Tuesday, August 10, 2010
The tsunami looms: By 2050, nearly 90 million Americans will have passed age 65, and every corner of society will feel the impact. With our inadequate health-care workforce, outmoded retirement ideas and rigid housing policies, how can our country prepare? Beyond rethinking ways to ensure retirement savings (mandatory government savings plans?) and redefining retirement (phased retirements? working longer?), researchers and professionals are trying out, and in some cases reviving, some ideas.
From hospital halls to cyberspace: telemedicine
Imagine a 75-year-old receiving wireless medication reminders, straight to his beeping wristband. Or an 80-year-old with a new hip, linked by body sensors to a device embedded in her carpet that tracks her movement patterns in case her mobility worsens.
In the future, we are going to start seeing telemedicine "as part of the medical home," says Dale Alverson, medical director at the Center for Telehealth and Cybermedicine Research at the University of New Mexico.
Although developers and advocates have promoted telemedicine for years, Alice Borelli of Intel points to barriers -- including Medicare reimbursement policies and inadequate broadband in parts of the country -- that have kept telemedicine a mostly conceptual solution.
One supposed barrier, wariness of new gadgets, may prove unfounded. "I was shocked; they love the technology," says Laurie Chichester, who directs home-care services at the Metropolitan Jewish Health System in New York, where 170 patients use remote monitoring.
Telemedicine can't replace hospitals or nursing homes, but it can delay the need for them. "We can move 30 to 40 percent of health care to the home," Borelli says.
Curing an ailing workforce
The health-care workforce for older patients is unwell. The country must recruit millions more doctors, nurses and aides with the skills needed for a surging geriatric population.
A 2007 study showed a 20 percent decline in the ranks of certified geriatricians over 10 years; only 11 percent of medical schools require students to complete a geriatrics rotation.
So Sharon Levine, a geriatrician, leads the Chief Resident Immersion Training program at Boston University Medical Center, where doctors from across the country gather for weekend boot camps on treating the elderly.
William "Skip" Nitardy, an internist at Marshall University Medical School in Huntington, W.Va., left the immersion program with greater knowledge of delirium and more interest in treating the elderly. "They've fought the world wars and built the country, and they deserve our best," he says. Meanwhile in Wisconsin, Cooperative Care provides home care by aides who are both employees and owners of the service, a possible key to retaining workers in a field known for turnover.
Enthusiasm for the work, plus profit sharing and higher wages, has translated into remarkably low turnover at Cooperative Care: less than 10 percent, a far cry from the 70 percent national rate.
Healing the workforce will take time, but it's essential. "These are all things that we've known about," says Tracy Harris of the Institute of Medicine. "It's not a pipeline that suddenly burst in the ocean."
Finding a home to grow old in
Older adults almost universally say they want to age in place.
"People want to be more in control," says Maribeth Bersani of the Assisted Living Federation of America.
But most seniors will require some form of care as they age. Some innovative ideas for senior housing:
-- College campus living: About 60 senior living communities have sprouted on college campuses, including Stanford and the University of Michigan, offering independent, assisted-living and nursing home services, plus university courses and activities and a multigenerational environment.
At Stanford, where the Hyatt-built community requires a deposit of more than $1 million, "very few people end up going to the nursing home or assisted living center," says Victor Regnier, gerontologist and architect at the University of Southern California. "They'll stay in their own apartments."
-- Apartments for life: Already prevalent throughout northern Europe, these mixed-age complexes offer private units with home-care services available. In contrast to sprawling suburban campuses, these urban buildings promote activity and independence with medical services close by.
-- Accessory dwelling units: Modular homes constructed on the same property as a family member's house, these allow seniors to live independently while receiving care from family; when occupants move or die, the unit can be removed or resold.
A doctor in the house
Older Americans consume the greatest proportion of health-care dollars; people with five or more chronic conditions account for two-thirds of all Medicare spending. House calls allow doctors to treat elderly patients with such illnesses before they require expensive hospital visits or a nursing home.
Bruce Leff, a geriatrician at Johns Hopkins University, worked with a research team studying 455 patients who were treated in hospitals and at home over 22 months. The team's 2005 report found that home treatment cost about 30 percent less than hospital care, because home patients required fewer procedures and improved more quickly.
Similar results at other hospitals and doctors' practices have prompted the Independence at Home Act, part of the health-care overhaul; it provides for pilot house-call programs aimed at reducing costs.
On home visits, doctors and nurses can do more than write a prescription or take a blood sample. "Within two to three minutes, doctors at home can spot things," says Leff, the founding director of Johns Hopkins's Hospital at Home program.
"From a physician's perspective, it is a very satisfying experience," says Mohamed Aniff, a geriatrician at New York's Montefiore Hospital, which has 600 patients in its house-call program. Aniff typically spends nearly an hour with each of his patients at home. "We get to go through everything."
Josh Tapper, Alex Berg and Sharaf Mowjood contributed to this report. Along with Egan, they are fellows of News21.