresidentphysicalactivityinindependentlivingsettings.
WithCareTracker,front-lineworkersareabletochartresidentinformationusingtouch-screen
kiosks.Tosimplifystaffworkflow,thesystemidentifiesrequiredactivitiesanddocumentation
The State of Technology in Aging Services in Pennsylvania
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withhighlightedyellowiconsandvisuallyalertsstaff
topast-duecareactivitiesandsituationsthatrequire
theirattention(i.e.,whenaresident’sbiometric
measurementsindicateanunhealthytrendorshow
insufficientnutrition).Byautomaticallyidentifying
at-riskresidentsandcommunicatingresident
information,CareTrackerfacilitatesqualitycare
andallowsforimmediatefollow-up.CareTracker’s
reportingfeaturesallowACTStoanalyzethequality
ofcareandcompliance–fromthefacilitytothe
corporatelevel–againstitsowninternalquality
standards.ThoughCareTrackerprovidesACTSwithapseudoelectronicmedicalrecord(EMR),
leadershipiscurrentlypursuingamorecomprehensivesystemtomovethemclosertoward
adoptionofafullelectronichealthrecord(EHR)andaplantodeployanewplatformoverthe
nextyear.
ACTSisnowplanningsignificanttechnologyupgrades.Informationtechnologystaffare
beginningtoprovideall5800employeeswithhand-heldandtouch-screenaccess,through
multiplepointsofcontactincludinghand-held,voiceandkiosktechnologies.ACTShastaken
thisstepbecausetheybelieveitisimperativethatallrelevantservicesbesupportedatalltimes
bytoolsandinformationsothattheyaremeasurable.Theyarecurrentlybuildingawiredand
wirelessdatacommunicationsinfrastructuretosupportaramp-upfromthecurrentpersonnel
footprintof1000dailytechnologyusersto5800.
Fromthisbroadplatform,ACTSalsoplanstoprovideself-serviceresidentaccesstoallcampus
services.Thiswouldincludeschedulingandorderingentertainment,healthandwellness,safety
andsecurity,energymanagementandcommunicationssystemstonameafew.ACTSbelieves
thattechnologywillprovideaconnected,collaborativecommunitythatwillempowergreater
synergyofcareandagreatlyenhancedqualityofserviceandexperienceforresidents.Eventually,
ACTShopesthatthiskindofcoordinatedvirtualandphysicalspacewillenablethemtobuild
moreflexibleandconfigurablelivingenvironmentsratherthancare-specificrigidsettingsthat
currentlyarethenorm.
5.1.2 Diakon Lutheran Social Ministries
DiakonLutheranSocialMinistries(www.diakon.org)isamongthelargestnot-for-profit
retirementcareprovidersservingPennsylvania,MarylandandDelawareandhas3200employees.
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Italsoserveschildren,youth,adults,familiesandcommunitygroupsthroughavarietyof
programsandservices.DiakonoffersCCRCs,retirementlivingaccommodations,assistedliving
services,dementiacare,nursingcare,memorycareandoutpatientrehabilitationservices.
Diakonistwoyearsintoa10-year“repositionplan”inwhichitisbuildingnewindependent
livingproduct,forbothhomesandapartments,andrenovatingitsexistingpersonaland
healthcarefacilitiesatsixof13locations.Theybelieveitisimportanttodesignseniorlivingin
awaythatwillbeattractivetothecomingagewave,andascribetothe“aginginplace”design
approach.
Thecompanyseekstoutilizetechnologytosupporttheexistingstaffandservicesonitscampuses
andthenusethismodeltoreachoutinthecommunitywithitsnewhomeservicesprograms.
Itsstrategicactivitiestowardthisgoalincludeparticipatinginproductresearchanddevelopment,
activelyparticipatinginCAST,collaboratingwithvendorsandotherserviceproviders,and
conductingsmallpilotprojectsofpotentialsolutions.Internally,Diakonisholdingdiscussions
anddemonstrationswithstaff,itsboard,andresidentsandfamiliestoeducatethemon
technologiesandservicesthatareavailable.
Consortium for the Future of Senior Living
Inorderforalllevelsoftheorganizationanditspartnerstousethesamelanguageoroverall
plan,Diakondevelopeda“futureofseniorlivingpyramid”thatincorporatesitskeyareasof
focus.Theyare:
• Infrastructure –physicalconnectiontoothers,Internet,caregivers,databasesandincludes
fiberoptic,copper,coaxial,andwirelesstechnologies
• Living Environment – physicallivingenvironmentincludesuniversaldesign,lighting,
temperature,security,access,fire/smoke,callassistance
• Personal Safety –falldetection,activitiesofdailylivingmonitoringandassessment,mobility
aids
• Social Connection –phones,email,intranet,portals,privatecablechannels,two-wayvideo,
messaging,TV
• Physical/Mental Wellbeing –wellnessmonitor,telehealth,cognitivestimulation,reminder
systems
Specifically,Diakoniscreatingalocalpartnership,namedthe“ConsortiumfortheFutureof
SeniorLiving,”amongseveraltechnologycompanies,aseniorlivingcontractor,anarchitect,
adesignfirmandaleadinguniversity.TheConsortiumwilladdressknownexistingobstacles,
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discoveradditionalunmetneedsandfindsolutions
toassistindividualstoremainindependentlonger.
TheConsortiumplanstobuildamodelapartmenton
Diakon’sLutherCrestcampusinAllentown,Penn.and
amodelhomeonitsToptoncampusinTopton,Penn.
campus.Thesemodelswillbeusedaseducationcenters
forseniors,families,staffandthelocalcommunityto
showcasetechnologythatiscurrentlyavailableandhow
itcanassistpeopleintheirhomes.TheConsortium
alsowillpilotnewtechnologieswiththegoalto
incorporateprovensolutionsandservicesthroughoutDiakon’sindependentandassistedliving
communitiesandeventuallyintotheneighborhoodhome.
Cognitive Impairment - Brain Fitness
OneofthetechnologiesDiakonhastestedandadoptedforimprovedresidenthealthand
engagementistheDakim[m]Power(www.
dakim.com).Positionedasfunandeasyto
use,[m]Powerisacognitiveexercisesystem
thatprovidesresidentswithachallenging,
entertainingandenjoyablementalworkout.
Itemploystouchscreentechnologyand
combinesoriginalcontentwithmemory-
invokingimagestostimulateparticipants’minds.Itisaselfcontainedcomputertouchscreen
thatrequiresnokeyboardormouse.Thechallengelevelisselfadjustingandnewcontentis
downloadedandinstalledautomaticallyeachnight.Diakonhasfoundthatthe[m]Poweris
senior-friendlywithanautomatedloginandmakescognitiveexercisealeisureactivity.Diakon
pilotedsixunitsoverthelastyearattwoofitscampusesandrecentlyinstalled32moreunitsthe
firstquarterof2008.
Monitoring Activities of Daily Living
DiakonispartneringwithGrandCare(www.grandcare.com),topilotanewtechnologydevice
calledComoforassistingindividualstoremainindependentinthehomes(nomatterwheretheir
homeis).GrandCareComoisanintelligentsystemthatincludesasuiteofsensorstomonitor
thehomeofanelderlyindividualinanon-intrusivemanner.Thesystemsendsnon-visual
informationviatheInternetaboutbasicactivityinthehouseholdofasenior.Diakonwillhost
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auser-friendlywebpageforbothformalandinformalcaregiverstomonitoractivityandtosend
communicationsdirectlytothe
senior’stelevisionscreen.The
caregiverscanspecifyhowthey
wishtobenotifiedintheevent
ofahouseholdirregularity.
UsingInternettechnology,GrandCarealsoallowsthefamilytostayintouchwiththeirlovedone
fromanylocationortimeofday.
Lighting Technologies for The Aging Eye
DiakonisworkingwithLutron(www.lutron.com),aleadinglightingcontrolcompanyand
Diefenderfer,alocalelectricalcontractortoprovidelightingandcontrolstoassistwiththevisual
changesthatoccurtooureyesasweage.DiakonandLutronareexploringwaystoimprovethe
qualityoflifeofolderadultsbyunderstandinghowlightingcompensatesforthechangesthat
commonlyoccurinagingeyes.Asweage,ourvisionexperiencesmanychanges:sensitivity
toglare;decreasingabilitytoreacttochangesinlightlevels;reducedabilitytodiscerndetails;
restrictedfieldofvisionanddepthperception;andreducedsensitivitytocontrastandcolor
recognition.Lightingcanmakethedifferencebetweenseeingandnotseeingforolderadultswith
deterioratingvision.
Diakonplanstochangelightingenvironmentstoincreaseambientlightlevels,increasetaskarea
lighting,minimizeglare,increasecontrast,balanceluminancelevels,improvecolorperception
andprovidegradualtransitionsbetweenspacesinthecommonareasofitsLutherCrest
community.Othergoalsincludeminimizinghoursoflightingoperationinsomeareasbyusing
lightingcontrollers,andthelightingpowerdensitybyusingenergyefficientlightingproducts,
whileprovidinglightingthattheresidentsfindattractiveandcomfortable.
Somelightingcontrolstrategiescurrentlybeingconsideredarewallbox“singlezone,”scene,
bedside,hand-heldremote,occupancy,andastronomicaltimeclockcontrol.Diakonalsois
exploringtechnologythatwillprovidedaylightcompensation,automatedwindowshades,light-
leveltuning,centralsystemcontroland/orintegration,andenergymonitoringthatincludespeak
powerdemandmonitoringandmanagementaswellasenergyusage.
Resident Information and Communications
DiakonispilotingaresidentinformationandcommunicationsproductwithTouchTownTV
(www.touchtown.tv)thatcanbebroadcastoverexistingcabletelevisiononaprivatechanneland
providesdigitalsignageinformationlocatedthroughoutthefacilityonflatpanelTVs.
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TouchTown TV+ and Resident Web Portalworktogethertounifythecommunicationthroughout
retirementcommunities.TV+isapassivesystem,deliveringcommunityinformationtoviewers
ontelevisions,websitesandprint.Itgivescommunitiesthepowertoconnectwithresidents,
familymembersandprospectiveresidents–evenifthosepeoplearenotphysicallyinthe
buildingorcampus.Itletsacommunitycreateanddeliveraprofessionalqualitychannel
automatically,generatingthefinalresultfromadatabaseoflocalinformation.Theuniquevalue
ofTV+derivesfromitsabilitytounifycommunicationsthroughoutaretirementcommunity.
TheResident Web Portalisaninteractivesystem,engagingresidentsinonlineactivitiessuch
asemail,discussionforums,signingupforactivities,schedulingmaintenancerequests,dining
menus,residentdirectories,etc.Touchtown Digital Signagesendscommunityinformation
toviewersviadigitalsignageinpublicareas.Thetechnologyprovidesamulti-window,
highdefinitiondisplaythatcombinesmultipleinformationsources:brandmessage,daily
announcements,activityschedules,diningmenus,transportation,time,date,weather,etc.
Donor Recognition / Diakon Information Kiosk Stations
Diakonwillinstallatouch-screenkioskbasedsystemfordonorrecognition,buildingdirectory
andotherDiakoninformationoneachcampusinconjunctionwithitsrepositionplan.Quality
Attributes(www.qualityattributes.com)isthesoftwarecompanyprovidingwebbasedsoftware
tobepresentedonthetouchscreenkiosks.IBDonor,thedonorandsponsorrecognition
managementpackage,providesweb-basedadministrationofdonorsandallowsup-to-date
recognitionofdonorswhilereducingphysicaldécorspacecommitments.iBDirectory,avisitor
managementtool,offersvisitorsandresidentsrealtimeinteractionwithDiakon’sinformation
includingbuildingdirectories,waypointfindings,campusmapsandeventcalendaring.
5.1.3 Keystone Home Health & Hospice
KeystoneHomeHealth&Hospice,basedinthegreaterPhiladelphiaregion,providesprivate
dutynursing,skilledhomecare,diseasestatemanagementprograms,telecare,palliativecare,
homehospiceandresidentialhospiceservices.
AsreferencedaboveinthediscussionofPennsylvania’sTeleCareMedicaidreimbursement
program,Keystonehasbeenanearlyleaderinusinginnovativeandlow-costtechnologyto
addresstheproblemoftheincreasingnumberofindividualswhoareagingandlivewithchronic
disease.Keystonepursuedusingtechnologybecauseitrecognizedthesignificantchallengesto
maintainingthehealthofanolderpopulation,whichisoftenahardshipforindividualsand
families.Withtheuseofsimpletechnologytomonitoractivityandambienttemperatureinthe
livingenvironment,trackanddispensedailymedicationdoses,andremotelymonitorvitalsigns,
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Keystonefounditcanalleviatesomeoftheescalatingcostsandsocialpressuresofmaintaining
thehealthandindependenceofthechronicallyillandagingpopulation.
Passive Monitoring System
KeystonedevelopedtheKeystoneTelecareProgram,combiningclinicalcasemanagementwith
theQuietCarepassivemonitoringsystemfromLivingIndependently(www.quietcare.com),a
motiondetectionsystemforthehomethatisspeciallydesignedtoanalyzepatternsofactivity
surroundinganindividual’snormaldailyroutine.Individualswhoareagingorwhohave
chronicdiseasehavecontinuedandpredictableepisodesofchangewithintheillness,relatedto
lifestyle,livingconditions,accesstofamily,communitysupport,andhealthcare.Patternsof
behaviorcanbecardinalsignalsofimpendingcrisiswithinchronicillnessandaging.
Fivediscreetwirelessmotiondetectorscollectandtrackanindividual’snormaldailyroutine
aswellasambienttemperatureinthehome.Informationfromthesensorsissenttoasecure
websitewhereitistranslatedintofunctionalstatus.Abaselineanalysisoftheindividual’ssafe
independentstatusathomeisrecordedandsubsequentinformationiscomparedtodetermine
changesinactivity.Installationofthesesensorsiscost-effectiveandimportantly,non-obtrusive
intheexistingenvironment.Informationgeneratedbythepassivemonitoringsystemisviewed
bothonadailybasisandthroughtrendanalysis,topinpointchangesinbehaviorthatcould
indicateaproblembeforeitbecomesacrisis.Passivemonitoringsystemincludesa24-hour
emergencyresponsebuttonwithoversightbyADT.Thepassivemonitoringcanbeeasily
integratedintosupportivehousingorprivateresidencestobettermanagethecostsofcareand
isasimpleandcost-effectiveplatformforothertechnologiestoenableindividualstoremainat
home.
Remote Monitoring of Vital Signs
Keystoneutilizeslowcost,FDAapprovedbiometrictools(glucosemeters,bloodpressurecuff,
incentivespirometer,digitalscale,etc.)thatcanbelinkedtoawirelessmodemtosendvital
measurementsoverphonelinestothephysicianandhomecarenurse.Thesemeasurements
createalongitudinalrecordforgreateraccuracyofdiseasestateassessment.Thefrequentvitals
monitoringathomeaffordsconstanttrendingandearlyinterventionbyaphysicianornurse
andcanavertworseninghealthstatus.In-homemonitoringdevicesconnectedtoanadaptable
modemcanguidepatientsinthedailyexchangeofimportantclinicalinformationsuchasblood
sugarlevels,bloodpressure,weight,andlungfunctioning.
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Medication Adherence
Keystone,alongwithotherproviders,foundthatfailuretotakemedicationbecauseofcost,
forgetfulness,confusion,orotherreasonsgreatlyunderminesthesuccessoftreatmentand
increasesthecostsofcare.KeystonehasusedtheMD2medicationsystemforoverthree
yearswithindividualswhohadbeenhospitalizedduetonon-adherencewithmedicationthat
complicatedotherhealthrelatedissues.Adherenceinthisgrouphasbeenincreasedonaverage
20percent,andforoneindividual,hospitalizationwasavertedformorethanayear.
Demonstrations and Research
Forseveralyears,Keystonehasworkedtoadvanceadoptingagingservicestechnologiesby
demonstratingtheirvaluewithvariouspopulations.Thefollowingisabriefsummaryofthese
efforts:
• KeystoneHospicewaspartofastudywithDr.EllenTedaldiatTempleCancerCenterto
trackmedicationadherencewiththeMD2inindividualsinfectedwithHIV-1whohave
asignificanthistoryofnon-compliance.ThisstudypassedtheTempleIRB(Institutional
ReviewBoard)inFebruary2004.
• KeystoneHospicereceivedIRBapprovalinOctober2005fromtheCityofPhiladelphia,
DepartmentofHealth,tobeginaprojectwithfundingfromtheAIDSActivities
CoordinatingOffice(AACO)todemonstratethecostandcarebenefitsofusingthese
technologiestoenhancecareandimproveclinicaloutcomesforindividualswhoare
chronicallyillwithHIV/AIDS.Thisstudyisongoing.
• InDecember2005,KeystonereceiveddiscretionaryfundingfromthePennsylvania
DepartmentofAgingtobeginasix-monthpilotprojectusingthepassivemonitoring,
medicationadherenceandremotevitalsignsmonitoringtechnologieswithhomecare
nursingsupervision,todemonstratethebenefitsforthehealthandwelfareofindividuals
whoareaginginMontgomeryCounty,Penn.
• InJune2006KeystonereceivedfundingfromTheChestnutHillHealthCareFoundationin
supportoftheTelecareProgramtooffertelecareservicesto12chronicallyillindividualsin
thezipcodessurroundingChestnutHillHospital.
Aftersixmonthsofpilotingtechnologieswith12frailelderlyindividualsnearChestnutHill
Hospital,Keystoneprovidedanaverageof119daysofcare.Individualswerereferredforcare
forfragilemedicalconditionsandnon-adherencetomedicationandwereconsideredatriskfor
nursinghomeplacement.Thefollowingaresummaryhighlights:
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• Demographics:average76yearsofage;75percentCaucasian;66percentfemale;50percent
werephysicianreferrals;and50percentwerereferredfromthelocalOfficeonAging.All
individualshadmultiplediagnosesincludingcancer,congestiveheartfailure,hypertension,
anddiabeteswith50percentcomplicatedbydementia,bi-polardisorderordepression.
• Elevenindividualsusedthemedicationdispensingtechnologybetweenoneweekandsix
months.Theaverageadherenceratefortheseindividualswas98.2percentwhile45percent
ofindividualswereadherent100%ofthetime.
• Tenindividualswereusingthepassivemonitoringsystem.
• Threeindividualswithcongestiveheartfailureandonewithdiabetesutilizedremotevital
signsmonitoring.
• Twoindividualswerehospitalizedduringthesix-monthperiodforatotalofsixdays;onefor
afall,andoneforahematomaatthesiteofself-injection.
• Noparticipantswereplacedintolong-termcare.
Bykeepingtheseindividualssafelyathomeusinglowcosttechnologyatapproximately$16a
dayversusnursinghomeplacementat$180aday,Keystonebelievedthecostandqualityoflife
benefitwasevident.Onepatientwhohadoriginallysaidthatshe‘justwantedtodie’because
ofherillness(congestiveheartfailure)andhadanunpredictablehealthstatusathome,enjoyed
independencewiththesupportofthepassivemonitors,amedicationdispenserandanurse
remotelymonitoringhervitalsignsdaily.Severaltechnology-informedinterventionsbythe
nursehavekeptthispatientwellandwithoutacrisisforthemonitoringperiod.
5.1.4 NewCourtland Elder Services
TheNewCourtlandElderServicesnetwork,foundedonJuly1,1995,isacareproviderformore
than2,000peopleinthePhiladelphiaarea.Itownsandoperatessevennursinghomes,provides
affordableseniorhousingcottagesandapartments,operatesaPACE(ProgramofAllInclusive
CarefortheElderly)programcalled“LIFE” in Pennsylvania (LivingIndependentlyForElders),
andprovideshomecareservicesthroughCourtlandatHome,itscertifiedhomehealthagency.
Itusesaninnovativeandindividualizedapproachtoprovidinghealthcareandsocialservicesin
fulfillingitsmissiontocareforthoseinneed.CourtlandatHomeprovidesskillednursing,home
healthaide,andskilledrehabilitativeservices.NewCourtlanddistinguishesitselfbyuniquely
blendingthecompassionofahighly-trained,dependable,andfriendlystaffwiththeinnovation
ofeasy-to-useassistivetechnology.
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NewCourtlandleadership–whosemissionistoprovidethebestqualityofcare–recognized
aconfluenceoffactorsincludinganursingandworkershortageandarapidlygrowingolder
populationanddecidedalargepartoftheanswerwastoadoptwhatevertechnologieswere
neededtoenablecaregivingexcellence.Thechallengewastobringtechnologytoeverylevelof
operationsandcareinanarenawherepeoplearenotgenerallyfamiliarwithtechnology(both
staffandolderadults).In2000whenthesearchbeganforadvancedagingservicestechnologies
therewaslimitedavailability.Butleadershipwasdeterminedtofindwaystomaximizethe
technologythatdidexisttomeetitsgoalsandchargedahead.Asevidencedbelow,NewCourtland
hasneverlookedback.
Clinical Systems and Resident Account Management
Unlikemostlong-termcareproviders,NewCourtlandin1998beganitsuseoftechnologywith
aclinicalinformationpackagebeforeitimplementedanelectronicresidentcensusandbilling
managementsysteminJulyof2006.ForbothofthesesystemsNewCourtlandusedVistaKeane,
byKeanecare(http://www.keanecare.com),anintegratedclinicalandfinancialsoftwarethatis
tailoredspecificallyforlong-termcare.TheVistaKeanesuiteofsoftwareallowsforaccuratereal-
timecensus,electronicresidentassessmentsandaccurateresidentfundsandbillingmanagement.
Point-of-Care System
InJune2005,NewCourtlandchangeditsnursinghomeclinicalsystemtotheCareTracker
point-of-caresystembyResourceSystems(as discussed in section 5.1.1 above)intheirseven
skillednursingfacilities(http://www.resourcesystems.net/caretracker.htm).Usingtouchbased
kiosks,CareTrackermakesiteasyfornursesandothercarestafftoquicklyandaccurately
documentresidentcareandobservations.NewCourtlandfoundthatusingCareTrackerled
tobetterresidentcareandmoreaccurateMDSsubmissions.Staffreportedthatthebiggest
benefitisabilitytospendmoretimewithresidentsandlesstimecompletingchartingandother
paperwork.NewCourtland’simplementationplanwasstaggered,beginningwithtwofacilities
andthenplacingitinonefacilityeveryothermonth.Amulti-disciplinaryteamapproachto
implementationwascriticaltosuccessandincludedanITprogrammanager,clinicalleadership,
operations,andactualusersforeachnursinghome.
Homecare Clinical and Financial System
InJuly2008,NewCourtlandimplementedHorizonHomecare,asuiteofhomecare
documentationapplicationsbyMcKesson(http://www.mckesson.com),whichintegratesclinical,
financialandadministrativedatainitshomecareagency.NewCourtlandbelievesithashelpedto
improvequality,manageclinicalcostsandotherresources,andcoordinatecare.
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Electronic Nurse Call System
NewCourtlandrecentlyinstalledCornellCumulaNurseCallSystems(www.cornell.com)ineach
ofitsskillednursingfacilities.TheCumulaNurseCallSystemisa
programmable,PCbased,addressablecallsystemequippedwith
Cornell’sAURAMonitoringSoftware.Inadditiontoservingthe
classicalfunctionofthenursecallsystem,itcanmonitoralltypes
of“alert”devices,equipmentandsystemsand,inanemergency,
sendamessageviacellphone,pager,email,messageboardortwo-
wayradiototheappropriatepersonnel.Allmonitoringandalert
activityisstoredinahistoricalreportingsystemthatprovidesaccountability,staffmanagement
andrecordkeeping
Time and Attendance Technology
Inanefforttodevelopaculturewhereallstaffbecomefamiliarwithusingtechnologyonaday-
to-daybasis,NewCourtlandimplementedtheKronosautomatedtimeandattendance
softwarein2006.Kronos(www.kronos.com)utilizesadvancedbiometric-enabled
timeclockstoimproveaccuracyandmanagelaborresourcesinreal-time.Atouch
identificationterminalverifiesemployees’identityusingbiometricfingerscanning,not
fingerprints,forincreasedaccuracy.ThepackageallowedNewCourtlandtoautomate
businessprocessesandeliminatemanyadministrativetasksaswellasmonitorlabor
activitiesinrealtimeforbetterinformedlabordecisions.Moreover,itfurtherenabled
theculturechangeNewCourtlandwasseekingandallowedstafftospendmoretime
withresidentsratherthanmanuallycompletingtedioustimesheetsandforms.
Infrastructure Enhancements and Electronic Record Systems
ByOctober2007allsevenofNewCourtland’snursinghomesandoperationalbuildingswere
convertedto100percentwirelessconnectionsandtools(laptops/handhelddevices/kiosks),
witharobusttnformationtechnologybackbonetolinkallfacilities.Thenetworkinfrastructure
utilizesstateofthearthardwareandqualityofservice(QOS)basedroutingtoensuredatais
deliveredtoend-usersinthemostefficientandtimelywaypossible.
EMR System
InMarch2007,NewCourtlandadoptedafullyelectronicmedicalrecordsystemcreated
specificallytosupportitsLIFE/PACEprogram.Aftersearchingunsuccessfullyforwhatit
deemedasuitablesystem,NewCourtlandteamedwithMediture(http://www.mediture.com/
lifeconnect.html)andanotherPACEproviderinBostontodevelopacustomizedsolutionto
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meettheuniquemedicalrecordschallengesthatfacePACEprograms.Throughthispartnership
“TruChartLIFEConnect”wasdevelopedtounifythevariousandcomplexcomponentsofPACE
programs.ThissoftwareallowedNewCourtlandtoopenandmaintaina100percentpaperless
environmentinitsLIFECenter.Asafullyintegratedsolution,thesoftwarecoversend-to-end
needsincludingassessments,interdisciplinarycareplans,authorizations,billing,scheduling,
orderentryandtransportation.NewCourtlandcurrentlyisdoingafullsystemsreviewto
determinewhetherthissystemcouldbeimplementedacrossitsotherprogramsandservices.
eMAR System
Alsoin2007,NewCourtlandimplementedafullyintegratedelectronicmedicationadministration
record(eMAR)systemthatprovidesmedicationmanagementanddeliveryinitsnursing
homes.MillenniumMPSRx(http://www.mpsrx.com)isawirelessweb-basedsystemthatallows
NewCourtland’snursestodeliverbar-codedmedicationsviacart-basedlaptops.Ataskforce
wasusedtoinvolvealargeusergroupandmanagementplannedtheroll-out.Toimplement,
NewCourtlandtrainedstaffingagencynurseswhohelpedrollitoutineachbuilding.The
approachwassosuccessfulthatMillenniumutilizedthetrainedagencynursestocompleteroll-
outsinotherlong-termcarecommunities.NewCourtlandhasrealizedimprovedefficienciesand
reducedmedicationerrorsasaresultofthispaperlesssystem.
SharePoint Dashboard and Resources
InApril2008,NewCourtlanddeployedMicrosoftSharePoint
homespagesforemployeesacrossalllocations,providing
asingleintegratedlocationwhereemployeescanfind
organizationalresources,manageelectronicformsand
workflow,andhaveaccesstodashboardsandreportsofkey
clinicalandoperationalmetrics.AnyNewCourtlandemployee
loggingontotheInternetencountersastartpagethatincludes:
theuser’sfacilitylogo;announcementsspecifictotheuser’s
facilityorprogram;alistofrecentNewCourtlandnewsandpublications;humanresource
documents;andrelevantqualitymeasures.
Telehealth Technologies
NewCourtlandalsohasbeenanearlyadopterofvarioustelehealthtechnologies.Severalyears
agoitpilotedwiredtelehealthdevicesthatwereconnectedtophonejacksandwiredtobiometric
tools.Theorganizationdeterminedthatthedevicesweretooexpensiveandwouldnotenable
thedevelopmentofanaffordableandcomprehensivesetoftelehealthtools.
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Telehealth Sensor Technologies
BeginninginJuly2006,NewCourtlandbeganusingadvancedtechnologiesfromHealthSense
(www.healthsense.com)andothervendorsinresident’shomes.Theseincludebedsensors,
refrigerator/stovesensorsandgeneralmotiondetectors.Currently
theHealthSenseeNeighbortechnologyisinplaceatseveralofthe
NewCourtlandLIFEandaffordableseniorhousingunitsandhas
allowedNewCourtlandtechnicianstobeproactiveinmonitoring
carebyprovidingaccuratealertsofkeyactivitiesofdailyliving.
Thirty-threetelehealthsensorsystemswereoriginallydeployed
intheaffordableseniorhousingresidences.Whilemanagement
foundthattheycouldhardly“giveaway”thefirst33units,they
couldn’tgetthenext33quickenough.Demandspreadbyword
ofmouthbecauseolderadultsusingthetechnologyfeltsaferand
moreconnectedtotheirneighborsandtheircommunitythanthey
didwithoutit.TheLIFEcommunityalsowasanearlyadopterofthetechnology,withhalfofthe
80membersusingtelehealthsensors.
NewCourtlandfoundthatthetechnologyenabledthemtoprovidehighqualitycarecost-
effectively.Whiletheyhavenotyetformallyquantifiedthecosteffectiveness,ithasbecome
self-evidentoverthepasttwoyears.Lessonslearnedincludemakingsurethereisachampionat
eachsite(housingcommunitymanager,servicecoordinator,etc.)andseekingthetrustofolder
adults.Theyfoundthatonceresidents’trustisearned,acceptanceofthetechnologyquickly
growsacrossthecommunity.
Oneofthepatients,a77yearoldretiredpharmacytechnician,hadlostherlegtodiabetes.She
movedintotheseniorhousingcommunitybecauseshecouldnolongermaneuverthestairsin
herfamilyhome.Inherapartment,shechecksherbloodpressurewithacuffthatautomatically
andwirelesslysendsthereadingtothemonitoringcenter,whichnotifiesherandherdoctorof
anytroublingchange.SensorsplacedineachroomkeeptrackofhermovementsandADLs,and
shehasabuttontosummonassistance,whichsheusedinAprilwhenshefell.Inaninterview
withamajornewspapershestatedthat“I’malonebutIknowI’mnotallbymyself,”andadded,
“AndIreallylikemyindependence.”
ResearchreleasedbyHealthsenseandNewCourtlandconcludesthatseniorswhorelyonremote
monitoringtechnologytohelpthemremainsecureandindependentadaptwelltolivingwiththe
technologyanddonotseeitasintrusiveorimpersonal.Conductedbyanindependentresearch
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consultingfirmatfourlocationswithintheNewCourtlandNetwork,thestudymeasured
theeffectivenessofHealthsense’seNeighborremotemonitoringtechnologyandcaptured
theperceptionsofresidents,familymembersandstaff
employingit.
Participantsinthesurveyreportedanoverwhelmingly
positiveattitudetowardtheeNeighborSystem.Seniors,
someofwhomhavelivedwiththetechnologyintheir
residencesformorethantwoyears,unanimouslyagreed
thatthesystemmakesthemfeelsaferandmoresecurewhile
enablingthemtoliveindependentlyforlonger.Ofthose
surveyed,onlyoneelderlyresidentreportedaconcernabout
intrusiveness.Staffmembersinterviewedforthestudy
unanimouslyagreedthattheeNeighborSystemallowsthem
tobetterassessthecareneededbyresidents,helpsthem
providetheappropriatelevelofcare,andimprovesthe
qualityofcareoverallthatresidentsreceive.
NewCourtland’sleadershipthoughtthatadaptingtothetechnologymightbeamajorissuefor
theirresidents,butclearlyitwasnot.Rather,theresultsofthesurveydemonstratethateven
seniorswithlittleornopriorexposuretothistechnologycanreadilyadapttoitoncetheyrealize
theimprovedqualityoflifeitoffers.
Telehealth Biometric Technologies
InOctober2006,NewCourtlandbeganimplementingbiometrictoolsasanadditional
enhancementtothesensorprogram.Biometricdevicesweredeployedtoremotelymonitorkey
vitalssuchasweight,bloodpressureandglucose,etc.NewCourtlandnowisbeginningalarge
demonstrationincooperationwithhealthinsurancecompanies,continuingcareretirement
communitiesandotherhomehealthagencies,installingbiometricmonitoringdevicesin
upto1,000residencesoverthenextsixmonths.TheyarepartneringwiththeUniversityof
Pennsylvaniatoconductevaluativeresearchforthepilot.
Cognitive Fitness
SinceJune2008,theDakim[m]Powersystem(seesection5.1.2)hasbeenusedatNewCourtland
LIFE.Asdiscussedabove,[m]Powerisanelectroniccognitivefitnesssystemforolderadults.
Thesystememploystouchscreentechnologytodisplayoriginalcontentwithmemory-invoking
images,movies,musicandsoundsofthepast.NewCourtlandhas30systemusersandasurvey
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founda90percentusersatisfactionrate.Plansnowcallforimplementingthesysteminits
nursinghomes,andthenew“homemodule”ofthesystemisbeingconsideredforothersenior
livingsettings.
Videoconferencing for Hi-Tech Staff Training, Telemedicine and Resident Socialization
Withtheassistanceofgrantfunding,NewCourtlandin2004openedahigh-tech41,000square
foottrainingcenterequippedwithwirelessconnectivityandwiredhigh-speedvideoconferencing
equipmentinallrooms.Thetrainingcenterispartoftheprovider’scommitmenttostaff
trainingandtechnologyuse.NewCourtlandalsohasoutfitteditssevennursingfacilitieswith
stateoftheartvideoconferencerooms.Furthermore,NewCourtlandispilottesting“Upstairs
Solutions”(www.upstairssolutions.com),acomprehensive,interactiveonlineweb-basedtraining
andcompliancesystemfornursesandseniorcareprofessionals.Itallowsforcollaboratedistance
learningandmulticastingofNewCourtlandevents.Thevideoconferencingtechnologyalso
hasenabledNewCourtlandtobeginapilotprogramwithphysicianstoremotelyinteractwith
patientsinnursinghomes.
NewCourtlandhasusedtheteleconferencingequipmentinoneofitssocializationprograms,
calledComfort&JoyTM.Inamulti-yearprojectwiththeMulticulturalYouthExchange
(MYX),olderresidentsarepairedwithlocalstudentstocreatequiltsbasedontheirsharedlife
experiences.Eachpaircraftsapatchofquiltandrecordsthoughtsandfeelingsontheircreation
viavideoconference.PatchesfromeachNewCourtlandNetworknursinghomewillbesewn
togethertocreatesevendifferentquilts,whichinturnwillbesewnintoonelargequilt.Aweb
pagealsowillbecreatedcontainingapictureofeachquilt’spatchandalinktotherecorded
messagefromtheelderandstudentartiststhatstitchedit.Plansalsoareintheworkstocreate
quiltsviavideoconferencewithotherintergenerationalgroupsoverseaswithinthenexttwoyears.
5.1.5 VNA of Western Pennsylvania
BasedinruralButler,Pennsylvania,theVNAFamilyofServicesconsistsoffivedivisions
includingVNA,WesternPennsylvania,VNAHospice,VNACompleteCare,VNAMedical
EquipmentandSupplies,andVNAHomeTech.SpecializedareaswithintheVNAFamilyof
Servicesincludehomehealthcare,hospice,personalcare,privateduty,healthandwellness
services,homemedicalequipmentandhometelemonitoring.VNAofWesternPenn.isanother
exampleofahomecare’searlyadoptionoftechnologytoenhanceservicestoolderadults.
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Home Telemonitoring:
Since2002theVNAofWesternPenn.hasbeenutilizingHoneywell’sHomMedhome
telemonitoringtechnology(www.hommed.com).WiththehelpofaUSDepartmentof
Agriculture(USDA)grantof$500,000overseveralyears,theVNAwasabletopurchase
telemonitoringequipmentandcreatearobusttelemonitoringprogramforitsservicearea.Most
ofitstelemonitoringpatientsareMedicareFee-for-Service,whileseveralreceivereimbursement
throughaMedicaidManagedCareinsurer,GatewayHealthPlan.Todate,theVNAhasone
patientinthePDA60+WaiverTeleCareprogramthroughtheButlerCountyAreaAgencyon
Aging,buthopestoincreasethatnumbersignificantlyoverthenextcoupleofyears.
Onaverage,200oftheVNA’spatientsaregettingacheck-upeverydayintheirownhomes.
WiththeHomMedsystem,theyareabletogatherclinicaldataregardingtrends
inindividuals’healthstatus.Theunitsareindividuallyprogrammedforpatients
accordingtoparametersestablishedbytheirpersonalphysicians.TheVNA’s
technicianssetuptheunitandteachthepatienthowtouseit.Atthesametime
eachday,avoicepromptwillinstructthepatienttotakevitalsignssuchas
weight,bloodpressure,pulse,oxygensaturationandtemperature.Thevoiceguidesthepatient
step-by-stepthroughtheprocessofpushingoneofthreecolor-codedbuttonsthatenablethe
systemtocollectvitalsignsdata.DataiscollectedeachdayandtransmittedtotheVNAwhere
trainedstaffreviewstheresults.Ifanyvitalsignsfalloutsideofthereadingsthephysicianhas
recommended,theunitwillsignalcliniciansandalertthemtothepatient’scondition.The
problemcanthenbeidentifiedandtreatedbeforeitbecomesserious.TheVNAalsoprovides
physicianswithweeklyormonthlygraphsofeachpatient’svitalsigns.Thesereportsallow
physicianstoseesubtlechangesinconditionsandschedulefollow-upofficevisitsaccordingly.
TheVNAofWesternPenn.iscarefultoinformpatientsthatthetelemonitoringsystemisnot
meanttoreplace,butrathertocomplementvisitsbytheVNAhomecareprofessional.The
systemallowsthemtomonitorhowthepatienthasbeendoingonadailybasisevenifthey
aren’tvisitingthehomeeveryday.TheVNAfocuseditsuseoftelemonitoringmostlyon
diagnosisgroupssuchaschronicheartfailure,diabetesandCOPD,wheretheyhavefoundthe
greatestreductioninrehospitalizationratesbecauseofthetechnology.Theyarefurtherfocused
onpreventinghospitalizationforthoseindividualswhoareintheearlierstagesoflivingwith
chronicconditions.
Typically,theVNAofWesternPenn.phasestelemonitoringtechnologyintoaperson’scareplan.
Whenbeginningapatientontelemonitoring,theagencywillmaintainatwoorthreein-person
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visitsperweek.Oncethepatienthasadjustedtousingtheequipmentandvitalsarebeingread
andtransmittedaccurately,theVNAwilltypicallyreduceitsin-personvisitstooneperweekbut
withdailyvitalsmonitoringandfrequentphonecontact.
TheVNAfoundthattelemonitoringforhealthvitalsisawin-win-winforpatients,providersand
payers.Itprovidesthepatientwithconstantmonitoringthatoffersminimalinterferencewith
theirdailyactivitiesandhasprovenaneffectivemeasureforpreventinghospitalre-admittance
andcontrollinghealthcarecosts.Itoffersthepatient’sfamilypeaceofmindknowingthattheir
lovedoneisbeingcloselymonitoredinthehomebyhealthcareprofessionalsonaconsistent
basis.Andlastly,itallowsprimarycarenursesandphysicianstofocusontreatingthepatient’s
conditionratherthanthedetailsofdiagnostictesting.Inaddition,theVNAfoundthatthe
technologyhelpspatientstodirectlyseetheresultoftheirpersonaldecisionsandlifestyleactions
(e.g.,dietary)andempowersthemtomakemorehealthydailylifestyledecisions.
Inoneexample,telemonitoringtechnologywassuccessfullyusedwithanoldermanwhohad
beeninandoutofthehospitaltwoormoretimesamonthforsixmonths.Hewasbedfastwith
multipleexacerbationsfromheartfailure.ThroughtheVNA’sservicemodelmadepossiblewith
telemonitoring,thisgentlemanstayedoutofthehospitalforaperiodexceedingsixmonths,
whenhewasdischargedfromtheagencysincehewasnolongerhomebound.Hereportedlywas
abletoagainenjoyhisfavoritehobbyoffishing.Inanotherexample,anoldermanstillworking
inhisowncompany,usesthemonitoringequipmenteveryMonday,WednesdayandFriday.If
themonitoridentifiesaproblemtheVNAwillcallhim.Asaresult,heisagainabletogetup
everydayatsixa.m.andworkasixtotenhourday,fivedaysaweek.Hestatedinaninterview
withnewsmediainastoryaboutthetechnologythat“mylifeisbetterbecauseoftheVNA;
they’vehelpedmekeeponliving.”
Medication Compliance and Monitoring
TheVNAofWesternPenn.alsohasutilizedmedicationcomplianceandmonitoring
systemswithitsclients,includingtheMD.2™,Honeywell’sMedPartnerandmost
recentlytheMedReady(www.medreadyinc.com).TheVNAbelievessuchdevicesarean
integralpartofanin-homecaremodelandplanstoincorporatethemintoitsservices
whereverappropriate.TheyhavefoundtheMedReadydeviceparticularlyaffordable,
easytouseandcompact.
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5.1.6 Provider Record Systems Integration
Someagingservicesprovidersintegratedpointofcare(POC)systems,electronichealthrecord
systemsandpharmacysystemswitheachotherandwithotherhealthcareproviderstoimprove
managingandutilizingkeyresidenthealthinformationandprovidebetterqualityofcare.Afew
ofthesearebrieflyhighlightedbelow.
Integration of Electronic Health Records with Health Care Systems
PHI Retirement and Senior Care Services,basedinDillsburg,Penn.istheparentcompanyof
PresbyterianHomes,Inc.andemploys2400peoplein14communities.PHIisimplementing
majortechnologyinitiativesincludingawirelessinfrastructure,anelectronicmedicationdelivery
system,anelectronicpoint-of-caresystemandintegratedsecurityandwanderingsystems.Its
philosophyregardingtechnologyhasbeentoavoidthe“cuttingedge”butstayonthe“leading
force”oftechnologyadoption.
PHIisontheleadingedgeofintegratingitselectronichealthrecordswithregionalhealth
systems.OneinitiativeintheLehighValleyiswithSaintLuke’sHealthSystem.PHInowisable
toreceivetheelectronicrecordsofupto700residentsfromfourhospitalsinthehealthsystem.
Itiscurrentlydevelopingitscapacitytoexchangeelectronichealthrecordsfromitslong-term
carecommunitiestothefourhospitals.
Inalargerregionalinitiative,PHIislikelytobethe“beta”long-termcareparticipantinthe
KeystoneHealthInformationExchange(www.keyhie.org).LedbyGeisingerHealthSystem,the
KeyHIE™formedin2005andnowinvolvesseveralhealthsystemsandphysiciangroupsinrural
NorthcentralPennsylvania.Undertheplannedinitiative,PHI’ssixlong-termcarecommunities
willbelinkedtoallparticipatinghealthcarefacilitiesandphysicianstoexchangecompletehealth
recordsinformation.Thiswillprovidethe“fullcontinuum”ofhealthcareintheregionalhealth
informationexchangedemonstration.
Point of Care Systems Integration with Health Care Providers
Phoebe Ministries,whichhas16communitiesthroughouteasternandcentral
Penn.offeringlong-termcare,short-termrehabilitation,respitecareand
programsforthosewithcognitiveimpairment,isworkingtotakeitsPOC
systemtothenextlevel.ItiscurrentlyimplementingthePointClickCare
electronicmedicalrecord-likePOCsystem(www.pointclickcare.com).
PointClickCareallowscaregiverstotrackvitalstatistics,recordcareplansand
doallrecordkeepingonwirelesstouch-screentabletsorlaptopcomputers.
Center for Aging Services Technologies (CAST)
34
It also has certain electronic medical record and electronic medication administration record
capabilities. Phoebe Ministries is in the process of making sure the system meets the health
record information needs of residents’ physicians. To do so, Phoebe has partnered with a
physician who provides medical care to residents living at its Allentown campus to be closely
involved in the implementation rollout of the POC system. Phoebe Ministries also is seeking to
tie the PointClickCare system with information from acute care referrals. Its goal is to begin
the process of gaining the buy-in of physicians and hospitals with the POC system they are now
implementing in order to position themselves to more readily take advantage of the benefits of a
full electronic medical system when it becomes available.
Multiple Systems Integration
Wesley Enhanced Living (WEL), an aging services provider based in Southeastern Penn. with
seven senior living communities, is actively engaged in integrating technology at several levels.
Among its key platforms are AccuNurse by Vocollect Healthcare
Systems (http://healthcare.vocollect.com), PointClickCare
(discussed above), and an external pharmacy system used by
Synergy Pharmaceuticals. Ken Franiak, WEL’s CFO, when
speaking about the need for technology integration in aging
services, stated that “we are an information-driven business and
we have no information. Essential information is everywhere but not together in one place where
we can press a button and get what we need.”
AccuNurse is a voice-driven communications, care management and documentation tool that
opens a two-way dialogue between care staff and the resident care plan information. With simple
voice requests, staff can hear plan of care details and document activities as they are
completed. Providers have found the system to lower operating costs (e.g., higher
staffing efficiency) while providing better quality of care. At first WEL leadership
found that nurse aides did not want to use the AccuNurse technology and felt it
was imposed upon them. Once the purpose and usefulness of the system was better
understood and care staff became more comfortable with the system, they found it
to be an invaluable tool in providing care to residents.
Wesley Enhanced Living applied what it learned about the importance of seeking
care staff buy-in at the outset of technology selection to its search for a robust point
of care and electronic records system. In this case, executive staff had one system in
mind but gave the choice to care staff who favored PointClickCare.
“We are an information-driven business and we have no information. Essential information is everywhere but not together in one place where we can press a button and get what we need.”
– Ken Franiak, CFO, Wesley Enhanced Living
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WELworksdiligentlywithallitstechnologyvendorsandpartners,includingitspartner
pharmacynetwork,toefficientlyinterfaceitsmultiplesystemswithoneanother.Itbelieves
takingtheintegrationapproachfromthebeginningofmajorsystemadoption,suchas
PointClickCare,iscrucialtosuccessfulintegration.WEL’spointofcareandelectronicrecords
systemsupportsthepharmacysystem’sinventorytracking,eRxordersandpostingofcharges.
5.2 Public Aging Services Programs
Pennsylvania’snetworkof52AreaAgenciesonAging(AAAs)isavitallinktoagingservices
formanyolderPennsylvanians,particularlylow-incomeseniors.Theagingnetworkhasbeen
increasinglyfocusedonwaystoleveragevarioustechnologiestobetterservethispopulationand
reachmorepeoplewithlimitedpublicresources.Asdiscussedinsection4.1.2AAAshavebeen
involvedinshapingtheCommonwealth’sMedicaidWaiverTeleCareProgram,andwillbesolely
responsiblefordevelopingcontractswithproviderstochannelreimbursementsfortechnology
useintheprogram.Alsodiscussedaboveinsection4.1.3,thenetworkiscurrentlyimplementinga
videoconferenceequipmentandtraininginitiative.
InrecentyearsthestateDepartmentofAgingchangeditselectroniccareplanningandassessment
systemtoanewin-houseweb-basedinterfacenamed“Agenet”fortheSocialAssistanceManagement
System(SAMS)(www.harmonyis.com).CaremanagersatAAAsuselaptopstoconductelectronic
consumerneedsassessmentsinthefield.
ManyAAAshavebeeninvolvedinplanningorimplementingvariousagingservicestechnology
initiatives,someofwhicharehighlightedinafewexamplesbelow.
5.2.1 Allegheny County Area Agency on Aging
TheAlleghenyCountyAreaAgencyonAging,basedinPittsburgh,isaproactiveadvocate
forincorporatingtechnologyintocareforolderadults.Whiletheagencytodatehasmostly
providedonlythosetechnology-enabledservicesthathavebeenreimbursedthroughthe
priorAgingWaiver,includingpersonalemergencyresponsesystems(PERS)andmedication
dispensers(seetablebelow),itispreparingtomoveaheadwiththebroaderarrayofaging
servicestechnologiestobereimbursedinthenewMedicaidWaiverTeleCareprogramaswellas
withtheuseofdiscretionaryfundsfortelehealthtechnology.
AlleghenyCountyleadershipassertedthatseveraloperationalchallengeswiththedraftMedicaid
TeleCarepolicyarebeingaddressedintherevisedpolicyinthenewwaiver.Theybelievethere
aretwopossiblereasonswhyagingservicestechnologieshavenotyetexperiencedgreater
growthwithitstargetpopulation:thereseemstobegreaterresistanceorlessreceptivitytothese
technologiesbylower-incomeolderadults;andthearea’shousingstockisamongtheoldest
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inthenationwhichpresentscertaintechnicalchallenges.Toovercomethesechallengesthey
emphasizetheneedforthoroughtrainingofstaffandconsumers.Forstaffandprovidertraining
theybelieveitwillbeimportanttodemonstratehowthevarioustechnologiescanbeusedinthe
home.Whiletherewillbealearningcurve,theagencydoesnotanticipatesignificantbarriers.
Intermsofconsumerorientationandtraining,theagencyanticipatesitwillneedtomonitor
thecomfortofconsumersverycloselyandgraduallychangetheworkflow(numberofvisits)
accordingtoconsumers’levelofcomfortwiththetechnologyandthenewmodelofcare.
Allegheny County AAA TeleCare Activities(prior to new expanded TeleCare reimbursement program)
Program Service DeliveryJune 2008
(Unduplicated consumers)
Service DeliveryFY 07 – 08
Annual CostFY 07 – 08
Options Program (non Medicaid)
Options PERS monthlymonitoring fee
528 715 $154,345
Medicaid Waiver Program
Waiver Program PERSmonthly monitoring fee
653 854 $194,393
Medication Set-up by Pharmacist(Service cost is only for monthly medication dis-penser)
46 60 $ 20,765
Med Dispenser Home Health–LPN*
30 - $ 46,644
Med Dispenser Home Health–RN*Skilled Nursing
5 - $ 8,316
Total costs $424,463
*Most RN and LPN prescription visits involve multiple services and are not solely made for the purpose of filling med dispenser. For example, checking vital signs or changing a dressing could also be included.
Four-Year Agency Plan Focused on Aging Services Technologies
OneofAlleghenyCounty’sfivegoalsdetailedinitsrecentfour-yearplanistoimplement
assistivetechnologyandtelecareservicesinsupportofin-homeservices.Thisisanexcellent
exampleofhowapublicagingservicesprogramcanbeintentionalaboutincorporatingtheuse
oftechnologyintoitsregularprocessofprovidingcaremanagementandintoitsexpectationsfor
careproviders.
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Thefirstobjectiveofthisgoalistomakecurrentandemergingtechnologiesavailableto
consumersbydevelopingandimplementinganongoingcost-benefitandevaluationprocess
basedonobjectivefactorssuchasequipment,training,personnelandalternativeplacement
costs,andsubjectivefactorssuchasconsumerinput.Itsstrategiestoaccomplishthisobjective
are:
• CreateatechnologyteamincludingAAAstaff,providers,communityexpertsandconsumers
toadvanceandevaluateimplementingassistiveandtelecaretechnologyresources.
CoordinatewiththeCarnegieMellonUniversityandUniversityofPittsburghQualityofLife
Center,andtheTelerehabilitationResearchCenterattheUniversityofPittsburgh.
• Correlatetechnologiestoserviceareasincludinghealthstatusmeasuringandmonitoring,
activityandsensormonitoring,andpersonalemergencysystems.
• Adjustutilizationofassistiveandtelecaretechnologysystemsbasedontheireffectivenessin
maintainingqualityoflifeandsafeconsumerindependence.
Thesecondstrategicobjectivesetforthbytheagencyistoestablishastrongnetworkof
providerstofullyimplementtheseinnovativeservicessothattheywillcomplementtraditional
homecareservices.Toaccomplishthisobjectivetheagencyplanstoidentifyandputinplace
providerswiththeresourcesandexpertisetoeffectivelyprovideassistivetechnologyandtelecare
servicestoconsumers.
AlleghenyCounty’sthirdstrategicobjectiveistoeducateAAAandproviderstaff,especiallycare
managersandnurses,tofullyunderstandthepotentialandapplicationsofassistiveandtelecare
technologiesusedtosupportconsumersseekingtoremainindependent.Toaccomplishthis,the
agencyplanstotrainstaffanddevelopimplementationguidelinesforassistivetechnologyand
telecareservicesincludingthespecificcriteriaforappropriateconsumerutilization.
Theoutcomestheagencyisseekingfromthesestrategicactionsare:
• Consumerswillhaveaccesstoappropriateassistivetelecaretechnologyservicestohelp
sustainandpromotetheirindependence,andfacilitateearlyidentificationandintervention
regardinghealthproblems.
• Useofassistiveandtelecaretechnologyserviceswillconservepersonalresourcesof
consumersinhelpingthemtomaintaintheirqualityoflife.
• Newassistiveandtelecaretechnologieswillcontinuetobedevelopedandmadeavailablefor
consumeruse.
Center for Aging Services Technologies (CAST)
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5.2.2 Bradford, Sullivan, Susquehanna and Tioga Area Agency on Aging
WhiletheB/S/S/TAAAhasbeeninvolvedinexploringtechnologiesonavarietyoflevels,what
moststandsoutisitsroleasabetasiteforthePennsylvaniaDepartmentofAging(PDA)virtual
caremanagementpilotprogramdubbed“PDAVirtual”(seesection4.1.8).TheB/S/S/TAAA
reportsitisfacingasharpriseindemandforitsserviceswhilefundinghasseenonlyhadmodest
increases.AccordingtoprojectionsdevelopedbythePDA,thenumberofadultsage85and
olderintheB/S/S/TAAAfour-countyserviceareagrewfrom2,949in2000to3,534in2006,a20
percentincrease.
Aspartofthe“PDAVirtual”pilotprojectfundedbythestate,fiveaffordablehousingand/or
seniorcenterlocationsinthetownsofSayre,Dushore,Westfield,MansfieldandLanesborowill
soonbecomesiteswhereseniorcitizenswillbeabletousehigh-techequipmenttointeractwith
socialworkersandbeconnectedtotheservicestheyneed.TheSayrelocationwillbeatKeystone
Manor,anaffordablehousingcommunityownedbythePennsylvaniaHousingAuthority.The
Westfield,LansboroandDushorelocationsareallaffordableseniorhousingcommunitiesand
seniorcenters.
UsingtechnologyandaservicepackagebyAgeServeCommunications(www.familyvirtualvisits.
com)includingflat-screentelevisionsets,Internet-controlledcomputers,andecho-canceling
microphones,camcordersandspeakers,olderadultswillbeabletoapplyformedicalassistance,
PACE,propertytaxrebates(andotherentitlementprograms)withthehelpoftheAAA’ssocial
workersfromfourofficelocationsinTowanda,Montrose,LaporteandWellsboro.Thevirtual
visitswillreducetraveltimebybothsocialworkersandolderadults,becausetheywillnothave
totraveltoseeeachother,andwillsaveongascosts.
Thesametechnologywillallowolderadultsattendingthecenterstovisitwithfamilymembers
forfree.Participatingfamilymembersneedaccesstobasictechnologyincludingapersonal
computer,ahigh-speedInternetconnection,awebcam,andamicrophonetohaveavirtualvisit.
Visitscanbescheduledonlineandtheolderadultwillonlyneedtobepresentatthescheduled
timeandthetechnologywillautomaticallyturnon.
B/S/S/TAAAleadershipplanstoinstallthetechnologyatotherlocations,ifpositiveconsumer
resultsareforthcomingfromthefirstfivelocationsandiffundingisavailable.Theagencyis
alsoworkingwithNorthPennLegalServicestoconductvideoseniorlegalcounselingservices
throughthevirtualcenters.
The State of Technology in Aging Services in Pennsylvania
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5.2.3 Clearfield County Area Agency on Aging
ClearfieldCountyAAAisaveryruralagencyincentralPennsylvania.Assuch,effectiveuseand
proliferationofagingservicestechnologiesofferstremendousvaluetoisolatedolderadultsin
ruralareasandpermitsthemtoremainsafelyintheirhomes.Initsrecentfour-yearplan,the
agencystatesthattechnologyisa“necessity”anddeclaresitsintentto“usetechnologytoits
fullest.”TheagencywasamongthefirstAAAstotakeadvantageofthestate’sMedicaidwaiver
TeleCaredemonstrationprogram.
ClearfieldplayedakeyroleinbetatestingtheDepartment’snewcentralizedweb-based
assessmentandcaremanagementsystem.Stafftrainingonspecific,appropriatejobcomponents
ledtoacceptancebystaffandwasconsideredsuccessful.Akeyfeatureisthe“alwayson”
functionalityfortheadultprotectiveserviceprogramthatoperates24/7.On-callstaffcanpull
upaclient’scaremanagementrecordsandtriagethecareneedtoappropriateserviceproviders.
ClearfieldCountyalsoisoneofthefewAAAstousetheBeaconIRelectronicinformationand
referralsystem(www.synergysw.com)andhopestoupgradetotheBeaconWebweb-based
systemfor24/7capability.
TheagencybeganutilizingthenewMedicaidwaiverTeleCareprograminApril2008yearusing
QuiteCare(www.quietcare.com),andcurrentlyhasfourconsumerhomesoutfittedwiththe
motionsensortelemonitoringsystem.AlertsregardingabnormalitiesinADLstypicallygofirst
totheAAA-contractedprovideragencybutalsototheAAAcaremanagementstaff.TheAgency
hassetprotocolsforresponsetimebyproviders,uniquelydeterminedforeachindividualolder
consumer.Dependingonanolderadult’ssupportnetwork,familymaybethefirstcontact,then
careproviders.
TheClearfieldAAAhasnotyetbegunusingvitalsignsmonitoringtools,butispresentlyexamining
opportunitiesandintendstoskippilottestingandproceedwithfulladoptionasappropriatefor
itsconsumers’needs.Theagencyfeelsitisnotaquestionofifthetechnologyworksorhasbenefit,
butratherisamatterof“hittingastridewithit,”orlearninginwhichcareenvironmentsitworks
thebesttomeetconsumers’needsandwhereitisnotaseffective.Clearfieldhasbeenusing
medicationmanagementforacoupleofyearsthroughtheMedicaidwaiver.Whileithasfoundthe
technologybenefitsmanyconsumers,italsofoundthatitdoesnotworkforeveryone(i.e.,those
whoarenotcognitivelyabletorespondtotheautomatedcues).
Center for Aging Services Technologies (CAST)
�0
6. unIversITy agIng servICes TeChnology researCh InITIaTIves and ProvIder ParTnershIPs
Theworkofresearchuniversitiesiscriticaltoassessingthestateoftechnologyofagingservicesin
Pennsylvania.CASTbelievesthatrobustresearchinpartnershipwithagingservicesprovidersina“living
testbed”approachiscrucialtoeffectiveproliferationofthesetechnologies.Pennsylvaniaclearlyhasthat
kindofresearchcommunityasdiscussedbelow.
6.1 Carnegie Mellon and University of Pittsburgh Quality of Life Technology Center
VerymuchinlinewiththeCAST“CenterofExcellence”model,theQualityofLifeTechnology
(QoLT)Center(www.qolt.org),apartnershipbetweenCarnegieMellonUniversity(CMU)andthe
UniversityofPittsburgh,isaNationalScienceFoundationEngineering
ResearchCenter(ERC).Itsmissionistotransformthelivesofpeople
withreducedfunctionalcapabilitiesduetoagingordisability.The
QoLTbringstogetheracross-disciplinaryteamoftechnologists,
clinicians,agingservicesproviders,industrypartners,endusers
(i.e.,olderadults),andotherstakeholderstocreaterevolutionary
technologiesthatimproveandsustainthequalityoflifeforallpeople.Its
fourprimarygoalsareto:
• Enablepeoplewhoareagingandpersonswithdisabilitiestoindependentlyparticipateinthe
community
• Assistprofessionalandinformalcaregivers
• Delayorpreventthemanifestationoffunctionalimpairment
• Empowerallpeopletocontributetosocietyandtheeconomy
TheCenterbelievesthatbyintegratinginformationtechnologiesandbiomedicalinnovations,the
resultingsystemsallowpeopletoindependentlyperformvaluedandnecessaryactivitiesofdaily
livingsothattheycanmorefullyparticipateinsociety.Futurecompassionateandintelligent
QoLTsystemsrangingfromindividualdevicestotechnology-richenvironmentswillmonitorand
communicatewithpeople,understandtheirneedsandprovidesafe,reliableandwelcomeassistance
bycompensatingorsubstitutingfordiminishednaturalhumancapabilities.Technologiesdeveloped
bytheQoLTCenterareaimedatenablingpeopletolivemoreindependently,pursueindividualgoals
andmorefullyparticipateinsociety.
Research Partnerships with Aging Services Providers
QoLTiscombiningsensing,perception,robotics,machinelearning,
communicationsandminiaturizationtechnologieswithadvancesin
rehabilitationandgeriatricstodevelopnewcapabilitiesthatimprovelives.
Mostimportantly,theCenteriscreatinganewscientificandengineering
knowledgebasethatenablessystematicdevelopmentofhuman-centered
intelligentsystems.Todoso,theQoLTpairsitsknowledgeresourcesin
robotics,rehabilitationengineeringandrelatedclinicalareaswithreal-world
testbedproviderpartnersincludingindependentlivingprograms,nursing
homes,vocationalrehabilitationcentersandotherlivingenvironments.As
mentionedabove(seesection5.2.1)theAlleghenyCountyAreaAgencyon
AgingisactivelyplanningacollaborationwiththeQoLTtobetheresearchpartneronitstechnology
teamincludingAAAstaff,providers,communityexpertsandconsumerstoadvanceandevaluatethe
implementationofassistiveandtelecaretechnologyresources.Anotherproviderpartnershipiswith
theCommunityLife-LivingIndependentlyforElders,aPACEPrograminWesternPenn..The
QoLTwillworkwiththeLifeprogramtointroduceandevaluateemergingtechnologiesforthose
livingindependentlybutreceivingremoteservices(e.g.,Medicare/Medicaid)asanalternativeto
nursinghomecare.
Throughthesepartnerships,theQoLTworkstoexaminetheimpactofqualityoflifetechnologieson
individuals,healthcareenterprisesandsocietyasawhole.
Education
TheCenter’seducationgoalistofacilitateagrowingcommunityofengineers,scientists,
practitionersandconsumerswhoareintellectuallypreparedandmotivatedtocreate,assessand
applytechnologythatbenefitspeoplewithdisabilitiesandolderadults.Itseducationactivitiestarget
thefullspectrumofpopulationgroups:K-12,undergraduate,graduate,postgraduate,industry,
end-usersandthegeneralpublic.QoLTparticipatesinandproducesworkshopsandconferenceson
QoLT-relatedthemesforawideaudience,particularlyprospectiveendusersandsupportproviders.
Theseactivitiesservetoincreaseawarenessofqualityoflifetechnologiesamongthosestakeholders
andtoinformitsresearchabouttheirneedsandrequirements.
IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving
IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving
IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving
The State of Technology in Aging Services in Pennsylvania
�1
Research Partnerships with Aging Services Providers
QoLTiscombiningsensing,perception,robotics,machinelearning,
communicationsandminiaturizationtechnologieswithadvancesin
rehabilitationandgeriatricstodevelopnewcapabilitiesthatimprovelives.
Mostimportantly,theCenteriscreatinganewscientificandengineering
knowledgebasethatenablessystematicdevelopmentofhuman-centered
intelligentsystems.Todoso,theQoLTpairsitsknowledgeresourcesin
robotics,rehabilitationengineeringandrelatedclinicalareaswithreal-world
testbedproviderpartnersincludingindependentlivingprograms,nursing
homes,vocationalrehabilitationcentersandotherlivingenvironments.As
mentionedabove(seesection5.2.1)theAlleghenyCountyAreaAgencyon
AgingisactivelyplanningacollaborationwiththeQoLTtobetheresearchpartneronitstechnology
teamincludingAAAstaff,providers,communityexpertsandconsumerstoadvanceandevaluatethe
implementationofassistiveandtelecaretechnologyresources.Anotherproviderpartnershipiswith
theCommunityLife-LivingIndependentlyforElders,aPACEPrograminWesternPenn..The
QoLTwillworkwiththeLifeprogramtointroduceandevaluateemergingtechnologiesforthose
livingindependentlybutreceivingremoteservices(e.g.,Medicare/Medicaid)asanalternativeto
nursinghomecare.
Throughthesepartnerships,theQoLTworkstoexaminetheimpactofqualityoflifetechnologieson
individuals,healthcareenterprisesandsocietyasawhole.
Education
TheCenter’seducationgoalistofacilitateagrowingcommunityofengineers,scientists,
practitionersandconsumerswhoareintellectuallypreparedandmotivatedtocreate,assessand
applytechnologythatbenefitspeoplewithdisabilitiesandolderadults.Itseducationactivitiestarget
thefullspectrumofpopulationgroups:K-12,undergraduate,graduate,postgraduate,industry,
end-usersandthegeneralpublic.QoLTparticipatesinandproducesworkshopsandconferenceson
QoLT-relatedthemesforawideaudience,particularlyprospectiveendusersandsupportproviders.
Theseactivitiesservetoincreaseawarenessofqualityoflifetechnologiesamongthosestakeholders
andtoinformitsresearchabouttheirneedsandrequirements.
IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving
IntheCareMediaproject,QoLTisdevelopingmachineperceptionfortrackingindividualsandmeasuringactivitiesofdailyliving
TheNursebot,evaluatedwiththehelpofpartnerPresbyterianSeniorCare,isaprototypepersonalrobotassistant
Center for Aging Services Technologies (CAST)
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Technology Partnerships
TheQoLTalsohasformedaconsortiumoftechnologycompanieswhoshareitsvisionoftechnology
enablingolderadultsandpeoplewithdisabilities.Currentmembersare
engagedinassistivetechnology,medicalgoodsanddevices,information
technology,robotics,consumerelectronicsandappliances,healthcare
products,andhealthservices.TheQoLTCenterisavehicleforcorporate
interactionbothacrossandwithinthosemarkets,providingopportunities
forcompaniestoshareinformationwhileprotectingconfidentiality.
Consortiummembersactivelyparticipateinthecenter,helpingshapeboth
thelongandnear-termresearchagendas.Theyenjoyfacilitatedaccessto
theCenter’sfaculty,students,testsitesandend-users.Throughunique
licensingprograms,membersathighergradescanquicklytranslatethecenter’sresearchresultsinto
practice.
QoLT Foundry – Commercialization and Start-Up Companies for ASTs
WithagrantfromtheBenedumFoundationandinitialfinancialsupportofCMU’sVicePresident
forResearch,the“QoLTFoundry”wasestablishedinMarch2008asapilotprogramtoaccelerate
thecommercializationofresearchprojects
associatedwithQoLTandtoadvancethe
proliferationofagingservicestechnologiesand
technologycompanies.TheFoundryisled
byanexecutive-in-residencewithexperience
asafounderofatechnologystart-upand
hasheldmanagementrolesinthemedical
deviceindustry.StudentsintheMBA,law,
engineeringtechnologyinnovation,healthcare
policy,andbiotechnologymanagement
programsatCarnegieMellonandthe
UniversityofPittsburghassisthim.
Thefirstobjectiveistorigorouslyqualifynew
productconceptsintermsoftheirgenuinemarketpotential.Thisprocesswilltakeseveralfactors
intoaccount.Technicalfeasibilityanddevelopmenttimewillbeassessedbygroupsofresearchers
withaggregateexpertiseintherequisitetechnologies;marketpotential,sizeandavailabilityof
WithpartnerBlueroofTechnologies,QoLTiscreatingintelligenthomesandneighborhoodsthatsupportindependentliving
The State of Technology in Aging Services in Pennsylvania
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Technology Partnerships
TheQoLTalsohasformedaconsortiumoftechnologycompanieswhoshareitsvisionoftechnology
enablingolderadultsandpeoplewithdisabilities.Currentmembersare
engagedinassistivetechnology,medicalgoodsanddevices,information
technology,robotics,consumerelectronicsandappliances,healthcare
products,andhealthservices.TheQoLTCenterisavehicleforcorporate
interactionbothacrossandwithinthosemarkets,providingopportunities
forcompaniestoshareinformationwhileprotectingconfidentiality.
Consortiummembersactivelyparticipateinthecenter,helpingshapeboth
thelongandnear-termresearchagendas.Theyenjoyfacilitatedaccessto
theCenter’sfaculty,students,testsitesandend-users.Throughunique
licensingprograms,membersathighergradescanquicklytranslatethecenter’sresearchresultsinto
practice.
QoLT Foundry – Commercialization and Start-Up Companies for ASTs
WithagrantfromtheBenedumFoundationandinitialfinancialsupportofCMU’sVicePresident
forResearch,the“QoLTFoundry”wasestablishedinMarch2008asapilotprogramtoaccelerate
thecommercializationofresearchprojects
associatedwithQoLTandtoadvancethe
proliferationofagingservicestechnologiesand
technologycompanies.TheFoundryisled
byanexecutive-in-residencewithexperience
asafounderofatechnologystart-upand
hasheldmanagementrolesinthemedical
deviceindustry.StudentsintheMBA,law,
engineeringtechnologyinnovation,healthcare
policy,andbiotechnologymanagement
programsatCarnegieMellonandthe
UniversityofPittsburghassisthim.
Thefirstobjectiveistorigorouslyqualifynew
productconceptsintermsoftheirgenuinemarketpotential.Thisprocesswilltakeseveralfactors
intoaccount.Technicalfeasibilityanddevelopmenttimewillbeassessedbygroupsofresearchers
withaggregateexpertiseintherequisitetechnologies;marketpotential,sizeandavailabilityof
CarnegieMellonandUniversityofPittsburghQualityofLifeTechnologyCenter’sIllustratedResearchModel
Center for Aging Services Technologies (CAST)
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competingproductswillbegaugedbypartnerserviceproviders;andtime-to-marketwillbe
estimatedbybusinessexpertsincludingtheIndustrialAdvisoryBoardandotherkeyopinionleaders.
Theproductconceptswillbeputthroughduediligence:intellectualpropertyevaluationandmarket
analysis,pricepointanalysisandpreliminarybusinessmodeldevelopment.Thentheprojectsare
evaluatedbyanadvisorygroupcomprisedofexecutivesinindustry,investorsandrepresentatives
oflocaltechnology-basedeconomicdevelopmentorganizations.Thefoundrywillworkwitheach
CentertoidentifyandcreateanIndustrialandPractitionerAdvisoryBoard(IPAB)andotherKey
OpinionLeaders.
Thepurposeofthescreeningphasesdescribedaboveistoevaluateopportunitiestocreatestart-
upcompanies.TheQoLTFoundry’ssecondobjectiveistoform companies that actually pursue the
identified opportunities.Thechallengesofthatstepwillbedramaticallyreducedbythevisibility
andtransparencyofthisprogramtothetechnologists,entrepreneursandeconomicdevelopers
whoactivelyparticipateintheprogram,aswellasothersinthecommunity,allofwhomwillshare
firsthandknowledgeofthesequalifiedbusinessopportunities.TheQoLTFoundryteamwillreach
outtothemtomatchpeoplewithproducts.
TheFoundryhasestablishedworkingrelationshipswithregionalentrepreneurs,investorsand
technology-basedeconomicdevelopmentorganizationsthatprovidecapitalandseedfunding,
businessexpertise,andothervitalresourcestostart-upcompanies.InJune2008,severalQoLTnear-
termcommercializationopportunitieswerepresentedtoagroupofmorethan30organizations.
TheQoLTFoundrywillfacilitatethecommercializationprocessbyprovidingsupportthrough
businessplancreation,prototypedevelopment,establishingstrategicrelationships,buildingqualified
andexperiencedmanagementteams,andobtainingseedmonies.Currentlyinprogressarespin-off
companiesbasedonQoLTvirtualcoachesandperception/awarenesstechnologies.
Initiatives with the University of Pittsburgh Medical Center (UPMC)
QoLTiscloselyassociatedwiththe$7.3billionUPMCHealthSystemaspartofitscommitmentto
partneringwithhealthcareandhomeandcommunitybasedservicedeliverysystems.TheUPMC
HealthSystemisoneofthelargestacademicallyaffiliatedmedicalcentersintheworld,withits
networkof19integratedhospitalsandmajorclinics,and400outpatientsitesanddoctor’soffices.
Furthermore,theUPMCHealthsysteminitiateda10yearagreementin2002withHighmarkInc.the
region’slargestcommercialinsurerandisitselfacommercialinsurerwithover400,000members.
UPMChasoneofthemostsophisticatedelectronicrecordsanddatamanagementsystemsofany
healthcaresystemintheworldandcurrentlyhasa$400millioneight-yearagreementwithIBMfor
informationtechnologyinfrastructuretoenhanceinnovationandadaptability.
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TheimpendingagewaveofolderadultsinspiredtheUPMCHealthSystemtoestablishoracquire
17freestandingretirementandlong-termcarefacilitiescaringforapproximately40,000people.
SeveralQoLTresearchershaveestablishedresearchcollaborationswithUPMC’slong-termcare
communitiesandcommunity-basedprograms.
UPMCisexploringanumberofapproachestousetelehealthinthecareofolderadults.UPMC
SeniorLiving,togetherwiththePittSchoolofNursing,Pitt/UPMCInstituteonAgingandtheRand
Corporation,ispilotingtheuseoftelemedicinekiosksinhighriseapartment
buildingsoccupiedprimarilybylow-incomeseniors.Theinitialimplementation
usesViterion100telehealthstations(www.viterion.com)withbloodpressure
andbodyweightperipherals.Withone-touchimplementationandvoice
prompts,theViterion100TeleHealthMonitorguidesthepatientthroughits
functionsincludingmeasuringbloodpressure,bloodoxygen,bloodsugar,
weight,temperatureandpeakflow(lungcapacity).
Sincethebeginningofthepilot,participationhasincreasedfromeightpercenttonearly40percent
oftheresidents.UPMCalsoisusingtelemedicinetomanagecongestiveheartfailurepatients.
InUPMC-managedskillednursingfacilities,newinformaticstechniquesarebeingdevelopedand
appliedtopredictadverseeventssuchasadversedrugreactionsandinteractions.Currentlythe
systemtapspharmacyandlaboratorydatawithclinicaleventmonitors:softwarethatgeneratesalerts
inresponsetodetectedconditions.Furthermore,aprocessisunderwaytoextendthesystemtohelp
detectandsignalelevatedriskoffalling.
6.2 University of Pennsylvania
TheUniversityofPennsylvania(UPenn)SchoolofNursinghasbeenaleaderinresearch,testing
andevaluationoftechnologiestoserveolderadults,primarilyintelehealth.Amongcollegesof
nursing,PennNursingconsistentlyranksnearthetopofthosereceivingfundingfromtheNational
InstitutesofHealth(NIH),enablingPennresearcherstoaffectthecourseofillnessthroughout
thelifespan,promotehealthandincreasediseaseprevention,enhancethequalityoflife,eliminate
healthdisparities,andsetdirectionforend-of-lifecare.Todoso,facultymembershaveadopted
andadaptednewtechnologies,includingtelehomecare.Inseveralofitsevaluativeresearch
initiatives,UPennhaspartneredwiththePennStateUniversityDepartmentofHealthPolicyand
Administrationandwithseveralagingservicesproviders,mostlyhomecare.
Forexample,from1998to2000,UPennresearchersandcliniciansfromtheVisitingNurse
AssociationofGreaterPhiladelphia(VNA)developedexpertiseintelehomecarethroughseveral
researchprojectsconductedattheVNA.ThefirstprojectwassponsoredbytheDepartmentof
Center for Aging Services Technologies (CAST)
��
Commerce’sTelecommunicationInformationInfrastructureAssistance
ProgramnowknownastheTechnologyOpportunitiesProgram.This
project,ledbyaPennStateUniversityresearcher,studiedtheuse
oftelehomecarewithelderlydiabetics.UPennprovidedtheclinical
coordinationfortheprojectandwentontoleadtwoadditionalpilot
projectstoexpandtheuseofthetechnologytocongestiveheartfailure
patientsandtotesttheeffectivenessandefficiencyofavarietyoftreatmentpatternsforelderly
homeboundpatientsrequiringfrequentmonitoringoftheirchronicconditions.
UPennhasutilizedseveraldifferentdevicesforitstelehomecareresearchandpilotstudies,
includingHomMed(www.hommed.com)(see section 5.1.5),
AmericanTelecare(www.americantelecare.com)andCareMatrix
(www.carematrix.com).ItiscurrentlypilotingtheCareMatrix
system.Thecoreproductisawirelessmonitoringsystemforvitals
likebloodpressure,pulse,temperature,weight,etc.Thesystem
consistsofRFenableddevicesthatcommunicatewithahub
locatedsomewhereinthehome.Thehubinterfaceswirelesslywith
multipleperipheralstoguidepatientsthroughseamlessvitalsign
retrieval.Oncethehubreceivesthereading,itispushedviaaphone/PCtotheInternetserverwhere
itisaddedtotheuserschart.Theuserorcaregivercannowtracktherelevantdata,graphit,monitor
trends,annotateitforvariances,setalertcriteriaandreceivealerts.Usersorcaregiverscaneasily
monitorthebasicwellnessparameterslikebloodpressure,pulse,temperature,weightandsugarlevel.
ContinuingwiththethemetouseITtoimprovethecareofolderadults,UPennutilizeditstelehealth
equipmentinaprojectwithchronicheartfailure(CHF)patientsinapartnershipwithPennHome
Care&Hospice,aUniversityofPennsylvaniahomecareagencyandfundingfromtheNIH.Theyare
currentlyintheirfourthyearofclinicaltrialswitholderadultswhohavebeenrecentlydischarged
fromthehospital.Fourvideointeractionsarerequiredtocountasoneepisodeofhomecare.Todate,
160patientsareenrolledintheprogram.EnrollmentswillcontinueasappropriateuntilJuly,2009.
UPennhasseenasignificantreductioninhospitalandemergencyroomuseforparticipantsaswellas
anincreaseinconsumerknowledgeandawarenessofhowtomanagetheirchronichealthconditions.
However,tryingtomakecosteffectivechangepatternsofhomecarehasprovedverychallenging.
InastudyfundedbytheCenterforDiseaseControl(CDC)andincollaborationwiththe
PennsylvaniaHomecareAssociation,UPennsoughttotestevidence-basedpracticeguidelinesfor
homecareagenciesusingtelehealthforchronicdiseasemanagementservicetoolderadultswith
CHFordiabetes.303olderadultsparticipatedinthestudy.UPennconductedanincremental-
interventionanalysis,comparingstandardhomecareservicestohomecarewithphonefollow-upand
tohomecarewithtelehealthfollow-up.
UPennresearcherswenttothevarioushomecareagenciesandtaughtnurseswhen/howtouse
telehealthequipmentaccordingtotheguidelines.Becausetheguidelinesrequired
regularcontactwithparticipant’spractitioners,theresearchersfoundthat
communicationwasamajorimpedimenttosmoothimplementation.Nurses
hadtorelaymessagestophysiciansthroughofficestaff,whichwasoftenavery
inefficientprocess.Thisrevealedjusthowhelpfulanelectronicrecordand
electronictransmissionoftherecordfromhomehealthnursestophysiciansand
visaversawouldbe,ratherthanplayingmedicalphonetag.
Duetothehighlymanagednatureoftheparticipantsselectedforthestudy,researcherswereunable
tofindasignificantreductioninre-hospitalizationratesduetotheuseoftelehealth.Existingre-
hospitalizationratesforthestudygroupwaslow,at17percent.However,inanotherstudyofCHF
patientsservedby10differenthomecareagencies,UPennresearchersfoundsignificantreductionin
re-hospitalizationandanincreaseinconsumerconfidencefromtheuseofbothvideoandnon-video
telehealthservices.
Beginninglatethisyear,UPennwillbepartneringwithNewCourtlandElderServices(see section
5.1.4)onanevaluationofalargetelehealthandtelemonitoringpilotwithupto1000olderadult
participants.Thestudywillbeginwithevaluatingthehealthandqualityoflifebenefitsoftelehealth
biometrictechnology,andpotentiallytoincludetheuseofactivity/wellnessmonitoring.As
discussedabove,theprojectalsowillinvolvephysiciangroupsandislikelytoinvolveinsurance
agencies.
InalargeelectronicheathrecordspilotprojectfundedbyMedicare,UPennwillconductastudyof
theimpactonhealthoutcomesbyusingstandardizedlanguageinelectronicrecordsfor200patients
insuredbyAetnaInsuranceinPennsylvania,200insuredbyBlueCrossinPenn.and300patients
insuredbyKaiserPermanenteinCalifornia.Thepilotwillseektostandardizetheterminologyused
bynursestodescribethecaretheyprovideaswellaspatients’conditions.
Finally,UPenniscurrentlydevelopingresearchontheuseofacommonmass-marketdevice,
theiPhone,togetherwithtelehealthbiometrictoolsforcancerpatientsattheMemorialSloan-
KetteringCancerCenterinNewYorkCity.Onereasonforthepilotistofindabettercare
managementmodeltoavoidunnecessaryandfrustratingappointmentsforpatients.Forexample,
whencancerpatientsgotothehospitalfortheirchemotherapyappointment,sometimesthey
The State of Technology in Aging Services in Pennsylvania
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CHFordiabetes.303olderadultsparticipatedinthestudy.UPennconductedanincremental-
interventionanalysis,comparingstandardhomecareservicestohomecarewithphonefollow-upand
tohomecarewithtelehealthfollow-up.
UPennresearcherswenttothevarioushomecareagenciesandtaughtnurseswhen/howtouse
telehealthequipmentaccordingtotheguidelines.Becausetheguidelinesrequired
regularcontactwithparticipant’spractitioners,theresearchersfoundthat
communicationwasamajorimpedimenttosmoothimplementation.Nurses
hadtorelaymessagestophysiciansthroughofficestaff,whichwasoftenavery
inefficientprocess.Thisrevealedjusthowhelpfulanelectronicrecordand
electronictransmissionoftherecordfromhomehealthnursestophysiciansand
visaversawouldbe,ratherthanplayingmedicalphonetag.
Duetothehighlymanagednatureoftheparticipantsselectedforthestudy,researcherswereunable
tofindasignificantreductioninre-hospitalizationratesduetotheuseoftelehealth.Existingre-
hospitalizationratesforthestudygroupwaslow,at17percent.However,inanotherstudyofCHF
patientsservedby10differenthomecareagencies,UPennresearchersfoundsignificantreductionin
re-hospitalizationandanincreaseinconsumerconfidencefromtheuseofbothvideoandnon-video
telehealthservices.
Beginninglatethisyear,UPennwillbepartneringwithNewCourtlandElderServices(see section
5.1.4)onanevaluationofalargetelehealthandtelemonitoringpilotwithupto1000olderadult
participants.Thestudywillbeginwithevaluatingthehealthandqualityoflifebenefitsoftelehealth
biometrictechnology,andpotentiallytoincludetheuseofactivity/wellnessmonitoring.As
discussedabove,theprojectalsowillinvolvephysiciangroupsandislikelytoinvolveinsurance
agencies.
InalargeelectronicheathrecordspilotprojectfundedbyMedicare,UPennwillconductastudyof
theimpactonhealthoutcomesbyusingstandardizedlanguageinelectronicrecordsfor200patients
insuredbyAetnaInsuranceinPennsylvania,200insuredbyBlueCrossinPenn.and300patients
insuredbyKaiserPermanenteinCalifornia.Thepilotwillseektostandardizetheterminologyused
bynursestodescribethecaretheyprovideaswellaspatients’conditions.
Finally,UPenniscurrentlydevelopingresearchontheuseofacommonmass-marketdevice,
theiPhone,togetherwithtelehealthbiometrictoolsforcancerpatientsattheMemorialSloan-
KetteringCancerCenterinNewYorkCity.Onereasonforthepilotistofindabettercare
managementmodeltoavoidunnecessaryandfrustratingappointmentsforpatients.Forexample,
whencancerpatientsgotothehospitalfortheirchemotherapyappointment,sometimesthey
Nursemonitoringapatient’sprogressatthecentralstation
Center for Aging Services Technologies (CAST)
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learnthattheyareunabletogoaheadwiththeirtreatmentbecauseofinsufficientbloodcellcounts.
Inthestudy,careproviderswillusetheiPhoneandtelehealthdevicestomonitorpatients’healthat
home.
Overall,asaresultofchangesinthereimbursementstructurefrompervisittoepisodic
reimbursement,UPennresearchersbelievethatthefinancialbenefitsoftelehealthwillcontinueto
ensureitsgrowth,particularlywiththecurrentnursingshortage.Theyalsoseeagreatvalueofthe
technologyisthatbyusingthetelehealthequipment,patientstakemoreresponsibilityfortheircare
andlearntounderstandtheirhealthvitals.Inaddition,nursescanseemorepatientsinaday,some
studiesreportasmanyas20perdayusingtelehomecareversusonlyfour-sixtraditionalin-person
homevisits.Thesavingsinnursetime,travel,andpreventionofhospitalizations;alongwithcloser
monitoring,alladduptoequalorbetteroutcomesatlesscost.
7. agIng servICes TeChnology resourCes In PennsylvanIa
Thefollowingisabriefhighlightofresourcesforproviders,consumersandtechnologycompanies.
7.1 PA Medicaid Waiver TeleCare Program
Asdiscussedaboveinsection4.1.6,thePennsylvaniagovernment-fundedTeleCareprogramis
amongtheonlyandmostthoroughpublicagingservicestechnologyreimbursementprogramsin
thenation.Bypartneringwithhomecareorganizations,technologycompaniesanddurablemedical
equipmentprovidersorbecomingacertifiedhomehealthagencyinPenn.,agingservicesproviders
haveauniqueopportunitytofulfilltheirmissionstoserveallolderadults,includingthosewith
limitedmeans.Bytakingadvantageofthisground-breakingpublicprogram,providerscanofferthe
careenhancementsaffordedbytechnologytopersonswhoarelow-incomeandwithsignificantcare
needsthathaveheretoforebeenlargelyunabletorealizethebenefitsoftechnology.Toparticipate,
providersmustcontacttheirlocalAreaAgencyonAginganddevelopaprovidercontractagreement.
7.2 HUD Financing for Technologies in Affordable Senior Housing
HUDNeighborhoodNetworksfundingisavailableforselectagingservicestechnologiesinaffordable
seniorhousingcommunitiesonacase-by-casebasis.Thisprogram,createdin1995,wasoriginally
focusedonlyoninstallingcomputerlabsincongregateHUDandFederalHousingAdministration
(FHA)-insuredandassistedcommunities.Theprogramhasnowbeguntoreimburseprovidersfor
installationcostsandmonthlyfeesofvideo-interactiontechnology,suchasFamilyVirtualVisits
(FVV)andsimilartechnologies(seesection5.2.2).
www.hud.gov/offices/hsg/mfh/nnw/nnwaboutnn.cfm
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SchwenkfeldManor,anonprofitagingservicesproviderinSoutheasternPenn.,operatesatotal
of225unitsacrossthreeHUD-subsidizedseniorproperties.Itwasthefirstprovidertopioneer
reimbursementforusingtheFVVtechnologythroughtheHUDNeighborhoodNetworksprogram.
HUDbelievesthistypeoftechnologyfitswellwiththeprogram’spurposetopromoteself-sufficiency
andprovidetechnologyaccesstoresidents.Olderresidentscurrentlyusethetechnologytovisitwith
friendsandfamilyaroundtheworld,whichhasbecomeverypopular.
Furthermore,asdiscussedabove,thiskindoftechnologyalsocanbeusedtoprovide“virtualcare
management”orotherservicessuchasseniorlegalservices,mentalhealthservices,andservice
coordnation.Infact,HUDalsowillpairthereimbursementofthetechnologyandmonthyservice
feeswithitsservicecoordinatorprogramreimbursement.Manysmallaffordableseniorhousing
communitiesaretoosmalltobeabletoaffordafull-timesocialservicecoordinator.HUDwill
provideservicecoordinationreimbursementof$15perresidentpermonththatcouldbeprovided
toownersofseveralcommunities.Thisamount,whenpooledtogethercanbeusedtohireaservice
coordinatortoservethecommunitiesvirtuallythroughthevideotechnology.
HUD’sNeighborhoodNetworkswebsitealsolistsmanyprivateorganizationswhohavefunding
availabletohelpcentersdevelopandimproveprogramsandservices.
http://www.hud.gov/offices/hsg/mfh/nnw/fundingopps/midatlantic.cfm
7.3 Economic Development Programs for Aging Services Technology Companies in PA
ThePittsburghLifeSciencesGreenhouse(PLSG)isapublic/privatepartnershipthatinvestsinand
supportsthegrowthofbiosciencescompaniesinwesternPennsylvania.ThePLSGhasinvestment
andbusinessgrowthprogramstargetedatbothlocalstart-upsandrelocatedbusinesses.Sinceits
inceptionin2001,PLSGhasfocusedonbiotechnologytools,diagnostics,healthcareIT,medical
devices,andtherapeutics.Ithasmade$12millionindirectinvestmentsin50companiesinthose
areas,resultinginover$375millionofadditionalfundraising.
PLSGsupportoftheagingservicestechnologysectorincludesaseedgranttoCarnegieMellonand
theUniversityofPittsburghforQualityofLifeTechnologyandsupportoftwostart-upcompanies,
CartesiaDxandSyncrateLLC.Thegreenhouseisincubatingcompanieswithproductsaimedat
chronicdiseasesthataremostprevalentinolderadults,includingParkinson’sandAlzheimer’s.
Pennsylvania’sBenFranklinTechnologyPartners(BFTP)issomewhatanalogoustoPLSG,operating
fourcentersacrosstheCommonwealththatprovideseedcapitalandmanagementsupportservices
totechnology-basedstart-upcompanies.Thoughitalsosupportssomelifesciences,itsportfolio
ispredominantlyelectronics,roboticssoftware,andotherIT.Athirdstate-wideprogramisthe
Center for Aging Services Technologies (CAST)
�0
TechnologyCollaborative(TTC).BothBFTPandTTCareinvestingincompaniesintheeldercare
space.
www.pittsburghlifesciences.com
www.benfranklin.org
www.techcollaborative.org
7.4 Grants and Financing for Consumers’ Purchase of Aging Services Technologies
The Pennsylvania Assistive Technology Foundation (PATF) isanon-profitorganizationthat
provideslow-interestloansandgrantstopeoplewithdisabilitiesandolderadultssothattheycan
buytheassistivetechnologydevicesandservicestheyneed.Assistivetechnology,or“AT,”isdefined
asanydevicethathelpsapersonwithadisabilityachieveamoreindependentandproductivelife.
Assistive technology servicesarethoseservicesthathelpwiththeselection,acquisitionoruseofan
assistivetechnologydevice.Servicesmayincludeevaluatingtheneedsofanolderadultorperson
withadisability,trainingtouseaparticulardevice,maintainingandrepairingadevice,designing
andbuildingadevice,orprovidingtechnicalassistanceforfamilymembers,personalcareattendants
oremployers.ManypeoplewithdisabilitiesandolderPennsylvaniansneedtomakemodifications
totheirhomesorbuysomeequipment,includingthefullrangeofagingservicestechnologies
(telehealthbiometricandactivity/wellnessmonitoring,cognitivefitness,safelightingtechnologies,
etc.)butcannotaffordit.
PATFprovidespeoplewithlow-interestloans,orinsomecasesgrants,sopeoplecanaffordthesedevices
andservicesthatwillhelpimprovethequalityoftheirlives.PATFhastwoloanprograms,onefor
loanamountsupto$1,000;andasecondforloanamountsgreaterthan$1,000.PATFmaybeable
toofferamini-grantofupto50%oftheloanrequestif theborrowermeetsthegranteligibility
guidelines.Guidelinesincludetherequirementthattheborrowermustexhaustallotherfundingoptions,
andmusthaveahouseholdincomethatisnogreaterthan150%ofthefederalpovertyguidelines.
PerhapsequallyasvaluableastheloanandgrantprogramsistheassistancethatPATFprovides
toindividualstofindanyandallavailablestateandprivateresourcestohelpthemachievethe
technologyneedsandgoalstoremainindependentintheirhomes.Forexample,PATFwillassist
olderadultsinknowingaboutthenewPennsylvaniaTeleCareprogramiftheyareMedicaid
eligible,orworkwithotherstatedepartmentsandprogramstofindapplicableresources.They
alsoarefamiliarwithwhatinsurerswillandwillnotcoverandwillhelpindividualsfindeligible
reimbursements.PATFishappytocollaboratewithagingservicesprovidersaswell,butisdesigned
toprovideassistancedirectlytoconsumers.
www.patf.org
The State of Technology in Aging Services in Pennsylvania
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8. Call for aCTIon
ThestateoftechnologyinagingservicesinPennsylvaniaissignificantlyfurtheradvancedthanin
manystates.Therefore,anappropriatecalltoactionisonethatpetitionsproviderstoseizeaplethora
ofopportunities,encouragesgovernmentto“staythecourse”infleshingoutandrampinguparobust
MedicaidTelecareprogram,challengeslong-termcareinsurerstostepuptoprovidereimbursement
similartowhatthestatehasdone,andurgestechnologycompaniestocontinueseekinginteroperability
ofitstechnologysolutionswithothers.CASTcanserveasafacilitatorandchangeadvocateinthis
processwiththevariouspartiesinvolved.Amongotherefforts,CASTwillsupportPANPHAinholding
anagingservicestechnologydemonstrationinthestatecapitoltoeducatestatepolicymakerson
availabletechnologyandpotentialbenefits.
8.1 Aging Services Providers
Providersarecalledtotakeadvantageofopportunities,bothpublicandprivate,toincorporate
technology-enabledservicesasdemonstratedbyearlyadoptersabove.Othersalreadyhavecharted
thenewestground,nowisthetimetoengageandfullyadoptagingservicestechnologiesintoyour
caremodels.
Providersshouldpursueresourcestoplanandexecuteadditionaloutcome-orientedfieldpilots
andlarge-scaledemonstrationprojects.Thisisparamountinshowinghowtechnologycanimprove
qualityofcare,consumersatisfactionandwellbeing,staffefficiency,etc.,withvariouspopulations
ofolderadultsindifferentcaresettings.Suchfindingscanleadthewayforinsurerstochange
traditionalreimbursementpoliciesandprogramstructurestoachievethesemutualgoals.
Earlyadoptersshouldraiseawarenessamongpolicymakersabout“bestpractices”ofhowproviders
havemadestrategicinvestmentsintechnologytoimprovecareaswellaswhatremainingbarriers
theyfacetoachievesustainedbusinessmodelsandbroaddeploymentofagingservicestechnologies.
Criticaltosuccessistheneedtoaddressorganizationalintegrationandadoptnewwork-flow
strategies,developinnovativebusinessmodelstosustainoperations,andprovidetechnicalsupport
personneltomanagenewprocesses.Privateagingservicesproviderswhoareprimarilyfundedby
private-payconsumersareuniquelypositionedtomodifyoperatingpracticesandservicedelivery
becausetheyarenotdependentupongovernmentorotherpayersources.
Providersalsoshouldcommitexecutivestaffresourcestopursuepossibleopportunitiesand
resourcessuchasthoseoutlinedabove.Forexample,providerscouldseekparticipationinthestate’s
MedicaidTelecareprogramasawayoffulfillingtheirmissionstoserveolderadultsinneed.
Center for Aging Services Technologies (CAST)
��
Finally,providersshouldadvocateforandbeproactivecollaboratorstoensurethatlong-term
caresettingsareincludedinHITlegislationandstate-wideprogramsincludingplanningand
implementationgrants,suchasinSB8discussedinSection4.2above.
8.2 Government and Private Payers
TheCommonwealthofPennsylvaniahas“steppedup”totheplateinabigway.CASTcommends
thedepartmentsofAging,PublicWelfareandtheOfficeofLong-termLivingforbeingamongthe
veryfirststatesinthenationtoputforwardathoroughMedicaidreimbursementprogramforaging
servicestechnologiesinitsTeleCareprogram(seesection4.1.2).Ittakesagreatdealofforesightto
beontheleadingedgeofMedicaidpolicy,especiallyinarelativelyunchartedpublic-fundingdomain
suchastelecare.Thestateisencouragedtokeepitscommitmenttomaintaintheindependenceof
olderPennsylvanianstothegreatestextentpossiblewithtechnologyasitrampsuparobustMedicaid
telecareprogram.
Legislatorsareurgedtospecificallyincludelong-termcaresettingsinHITlegislation,including
planningandimplementationgrants,suchasinSB8discussedinSection4.2above.Thecost-
effectivenesspotentialforHITisespeciallyhighfortheolderpopulationduetointeractionwithand
transitionbetweenmultipleprovidersandsettingsinthehealthcarecontinuum,includinglong-term
careproviders.
Privatehealthplansareacriticalparticipantinthiscallforaction.Becauseoftheirabilitytotailora
packageofservicestomeettheneedsofconsumerswithinacertainamountofreimbursement
(e.g.,capitatedpayment),theyareuniquelypositionedtochangetraditionalserviceandpayment
models.GatewayHealthPlanisoneoftheveryfewhealthplansinPennsylvaniathatprovides
reimbursementfortelecareservicestohomecareagenciesforitsparticipantswithchronicheart
failure.Insurancecompanies,includinglong-termcareinsurers,areurgedto“stepup”toprovide
reimbursementsimilartowhatthestatehasdone.
Healthplansalsoshouldseekpartnershipswithagingservicesprovidersandtechnologycompanies
tofurtherquantifythevalueoftechnology-enabledcareanddemonstrateeconomicandnon-
economicbenefitsfortheirplan’sbenefitpopulations.Becausethecareneedsoftheplans’
beneficiariesareoftencomparabletothoseofpublicfee-for-serviceprogramconsumers,thestate’s
experiencethroughtheTeleCareprogramcouldbeespeciallyinformativeforinsurers.
8.3 Technology Companies
Technologycompaniesareurgedtocontinuetoenhancethetechnicalcapabilitiesoftheir
technologiestorealizethetechnology-enabledcarevision.Importantstepsincludeachieving
interconnectivitybetweendifferentanddisparateclinicalinformationtechnologysystems,which
The State of Technology in Aging Services in Pennsylvania
��
isneededtoguaranteecompletenessandcontinuityofinformationbetweenthehomeandlong-
termcaresettingsandassuringcontinuityofcare.Technologycompaniesmaywishtocrafta
commonstandardofpracticetoprovideadequatetechnicalsupporttoensurethatemergingtools
aredependableforconsumersandcareprovidersforon-goingserviceoperations.Companiesalso
shouldaddressacceptanceandusabilityoftechnologybyend-users.Thismightbeachievedby
takingasystematicapproachtoresearchanddevelopmentthatinvolvestheparticipationofseniors,
caregiversandprovidersintheproducts’designanddevelopmentcycle.3
9. ConClusIon
ThestateoftechnologyinagingservicesinPennsylvaniaisstrong.Thisstrengthisduetoan
innovativegovernment“TeleCare”reimbursementprogram,theleadershipofhomecareagenciesin
adoptingtelehealthandrelatedtechnologies,robustresearchanddevelopmentworkbyuniversities,
andahostof“earlyadopter”agingservicesorganizationswhoareenthusiasticallytakingadvantageof
technologyineveryaspectofwhattheydo.
Byfocusingonthecommongoalofprovidingeffectiveandefficientcareforolderadults,more
interestscanalign,includingthoseofinsurers.Throughthisprocess,newideaswillemergeand
additionalopportunitiestoharnessthevalueoftechnologycanbefound.Furthersuccesseswillrequire
allpartiesinvolvedtotakeaction.CASTcanbebothacatalystandbridgetohelpbringaboutthis
change.
� Alwan and Nobel, CAST “State of Technology in Aging Services According to Field Experts and Thought Leaders” February, 2008.
25�9 Connecticut Avenue, NWWashington, DC 20008-�520
www.agingtech.org
Phone (202) 508-946�Fax (202) 220-00�2
abouT CasT
TheCenterforAgingServicesTechnologies(CAST)isleadingthechargetoexpeditethedevelopment,
evaluationandadoptionofemergingtechnologiesthatwilltransformtheagingexperience.
CAST four focus areas: 1. Driving a global vision of how technologies can improve the quality of life for seniors
while reducing health care costs; 2. Accelerating technology research and development through pilot evaluations with
seniors; 3. Advocating to remove barriers to the rapid commercialization of proven solutions; and 4. Promoting dialogue about standards to ensure interoperability and widespread access to
aging-services technologies.
CASTisnowaninternationalcoalitionofmorethan400technologycompanies,aging-services
organizations,businesses,researchuniversitiesandgovernmentrepresentativesworkingtogetherunder
theauspicesoftheAmericanAssociationofHomesandServicesfortheAging(www.aahsa.org).The
membersofAAHSAhelpmillionsofindividualsandtheirfamilieseverydaythroughmission-driven,
not-for-profitorganizationsdedicatedtoprovidingtheservicesthatpeopleneed,whentheyneedthem,
intheplacetheycallhome.
ConTaCT CasT
MajdAlwan,Ph.D,Director
(202)508-9463
JoIn CasT
MembersandSponsorsreceiveawidevarietyofbenefits.PleasevisitourWebsite
www.agingtech.org/join.aspxforafulllistingofbenefitsandduesstructure.