Coordinated Care Management

June 08, 2010

Telemedicine Plus Smart Devices for Home Health Monitoring

According to the U.S. Department of Health and Human Services' Administration on Aging, the 65-and-over population will increase to 55 million in 2020 (up 36 percent for the decade). By 2030, that will grow to about 72 million, almost twice the 2007 number. By 2030 those among us who are age 65-plus will represent more than 19 percent of the population.

Statistics show that the older we are, the more care we require. And the trend is for families to do all they can to enable their loved ones to remain at home - to age in place - for as long as possible. Care management companies are adopting home health monitoring technology to support families in this effort.

SeniorBridge provides personalized care management and healthcare services to people with complex, chronic health conditions, allowing them to avoid having to live in a nursing home or other residential facility.

From Pilot to Ongoing Program

According to Jackie Morrison, SeniorBridge's senior vice president of clinical services and quality management, the average age of the company's clients is 84, and more than 50 percent have some degree of memory impairment. She told us that the company is strongly embracing the concept of "telemedicine" to strengthen the level of care provided to their clients … and are implementing it in conjunction with their team care approach.

They began with a pilot program early in 2009 utilizing a home health monitoring system to provide daily remote patient monitoring and disease management. They continue this in partnership with Cardiocom, an industry leader in the development of telehealth devices.

Typical SeniorBridge clients have a history of frequent hospitalizations, perhaps some cardiac history, and because they have some cognitive impairment they also have a caregiver present at least during the day when the monitors would be used. Another type of client would be someone who still may be able to self direct, perhaps has a history of cardiac disease and/or fluctuating blood pressure, and some level of medication compliance issues.

Patient Parameters, Monitoring and Benefits

According to Morrison, "Our goal is that this program, along with our model of care management in the home, will help our patients stay independent longer and be more compliant with the medications and the medical regime the physician has provided them with," Morrison said.

Parameters are set up in the system for each patient's specific condition, including all of his or her medications and dosages. A small monitoring unit is provided for the patient's home, and once this unit is activated it provides spoken instructions, prompting the patient through the steps of a home health check. SeniorBridge uses specific devices that plug into this main monitoring unit. Monitoring and reporting can be done with or without a home health aide or caregiver present, depending on the level of care and supervision the particular patient requires. The simple instructions enable them to monitor their blood pressure, respiratory rate, heart rate and weight. SeniorBridge has plans to add collateral devices to measure blood sugar (glucometer) and oxygen levels (pulse oximeter).

The system also reminds patients to take their medications. The majority of the SeniorBridge clients take as many as five medications a day, with some patients taking as many as 15 or 20.

All data collected by the home monitoring devices are transmitted securely over the phone line to a call center. If the data reflects a deviation from the pre-programmed parameters, the call center nurse contacts a SeniorBridge care manager immediately to report an alert for a particular client. The care manager will speak directly with the patient to determine if the monitoring was done correctly and if additional care will be required.

If the patient doesn't log on and follow the instructions on a given day, that triggers an alert to the call center and the caregiver. SeniorBridge asks all of their clients to log in daily by 11 a.m., so there would be time for an intervention with the physician if necessary.

The system generates reports from the live data that can be used by the care managers and the physicians involved. In analyzing the data, medications and/or care may be increased or decreased according to the trends measured.

"Home health monitoring has many benefits for all of our patients," Morrison said. "Both those more complex cases with dementia, and for those who only have early stage Alzheimer's, or no dementia, and are still able to self-direct."

She said that in addition to enabling the patient to remain at home longer, the system provides quantitative data to increase quality of care. Home health monitoring allows SeniorBridge to work collaboratively with the physician in reducing hospitalizations and unscheduled ER and physician office visits. It also provides the family with an extra level of reassurance and security.

Linda Kallman is a freelance writer/editor and communications consultant. To read more of her articles, please visit please visit her columnist page.

Edited by Michael Dinan
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