Towards an Aging in Place 2.0 vision

Nice goal, but how to age in place?  In the pendulum swing of all 'aging in place' all the time, a murky target has been set, but the tactics are more like a meandering and treacherous hiking trail than a well-marked pathway. Some of us will pick up and leave for a more service-rich environment in advance of need, usually at an age or level of actual or anticipated limitations. But these service-rich environments, typically Continuing Care Retirement Communities (CCRCs), represent a relatively small proportion of older age range of the 65+ population. And CCRC moves require sale of a house, downsizing of possessions, and a move that can be a traumatic change. In addition, these 'enclaves' (as described in a recent NY Times article) are not without financial issues. Certainly the word 'continuing' is a misnomer unless one counts a campus change to a smaller space for both person and possessions as not really moving.

We need a vision -- here's a good start. MetLife's Mature Market Institute deserves a round of applause: last week they published a report (with consultant Louis Tenenbaum) that should push us to envision the path for this elusive aging in place goal. In Louis' Aging in Place 2.0 world, we're not moving to a destination where we will likely experience 'overcare', that is access and cost of more services than we need for much of our time there -- think CCRC.  And we won't need to suffer from 'undercare' -- that is we can't find and don't have the services when they are most needed. Or we can't find them on behalf of an aging parent dwindling away in increasing isolation and frailty in a condominium in Florida, surrounded by other frail seniors also desperately in need of help. So what will be different in an Aging in Place 2.0 world?

The vision is tantalizing -- coordinated care, in our home. From the report: "In AiP2.0, people live in the home of their choice equipped with tools and design features that support independence and assure that individuals and their caregivers are safe. Preventive medical care and wellness assistance encouraging self-management of health is available. Care, meals, supplies, transportation to appointments, and activities as well as social connections, etc. are all managed easily." What struck me is how management of this coordinated care will be provided  through "neighborhood care hubs, in which passive and active devices connect homes to family, friends, and care managers who staff them."  Neighborhood care hubs could be located in senior or wellness centers, or, in my view, these neighborhood care hubs could also be provided by nearby CCRCs on behalf of the surrounding community.  The care hub's monitoring system -- think response center -- evolves into a management system in which trained and qualified staff coordinate and dispatch a wide variety of resources to subscribing participants.

From a patchwork of responders to a management system. So how to transition beyond today's unintegrated call center responders for individual product subscriptions -- like personal emergency response systems, remote activity monitoring, medication management, or chronic disease management tools that transmit to doctors? And how to incorporate the care coordination service skills already present in today's CCRCs? As the MMI report notes, this requires a database-driven ability to 'calibrate care'  in which the right amount of information is known about an individual in order to prompt the care manager in the neighborhood care hub (or perhaps prompt the 'virtual' care manager) to correctly respond to online inquiries, alerts, or calls. These alerts enable the neighborhood care hub to enlist the right service as needed, notifying pre-identified family and contact points that are previously specified. You may ask, isn't this a PHR or an EHR database or system? While they could be useful data sources (if they were current, for example, with a list of prescribed medications), I don't believe they are necessary for the neighborhood care hub to function.

So who builds the 'management' system? Think back to the enterprise world of individual transaction systems -- material planning, procurement, manufacturing, customer management -- which were ultimately linked together into an 'enterprise' management system that became an ERP (Enterprise Resource Planning) integrated suite.  Today we have the basic elements for neighborhood care hubs locked away in individual transaction systems -- for example, Philips, VRI, Healthsense, GE QuietCare, Bosch's Health Buddy. These all have elements of the neighborhood care hub data set, potentially organized into geographic zones, shared with other local care services operating in those zones.  Think about home care franchise territories, senior center membership lists, meal delivery maps, transportation subscriber lists, health care patient databases, or community church membership lists. Combine that with the plethora of senior care directory search tools on the market today.  If such combined data sets could be searched by staff using these directory search tools -- now that's a powerful foundation to help achieve the AiP 2.0 vision. 

Opt in, subscribe, share, access. Vendors who share the 'neighborhood care hub' vision could assemble opt-in local databases about people and resources into a repository with rules for matching AiP 2.0 clients to required resource. They could do this with little difficulty, given their directory systems and call center response databases, integrating on behalf of local participants.  Subscription fees would be paid by individuals in the community, family members on their behalf, and resource providers for the ability to include their information into such a neighborhood care hub system. Care hub managers would have tools to access that system when needed. Eventually, vendors would see a need and benefit to link systems together through some type of interface, selling subscription access to a hosted (Software as a Service) integrated Care Resource Planning (ICRP) system sold to home care agencies, senior housing organizations, health care providers, and local social services organizations.  

Crazy, huh?  That's what an AiP 2.0 vision document can inspire. :) 

Thanks, MetLife and Louis. Now we need your additional inspired thoughts, including how the roles of responders, CCRC staff, health or other service providers would need to change to participate in an AiP 2.0 world.