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Independence at Home Provision Will Help Providers Replicate “Medical House Call Program”

July 20, 2010 in innovation, policy, retirement, seniors by PeterNotarstefano | No comments

On July 18, the Washington Post had a wonderful article about the reunion of an 85 year old daughter with her 110 year old mother who lives in D.C. This reunion is the result of the “Medical House Call Program” at Washington Hospital Center.

The program’s staff, which includes physicians, nurse practitioners, and social workers, provides compassionate and skilled primary health care to elders in the comfort of their homes.

Dr. Eric De Jonge, a physician who works in the program, presented on the Independence at Home Act, which was included in this year’s health care reform law, at our Futures of Aging Services Conference this year.

The Independence at Home provision will help providers replicate this “medical house call” program model throughout the country. The program gives incentives for physicians to improve quality of care and reduce costs.

It also increases physician-patient interaction through regular assessments and patient/caregiver education on treating a chronic disease. It is obvious from the article that Dr. De Jonge has a special positive relationship with his 110 year old patient.

I am pleased that this program can help families stay together in the community. It not only improve health outcomes, it improves the person’s quality of life.

Sen. Ron Wyden (D-Ore.) and Rep. Edward J. Markey (D-Mass.) are encouraging the Centers for Medicare and Medicaid Services (CMS) to implement the Independence at Home (IAH) program . We shouldn’t have to wait to January 2012 for this innovative program. Implementing this program now will bring us more wonderful stories where older individuals can remain in their own homes with their family.

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Dream a Little Dream

July 18, 2010 in AAHSA member, CCRC, Uncategorized, culture transformation, innovation, leadership by Melissa Sharp | No comments

Last week I had the opportunity to visit with the senior leadership team of Westminster-Canterbury of the Blue Ridge. Over lunch, we discussed the biggest challenges this stand alone CCRC overlooking Charlottesville faces. Not surprising, theirs are similar to many AAHSA members: aging buildings, occupancy, developing capacity, growing endowment.  As our discussions unfolded I asked the group a new question, “if you could dream anything for Westminster-Canterbury, what would it be?”  President and CEO Gary Selmeczi grabbed his pen and promised not to say a word as staff considered their answers.

What I am most impressed with at WC Blue Ridge is the culture.  Every member of the leadership team believes in it, promotes it and is an ambassador of it.  Many of the dreams they have for the community is to enhance and expand this culture.  Dreams like growing their development office, expanding their wellness focus, exploring energy conservation, growing spirituality programming and involving employees in decision making.  As we wrapped up, Gary said he would like to help each staff member achieve their dream and they should share with him in the coming weeks a strategy for doing so.

It is so easy to get bogged down in the day to day of what we do.  Do you ever ask your team or staff what their dream is for your organization?  Make this the week to do just that.

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Use of Electronic Medical Records on the Rise in Home Health and Hospice Agencies

July 15, 2010 in health care, innovation, research, technology by Helaine Resnick | No comments

Doctor tabletMajd Alwan, vice president of AAHSA’s Center for Aging Services Technologies (CAST) and I came up with some interesting and meaningful results from work we did on the National Home and Hospice Care Survey, and our research was just published online at the Journal of the American Medical Informatics Association.

Our report, Use of health information technology in home health and hospice agencies: United States, 2007, shows that 43% of home health and hospice agencies nationwide used an electronic medical records (EMR) system of some kind, and these systems were most often used for capture of patient demographics and clinical notes.

Interestingly, this 43% rate of use was about 1/3 higher than the 32% usage rate in a similar survey conducted 7 years before.  However, we still have less than half of these agencies currently using an EMR.  About 20% of agencies had systems that allowed them to share health information, about half of those with this capacity were using it.

Although we were impressed by the 50% utilization rate among agencies with information sharing capacity, it is important to remember that most of the agencies that were not sharing health information were not doing it in part because their systems didn’t have the functionality allowing them to do so.  We were very surprised to see large differences in terms of the extend of EMR use according to whether the agency was a for-profit or not-for-profit: 70% of not-for-profit agencies used EMR systems compared to only 28% of for-profit agencies—this was a striking difference and one that shows more willingness on the part of not-for-profit providers of home and community-based services to embrace technology as they seek to fulfill their missions to care for the most vulnerable segment of our population.

Helaine E. Resnick, Ph.D., MPH is the director of research at AAHSA’s Institute for the Future of Aging Services (IFAS).

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The Passing of Dr. Robert Butler

July 12, 2010 in advocacy, aging, diversity, innovation by PeterNotarstefano | No comments

I was sad to read in the New York Times that Dr. Robert Butler died of Acute Leukemia.

Dr. Robert Butler’s book, “Why survive,” was one of the best books that I read in graduate school. I was fortunate enough to meet the good doctor at Mt. Sinai Medical Center when I worked on the development of a geriatric assessment program.

Butler fought age discrimination, and his book encouraged politicians and advocates to look at the way we care for seniors in our society. I wish all physicians would embrace Dr. Butler’s philosophy about growing old.

He told a story about Sarah, a senior who had a doctor’s appointment because she had pain in her right knee. When she told the doctor about the pain in her right knee, the doctor responded, “Well, Sarah, what can we do? Your knee is 80 years old”.

Sarah responded by saying, “Well, Doc, my left knee is also 80 years old and it is working fine!”

I used to use that story during my orientation for new staff in the geriatric assessment program. You don’t treat a person’s age, you treat the person as a unique individual, and that was Dr. Butler’s philosophy.

I am sad that we lost such an intelligent person, who was so far ahead of his time.

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Housing With Services: The Birmingham Green Model

June 22, 2010 in AAHSA member, advocacy, housing, innovation, relationships by Morgan Gable | No comments

On Friday, June 18, 2010, a few members of the AAHSA advocacy staff, myself included, were lucky enough to visit AAHSA member Birmingham Green.

Birmingham Green has an assisted living unit, a nursing healthcare center, and independent living, a Section 202 and Section 811 (which includes personal care services, nursing and medical care, physical, occupational, and speech therapies, meal services, and activities).

This organization was the subject of our mini field trip (man, it was nice to get out of the office/city on a Friday morning!) because of the amazing work that they are doing in regards to housing with supportive services.  The Birmingham Green model of using auxiliary grants (funded by the state, the counties of Fairfax, Fauquier, Loudoun and Prince William, and the City of Alexandria in Northern Virginia) represent an innovative way of providing licensed assisted living services in an independent living environment.

Many AAHSA members are currently wrestling with the idea of how to support their aging residents in their independent living environments without bringing in unwelcome and restrictive regulations that accompany licensed services.  Birmingham Green’s senior vice president for development and community relations, Tommy Dodson, will tell you that it wasn’t easy setting up such an arrangement.

Dodson had to work closely with the U.S. Department of Housing and Urban Development (HUD) to make sure that they were okay with his organization supporting this type of housing model.  Dodson will tell you that after many back-and-forths, HUD came to understand what Birmingham Green was trying to accomplish-helping its residents age in place.

Other than working with HUD, Birmingham Green has an excellent relationship with its locally elected politicians.  Over the years, through constant contacts and advocacy efforts, they have been able to forge a relationship with their representative and with others in the nearby districts.

Dodson told a few stories of politicians attending ground-breaking cermonies, helping with funding, and even actually asking what they could do to help… really! Birmingham Green also has an excellent relationship with their area agency on aging in order to ensure that the care for their residents is always coordinated.

Dodson and Joan Thomas, social services and admissions director, gave us a great tour of their beautiful facilities and allowed us to stop and chat with residents along the way.  We even got to meet Birmingham Green’s artist in residence — trust me, it’s worth the trip to see his paintings!

They also treated us to a delicious lunch in their beautiful dining room (where they provide their residents with three meals a day).  We considered staying for dinner, but we didn’t think that Larry would like that idea!

Sounds simple, right?  All you have to do is build a good relationship with your city, county, your elected officials, your local agencies, and the feds, right?  Anyone in this business will tell you that’s much easier said than done.

However, if you’d like to see it in action, I highly recommend packing up your fellow employees and heading on down to Manassas, Va., to check out Birmingham Green.

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Creativity and Leadership…Like Peanut Butter and Chocolate

May 25, 2010 in Uncategorized, innovation, leadership, making a difference by Mary Kemper | 2 comments

One of my favorite commercials as a kid was the Reese’s peanut butter cup commercial. You remember – someone with peanut butter and someone with chocolate collide and accidentally create this delicious new candy.

To me, it represented possibilities. It meant there were still opportunities to invent something new and exciting.

So what does this ‘70’s ad have  to do with creating the future of aging service? How will it help you survive and thrive in these tough, unpredictable economic times?

The answer is creativity. Yes, creativity.

CEOs identified “creativity” as the most important leadership competency for the successful enterprise of the future, according to a study reported by Business Week and conducted by IBM’s Institute for Business Value.

Is it just me or is this fascinating? And what does this really mean?

I think it means seeing connections where they might not currently exist. It’s about looking at our mistakes and failures as much as our successes to find opportunities. At a time when funneling more funds is not an option for addressing key challenges, innovations and partnerships may offer solutions.

CEOs get this.  They see leadership competency in those who remain agile and open-minded. They see value in entrepreneurs who take risks to make something out of the different and unexpected.

Now, don’t get me wrong. I love structure, rules and predictability.

The kid in me, though, is excited about once again coloring outside the lines and mixing up ingredients. The kid in me is thrilled to know that despite all of the risks and uncertainty that come with future leadership, there is still a chance to create something that has never before existed…and is potentially great tasting.

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National Broadband: Bringing Health Care Technology Home

April 23, 2010 in advocacy, innovation, long-term care, policy, research, residents, retirement, seniors, technology by majdalwan | 2 comments

Eric Dishman

Eric Dishman at hearing on National Broadband Plan

On April 22, the U.S. Senate Special Committee on Aging held a hearing entitled, The National Broadband Plan and Bringing Health Care Technology Home.

The hearing featured testimony from Eric Dishman, global director of health innovation and policy at Intel Digital Health Group, and a senior fellow at AAHSA’s Center for Aging Services Technologies (CAST) in Washington, D.C.

Dishman said that he, like nearly 50 million other family caregivers in America, is living the need for innovative solutions to help aging adults stay healthy and happy at the place they call home.

According to Dishman, there are too many barriers and too little national attention to building aging-in-place inventions, infrastructures and industries that all Americans will eventually utilize. His testimony focused on answering three vital questions:

  • What are we doing as a nation to prepare for global aging, and how do we make sure investments in fundamental infrastructure like broadband and health information technologies (HIT) are ready to support e-care in the home?
  • How are we ensuring that payment reforms and new care coordination incentives at the Centers for Medicare and Medicaid Services (CMS) and private market encourage doctors  to care for seniors in their own homes when appropriate?
  • How can we accelerate research and commercialization of aging-in-place technologies to let e-care best practices advantage our nation’s families, businesses and overall economy?

“As a social scientist who has run Intel Corporations research and innovation efforts around aging-in-place and e-care for more than a decade, I have seen firsthand that these technologies, when designed intentionally to fit into the home and to connect families with professional providers, can dramatically help with prevention, early detection, behavior change and self-care,” Dishman said in his testimony. “As co-founder of the CAST, I have evaluated many promising aging-in-place solutions being researched in universities and companies that now need to move from laboratories to the lives of seniors and families across the country.”

Dishman explained the importance of making sure no senior is precluded from access to aging-services technologies because of the outdated practices or payment structures inherent in today’s government or private reimbursement systems. “We must make sure our country’s investment in health information technology (HIT) and broadband do not stop at the hospital door but extend to the home and to seniors and their caregivers in the community.”

The committee also heard testimony from Robin Felder, Ph.D., professor of pathology and associate director of clinical chemistry at the University of Virginia School (UVA) of Medicine. Robin, who is a CAST Commissioner and was my boss at UVA, focused on how an expanded broad band infrastructure can result in dramatic cost savings, yet higher quality of health and wellness for the elderly. Felder said that broadband has the potential to reduce the cost of medicine by more than 50 percent, and stimulate economic growth in the medical technology sector.

A study by Felder and his colleagues showed that home-monitoring, which uses the Internet to send and receive data, demonstrated a 36 percent reduction in billable medical procedures and a 78 percent reduction in hospital stays. Moreover, the study showed a 68 percent reduction in the cost of care. The study referenced by Felder was conducted in partnership with AAHSA member Volunteers of America.

“Despite the reduced cost of care, the efficiency of the caregivers increased by over 50%. Thus, monitoring technologies can significantly reduced billable interventions, hospital days and cost-of-care to payers, and has a positive impact on professional caregivers’ efficiency,” Felder told the committee.

It is worthy to note that AAHSA’s own Robyn Stone, Barbara Manard, and myself have provided input to the National Broadband Plan with respect to enabling more services to support the independence and quality of life of seniors wherever they live.

AAHSA and CAST have also recently submitted comments that aim primarily to improve the broadband plan in terms prioritizing Internet traffic for health care delivery to seniors. If you have any questions about the broadband plan, or the hearing, send me an email.

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Aging and the Arts: New Program for Seniors in San Francisco

March 23, 2010 in CCRC, art, consumers, health, innovation, long-term care, not-for-profit, quality, seniors by Linda Bloxham | No comments

For residents at Bethany Center Senior Housing in San Francisco, the idea of “housing with services” is not new. In fact, Bethany, an affordable housing community serving more than 130 older adults, has been one of the pioneers in incorporating progressive and even unique services to help residents stay in their homes longer, safely and securely, with quality of life at the forefront. A new program housed at Bethany called Ruth’s Table is just such an example.

Ruth’s Table is a center for creative learning for people aged 50 plus living in San Francisco and was inspired by the life and work of San Francisco artist Ruth Asawa. Asawa’s ties to Bethany date to the 60’s and her philosophy that the need to learn and create does not diminish with age have influenced Bethany’s arts programs over the decades. In fact some studies show that when older people participate in arts programs the result is better health, fewer doctor visits, less medication and increased activity and social engagement (Sept. 2008 issue of Monogram, Americans for the Arts newsletter).

To accommodate the new program on site, Bethany engaged students from the Academy of Arts University Interior Architecture Department to redesign the building’s first floor space, which now includes an art gallery, along with the Ruth’s Table Center. A table built by Asawa’s husband, architecht Albert Lanier was donated to Bethany, giving rise to the program’s name.

“The simple act of sitting around Ruth’s Table gives our program human scale,” says Lola Fraknoi, director of community programs for Bethany. “As artists and community members did at Ruth’s house for decades, we can share a meal, find the comfort of being listened to, and discover a safe springboard to explore new media, to be curious, and to take chances.”

Fraknoi directs the team implementing the Ruth’s Table program, including Elizabeth Worthy, artist in residence, Tamara Loewenstein, curator of the gallery, and Gabrielle Messeri, community student fellow from the California College of Arts graduate school. The program is outside of U.S. Department of Housing and Urban Development (HUD) funding parameters and a fundraising campaign is planned to help support the program.

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National Elder LGBT Resource Center Created

March 15, 2010 in AAHSA conferences, LGBT, aging, caregiving, consumers, culture transformation, diversity, innovation, take action by Kevin Bradley | 2 comments

Rainbow FlagLesbian, Gay, Bisexual and Transgender (LGBT) elders often face discrimination and isolation. To help address these challenges, U.S. Department of Health and Human Services Secretary Kathleen Sebelius awarded Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) a three year, $900,000 grant to create the first National Technical Assistance Resource Center on LGBT aging.

Assistant Secretary for Aging Kathy Greenlee said the center will provide aging services providers with the information, technical assistance and the training necessary to serve LGBT elders. Some of the services and supports include web-based clearinghouse that will include diverse resources, social networking tools, an “Ask the Experts” service, Web-based trainings and other features.

According to the LGBT Aging Project, who along with the Transgender Aging Network are two of ten organizational partners working with SAGE and whom have presented at past AAHSA Annual Meetings, the resource center has three goals:

  • Educate mainstream aging services organizations about the existence and special needs of LGBT elders.
  • Sensitize LGBT organizations about the existence and special needs of older adults.
  • Educate LGBT individuals about the importance of planning ahead for future long-term care needs.

For more information click here. And to read how AAHSA members are serving LGBT elders see “Building a Culture of Acceptance” in the January/February issue of AAHSA’s Future Age magazine.

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How Big is the AAHSA Marketplace?

December 29, 2009 in 1, aging, innovation, retirement by zacharysikes | 1 comment

I often get calls from AAHSA member businesses related to their business plan development, budgeting and plans for the coming year.  Without a doubt, the most frequently asked question is: How big is the AAHSA Market?

Over the last year, AAHSA worked with a number of AAHSA Partner organizations to better answer this question.  The findings have improved our ability to communicate the total economic value of our field to the current administration and acted as an incentive to help businesses focus on not-for-profit providers of aging services.  After many conversations, I can speak to several AAHSA business members that reorganized themselves to better focus on aging services and specifically not-for-profit providers.  This is great for our field and enables AAHSA providers to receive better support and solutions as AAHSA business members focus on understanding the needs and connecting their services to our not-for-profit and mission driven focus.

What did we learn?  AAHSA’s research conservatively puts the total expense budget of members at between $6 and $7 billion a year. This number excludes construction and redevelopment related costs, utilities, as well as labor (except when provided through an outsourced food services or therapy contracts).  While we are less certain about the value of these excluded categories, we conservatively estimated the total economic value in 2009 at $8.7 billion.

As we work to refine these numbers, I expect our understanding of total economic value to increase beyond $8.7 billion. Of course, the true value that AAHSA members bring to lives cannot be measured in terms of dollars and cents.  But, increased focus on innovative products and solutions from the business sector can only help us all create the future of aging services.

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