Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community

Mountain Empire is one of the newest of more than 100 independent PACE organizations across the nation that serve both as health plans and as medical and long-term service providers to elders—offering meals, checkups, rehabilitation services, home visits, and many other supports that enable enrollees to preserve their independence. The model for PACE dates back to 1971, when a public health dentist and social worker from the San Francisco Public Health Department working in Chinatown-North Beach noticed that as their clients aged, many needed extra support but dreaded moving into nursing homes. They founded On Lok Senior Health Services as an alternative to institutional care that would allow elders to "age in place" in their homes; on lokis Cantonese for "peaceful, happy abode."On Lok's founders were particularly concerned about elderly clients who suffered when their various clinicians failed to work together, sometimes leading to complications that necessitated moves into institutional care. They designed On Lok to promote what was then an innovative approach: coordinating care from an interdisciplinary team of professionals who provide all primary care services and oversee specialists' services.A Medicare-funded demonstration spanning 1979 to 1983 found this approach had many benefits. Care teams were able to prevent or quickly address problems, resulting in better health and quality of life and producing 15 percent lower costs than traditional Medicare. In the decades since, the model has spread slowly, though enrollment has grown nearly 40 percent in the past three years. As of January 2016, there were 118 PACE organizations in 31 states serving some 39,000 elders

Contributions of ambient assisted living for health and quality of life in the elderly and care services - a qualitative analysis from the experts’ perspective of care service professionals

BACKGROUND: Because of the demographic change in industrial countries new technical solutions for the independent living of elderly will become important in the next years. Ambient Assisted Living seeks to address the upcoming challenges by providing technical aids for elderly and care givers. Therefore it is crucial to understand how those socio-technical solutions can address their needs and quality of life (QOL). The aim of this study was to analyse the main needs of dependent elderly and to investigate how different solutions can contribute to health and quality of life. METHODS: A qualitative study design consisting of interviews with 11 professionals of geriatric care organisations was chosen. The data analysis was done by applying the qualitative content analysis by Philipp Mayring. The analysis was based on the basic principle of the bio-psycho-social model of health RESULTS: Ambient Assisted Living solutions and assistive technologies can have positive impacts on different dimensions of health and quality of life. The needs and problems of elderly can be addressed by applying appropriate solutions which influence the physical, mental and social dimensions of quality of life. There are also benefits for social care providers, their staff and caring relatives of impaired elderly. Ambient Assisted Living solutions can also be used as a facilitator for operational optimization of care services. CONCLUSIONS: Solutions for telemedicine and telecare which are connected to Ambient Assisted Living solutions will have the biggest positive impact on care giving services. Also simple technical aids can be beneficial for elderly to enhance QOL by enabling autonomy in their familiar surroundings

Internet of Things-based care monitoring for the elderly and those with special needs

As a society, we should provide support and care for individuals who are advanced in age or have special needs. We must offer them the opportunity to lead a safe and comfortable life. Sometimes, addressing simple things can mitigate critical problems. For instance, an improperly functioning heating system can put the users’ lives at risk, and a gas leak can prove fatal if not detected in time. Hence, this study aims to identify solutions that can help prevent accidents in such vulnerable populations. To achieve this, a safety device equipped with essential sensors continuously monitors the living environment of people with special needs. If there are any anomalies, the system will immediately alert the concerned family members and competent security authorities, ensuring a quick and efficient response to potential emergencies. The proposed safety device aims to provide extra protection and peace of mind for special care individuals. By implementing such safety measures, we can make significant strides in promoting the well-being and safety of vulnerable populations.info:eu-repo/semantics/publishedVersio

Design of a Predictive Scheduling System to Improve Assisted Living Services for Elders

International audienceAs the number of older adults increases, and with it the demand for dedicated care, geriatric residences face a shortage of caregivers, who themselves experience work overload, stress and burden. We conducted a long-term field study in three geriatric residences to understand the work conditions of caregivers with the aim of developing technologies to assist them in their work and help them deal with their burden. From this study we obtained relevant requirements and insights of design that were used to design, implement and evaluate two prototypes for supporting caregivers' tasks (e.g. electronic recording and automatic notifications), in order to validate the feasibility of their implementation in-situ and the technical requirements. The evaluation in-situ of the prototypes was conducted for a period of four weeks. The results of the evaluation, together with the data collected from six months of use, motivated the design of a predictive schedule. Such design was iteratively improved and evaluated in participative sessions with caregivers. PRESENCE, the predictive schedule we propose, triggers real-time alerts of risky situations (e.g. falls, entering off-limits areas such as the infirmary or the kitchen) and, informs caregivers of routine tasks that need to be performed (e.g. medication administration, diaper change, etc.). Moreover, PRESENCE helps caregivers to record caring tasks (such as diaper changes or medication) and wellbeing assessments (such as the mood), which are difficult to automatize. This facilitates caregiver's shift handover, and can help to train new caregivers by suggesting routine tasks and by sending reminders and timely information about the residents. It can be seen as a tool to reduce the workload of caregivers and medical staff. Instead of trying to substitute the caregiver with an automatic caring system, as proposed by others, we propose the design of our predictive schedule system that blends caregiver's assessments and measurements from sensors. We show the feasibility of predicting caregiver's tasks and a formative evaluation with caregivers that provides preliminary evidence of its utility

Care Management of Patients With Complex Health Care Needs

Explores how patients' complexity of healthcare needs, vulnerability, and age affect the cost and quality of their health care. Examines the potential for care management to improve quality of care and reduce costs, elements of success, and challenges

Unobtrusive Health Monitoring in Private Spaces: The Smart Home

With the advances in sensor technology, big data, and artificial intelligence, unobtrusive in-home health monitoring has been a research focus for decades. Following up our research on smart vehicles, within the framework of unobtrusive health monitoring in private spaces, this work attempts to provide a guide to current sensor technology for unobtrusive in-home monitoring by a literature review of the state of the art and to answer, in particular, the questions: (1) What types of sensors can be used for unobtrusive in-home health data acquisition? (2) Where should the sensors be placed? (3) What data can be monitored in a smart home? (4) How can the obtained data support the monitoring functions? We conducted a retrospective literature review and summarized the state-of-the-art research on leveraging sensor technology for unobtrusive in-home health monitoring. For structured analysis, we developed a four-category terminology (location, unobtrusive sensor, data, and monitoring functions). We acquired 912 unique articles from four relevant databases (ACM Digital Lib, IEEE Xplore, PubMed, and Scopus) and screened them for relevance, resulting in n=55 papers analyzed in a structured manner using the terminology. The results delivered 25 types of sensors (motion sensor, contact sensor, pressure sensor, electrical current sensor, etc.) that can be deployed within rooms, static facilities, or electric appliances in an ambient way. While behavioral data (e.g., presence (n=38), time spent on activities (n=18)) can be acquired effortlessly, physiological parameters (e.g., heart rate, respiratory rate) are measurable on a limited scale (n=5). Behavioral data contribute to functional monitoring. Emergency monitoring can be built up on behavioral and environmental data. Acquired physiological parameters allow reasonable monitoring of physiological functions to a limited extent. Environmental data and behavioral data also detect safety and security abnormalities. Social interaction monitoring relies mainly on direct monitoring of tools of communication (smartphone; computer). In summary, convincing proof of a clear effect of these monitoring functions on clinical outcome with a large sample size and long-term monitoring is still lacking

Remote Home Monitoring of Older Surgical Cancer Patients:Perspective on Study Implementation and Feasibility

BACKGROUND: Remote home monitoring might fill the perceived surveillance gap after hospital discharge. However, it is unclear whether older oncologic patients will be able to use the required new digital technologies. The study aimed to assess the feasibility of postoperative remote home monitoring for this population. METHODS: This observational cohort study recruited patients aged 65 years or older scheduled for oncologic surgery. The study patients used a mobile application and activity tracker preoperatively until 3 months postoperatively. A subset of the patients used additional devices (thermometer, blood pressure monitor, weight scale) and completed electronic health questionnaires 2 weeks after hospital discharge. Feasibility was assessed by the study completion rate, compliance in using components of the information technology system, acceptability [Net Promotor Score (NPS)] and usability [System Usability Scale (SUS)]. The NPS score varied from - 100 to + 100. An SUS higher than 68 was considered above average. RESULTS: Of 47 participants (mean age, 72 years; range, 65-85 years), 37 completed a follow-up assessment, yielding a completion rate of 79%. Compliance in using the activity tracker (n = 41) occurred a median of 81 days [interquartile range (IQR), 70-90 days] out of 90 post-discharge days. Compliance in measuring vital signs and completing health questionnaires varied from a median of 10.5 days (IQR, 4.5-14.0 days) to 12 days (IQR, 5-14 days) out of 14 days. The NPS was + 29.7%, and the mean SUS was 74.4 ± 19.3. CONCLUSION: Older oncologic patients in the study considered postoperative home monitoring acceptable and usable. Once they consented to participate, the patients were compliant, and the completion rate was high

Heat-Ready: heatwave awareness, preparedness and adaptive capacity in aged care facilities

AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.Please cite this report as: Black, DA, Veitch, C, Wilson, LA, Hansen, A 2013 Heat-Ready: Heatwave awareness, preparedness and adaptive capacity in aged care facilities in three Australian states: New South Wales, Queensland and South Australia, National Climate Change Adaptation Research Facility, Gold Coast, 47 pp.AbstractThis study identifies the current policies and strategies Australian ACFs use to keep residents well, and highlights the barriers to heatwave adaptation and maintaining wellness in the residential aged during periods of extreme heat. As the Australian population ages, planning for the health effects of extreme heat in elderly residents is critical to ensure wellness in this population group is maintained.Aims were to: 1) investigate current heat-wave planning, policies, staff knowledge and heat prevention strategies and 2) identify barriers to adaptation and successful implementation of adequate heat-wave health care in ACFs in three Australian states (NSW, Queensland and South Australia).Residential ACFs were identified across three states using Department of Health and Ageing databases, white pages and internet searching. After removal of duplicates, 1,561 facilities were invited to participate in the study. Each participating facility was asked to provide informed consent and invited to select one administrative and one clinical staff member to participate in a 15 minute Computer Assisted Telephone Interview (CATI). Participants were asked about their knowledge of the effects of heat on the elderly and to detail current plans and policies which addressed residents’ health during heat-waves, and barriers to care during periods of extreme heat. Data was entered into a purpose-built database and analysed using Statistical Package for the Social Sciences (SPSS) Version 19.Two hundred and eighty seven (287) facilities (18%) participated in the telephone interview. The ACFs enrolled represented 20,928 Australian aged care residents.  Ninety percent of facilities had a current ACF emergency plan, although only 30% included heat-wave emergency planning. Heatwave policies were not routine in all ACFs in any state. Staff used a range of strategies to keep residents cool in extreme heat, although strategies were not consistent across all states or facilities. The issues raised in relation to clinical care in this group can be synthesised into four key messages; cooling, hydration, monitoring and emergency planning, which, at a practical level are essential to maintain the health of older people in very hot weather.&nbsp

Emotional Care in the Nursing home Setting

This research project examines emotional care provided to nursing home residents, prior to them being hospice qualified. Hospice offers a continuum of care that has documented success. In review of the literature, it appears that the nursing home setting provides a set of standards for how needs are responded to that inhibit the type of care hospice is able to provide. By conducting qualitative semi-structured interviews of six employees working in the role of case management in a nursing home setting, an analysis by phenomenological method was done and several themes were found. The following themes emerged: The following themes were found: multiple roles of case managers with the subthemes; intake process and acclimation of new residents; ongoing care with the subthemes; social health, emotional health, medical health and spiritual health; residents with complex issues with the subtheme insurance frustrations. Following the findings, there is a discussion and implications for further study