American Soceity On Aging 031809

Emerging Technologies for
Independent Living
Aging in America: ASA-NCOA Conference

March 18, 2009
Molly Coye, MD, MPH

Barbara Harvath, RN, BA
David Lindeman, PhD
1 © 2008 Health Technology Center

Introduction and Objectives
Beneficial Technologies
¾ Emerging technologies are having an ever greater impact on the field of aging, and no more so than in
the area of community-based independent living
HealthTech
¾ HealthTech is a non-profit research center that has been engaged in forecasting the future of beneficial
technologies for over 8 years
¾This presentation includes work done in collaboration with United Cerebral Palsy and through support of
The SCAN Health Plan
In this session we will:
1. Provide an Overview of promising technologies for maintaining the independence of older

adults in community-based settings
2. Present forecasts of specific technologies and their relationship to the workforce
3. Discuss challenges and opportunities for using beneficial technologies to support the
independence of older adults

HealthTech’s Research Methodology
Literature
Review
Webinars
Technology Profiles
Stakeholder Expert
ExpertInterviews Expert
Analysis Interviews ExpertPanel
Panel Forecast & Trend Reports
Demonstration Projects
Developer and Education
Product Review
Analysis Forecasting Validation Diffusion

Persons With Disabilities
46.1 million people (20.8%)

over the age of 15 have a
disability
30.5 million people
(13.7%) have a severe
disability
have a non-severe
disability
over the age of 65 have a
disability

Challenges of the Aging and Persons with Disabilities
Everyday
ChangingLiving
Demographics
Activities Changing
Health Management
Demographics Staying Connected and
Supported
•ADLs: bathing, dressing, •Disease self-management
grooming, transferring, •Personal engagement
•Vision, hearing, sensory,
feeding, toileting •Lifelong learning
motor
•IADLs: using phone, taking •Social interaction
•Nutrition
meds, light housekeeping,
•Vital signs •Being supported by
preparing meals, managing
caregivers
finances, going outside alone •Exercise
•Leisure activities
•Home and personal safety •Fatigue/sleep
(fall prevention, wandering) •Emotional and spiritual well-
•Cognitive function being
•Mobility
•Care coordination
•Transportation

Understanding Disability: Types of Impairment
There are 3 categories of impairments that can cause functional limitations:
Sensory – long-lasting blindness, deafness, or a severe vision or heading

impairment
• Examples: Blindness, deafness
Physical – a long-lasting condition that substantially limits one or more basic

physical activity such as walking, climbing stairs, reaching, lifting or carrying
• Examples: Muscular dystrophy
Cognitive – difficulty learning, remembering, or concentrating due to a

physical, mental or emotional condition lasting six months or more
• Examples: Dyslexia, Dementia
* These are definitions for disabilities from the American Community Survey (Census). They need to be
reworked.

Depression: The Leading Cause of Disability Worldwide By 2030
By 2020, Depression will be the second leading cause of disability worldwide
Source: World Health Organization

Needs of the Aging and Persons with Disabilities:
Shared Needs: Needs of

Needs of Health management, help with Persons
the ADL, IADL, staying connected With
Aging and supported, care Disabilities
coordination

Stakeholder Analysis
Aging & Persons (Formal & Informal)

With Disabilities Caregiver’s
Needs & Needs &
Challenges Challenges
Technology Identifying technologies Builders &

Developers that maintain or improve Developers
Needs & quality of life and Needs &
Challenges level of independence Challenges
for the aging and PWD
Care Providers Human

& Insurers Service Orgs
Needs & Needs &
Challenges Challenges

Stakeholder Research Needs
Builders and Technology Human Services Care Providers and

Developers Organizations Insurers
• Design • Quality of Life • Reimbursement
• Outcomes Data • Prevention • Outcomes Data
• Business Model • Safety • Policy changes
• Policy changes • Well-being • Workforce
• Policy changes

Framework For Forecasts
Consumer
Service
Experience
Settings and Business

Facilities Models
Technology
Development, Adoption,
and Dissemination
Regulations
Workforce and
Standards
ICT

Key Trends for Technologies of Independent Living
Consumer
Service
Experience
Many More People With Less Severe Functional Impairment
Consumers Become the Primary Drivers of Technology Adoption

Care Models
SettingsIncorporate
and Prevention and Self-Care Business
Facilities Models
Older Adult Bulge has Windfall Benefits for Persons With Disabilities
Technology
Mainstream Products Repurposed, Intuitive,
Development, Customized
Adoption,
and Dissemination
The Rise of the Algorithm
Cell Phones are the Primary Platform Regulations

Workforce and
Social Support and Connectedness Gain Importance
Standards
Downshifting Labor
ICT

Example Trend: Consumers Become Primary Driver of Technology
TREND
Consumers become the primary driver of technology and service adoption.
Boomers, as family caregivers, begin to purchase lifestyle needs
technologies and services for their parents, and then continue to demand
and purchase technologies and services that enable independent living as
they age. Providers and payers will expand their adoption of medical needs
technologies and services due to persistent demand of consumers and
supporting translational research.
Important Technologies and Characteristics:
Discreet technologies
Personal safety
Monitoring and sensors
Safe designed housing
Telehealth/Remote Care
Consumer Driven Technology Trend: Supporting Forecasts
Consumer Experience
•The desire to appear independent drives

development of discreet technologies and
services related to lifestyle needs.
0-2 years: Technologies with simple
interfaces and minimal features appeal to
older adults.
• Example: GreatCall’s Jitterbug
2-5 years: Discreet and affordable wearable

sensors are the major modality for collecting
physiologic and personal data in remote
monitoring applications.
5-10 years: Developers produce aesthetic Consumer
and functional technologies to meet large Service Experience
Boomer market.
Facilities Technology Models
Development,
Adoption, and
Dissemination
Regulations
Workforce
and Standards
ICT
Service
•Technology develops to help older adults safely
transport themselves, whether on foot, driving or
public transportation.
2-5 years: GPS-enabled cell phones are customized
to help older adults navigate on foot and on public
transportation.
• Example: iPhone, Blackberry
Geographical Information System (GIS) on cell
phones enable older adults to map where they live
relative to local services, to reroute public
transportation to suit their needs, etc.
5-10 years: Virtual reality driving simulators gain use
in clinical practice to assess executive functions and
make specific driving recommendations. Service
Consumer
Experience
• Example: Drexel University Applied Neuro-
Technologies Lab’s Virtual Reality Driving Settings and Business
Simulator, University of Florida’s Independence Development,

Adoption, and
Drive Program Dissemination
Regulations
Workforce
and Standards
ICT
Settings and Facilities
•Consumer demand for independent living drives senior living facility design.
0-2 years: Senior living facilities adopt cognitive fitness, sensor and monitoring
technologies initially in more high-end housing.
• Example: Eskaton’s National Demonstration Home
2-5 years: Senior living facilities partner
with universities to create learning
communities
• Example: Hebrew SeniorLife’s
NewBridge on the Charles
5-10 years: Design elements that

promote physical and psychological well
being become wide spread
Consumer
Service
Experience
Settings
and Business
Technology Models
Facilities Development,
Adoption, and
Dissemination
Regulations
Workforce
and Standards
ICT
Workforce
•New roles emerge to navigate complex systems.

0-2 years: Roles of care coach/manager, ombudsmen, mentors, super-users expand and
proliferate.
2-5 years: Increased importance of and demand for web managers in complex service
organizations.
5-10 years: Systems integrators needed to manage increasingly interdependent operations:
reimbursement, PHR/personal health info, supply chain and Durable Medical Equipment
(DME)/equipment, social/gaming, and services.
Consumer
Service
Experience

Development,
Adoption, and
Dissemination
Regulations
and Standards
Workforce
ICT
The Growing Need for Direct-Care Workers
Between 2000 and 2030, the number of US elders will increase by 104% while women aged 25 to 44
(the traditional source for direct care workers) will increase by only 7%.

The Growing Need for Direct-Care Workers
•The majority of direct-care workers are now employed in home- and community-based settings,
and not in facility-based long-term care settings.
•By 2016, home- and community-based direct-care workers are expected to outnumber facility
workers by nearly two to one.

Information & Communication Technology
•Sensors and monitoring technology evolve to be less intrusive, easier to use, and more
flexible.
0-2 years: Due to the early stage of the development, the use of monitoring and sensing
technologies is limited to a few simple and basic applications.
• Example: Tunstall’s Falls Management System, QuietCare
0-2 years: Monitoring of physiological data and personal data is done discreetly through
wearable sensors.
2-5 years: Environmental monitoring appliances are designed with plug-and-play capability
to meet the evolving monitoring and support needs of consumers.
5-10 years: Personal and environmental monitoring converge. Cell phones become the
main data collection device.
Consumer
Service
Experience

Development,
Adoption, and
Dissemination
Regulations
Workforce
and Standards
20 © 2009 Health Technology Center ICT

Aging and Technology Use
Internet Penetration
•A third of seniors (age 65 and older) have the Internet at home.
•More than two-thirds (70%) of the next generation of seniors (50-64 year-olds) have
gone online.
Internet Usage
51% of adults age 60-69 go online 26% of adults age 70+ go online
• 88% use email • 86% use email
• 72% get health info • 65% get health info
• 75% get hobby info • 56% get hobby info
• 67% get news online • 53% get news online
Broadband Use
•Those age 50 and over experienced a 26% growth rate in home broadband
adoption from 2007 to 2008.
•Half of Americans between the ages of 50 and 64 have broadband at home. Some 19%
of those 65 and older had home broadband access as of April 2008.
Cell Phone Use
• 50% of Americans age 65 and older have a cell phone.
What are they doing on line?

Regulations and Standards
•Regulation changes lag despite pressure from older adults and persons with disabilities
to adapt environments for accessibility.
0-5 years: Higher visibility of

environmental challenges for persons
with disabilities brought by aging
populations.
5-10 years: Better access in public and
commercial areas, but low-income
housing remains a challenge because of
the lack of market power.
5-10 years: Housing developers begin
going beyond code standards toward
individualization for residents’ needs, but
face challenges with local regulators. Service
Consumer
Experience
10+ years: ADA criteria expands to Settings and Business

reflect the changing population. Development,

Adoption, and
Dissemination
Workforce
Regulations
ICT
and
Standards
Business Models
•Willingness to pay for services out-of-pocket and lack of reimbursement cause

technology developers to shift focus away from institutions to individual consumers.
0-2 years: Care-in-place and remote monitoring technologies continue to be paid for out-of-
pocket.
•Example: Centura Health at
Home’s Home Care
2-5 years: Community living facilities

pay for inclusion of beneficial
technologies in new construction, but
pass the costs on to the consumer.
5-10 years: Fee-for-service bundled
packages of technology and in-home
technical support become available. Consumer
Service
Experience
5-10 years: commercially available Business

technologies such as assistive devices
Settings and
Facilities Technology
Models
Development,
and home health monitoring become Adoption, and

Dissemination
widely available in retail stores. Workforce

Regulations
and Standards
ICT
Baby Boomers as Caregivers for their Aging Parents
• More than 15 million take care of their aging parents, a

responsibility that often includes paying for all or part of their
housing, medical supplies and incidental expenses. Many
costs are out of pocket and largely unnoticed: clothing, home
repair, a cellular telephone.
• Adult children with the largest out-of-pocket expenses are

those supervising care long distance, those who hire in-
home help and those whose parents have too much
money to qualify for government-subsidized Medicaid but
not enough to pay for what could be a decade of frailty and
dependence.
• The burden is compounded by ignorance, according to a study

by AARP, released in mid-December, which found that most
Americans have no idea how much long-term care costs
and believe that Medicare pays for it, when it does not.
• Families have always looked after their elderly loved ones. But
never has old age lasted so long or been so costly,
compromising the retirement of baby boomers who were
expecting inheritances rather than the shock of depleted
savings.

The Perfect Storm
Stakeholders, whether they are developers, policy makers, providers, or the consumers
themselves, are all interested in the different ways of keeping this population healthy at home.
Changing Demographics
Scarce Resources
- Increased longevity
- Uncertainty of government
- Age wave
safety net programs
- Increased disability incidence
- Uncertainty over individual
- Increased chronic disease
financial security
among older adults
- Overstretched healthcare $
- Increased desire to lead
- Workforce shortages
independent lives at home Technologies for
Independent
Living
Technological Innovation

The Challenge: Chronic Diseases and the U.S. Care Experience
Several themes predominate in the care management of U.S.
residents with chronic diseases compared with residents of
other nations with such conditions:
High cost of care with an emphasis on high personal cost
• 54% did not receive recommended medical care, fill
prescriptions or visit a physician at some point because of high
costs, compared with 7% of participants in the Netherlands
• 41% spent more than $1,000 on out-of-pocket medical costs

last year, compared with 4% of participants in Britain and 5%
of participants in France
Medical errors
• One-third experienced a medical or medication error, received
incorrect laboratory test results or experienced delays in test
results, the highest rate among participants
Lack of access and continuity across sources of care

• Almost half wasted time because of disorganized care or had
received care of limited or no value during the past two years,
the study found

Remote Patient Management Technologies:
A Disruptive and Transformative Solution To A National Health Care Challenge
The health care system is ill-

equipped to manage the growing
disease burden challenge
New business models are
emerging in response to policies
designed to improve outcomes
and reduce spending
Remote patient management
technologies are an opportunity to
advance national health care goals
technologies are a disruptive and
transformative technology
Adoption and diffusion paths
reflect a balance between
technology, policy and market
interests

The Telehealth Process
Person interacts with Personal information is Caregiver or clinician

telehealth device collected & transmitted receives data & uses
Data collected includes: Data transmitted over: Results include:
•Vital signs (blood •Video over low- •Enhanced communication

pressure, glucose meters, bandwidth POTS between caregivers,
pulse oximeters, weight) providers, and patients leads
•Video over IP
to improvements in:
•Physical and emotional
•LAN/WAN - care coordination
well-being assessment
•Broadband - caregiver support
•Reduce unnecessary visits
•Improve medication
compliance

The Opportunity: RPM of patients with congestive heart failure
The New England Healthcare Institute’s Research Update: Remote Physiological Monitoring reports the
following cost savings for all Class III and Class IV heart failure patients, assuming that 80% of the 1.59 million
patients in these two classes, or 1.27 million patients, will be hospitalized in a year, at an annual cost of $2,052
per patient for the monitoring technology ($2,802 with DM software):
60% reduction in hospital readmissions compared to standard care and a 50 percent reduction in hospital
readmissions compared to disease management programs without remote monitoring.
Based on the potential to prevent between 460,000 and 627,000 heart failure-related hospital readmissions each
year, NEHI estimates an annual national cost savings of up to $6.4 billion dollars.
The annual cost of a heart-failure related

hospitalization per patient ranged from
$5,632 for RPM patients to $11,387 for
disease management without RPM
patients to $13,468 for standard care
patients.
The net savings of RPM technology (i.e.
savings after the costs associated with
interventions) were $3,703 per patient per
year for those with disease management
programs and $5,034 for those with
standard care.

The Early Adopter Experience: Veterans Health Administration
The cost of the program is $1,600 per

patient per annum. This compares with
direct cost of VHA’s home-based primary Age Distribution of all CCHT Patients
care services of $13,121 per patient per
annum, and market nursing home care
rates that average $77,745 per patient per
annum.
Since VHA implemented CCHT, a total of
43,430 patients have been enrolled in the
program. CCHT patients increased from
2,000 to 31,570 from 2003 to 2007. VHA
plans to increase its NIC services 100%
above 2007 levels to provide care for
110,000 patients by 2011, or 50% of its
projected NIC needs.
VHA attributes the rapidity and robustness
of its CCHT implementation to the “systems
approach” taken to integrate the elements
of the program. Wherever possible, CCHT
incorporated existing business processes to
reduce the program’s overhead costs and
increase efficiency.

Significant Barriers Remain to RPM Adoption and Diffusion
Principal barriers include the limited experience of most providers with this technology, poor
preparation for adopting such technologies, and lack of financial models that document return on
investment.
NEHI updated its 2004 findings on barriers to RPM adoption in Remote Physiological Monitoring to
include:
Inadequate reimbursement: Medicare does not widely support remote health services, nor do about half
of the state Medicaid programs, but approximately 130 insurance companies now provide coverage for
telemedicine in some capacity.
Provider concerns: Providers remain concerned that telemedicine will generate large volumes of
additional work, increase legal liability, and lead to the loss of traditional provider control.
Limited patient awareness: Patient awareness of RPM remains low because there is a limited amount of
public information available and that which is available is not reaching the target audience – seniors, the
chronically ill and their caretakers.
Information technology barriers: The lack of interoperable connectivity standards among providers, the
spotty adoption of electronic medical records, and the lack of infrastructure in rural areas must all be
addressed before RPM technology can diffuse widely in the marketplace

Policy Change To Support Broad RPM Diffusion Will Drive Cost Savings
Analyzing data from the remote monitoring program at the VA, as well as other smaller programs,
Better Health Care Together finds the US health care system could reduce costs by nearly $200
billion during the next 25 years if remote monitoring tools were utilized much more widely and
supported by specific policy adjustments that include reimbursing health care organizations for
remote care and encouraging continued investment in broadband infrastructure.
Estimated Savings and Gain from Policy Implementation, by Condition
Net Present Value of Net Present Value of Gain From Policy

Savings – Baseline Case Savings – Policy Case Change
CHF Patients $79.7 Billion $102.5 Billion $22.8 Billion
Diabetes Patients $42.3 Billion $54.4 Billion $12.1 Billion
COPD Patients $18.7 Billion $24.1 Billion $5.4 Billion
Chronic Skin Ulcer Patients $12.5 Billion $16.0 Billion $3.5 Billion
Total $153.2 Billion $197 Billion $43.8 Billion
Source: Vital Signs via Broadband: Remote Health Monitoring Transmits Savings, Enhances Lives

Ideal Technology Deployment: Stakeholder Alignment
Government & Payer Healthcare Provider
Disease
Efficient &
Partial or Full Supportive management
effective care
Reimbursement Policy & prevention
coordination
focus
Successful
Technology Deployment
Vendors Community Services Provider
Business model Underlying Consumer

Caregiver
is affordable infrastructure education &
buy-in
& scalable in place trust

Center for Technology and Aging
Initiative of The SCAN Foundation and HealthTech

3-year grant of $5 million to establish the nation’s first center devoted exclusively to advancing the
use of technologies that enhance home and community-based care for seniors.
Address the continuing challenge of adoption, expansion and sustainability of creative technologies
that benefit the health and healthcare of older adults and the long-term care work force.
Goals
Identify and evaluate best practices in the diffusion of emerging technologies.
Serve as a state and national resource base for providers and policymakers who are engaged in
the expansion of technology that improves the quality and efficiency of long-term care services.
Develop supportive tools to accelerate adoption of technologies that improve the care and well
being of older adults.

Center for Technology and Aging Activities

Grant program to test diffusion strategies starting in 2010
Research and evaluation on adoption and diffusion strategies
Technical assistance tools
Policy and position papers that support the adoption and diffusion of beneficial technologies
National dissemination of information concerning successful strategies and programs through web
page, e-newsletter, fact sheets, white papers, and publications
The Center will focus on an array of technologies, including among others:

Medication management
Cognitive assessment
Assistive technologies
Caregiver communication

Translating Expert Research and
Partner Networks Into Results
Molly Coye
CEO
415-537-6966 assistant’s phone
415-537-6949 fax
mcoye@healthtech.org
David Lindeman
Director-Center for Technology and Aging
Senior Advisor - HealthTech
415-537-6598 phone
415-537-6949
dlindeman@healthtech.org
Barbara Harvath
Senior Advisor
415.537.6969 phone
415.537.6949 fax
bharvath@healthtech.org

524 Second Street, 2nd floor
www.healthtech.org Health Technology Center San Francisco, CA 94107
nd
524 Second Street, 2 floor
San Francisco, CA 94107

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Emerging Technologies for

Aging in America: ASA-NCOA Conference

Molly Coye, MD, MPH

1 © 2008 Health Technology Center

In this session we will:

1. Provide an Overview of promising technologies for maintaining the independence of older

2. Present forecasts of specific technologies and their relationship to the workforce

2 © 2009 Health Technology Center

Analysis Forecasting Validation Diffusion

3 © 2009 Health Technology Center

46.1 million people (20.8%)

4 © 2009 Health Technology Center

5 © 2009 Health Technology Center

Sensory – long-lasting blindness, deafness, or a severe vision or heading

Physical – a long-lasting condition that substantially limits one or more basic

Cognitive – difficulty learning, remembering, or concentrating due to a

6 © 2009 Health Technology Center

By 2020, Depression will be the second leading cause of disability worldwide

Source: World Health Organization

7 © 2009 Health Technology Center

Shared Needs: Needs of

8 © 2009 Health Technology Center

Aging & Persons (Formal & Informal)

Technology Identifying technologies Builders &

Care Providers Human

9 © 2009 Health Technology Center

Builders and Technology Human Services Care Providers and

• Design • Quality of Life • Reimbursement

• Outcomes Data • Prevention • Outcomes Data

• Business Model • Safety • Policy changes

• Policy changes • Well-being • Workforce

10 © 2009 Health Technology Center

Settings and Business

11 © 2009 Health Technology Center

Consumers Become the Primary Drivers of Technology Adoption

Cell Phones are the Primary Platform Regulations

12 © 2009 Health Technology Center

•The desire to appear independent drives

2-5 years: Discreet and affordable wearable

Simulator, University of Florida’s Independence Development,

Drive Program Dissemination

5-10 years: Design elements that

•New roles emerge to navigate complex systems.

Settings and Business

18 © 2009 Health Technology Center

19 © 2009 Health Technology Center

Settings and Business

20 © 2009 Health Technology Center ICT

•A third of seniors (age 65 and older) have the Internet at home.

Cell Phone Use

• 50% of Americans age 65 and older have a cell phone.

What are they doing on line?

21 © 2009 Health Technology Center

0-5 years: Higher visibility of

10+ years: ADA criteria expands to Settings and Business

reflect the changing population. Development,

•Willingness to pay for services out-of-pocket and lack of reimbursement cause

2-5 years: Community living facilities

5-10 years: commercially available Business

and home health monitoring become Adoption, and

widely available in retail stores. Workforce

• More than 15 million take care of their aging parents, a