Contributed Article by Laurie Orlov
What could have happened in the home care industry didn’t.
In 2012, based on interviews with the best and the brightest in and around the home care industry, an idea was born and documented. It was radical – the idea of a network for sharing relevant information across organizational boundaries about a home care recipient with stakeholders, family, health providers. In this vision, the care recipient was at the center of this information sharing across the stages and steps of living independently, senior housing, rehab, hospital, and home. Instead of this vision outlined in The Future of Home Care Technology 2012, we have today’s franchised and fragmented home care industry – regionally focused, achieving the most minimal advances in technology deployment.
The role of technology -- big money, big failures.
Attempts to Tech-Enable Home Care in 2017 were extremely well-funded, but had virtually no impact on the industry. Not only have the inefficiencies and potential for sub-optimal care remained, but labor shortages have magnified those inefficiencies to today’s near-crisis proportions. Today's home care businesses must compete (and pay competitively) for workers considering easier jobs at Walmart and Target. The Home Care industry, post pandemic, is the recipient of broad family rejection of senior living communities and nursing homes in favor of keeping loved ones at home. In addition, note the growing percentage of childless older adults -- to whom home care services will matter a great deal. Although there is a desire for more innovation among stakeholders, the structure of the industry (franchises) limits transformation. Instead efforts seem focused on improving recruiting and retention -- though ironically, this is still an industry that lacks visible opportunities for workers to grow into new careers. No doubt, a career path could potentially boost retention.
What elements seem even more useful today?
Consider these three elements of the 2012 vision for the future and the Table shown below (Figure 1). Now imagine the potential for achieving that Future state in 2022 and beyond, now that the home is increasingly the hub of care for older adults -- comments and feedback welcome:
- Portals will link the informal caregivers to the formal care system. Traditional and operational home care systems will be supplemented with tech-enabled and fee-based services that engage the care recipient with the formal as well as the informal care network. Family members will be able to share pictures, music, and chat conversations with care recipients through a portal that normalizes variations in terminology and enables recipient-centric care information to be shared just in time to offer just the right care.
- Life, health, and business activities will be integrated. Home care support systems – across health, non-medical home care, and geriatric care management -- if implemented at all, are internally focused on productivity and effectiveness of business. In the future, redesigned processes will enable non-medical information like a care recipient’s ADL (Activities of Daily Living) status to be linked to EMR/condition-centric processes and remote monitoring systems. Information about that status will be regularly communicated (email, chat, portal update) with invited family members. Home care managers will be able to switch easily from viewing their own resource utilization to discussing care status with a family member, to reporting health status exceptions to a clinician.
- Care coordination will be required. In the future, the assessment of condition and status will be initiated at each location from information in existing online records. A common lexicon of terms that combine health record and ADL status will enable information to be accessed as easily as plugging in a memory stick in a USB port. Based on type of insurance, home care coordinators will be easily identified at point of admission and passed to any location along transitions of care, where they will be notified and engaged. If no care coordinator exists, just as a hospitalist is assigned for care coordination within the hospital, a home care coordinator will be named on admission so that a person can be discharged to coordinated care. To ensure the highest level of care and the lowest requirement of institutional care, information about condition, medications, and care status will be transferred through the network’s secure portal and shared between family, insurer, physician/provider, and pharmacy.
