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The third annual Long-Term Care Colloquium, sponsored by The Commonwealth Fund and conducted by AcademyHealth, was held in Seattle on June 24 th in conjunction with AcademyHealth's Annual Research Meeting. The colloquium provided an opportunity for long-term care (LTC) stakeholders to forge an agenda and bring information to bear on the problems faced by LTC policymakers and practitioners. Building on the momentum generated by the 2004 and 2005 Colloquia, the 2006 Colloquium highlighted two new policy topics: 1) Technology and long-term care Russell Bodoff, executive director of the Center for Aging Services Technologies (CAST), and Mary Naylor, PhD, RN of University of Pennsylvania School of Nursing presented highlights from background papers on this year's topics. These were followed by commentary from experts representing providers, consumers, and state and federal policy leaders who placed the discussion in a real world context. A facilitated small group table discussion took place to generate collaboration and dialogue on questions raised during the plenary discussion. Our hope is that the colloquium papers and discussion will stimulate timely research and its application to high priority areas of LTC financing and service delivery. Russell Bodoff, executive director of the Center for Aging Services Technologies (CAST), highlighted technology's promise to address a range of challenges associated with an aging U.S. population that will require increasing levels of assistance and health care. While other countries throughout the world, like Japan and South Korea, have more actively undertaken initiatives to use technology to address the special needs of the aging, the United States ' adoption has been slower. Bodoff argued that the long-term care community is in an optimal position to lead the revolution that technology can make to long-term care services and health care delivery. A broad range of technologies can be useful to long-term care. These include interoperable electronic health records that could smooth transitions between settings such as the hospital and nursing home. Other forms of health information technology (HIT) also could increase the capacity of a limited long-term care workforce. Assistive technologies could enhance the ability to serve more individuals in home and community-based settings. Potential for real impact lies in the ability to connect common devices like cell phones and PDAs to devices that can monitor events such as falls, changes in sleep patterns, and blood glucose levels. Policy actions that might encourage broader dissemination of aging-related technologies include:
Finally, to move the field forward, Bodoff encouraged the development and evaluation of larger trials and demonstrations to determine which technologies are most effective and when. This requires collaboration among the technology industry, research institutions, government officials, providers, caregivers, and consumers. Carol Raphael, president and chief executive officer of the Visiting Nurse Service of New York (VNSNY), discussed VNSNY's investments in health information technology (HIT) for home health care. Their innovative system emphasizes improving the efficiency of their staff, quality of care, and outcomes. Raphael emphasized the importance of workforce buy-in relative to the success of technology adoption. She identified ways that the technologies described by Bodoff could advance care, citing VNSNY's improved quality, efficiency, and capacity. Nancy Wolske, director of care innovations for Elite Care at Oatfield Estates illustrated how her facility utilizes state-of-the-art technology in the provision of long-term care to their residents. Wolske gave a virtual tour of a "smart home" at Oatfield Estates and described a novel software tool developed at the facility known as the Family Portal, which allows family members to monitor data and activities approved by loved ones over the internet. Colloquium participants discussed the potential technology has for changing the delivery of long-term care. Participants recommended that the long-term care community determine which goals are most appropriate and amenable to the use of technology. Once goals are identified, the field and federal government needs to develop an evidence base and better reimbursement mechanisms to encourage the implementation and adoption of effective models responsive to stakeholders' needs. Many expressed the importance of equal access to beneficial technologies to prevent the development of a two-tiered system that has disparate levels of technology for those who can afford it and those who cannot. Participants also highlighted the importance of ensuring the privacy and security of electronically collected information. Most importantly, participants felt that technology should enhance-not replace-human interaction. Transitions in Long-term Care Settings Mary Naylor, professor of nursing at the University of Pennsylvania, discussed efforts to avoid preventable transitions to acute care settings when possible and making those transitions better when they must occur. These transitions are a critical juncture in patient care since the distinct natures of acute and long-term care often clash in their goals, services, and methods of financing. Current research shows that transitions in long-term care settings are occurring at a rapid rate, a high proportion being preventable. These transitions often are tied to poor and costly outcomes. While integrating acute and long-term care strategies has been difficult, efforts have been very informative. They reveal that more experimentation must be done. A transitional care model is emerging that centers on nurse-led multidimensional, multidisciplinary teams to manage the transition process. The core elements of successful transition are being identified and work is focusing on translation of these evidence-based models into real world practice. Policy actions to encourage minimizing transitions and improving their outcomes include:
Carol Levine, director of the Family and Health Care Project at the United Hospital Fund, stressed the importance of the family caregiver in the long-term care process. She outlined the caregiver's unique position as a source of information and expertise on the patient's health, especially as the patient makes transitions among settings. Levine highlighted the key role family caregivers have in providing early warning to help avoid preventable hospitalizations. Thus, the family caregiver should be explicitly considered in the research agenda and transition model development to ensure a successful care experience. Richard Della Penna, a geriatrician with the Kaiser Permanente System, described Kaiser's efforts to collaborate with researchers to ensure the development of a system in which the needs of the practitioner, payer, and patient are considered. From a policy perspective, he notes that any intervention must satisfy the triple bottom line for quickest implementation: it must have:
Following the presentation, participants discussed the complexities that make transitions between settings increasingly difficult to manage. The field should examine reimbursement and financing as a tool to drive better care coordination and proper transitions between care settings. Naylor argued that the research field must be able to make the business case for proper transitions. This could include findings that indicate it is possible to identify a subset of the long-term care population who would most benefit from care coordination services. Additionally, many participants agreed that the examples of a nurse-led team to guide patient care has shown promise, and work must be done on how to translate that research-based model into an effective systems model. Next Steps Peter Kemper, co-chair of the Building Bridges initiative invited Anthony Rodgers, director of the Arizona HealthCare Cost Containment Program, to share his thoughts on how states view research and implementation of new transition models and technologies. Rodgers urged researchers to develop models that are relevant to policymakers and to consider whether proposals require transforming a system or gradual change. For example, implementation of HIT would require transforming the system. Those kind of wholesale changes in long-term care are much harder to implement. Finally, Rodgers urged those in health care management to adapt and respond to changes in the system over time. Just as medical professionals must undergo continuing medical education, leaders in health care management must be aware of the impact their actions have on the system and then respond to those changes appropriately. Kemper emphasized the great potential for technology to revolutionize long-term care and the need to address unnecessary transitions in long-term care, given the poor outcomes that result. He concluded that often the barriers to implementing new ideas are policy related-issues such as reimbursement, licensing, and financing. He stressed the importance of stakeholder collaboration to develop solutions and overcome barriers to change. Kemper encouraged continuation of the colloquium discussion within the Building Bridges workgroups. To learn more about ongoing activities of this initiative, please contact us at ltc@academyhealth.org. 2006 Colloquium Morning Session (Technology)
2006 Colloquium Afternoon Session (Transitions)
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