Aging has changed during the past generation.  From an elderly woman choosing to live alone in Belmont, MA rather than enter assisted living, to a Concord wife with mild dementia struggling to provide senior care for her ailing husband, to a Bedford couple in their 90s and still home with outside help, we see many more families with elders who have moderate to significant needs. Those terms of care can stretch into years.

This requires a change in attitudes and expectations for families to reduce their stress. It’s necessary to reset our expectations and assumptions that result from such widespread changes. Let me illustrate with a story.

Ted and Mikie

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I am so very proud of our wonderful staff, and want to pay tribute here to their amazing work.

Yesterday I attended the funeral for a Newton, Massachusetts, home care client for whom we cared literally up to the moment of her recent passing.  Four of our caregivers also attended, and I knew they had done an absolutely super job on this assignment for this very special woman and her family.  But it wasn't until the service that I got to hear, directly from the family, chapter and verse of just how special their work was.  I am so moved and proud by the warmth, love, tenderness, and care they gave that I want to pay tribute to them here.

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Topics in this just-published snailmail newsletter:

• Better Care - Lower Cost - Improved Health! Elder Care Remote Activity Monitoring Technology Pilot
• Want to Participate in One of Our Pilots - Free!
• Caring Companion Awarded Home Care Agency Accreditation
• Optimism Connected to a Stronger Immune System

Download this newsletter here: CCCnewsletterv2.1 (if you would like to receive our next newsletter  by email or snailmail -- or to have it sent to a friend, client or family member -- This email address is being protected from spambots. You need JavaScript enabled to view it. with the name contact info).

Being able to stay in the home we've lived in as we've aged is a real blessing, and almost always preferred by elders.  But some homes are just not set up for aging in place -- too many stairs, bathrooms and bedrooms in the wrong part of the house to fit the elder's needs and mobility.  Home modification is an option, and the Commonwealth of Massachusetts makes low- and no-interest loans to modify the homes of elders and individuals with disabilities where there is income qualification.

Monday, January 31 at 7PM at the Gleason Library in Carlisle, MA, there is a meeting about this program. I just noticed it in the Boston Globe, following a Facebook pointer from our State Representative, Cory Atkins (isn't life in 2011 strange??!) -- you can fit in this meeting before the next snow storm starts. Download a program brochure here.

At Caring Companion, we already do far more than the industry standard to reduce the costs of health care and improve the quality of life for elders and the disabled. We provide real-time information and reports to health care professionals and families via our unique online system -- we are the only agency in the country doing this.  We already place appropriate technology in homes to help reduce the number of care hours needed.   Our guiding model combines our outstanding on-site caregivers with with the appropriate technology to improve care and reduce its cost.

Throughout 2011, we will demonstrate this in a series of public pilots.  In partnership with some Massachusetts Aging Services Access Points (ASAPs) and Councils on Aging (COAs), we will pilot promising technologies that we have identified to help at-risk elders and the disabled.  Testing such technologies in elders' homes has not been done before in our region; in fact, it's seldom been done around the country. In these carefully crafted pilot studies, we will demonstrate that we can:

• significantly reduce care costs
• reduce hospitalizations
• reduce falls
• identify problem areas before they fully develop
• proactively intervene to prevent crises
• reduce stress, increase efficiency for care partners
• allow elders to live longer in their homes
• delay or prevent entry into higher levels of care
• increase elder safety
• maintain elder privacy

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Striking front entries with winding front stairs... luxurious bath suits with rooms for toilet, shower and dressing... inviting sunken living rooms. These residential features add to the interest and drama.  But given the aging of our population, the homes of the future with higher and more sustained value may be ones suited for aging or disabled occupants.

However, a lot of housing stock now is simply unsuitable for people with mobility or memory  issues. If a family member becomes disabled due to age, illness or injury, a move to a safer environment or an often-costly home modification may become inescapable. And you'd see increased costs of home care for seniors and the disabled.

But "assisted living" can start at home: regardless of the age of the occupants, we can start right now making homes more adaptable for aging in place.  This takes a shift in thinking, but it's one that will pay back the homeowner handsomely. Every time you make a lasting change to the interior or exterior of your home, answer these three questions:

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Last Thursday and Friday I attended Connected Health Symposium in Boston - and I'd like to start by thanking Dr Joseph Kvedar and the Center for Connected Health for organizing what has become one of the industry's leading gatherings of health care professionals, technologists, venture capitalists, entrepreneurs, and industry analysts focused on using connected technologies to improve health and wellness. Topics ranged from DNA sequencing to remote sensors to allow you to watch mom sleep (which can be more interesting than it may sound). It was professionally productive, intellectually stimulating - and just plain fun. And I shook hands and spoke folks I usually only "see" in the blogosphere.

Personal favorites - no claim made for exhaustive analysis. These are unstructured and impressionistic.

Remote Monitoring

I am always on the lookout for productive home care technology that can improve independence and safety for clients at acceptable prices and risks.  Two companies in particular interested me here:

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The post below is adapted from an except of our white paper, Re-Imagining Home Care: New Needs, New Approaches. This is the 4th in a series of of 11 posts.

Consider the changes in consumer technology since 1980, and stop to think about how they have changed the way home care agencies can now interact with client families.  In contrast to service providers in other industries, home care agencies offer little more than email, if they offer even that.  There are many reasons for this – e.g., concerns about HIPAA regulations and the slow pace of physicians’ electronic medical record adoption.  But failure to take advantage of the wide adoption of Web 2.0 technologies and social media leaves remote family – a fast-growing component of the senior care environment – in the dark about the status, important changes, and key needs of their loved ones.

This is unnecessary and borders on unforgivable. The technology is inexpensive and widely available.  There is no need for remote family to lack any relevant information on a nearly instantaneous basis.  Furthermore, access to this information can easily, at the request of the client, be provided to physicians, case managers, Geriatric Care Managers, or other members of the care team to support follow up care decisions.

Caring Companion Connections has developed a proprietary system delivering all the functionality discussed here and more. All our caregivers use it, every day. Completing online reports is a job requirement, not an optional service - and it is included at no charge with all client visits.  Upon seeing this system, one of our clients said, "You know, when I leave my dog at the kennel, I know more about what happens to him than I do when I have an aide come to my 84-year-old mother's condo. I know what my dog ate, when he went outside, who he played with, when he pooped. I see pictures. But I just have to hope the aides show up and until I go to her condo again, I don't really know what happened."

In the 21^st Century, client families should insist upon web access to daily reports of client visits. Just as they would not choose a bank, an airline, or a retail store that could not provide basic account activity information online, there is no reason to accept this failing from a home care agency.  Caregiving staff should carry smart phones or other mobile devices that enable mobile updates. Family members and authorized users should be able to review reports, ask questions, and communicate among themselves regarding the service plan, independent of location.  The improved information flow allows family decisions to be made more quickly and ensures that data is available to all interested parties.  It reduces anxiety, improves peace of mind, and promotes better care.

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The Center for Connected Health in Boston hosts the  Connected Health Blog, and recently Dr Joseph Kvedar discussed developments he expected, or was watching, over the next 10 years. His observations are telling for their omissions: he focuses on electronic medical records and on payment issues -- issues of enormous import, no doubt.  However, he was speaking of a world as-yet emerging: ubiquitous high-speed wireless works and (even) smaller, cheaper mobile technologies that will come.

But improvements in connected health do not need to await the day of universal 4G networks and RFID chips in our underwear. We could do more with what is available today. It requires more a change in thinking than the development of new technology.