Everything old is new again

Mar 13, 2008, 8:00 AM, Posted by Paul Tarini

I was at a meeting last week, called Caring for Aging Adults: The Future of Geriatric Care. It was hosted by HealthTech, a non-profit group founded by Molly Coye, MD, MPH, that develops technology forecasts, decision-making tools and facilitates a learning network of experts and health system leaders. They do this work for the exclusive benefit of its partner organizations, which include healthcare systems, hospitals, safety-net providers and government agencies.

For this meeting, HealthTech had convened a group of national experts in geriatrics to help them strengthen a scenario they are building about what the five- and 10-year future of geriatric care will look like in this country. The charge to the experts was to question, challenge, accept or reject a set of assertions on the basis of what they think is likely to happen, as opposed to what they think needs to happen. HealthTech had seven broad areas of focus to frame its scenario:

  1. Clinical care
  2. Care setting and facilities
  3. IT & communications
  4. Cost & coverage
  5. Workforce
  6. Patient experience; and
  7. Regulations & standards

Given the proprietary nature of meeting, and the fact that I was there by invitation, I can’t get into exquisite details about the specific predictions. However, there were some themes that ran through the discussion that led me to want to pose four questions to our blog readers.

There was a lot of discussion about the role of social support as someone ages and the potential role for virtual social networks with this population. But in a discussion on robotics in care settings that touched briefly on whether you could use robots to regularly turn bed-ridden patients, one expert noted that the richness of human contact and conversation you could have while turning a patient was as important to long-term outcome as the physical turning. That led me to Question 1: Are there some social supports that cannot be delivered sufficiently through virtual networks or technological implements and need to be delivered in person?

The group agreed that geriatrics as a field of practice has a poor image. It’s not that providers have poor skills; rather, it’s that ‘geriatrics’ means you’re old, you’re on your way out, and we’re going to focus on all your illnesses. Who wants that? One consequence is that the field is under-staffed and under-reimbursed. But there are some unique aspects to caring for elderly patients that benefit from specialized training. So, Question 2: How might we re-brand ‘geriatrics’ so it conjures up more positive connotations?

A major emphasis in geriatric care is about preventing or forestalling, and then closing, the gap between a person’s internal abilities to manage their lives and the needs of their lives. There’s a lot of technology being explored to help with management—electronic medical records are expected to play a major role; more real-time personal monitoring with arrays of sensors will continue to be explored—but payment policies for prevention and specific services will be a significant barrier to innovation of all kinds. Question 3: Are there specific innovations in payment policies that could facilitate advances in geriatric care?

And speaking of the gap between someone’s abilities and the needs they have, one panelist noted that older adults will likely increasingly depend on community-based social service providers to help meet their needs. Given that, they felt that the current generation of electronic medical records and even personal health records would not be able to deliver on their promise to help integrate and coordinate care for seniors because they were focused mostly on clinical care and couldn’t document and track social services. Question 4: Has anyone seen a PHR that is able to document and track social services?

This commentary originally appeared on the RWJF Pioneering Ideas blog.