Home Care Technology: A New frontier in Health Care

In Ontario and across Canada, health care is changing. Policymakers are recognizing the benefits of expanding in-home medical services – especially for aging patients. These benefits go far beyond government savings to include a higher quality of life for those receiving care.

Home care providers – from agency managers and directors to nurses, therapists, and personal support workers – have long known the value of in-home care. If you fill one of these roles, chances are you’ve seen smiles on the faces of clients who feel good about retaining their independence while experiencing the day-to-day comforts of home.

In a piece of great news for advocates, health ministers from across the country recently agreed to work together to improve home care. But positive change takes time, and right now, Canadians are reaching retirement age in droves. How will home care providers deal with the sudden leap in demand for services?

There’s a lot of government work to be done. But during the transition, home care technology can help agencies do more with less. This post will look at a crop of recent technologies and consider their potential to solve some of home care’s biggest problems.

New Demands, New Challenges 

It’s happening. Canada’s population is getting older. In 2015, for the first year on record, there were more Canadians over the age of 65 than under the age of 14. Needless to say, the number of people living with chronic health conditions is growing quickly. Available space in traditional health care facilities is not.

On the bright side, being treated at home is the option most patients prefer. According to a 2013 RBC survey, a whopping 83% of Canadian baby boomers would rather receive health care in their homes than anywhere else. In many ways, government commitments to home care are a win-win. That said, those involved in providing and coordinating this care know there’s no quick and simple solution.

In Ontario, the government’s shift towards more home-centred care is happening fast. Many service providers and public agencies (CCACs in Ontario) are finding themselves stretched too thin. If you work for one of these organizations, you’re probably well aware of some of the major problems this situation has created.

As the number of people who need home care continues to grow, shortages of qualified registered nurses and PSWs is becoming a serious challenge.  In many cases, agency directors are struggling to find dedicated and passionate staff who can fill the demand.

Meanwhile, a lot of existing caregivers are suffering from physical and emotional burnout. They’re dealing with the fatigue of constant commuting and the guilt of never feeling like they have enough time for the people they’re caring for.

Of course, providers are concerned first and foremost about impacts on their clients. In many cases, recent changes have resulted in fewer hours of care. This can mean more time alone, which can increase certain types of risk for some clients. Here are a few potential consequences that can result:

  • Dangerous incidents – falls and other emergencies can occur when clients with limited mobility or dementia are left alone.
  • Lapses in health-care routines – health risks can occur when clients forget to take medication or engage in other self-monitoring activities.
  • Health complications – health complications can arise when in-home treatment is based on incomplete patient histories sent from hospitals and other facilities. Complications may also occur while clients are waiting to see busy specialists.
  • Patient loneliness – social isolation can cause problems when client time with caregivers is cut.

If you’re a home care service provider, this situation may leave you feeling like you can’t provide the level of care and support your clients deserve. It’s a matter of too little time and too few resources – you can’t be everywhere at once.

The good news is, you probably have a talent for making the most of the resources you can access. At the moment, there are plenty of new resources to explore in the form of home care and aging in place technologies.

Home Care Technology: Providing Real Solutions

From emergency notification systems to videoconferencing platforms, home care technology helps clients retain their independence without sacrificing their safety.

Many of these technologies have the potential to do more than improve the lives of individual users. When implemented correctly, they can help home care agencies provide better, quicker and more responsive care to a larger number of clients.

Telemedicine is one of the most talked-about types of medical technology in the world, with good reason. There are huge benefits to connecting patients with health care providers remotely.

Nurses and PSWs can’t always be at a client’s home. But with the right digital videoconferencing platforms, they can use phones and tablets to check in from anywhere, at anytime.

The value of video contact is immense. Service providers receive visual confirmations that their clients are doing well. With some systems, they can send out and track reminders about medications and other activities. Clients see a friendly face. They get the opportunity to interact with caregivers in a way that’s more engaging than a simple phone call.

Videoconferencing can also be used when nurses performing in-home visits need to consult with outside specialists. For example, technology capable of capturing high-quality video can enable a wound care nurse to assess a patient’s wound remotely and advise her caregiver on how to treat it.

Wearable monitoring devices that track indicators of patient health – such as heart rate and blood sugar – can also help qualified health care providers get a more complete picture of what’s happening with the overall health of home care patients.

Advances in telemedicine and remote monitoring are allowing home care workers to treat more patients, more often – all without the stress of constant commuting.

Emergency notification systems are one of the most widely-used classes of aging in place technology. Given that an older adult dies from fall-related trauma every twenty seconds, it’s no wonder. Wearable devices that detect dangerous events and send out calls for help act as lifelines in many cases.

In the home care realm, service providers can set up emergency notification systems so that they’re notified the moment a client falls or experiences some other form of physical trauma. The sensor technology that makes fall detection possible can also be installed around the homes of clients who are prone to wandering and other risky behaviours.

These are just a handful of technologies relevant in the home care context.

What to look for

As more and more people with chronic health conditions are choosing to stay at home, the number of companies that provide home care technologies is growing. With so many solutions to choose from, it can be difficult to figure out which ones will best serve the needs of your clients.

There are a few basic considerations to keep in mind. Technologies that work best for home care agencies tend to meet the following criteria.

  • Intuitive and easy to use – These days, older people are navigating social media with ease. So it’s easy to forget that many older adults still aren’t very tech savvy. When selecting products that clients will interact with, think “intuitive”. Touch screens with clear visuals are great.
  • Compatible with familiar technologies – Platforms and tools that can be accessed through everyday devices (like iPads, iPhones, and laptops) will more useful to everyone, including home care staff.
  • Designed for family involvement – Technologies that enable a caregiver and client to interact and exchange information are even more useful when the client’s family members can be included. Adding new people for clients to talk to should be a simple process.
  • Capable of meeting communication & data goals – Technologies that facilitate communication can serve other important functions, like collecting patient data and generating related reports.

Looking Ahead

Home care providers give people the support they need to stay safe and retain their independence, dignity and comfort. As at-home care expands, new technologies that advance these goals will continue to appear. In order to better serve their clients, providers should look to technology developers that understand their needs and share their values.

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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