July 2009 Archives

How much can technology help the frail elderly live independently?

The promise of high-tech assistive devices and monitoring systems has attracted the attention of many long-term care families, desperate for new ways to keep an eye on mom. Not surprisingly, some big companies, including GE and Cisco, as well as smaller start-ups and university research labs, are increasingly interested as well.  

We have come a long way from that old late night TV ad: "Help, I've fallen and can't get up."

Old-style push-button pendants and bathroom pull chords are being replaced by passive wireless sensors that automatically report unusual activity to a central monitoring station. If someone falls, spends too long in the bathroom, or doesn't open the fridge at their usual time, these devices can notify a caregiver, assisted living facility staff, or even the police or 911.

Even more sophisticated devices embedded in the floor can tell when someone's gait has changed: an important warning for someone who has a history of small strokes.

Monitoring equipment is not cheap--the cost for a typical system is about $100/month. While they can be a lot less expensive than an aide, high-tech systems are not reimbursed by Medicare. Some private insurance policies may pay if they allow a flexible alternative plan of care. Medicaid often will pay.

New devices can also remotely monitor weight, blood oxygen levels, and blood pressure. The problem is: Who do they report to? The information could go to a physician's office, but nobody will pay that doctor for either the equipment she needs or the time it takes for a nurse to track this data.

While monitoring is getting increasingly sophisticated, there are some key chores technology cannot yet do. For instance, there is still no reliable way to know whether someone has taken the right pills at the right time. Lots of people are trying but, in truth, we are not doing much better than we did with those $10 plastic pill boxes.

And, in the end, the best monitoring the world won't improve someone's quality of life if there is no-one to provide hands-on help when she is in distress. That still takes aides or family. And it is the biggest reason why, for now, the most appropriate places for these devices are assisted living facilities and nursing homes, rather than people's own homes.

This equipment would not have helped many of the families I met while writing Caring for Our Parents. But one woman, Caroline Foye, might have benefited. Caroline lived a mile down the road from her son, had an aide for only part of the day, and was alone the rest of the time. I'm not sure what Caroline would have thought about having a house full of sensors following her every move, but they might have made her life a bit more secure.  

When it comes to assistive technologies and long-term care, we are making progress, but still have a long way to go.  

The House Energy & Commerce Committee has added Senator Ted Kennedy's national long-term care insurance proposal (the CLASS Act) to its version of health reform legislation. This is another remarkable step forward for the measure although, as I've noted before, the fate of this and other long-term care provisions won't be decided until Congress writes a final health care bill sometime this fall.

The House panel included CLASS in its bill despite a new letter opposing the measure from the American Council of Life Insurers, a major industry lobbying group. ACLI says it opposes the bill because its benefit level, a minimum of $50 per day for life, is insufficient for someone who needs a nursing home level of care.

I suspect ACLI's opposition reflects a major industry split. I'm told that many of the biggest writers of private LTC insurance oppose the CLASS Act while many smaller carriers support it. Although Kennedy has explictly said private insurers could write policies to supplement CLASS Act coverage for many consumers, many of the major writers of private LTC insurance prefer the current environment, where they dominate a small market.

It seems that if I were an insurance company, I'd welcome an opportunity to revive what has been a moribund market. As currently designed, private LTC insurance is too complicated, too expensive, and too far off the radar screen for many consumers. Just as Medigap and Medicare Part D insurance have provided a nice kick for the health insurance business, CLASS has the potential to do the same for private LTC carriers. I think ACLI may be missing the boat here.   

    

A new poll suggests the public would like to see long-term care reform included in any congressional remake of the health system. While many respondents were concerned about their ability to pay for care, their biggest interest was in better coverage for home and community supports that could keep them out of nursing homes.

The survey, done by Lake Research Partners for the California-based SCAN Foundation, reported that 92 percent felt it was important to improve home-based services, and 80 percent said they'd be more likely to back a health reform bill that did that. 

More than two-thirds said it is important to improve insurance coverage for home-based services. However, they did not say whether that coverage should be provided by private carriers or government insurance.

Whether, and how, the public is willing to pay for better home and community services will be critical to the future of any congressional debate over long-term care. Americans have made it clear they want more acute medical care at no extra cost--an impossible demand. If they feel the same way about long-term care, it is hard to see lawmakers making much progress toward reform.   

 

 

 

For those interested in long-term care, the House Democrats' consensus health reform bill is pretty disappointing. Unlike the Senate Health, Education, Labor, and Pensions Committee version, it includes no proposal for national long-term care insurance. And it largely ignores efforts to expand access to home care for those on Medicaid, who now often can only get care in nursing facilities, or to better coordinate care for those receiving both Medicaid and Medicare benefits.

Key House Democrats, including Representative Frank Pallone (D-N.J.), are long-time supporters of Sen. Ted Kennedy's plan to provide national long-term care insurance (the CLASS Act). Still, the draft is silent on the issue. Similarly, despite strong Democratic support for efforts to enhance Medicaid home care, the proposal calls for little more than studies. Better than nothing, I suppose, but not by much. 

I expect lawmakers will attempt to add some long-term care provisions to the House draft, which will be considered by three committees over the next few weeks, For those of us looking for help caring for our parents, it will be interesting to see how they fare.   

The Obama Administration has given a boost to Senator Ted Kennedy's national long-term care insurance program, the CLASS Act. In a July 6 letter to Kennedy, Health and Human Services Secretary Kathleen Sibelius said President Obama believes "it is appropriate to include the CLASS Act as part of health reform." Obama co-sponsored the bill when he was in the Senate, but has been silent on the issue since he was elected President.

While Obama's endorsement is a major step forward for the plan, it by no means assures its passage. Senate Finance Committee Chairman Max Baucus (D-MT) has been reluctant to include the proposal in his bill. White House aides have said Obama will not get deeply involved in a final health reform measure until after the House and Senate have passed their versions of reform--probably sometime this fall.

The CLASS Act would provide access to government long-term care insurance to every worker. It would provide a benefit of at least $50 a day for life. Kennedy is aiming for an average premium of $65 per month, although the HHS Secretary would have broad discretion to set both benefits and premiums. Workers would be automatically enrolled, but could opt out of coverage should they choose.   

  

I've begun writing a regular, bi-weekly column for Kaiser Health News, a new independent news service. This morning's column looks at how much CLASS Act premiums would cost. The bottom line; Monthly payments for a national long-term care insurance policy would be more than its backers hope, but would still be affordable for many middle-class buyers.