Aging in Place


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Presentation by Mike Brett, MD, Medical Director for LIFE Programs, Lutheran Senior Life and Kelly Besecker, Vice President, Sales & Marketing, A-Frame Digital

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  • Good Afternoon My name is Kelly Besecker of AFrame Digital in Reston VA and this Dr. George Brett from Lutheran Life in Pennsylvania
    I will give you a quick overview of our products and then we can take questions and answers.
    Managing chronic conditions is the #1 health care cost we have in the United States, and our demographics of an aging population,the hospital readmissions levels, and use of the Emergency Room because of crises that could have been prevented, if only someone or some thing knew it was developing.
    $4 billion readmssions 2008 Medicare
    Hospitals tell us that many of the post-acute telehealth tools we have provided them in the past are too difficult for their populations and adherence is low.
    Without patient adherence, our most brilliant products are not effective.
  • Dr. Brett
    LIFE Model of Care Philosophy
    To allow participants to continue to live in their home and surroundings
    Maintain “Connectedness” and Dignity
    Our Participants want to “Age in Place”
    To Respect our participant’s Autonomy
    Physical Safety does not trump Psycho-Social Safety
    Being self-aware that we don’t mistake our values and for the value system for our patients
    Help participants maximize their physical, functional, social and cognitive function
  • Dr. Brett: Our participants have all been determined Nursing Home Eligible by the County Area Agency on Aging (AAA)
    Challenge is this: What does a Nursing Home provide that cannot be duplicated in an alternative setting?
  • Dr. Brett: This is what is unique about our program. Providing total holistic interdiscliplinary care, and have the health care dollars to provide the care we deem appropriate for each individual
  • Dr. Brett: We are captiated by both Medicaid and Medicare. This is a “Blessing and a Curse.” Curse because we are at risk for all medical expenses for the most expensive subset of the population: People who are Dual Eligible and Nursing Home Eligible. It is a blessing
    in that we can direct the health care dollars based on a individualized Care Plan and not on what Medicare might or might not allow.
    This allowed us to “step outside the box” and make monies available for a project with AFrame Digital.
  • Dr. Brett: I’ll address ad lib.
  • Dr. Brett: Moving a participant from living home with daughter to a skilled nursing home can be “overkill.” Akin to killing a mouse with a hand grenade.
  • Dr. Brett
    Participants were identified who could move out of a SNF:
    Must be no more than a One Person Transfer.
    Wandering was not an issue with proposed layout
    Participants were identified who were in imminent danger of Nursing Home Placement
    Task List was created and weekly updated. Community Care Coordinator identified
    Needed “Ownership.”
    C.N.A’s were hired.
    LIFE Staff
    Home Health Agencies identified
    All C.N.A.s were trained on AFrame Digital System
    “Train the Trainer”
    Nurse Case Manager chosen to oversee the participant’s residing there
  • Dr. Brett
    We looked at 8 monitoring systems. For us, detecting falls in real time, notifications going as a text message to our CAN in real time, and being able to assure families their loved one couldn’t wander out of the facility were key features, and unique to the AFrame Digital product.
  • Dr. Brett
    Routers are plugged into electrical outlets throughout the hallways & Participant’s Rooms to create a mesh or “Electrical Cloud” throughout building
  • Dr. Brett:Since our initial project at Friendship Commons, we have successfully replicated this with our LIFE Program in Butler County, and
    replicated it again at a second Low Income apartment project in Beaver
  • Kelly
    We have taken a wholistic view of the risks facing this population and their health care. A profitable patient-centric team approach requires
    -- for basics, nurse call that is UL 1069 compliant for SNFs with 2-way messaging that help is coming
    -- vital signs collection, charting, trending and alerting within the context of the care plan
    -- the ability to push surveys for self-report data and context-sensitive education
    -- medication reminders
    -- the ability to measure increasing instability for falls prevention and detection, which is actually the #1 cause of premature death for seniors
    -- the ability to measure activity, location and behavior inferences, such as reaction to new meds, sleeping problems or going to the bathroom several times at night
    A key part of the 24/7 data collection system that we designed and manufactured is the wearable monitor in wristwatch form factor that is socially acceptable and promotes adherence..
  • Kelly
    Plug and play for the patient, familly or home nurse. It’s cellular to the cloud and the home network plugs into convenient wall outlets to form a wireless ZigBee mesh with Bluetooth for additional medical devices and WiFi
  • Kelly
    The care nurse gets all the individuals in their portfolio in a single dashboard view with support for all popular mobile devices
  • The nurse can drill down for details fo the current alert, current location and history
  • Kelly
    Optionally, the patient can be given a wireless tablet
    Popular inexpensive touch tablet
    Hardened and bullet proof – you cannot do anything to get lost because all navigation has been disabled
    This is currently deployed in an NIH study for CHF patients in self-maintenance to reduce hospital readmissions
    Patient surveys are pushed to the tablet
    We are working with partners for context-sensitive education for underserved populations
  • Dr. Brett:This is a TRIPLE “Win Win Win” project. 1) Participant moved out of 4 bed nursing home wards into new clean single apartment with private bath etc. 2) Participant was receiving $45 per month while permanently placed in a SNF. Now, Participant gets their Social Security and, possibly pension check back. In turn they pay 30% of their adjusted gross income for rent. The rest is theirs! 3) LIFE program saves $3,000 PMPM in nursing home costs.
  • Dr. BrettTwo projects on the horizon. Utilizing AFrame in individual homes with alerts going to family members.
  • Dr. BrettPurchase of two 3 bedroom ranch style homes adjacent to each other with a CNA going between two homes with Aframe
    Digital installed at each house.
  • Kelly
    In conclusion,
    I’ve show you some features of an integrated patient health and safety that uses wireless sensors, wearable monitor, smart phones, and tablets to engage patients in their health and wellness.
    It is patient focused and promotes independence and engagement in their health and wellness.
    Personalized models allow caregivers to be proactive and intervene before a crisis develops.
    Better care leads to better health and lower costs
    Time of rapid change in healthcare and we believe this is the leading platform for adherence and ease of use at the point of care for telehealth. If you are a manufacturer of an FDA-cleared medical device looking for these capabilities, I would love to speak with you later today.
  • Aging in Place

    1. 1. COMBATING THE RISING COST OF CARE: AGING IN PLACE Kelly Besecker Dr. George Brett March 18, 2013 11:00 – 12:15 pm
    2. 2. LIFE Programs LIFE: LIFE Living Independence For the Elderly (Pennsylvania) PACE: Program for the All Inclusive Care of the Elderly (Nationally)
    3. 3. PACE (LIFE): What is it??  Who: Program for the Frail, Indigent, Elderly - Elderly: Eligible for Medicare Indigent: Eligible for Medicaid Frail: Eligible for Nursing Home Placement  Purpose: Keep participants living in their own home  Keep participants healthy, independent, living in the community avoiding hospital stays and nursing home placement  “Age in Place”  Holistic Care and Services provided in their home, and at a Day Health Center  Multidisciplinary Care 3
    4. 4. PACE (LIFE) is a HYBRID Program It’s the Participant’s PROVIDER of Health Care And It’s the Participants’ HEALTH PLAN 4
    5. 5. L.I.F.E. has Opportunities for Innovation Medicaid Medicare Revenue Revenue (Capitated) Part A,B,D Risk Adjusted Capitated Patient Care Do what is Appropriate We make the rules No “Mother May I?”
    6. 6. Typical Participant in PACE 80 Years Old 7.9 Chronic Medical Conditions 2-3 Impairments in ADL’S 39% Live Alone 49% Have Dementia 55% Incontinent 80% Female 90% Live in the Community
    7. 7. Framing the Problem  PACE mission is to keep the frail indigent elderly in their home and community avoiding institutionalization.  Want our elders to “Age In Place.”  PACE is a Managed Care Program - Medicaid Payment is Capitated - Medicare Payment is risk adjusted and Capitated  LIFE Programs in Pennsylvania are not allowed to place their participants in Personal Care Homes (PCH). Assisted living costs generally prohibits their use.  LIFE Participants live independently or live with family members  If this is not possible, LIFE Participants must be placed in a Skilled Nursing Facility (SNF)
    8. 8. Solving the Problem  Housing Authority of Beaver County was building a 24 unit Low Income Housing Tax Credit Building.  LIFE Beaver was not permitted to hold long term leases. - The Lending institution would lose their Tax Credits  LIFE Participants applied for a lease & added to Waiting List  Case Management team was transformed into a Task Force - Nurse Case Managers - LIFE Center Manager - Dietary Manager - Social Service Department - Medical Director  Many technologies were researched and 8 were chosen to present a Passive Monitoring solution for our LIFE programs  AFrame Digital was chosen. Let’s get into Why?
    9. 9. What were we looking for?  The System must include real time monitoring  Need a platform that can handle all needs in one system if possible.  The check list of features needed included: - PERS - Fall Detection - Location Monitoring – real time - Activity Monitoring - Feature rich for future needs, including health data - Must be research based and tested
    10. 10. Our Chosen Technology  AFrame offered a comprehensive platform that included everything we were looking for all in one system  They were research based  They had an FDA cleared system  They had an automatic impact detection system that allowed us to take a proactive approach to falls.  The plug and play system makes it easy.  Access anywhere and anytime.  Participants wear a Personal Help Device (PHD) - The “Watch” and It really does tell time as well!  Monitoring done by the On-Site C.N.A.  It is a Real Time Monitoring system.
    11. 11. LIFE Programs and AFrame: The Present  July 2011: Friendship Commons, Beaver, PA  24 Unit Low Income Senior Apartment  Supportive Housing. LIFE has a C.N.A. there 24/7  LIFE Beaver Participants using Aframe in 15 of the apartments  January 2012: Under Our Wing, Butler PA  24 Unit Low Income Senior Apartment  Supportive Housing. LIFE has a C.N.A. there 24/7  LIFE Butler Participants using AFrame in residence in 14 apartments  August 2012: Francis Farmer Apartments, Beaver, PA  105 Unit Low Income Senior Apartment Complex  Supportive Housing. LIFE has a C.N.A. there 24/7  LIFE Beaver Participants using Aframe in 11 of the apartments 11
    12. 12. Continuous, Non-Intrusive Monitoring for Timely and Proactive Interventions  Personal Emergency  Automatic Vitals Response – Panic Button Collection  Activity, Wellness & Location  Medication Reminder  Impact/Fall Detection  Survey Device 12
    13. 13. Remote Monitoring System for Home or Facilities Wireless Mesh Network 5-Minute Install Wristwatch Monitor DSL or Cellular Gateway Other Wireless Devices 13
    14. 14. Real-time Status and Alerting 14
    15. 15. Real-time Location and Alert Resolution Wellness Indicator 15
    16. 16. Tablet for Patient Self-Reporting, Motivation, and Biofeedback 16
    17. 17. RESULT  The program saved $2,990 per resident per month  Now, 15 of the 24 units are occupied by LIFE Beaver County participants using the applied concepts and technology.  People were able to live in their own environment and enjoy a better quality of life. One of our residents was able to get her beloved cat back to live with her.  Program has been duplicated by LIFE Butler in low income senior apartments  LIFE Beaver has expanded into 2nd Senior Apartment Complex  New location under development for LIFE Lawrence
    18. 18. Individual Home Applications  AFrame Digital Installations into family homes – providing safety net  Affordable Pricing for individual families  Floor Plans of individual homes - Multiple family members can check in on loved one  Alerts sent to designated family member  Alerts for Wandering if necessary: Peace of Mind
    19. 19. LIFE Programs and AFrame: The Future  December 2013: Residential Homes in New Castle, PA  Purchased two three-bedroom homes  Homes adjacent to each other  Will locate 6 participants from LIFE Lawrence County there.  Three participants into each home  By Regulations, cannot have 4 or more in a home.  Several will be moved out of Nursing Homes where they currently reside  Several will be Participants at high risk for Nursing Home Placement  Will have C.N.A. oversee both homes  Both Homes will be wired with AFrame Digital  C.N.A. can be alerted even when in the adjacent home 19
    20. 20. Innovative Care Delivery  MobileCare Monitor is an integrated patient health and safety platform  Patient-focused promoting independence and engagement in their wellness  Personalized models allows caregivers to be proactive and stay ahead of a crisis  Better care, lower costs and better outcomes. 20
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