Tech Innovation Improves Home Health’s Cost-Care Equation

Most Americans want to remain in their homes throughout retirement, yet the one thing that most hope to achieve by aging in place may be taking a toll on mental and physical health: independence.

Keeping seniors healthier—and happier—is a priority for health care agencies, but keeping seniors engaged and feeling healthy in the home setting can be extremely challenging. The consequences of isolation can negatively impact not only seniors’ health, but drive up costs to the provider and health system at large.

Nearly 2 million Americans over the age of 65 rarely or never leave their homes, according to research from the Journal of the American Medical Association (JAMA).They are more likely to be depressed with serious chronic conditions like cardiovascular disease or dementia, research shows. This population, often referred to as “shut-ins,” frequently relies on home health care services, but the social consequences of living alone with limited access to the outdoors and social events are far-reaching.

Shut-ins No Longer Shut Out

Selfhelp Community Services, Inc. is one health care service provider trying to address this issue with seniors in New York City. While the non-profit organization originally began to take care of victims from World War II, it has since grown to offer a number of services, including senior centers, affordable housing, naturally occurring retirement communities (NORC) programs and home care, to serve about 20,000 people.

It’s most innovative approach to helping homebound seniors is its virtual senior center, a system that offers live, interactive classes and exchanges for seniors in New York City, Chicago, Baltimore and San Diego. The system utilizes a 22-inch touch screen desktop computer that goes into the home of an isolated senior. Several organizations act as referrals for the virtual senior center, and an agency can help seniors arrange to have the system brought into their home.

Instead of focusing on the location of a center, Selfhelp has shifted to providing services wherever a senior may be living. This approach is part of what Stuart Kaplan, CEO of Selfhelp, refers to as “blended care,” which integrates housing and health care. This approach mirrors the changing payment methods by the Centers for Medicare & Medicaid Services (CMS) by moving toward integrated health care measures.

“We espouse that we are living at the intersection of social housing, affordable housing and health care,” says Kaplan. “Technology is one aspect that fits within the blended services and ultimately should fit into a payment system of bundled payments.”

For adults who once spent their days alone, the virtual center is life-changing, according to Kaplan.

“The virtual senior center was developed for a specific population who are isolated and at home due to health conditions or other disabilities,” Kaplan told HHCN. “They cannot get out of their homes to come to the senior center. We bring the activities of senior centers into the living room to seniors who are isolated and living at home.”
From music and art classes to yoga, the center provides seniors an entry into an engaging space without leaving home. Kaplan says the programming is the most important component of the center, but seniors have formed their own groups outside of classes as a result.

“One of the keys of keeping this vibrant and attractive to seniors is having somebody who organizes the programming,” Kaplan explains. “It’s just like having a television station. One of the benefits that we have found is that once somebody starts using the center, they form their own chatrooms and start social interactions outside the classroom, which further combats isolation. The majority of seniors who are participating are now talking to each other and using other adaptations.”

Virtual World, Real Results

The results of the virtual centers are undeniable, Kaplan says. Currently, just over 250 participants utilize virtual senior centers in their homes, with 83 as the average age of a user. A study conducted by Selfhelp of this population revealed that engaging in the centers improve health, attitude or the feeling of being healthier in many.

“When we ask people if it improved their quality of life, 97% of participants said yes,” David Dring, executive director of Selfhelp Innovations, told HHCN.

The survey asked participants if they lacked companionship. After some time with the virtual center, Selfhelp reduced those feelings by 60%. The effect on feelings of isolation was even more dramatic, with an 85% reduction among participants.

While the most immediate impact of engaging with the center is on mental health, seniors perceived themselves as healthier once they were involved, which may mean they need fewer health care services, says Dring. Virtual senior centers could also have bigger implications for telehealth and remote monitoring, which could lead to fewer hospital visits and lower care costs.

When asked to self-report their health status, 51% of seniors engaged with virtual centers increased their status, Selfhelp found.

“That indicates that the higher they are on that scale, the fewer health services they consume,” Dring told HHCN. “People who feel better about themselves will go to the doctor less and with a better attitude.”

Kaplan expects that as more baby boomers enter retirement, technology will play a critical role in overcoming some of the debilitating effects of isolation among homebound adults. In fact, the role of technology could revolutionize how seniors age in place.

“From a population standpoint, as younger seniors age, technology will become more and more the norm for the reason that they are already engaged,” Kaplan says. “They will be calling for technology to make it easier for them to live at home. The development of apps going on right now and how that is heading into the health care world, we’ve only scratched the surface in the use of tech.”

However, the program, which currently receives grants from the Consumer Electronics Association Foundation and the AARP Foundation, only serves a small population and faces a huge funding hurdle to expand, says Kaplan. The cost to seniors is about $600 to purchase the software and touch screen device, while service runs about $60 per month.

Many homebound seniors are Medicare beneficiaries, which does not pay for technology and systems like the virtual senior center. Medicare will typically cover medical devices that can make it easier for seniors to get around, but many still lack the ability to get outdoors on their own.

Written by Amy Baxter