What Is Aging in Place in Florida?
Aging in place means continuing to live at home as you grow older, rather than moving to an assisted living facility, nursing home, or another long-term care setting. For many older adults, that’s the goal. AARP reports that 75% of adults aged 50 and older want to remain in their current home as long as possible, and 73% want to stay in their current community. Home offers privacy, familiarity, and a sense of control. It’s where the coffee mugs are in the right cabinet, where neighbors know each other by name, and where the day has a rhythm that still feels like their own. But aging in place is not successful simply because someone stays home. It only works when the home, care plan, health needs, and family system can keep up. Without that structure, “staying home” can quietly turn into unsafe and unhappy living conditions. That’s why families need to think about aging in place as a care strategy, not just a preference. The question is not only, “Does my loved one want to stay home?” It’s, “What needs to be in place for home to remain safe and supportive?” Understanding What it Means to Age in Place Aging in place is often defined as staying in your own home as you age. That definition is accurate, but incomplete. In real life, aging in place means adapting the home and support system around a person’s changing abilities. Someone may be independent today and need a higher level of care down the line. A spouse may be able to assist with meals and errands for a while, then struggle when the needs become all-consuming or beyond their own capabilities. An adult child may want to help from another state, but can only do so if there is reliable communication and someone trustworthy inside the home. Aging in place is not static. It changes as the person changes. Families who understand this early are usually better prepared. Families who wait until a fall, hospitalization, or crisis often have fewer options and more pressure. Why Aging in Place Looks Different for Seniors in Florida Florida has its own aging-in-place reality. According to the U.S. Census Bureau, 21.8% of Florida residents are age 65 or older. People move here specifically for retirement and build lives around seasonality, senior communities, local physicians, faith groups, sports clubs, and family visits during certain times of year. Staying home can feel especially important because the home represents the life they chose after years of planning. But Florida also creates challenges families can’t ignore. Many adult children live out of state and are trying to understand what’s happening in their parents’ lives from a phone call, a short visit, or a neighbor’s concern. A parent may sound fine on the phone but be skipping meals, struggling with laundry, or becoming less steady in the shower. For snowbird families, care can become even more complicated when ways of life change between Florida and another home. The climate matters too. Heat and humidity can affect hydration, energy, and fall risk, especially for older adults who already have mobility challenges, chronic conditions, or medication schedules that make them more vulnerable. Hurricane season also adds another layer of planning. Families need to know who will check on their loved one, whether medications and supplies are available, and what happens if power, transportation, or communication is disrupted. In South Florida, aging in place involves making sure the right support is in place for the way people actually live here. Is Aging in Place Right for You or Your Loved One? Before making decisions about home modifications, care schedules, or long-term plans, start with a simple but honest question: Is daily life at home still working? Not “Can they get by?” Not “Do they say they are fine?” Not “Can the family keep patching things together for a little longer?” Is home still working in a way that protects health, dignity, safety, and quality of life? Here is where families should look closely: These questions often reveal the difference between a home that still encourages independence and a home situation that needs more structure. Why Home Modifications Are Only Part of the Plan Home modifications are important. Grab bars, better lighting, clear walkways, shower chairs, non-slip surfaces, and accessible bathrooms can reduce risk and make routines easier. But home modifications do not replace care. A grab bar doesn’t prepare dinner. A shower chair doesn’t notice that someone has stopped bathing. Better lighting doesn’t help a person with dementia who becomes confused after sunset. That’s where families sometimes misjudge the situation. They improve the home, but daily life is still not working because the person needs extra hands and eyes, not just a safer layout. Growing old at home requires both an environment that reduces risk and a care plan that matches the person’s actual needs. When Home Care Becomes Part of Aging in Place Home care, which is when a caregiver comes to the house to assist a loved one, often becomes the difference between wanting to stay home and being able to stay home. At first, support may be simple. A caregiver may help with light housekeeping, laundry, meal preparation, errands, transportation, or companionship. That may be enough for a while. Over time, the need may shift, requiring a bigger hourly commitment each week or even medical care. This is usually the point when families realize the current plan is not enough. A trained caregiver can help with daily routines, but the value goes beyond task completion. A good caregiver notices patterns that indicate the wellbeing of a person. These professional observations help families make better decisions before small changes become emergencies. Home care works best when it is introduced before the family is in crisis. It gives everyone time to build trust, establish routines, and adjust care as needs change. Home Care vs. Home Health Care Families researching aging in place often run into two similar-sounding terms that have two different functions. Home
Improving Chronic Care Through Remote Patient Monitoring (RPM)
Each year, $3.8 trillion is spent on healthcare services, with 90% of the cost attributable to the care of chronic conditions1. Of the national health expenditure, 21% or $799.4 billion was spent by Medicare alone2. This number is only anticipated to grow as “baby boomers” age and increase Medicare enrollment to more than 73 million individuals by 20303. The increase in a senior population creates more than just budgetary challenges, it will drastically increase the demand for specialized services that treat and manage chronic conditions that affect nearly 80% of older adults4. However, as the public health crisis has demonstrated, physicians and patients need alternatives to in-office visits that may pose health risks. In April 2020, 25% of patients with chronic conditions expressed fears of going into a doctor’s office or hospital5. This fear is understandable, as 73% of patients hospitalized with COVID-19 had a preexisting condition6, making it essential for patients with chronic conditions to appropriately mitigate the risk they have for contracting such an illness. COVID-19 has only accelerated existing trends, like telehealth and remote patient monitoring (RPM), to deliver quality, effective care to a patient in the comfort and safety of their home. Even before the public health crisis, Medicare made steps forward when they announced reimbursement for RPM in January 20196. This allowed physicians to receive reimbursement for remotely reviewing a patient’s biometric data. It was further expanded in January 2020, allowing physicians to bill Medicare for additional time spent reviewing data and allowing more diverse practice staff to participate. Additionally, the Quality Payment Program and Hospital Readmission Reduction Program provide further incentives for physicians to improve patient outcomes through RPM7. RPM has been successful in both lowering emergency room visits and readmission rates by up to 92% and 40%, respectively6. Rather than collecting health data from patients at infrequent office visits, RPM works by providing patients with the tools to measure data such as blood pressure, heart rate, blood oxygen, or glucose levels at home. The data is then recorded and shared with their healthcare providers, who can remotely monitor patient status. This enables physicians to assess the health of their patients more frequently and before something goes wrong. Rather than reactively treating a patient, RPM allows physicians to take a preventive health approach to reduce emergency room visits, readmissions, and health complications. Especially when it comes to patients with high-risk and chronic conditions, deterioration in their health can be detected far sooner than if they had waited for significant symptoms to appear or an in-office visit to alert the doctor of any changes in their health. Patients benefit from improved outcomes, while physicians can deliver better care, and payers are faced with reduced costs. Many RPM devices currently available integrate with sophisticated mobile apps that share data in near real-time or sync with apps like Apple Health so that both patients and physicians can easily view the data. By making patients an active part of the healthcare process, they become more engaged and understand what is needed to improve their chronic conditions. RPM facilitates collaboration between healthcare providers and patients to avoid preventable deterioration. By avoiding hospitalizations and managing symptoms of their chronic conditions, patients are provided with a higher quality of life. Sources: https://www.cdc.gov/chronicdisease/about/costs/index.htm https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet https://www.forbes.com/sites/howardgleckman/2019/02/22/what-really-is-happening-to-medicare-spending/?sh=1cf2bfeb6d2f https://www.ncoa.org/article/get-the-facts-on-chronic-disease-self-management https://healthpayerintelligence.com/news/how-coronavirus-influenced-medicare-chronic-disease-management https://www.medicaleconomics.com/view/your-doctor-will-remotely-see-you-now https://medcitynews.com/2021/03/why-the-next-generation-of-remote-patient-monitoring-holds-the-key-to-a-new-model-of-care-delivery/?rf=1
Telehealth Aids Rural Healthcare
Americans living in rural areas are disproportionately affected by the lack of quality healthcare service. With higher rates of preventable diseases and worse health outcomes than the 57 million Americans living in urban areas1. At the same time, rural physicians are challenged by workplace shortages and thin margins. To further compound this prevalent issue, in the past decade, 120 rural hospitals have closed. Of these, 39 were designated critical access hospitals, intended to keep essential services in rural areas3. These persistent issues can be solved through technology and the increase in home health. If COVID-19 has demonstrated anything, it was the healthcare community’s ability to rapidly implement telehealth alternatives. In the last week of March 2020, telehealth visits increased by 154%4. For Medicare beneficiaries, nearly half of all primary care visitors in April were a direct result of COVID5. The use of telehealth services was further supported by emergency presidential declarations lifting the Centers of Medicare and Medicaid Services’ geographic or site of service requirements. With this change, CMS was able to add 135 services to their telehealth services list. This increase in telehealth adoption shows the openness to telehealth options, previously not seen. In rural settings, telehealth is a particularly attractive solution to the challenges healthcare faces. As rural communities lose healthcare providers, telehealth is uniquely positioned to supplement limited resources6. Telehealth also opens the door to more efficient home healthcare and remote patient monitoring, which increases favorable patient outcomes. With remote patient monitoring (RPM), a patient’s condition can be monitored outside of the hospital through telehealth and digital devices to facilitate patient engagement and inform better treatment decisions. Physicians receive continuous data on patient conditions and can encourage patients to modify behaviors and take ownership of their healthcare journey7. Typically, patients can make positive behavioral changes while under hospital care but fail to maintain a health care plan when they return home. Using telehealth in combination with RPM can significantly improve a patient’s quality of life and reduce the risk for future hospitalizations. Before the public health crisis, home-based care delivery was in stages of experimentation but lacked consensus about what was reimbursable at home8. This changed as payers, providers, and patients became aligned in favor of home-based care. While not all changes have been permanent, it will give providers the ability to strategize how care is delivered in a post-COVID environment8. The widespread adoption and support of telehealth and RPM measures have shown that effective, efficient care can still be delivered in a home care setting. Not only does it make healthcare more effective, but it also makes it more accessible to the rural communities desperately in need of healthcare resources. Sources: https://www.cms.gov/newsroom/press-releases/trump-administration-announces-initiative-transform-rural-health https://www.chartis.com/forum/wp-content/uploads/2020/02/CCRH_Vulnerability-Research_FiNAL-02.14.20.pdf https://www.ruralhealthinfo.org/topics/critical-access-hospitals https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm https://www.hhs.gov/about/news/2020/07/28/hhs-issues-new-report-highlighting-dramatic-trends-in-medicare-beneficiary-telehealth-utilization-amid-covid-19.html https://www.chcs.org/news/telehealth-in-rural-america-disruptive-innovation-for-the-long-term/ https://www.homecaremag.com/february-2021/rpm-reduce-unnecessary-hospitalizations https://medcitynews.com/2021/01/the-home-health-landrush-getting-ahead-in-a-complex-market/?rf=1
The Rise in Virtual Care Visits
COVID-19 imposed many challenges for the healthcare sector. Fears of contracting the virus led many patients to cancel in-person visits, generating large demand for telehealth and virtual care. While telehealth technologies are not new, they have long been discussed. However, the pandemic forced providers to quickly implement virtual care options to support the patient demand, advancing the use of this technology “seven years in the last seven months”1. This especially makes access to care easier for the older population that may prefer to receive care at home. In a study, 60% of patients report the desire to continue receiving healthcare through telehealth methods, citing the care felt more personal, convenient, and timely2. Rather than need to travel into the doctor’s office, patients were happy with the ability to revive quality care in an environment they feel most comfortable in. Plus, 90% report that the level of care they received was as good or even better than traditional in-person care. With the overwhelmingly positive response to telehealth, the technology will continue to be an asset and change the way people receive care far into the future. As telehealth adoption rapidly grew, remote patient monitoring (RPM) technologies were implemented to monitor patients at home. With RPM, continuous monitoring and frequent check-ins allow physicians to intervene early when necessary. This created a fundamental shift, patients are incentivized to stay healthy, and with real-time monitoring, patients are evaluated more than at 3, 6, 9, or 12-month intervals. Continuous data, like blood pressure, weight, or blood sugar levels, give physicians the data they need to understand the patient’s health. Beyond meeting the patients’ needs, the combination of telehealth and RPM will decrease inefficiencies experienced by home health providers. Rather than having set home health visits, patients can be seen only when necessary since these tools allow for constant and effective communication between patients and providers. Sick patients can be seen as soon as they begin to display signs of illness, while healthy patients can forgo seeing a physician. When a home visit is necessary, RPM enables providers to have all necessary documentation needed to justify the visit3. On top of the healthcare industry and patients realizing the value of telehealth and RPM, government agencies are getting on board as well. The USDA is investing $42.3 million to 86 programs, many of which include “connected health programs”4. These programs are designed to expand and support many healthcare programs, a major of which deliver telehealth to rural and underserved communities. At a critical time in the development of these programs, funding is imperative to continue to positive momentum and expand care to serve more patients. Despite the challenges of the pandemic, telehealth and RPM rose to meet the changing demands of patients around the country. Through more effective and efficient care, patient health is encouraged, and physicians can more easily collect the data needed for support. Rapid innovation and implementation of telehealth have already generated positive results, so it will be interesting to see where this technology leads in the future. Sources: https://validic.com/on-demand-2021-state-of-healthcare-the-rise-of-virtual-care/ https://www.fiercehealthcare.com/practices/patients-want-to-keep-using-virtual-care-after-covid-19-pandemic-ends-survey-finds https://news.careinnovations.com/blog/how-home-health-and-rpm-benefit-one-another https://mhealthintelligence.com/news/usda-announces-latest-round-of-telemedicine-distance-learning-grants
How Technology is Helping CHF Patients Get Better in Their Own Homes
As we mark American Heart Month this February, a combination of virtual care and monitoring technology enables CHF patients to stay connected to care in the comfort and safety of their own homes. Home is where the heart is – it’s also the place we usually feel most comfortable, which can be a boon to the healing process. And being at home instead of the hospital reduces the risk of infections and dramatically reduces cost. Linking Home and Hospital At the University of Pittsburgh Medical Center (UPMC), a team of physicians has been working with remote patient monitoring and telehealth to help CHF patients heal at home and prevent ER visits and hospital readmissions. Patients’ smartphones, laptops, and even landlines become the eyes and ears of their care team. When connected wirelessly to scales and blood pressure cuffs, for example, the devices can transmit vital signs back to the hospital, where they can be analyzed and interpreted. If data received indicates a problem, the patient is contacted via phone or video call and given instructions to perhaps amend their medication or pay closer attention to their diet or make an appointment to see their doctor. Small issues can often be treated before they can trigger a hospital admission. Empowering Patients with Information and Guidance The initiative has also helped CHF patients better understand their condition and learn how to effectively care for themselves at home, according to Kimberly Armahizer, clinical supervisor for innovative homecare solutions at UPMC. “The programs are for 60 or 90 days, and afterward, patients are more aware of their symptoms and can better assess themselves daily.”[1] A program piloted at two Kaiser Permanente locations in California experimented with a telemonitoring program for their CHF patients that provided in-home training in the use of a device that measures weight, blood pressure, heart rate, and blood glucose for those patients who are also diabetic. Via modem, patients transmit daily readings to a call center monitored by nurse case managers. Software sorts and ranks the data, allowing nurses to see at a glance who most urgently needs contact. Careful daily monitoring helps patients stay on track with their care plan and learn more about which symptoms need immediate attention. Philip Madvig, MD, Associate Medical Director of The Permanente Medical Group in Oakland, California, reports that their remote monitoring program has cut the rate of hospitalization and readmission for CHF patients to about a third of the average rate system-wide. “This was not a controlled experiment, the patients weren’t randomized, but there is nothing else to explain this dramatic change,” says Madvig.[2] Remote Monitoring Provides Reassurance Recently discharged CHF patients have plenty to process and integrate into their new home routine. Being connected daily with their doctor’s office can reduce their anxiety and give them confidence, knowing a qualified medical professional regularly sees their vitals. [1] https://healthtechmagazine.net/article/2020/04/how-remote-patient-monitoring-programs-are-beneficial [2] http://www.ihi.org/resources/Pages/ImprovementStories/GoodHeartFailureCareFollowsPatientsHome.aspx
Caring for Your Loved Ones When They Have CHF
Getting a diagnosis of congestive heart failure (CHF) is difficult and often alarming, but the good news is that people can live happy, fulfilling lives in spite of it. If you’re bringing home a family member who’s been discharged from the hospital after a CHF diagnosis, it can feel like a huge responsibility to take on. But you’re not alone. Over 5 million people live with CHF, many of whom are able to be at home relying on family members as caregivers. And with the procedures doctors have honed over time, combined with new technologies like remote patient monitoring and video or telehealth calls, even heart failure patients living alone can take care of themselves. Either way, the experience is likely to spark questions. Below are some of the most common. But be sure to contact your doctor if you need further help. It’s not unusual for patients to feel they are bothering their physician, but that’s what they’re there for. What does it mean to have congestive heart failure? CHF is a bit of a misnomer since your heart has not actually stopped working but has slowed down. As a result, it’s unable to pump enough blood into all areas of your body. Veins can get backed up, with blood creating congestion that causes swelling in the lungs, stomach, legs, and ankles. This congestion in body tissues can cause a number of symptoms, including: Shortness of breath Persistent cough or wheezing Trouble breathing while lying down Nausea or complete lack of appetite Recent fluid build-up How do I treat heart failure at home? When CHF patients are discharged from the hospital, their families can feel overwhelmed by the requirements of their care. Home care can be especially difficult when the patient suffers from multiple chronic conditions. And while it’s true CHF can create serious problems if the condition is not treated on a daily basis, these treatments are manageable at home. They include: Checking vital signs daily. Weight and blood pressure readings help patients, and their doctors stay abreast of changes that could signal a treatable decline. Weight gain can indicate a build-up of fluid, in which case you should contact your doctor immediately. And high blood pressure puts a strain on your heart. Your doctor can recommend an easy-to-use blood pressure monitor. In some cases, doctors recommend remote patient monitoring, which allows you to input your daily vitals check into a computer app. This app automatically transmits the data to your provider’s office, where staff continuously monitor their patients’ status. Closely following your doctor’s instructions with medications. Be sure to take your medicine exactly as directed every day. A simple regimen of reminders, either in your calendar, in the form of a note on the refrigerator, or setting an alarm on your phone, can help. Remote patient monitoring programs can also be programmed to automatically remind you. Incorporating healthy lifestyle changes. Simple modifications to your daily routines support better circulation, minimize additional health risks, and help reduce symptoms. For example, dressing in loose clothing reduces the restriction in blood flow that can cause clots. This is especially important in your extremities. For that reason, avoiding socks with a tight band at the top is important. Also, wearing layers that can be easily added or removed helps avoid extremes in body temperature. Adopting a heart-healthy diet is another key lifestyle change. That means reducing salt-intake and eating a variety of fruits and vegetables. Other heart-healthy options include whole grains, nuts, legumes, low-fat dairy products, and skinless poultry and fish. Managing your stress. The American Heart Association notes the value of meditation and managing anger by counting to 10 before responding to a situation. Good sleep habits are another key stress reduction strategy. Since CHF is linked to sleep-disordered breathing, it’s important to keep track of snoring and report problems to your doctor. Where can I get help? Your doctor’s office will provide a thorough treatment plan that will get you off to a good start. It will guide you through the various health conditions or problems your may encounter, along with a corresponding list of actions to take. Of course, never hesitate to contact your physician if you are unsure about any aspect of at-home care. For patients with multiple chronic conditions, there’s a lot to manage. This was the case for Elena C., a CHF patient in her 60s who also needed to manage her diabetes and HIV. On her doctor’s recommendation, she began working with a home health care agency. Clinicians followed up with her regularly, explaining how to detect the difference between warning signs that require an ER visit and symptoms that just need a phone call follow-up from her doctor. As a result, Elena and her family get daily reassurance and confidence that she is getting the care she needs at home. While heart failure can’t be cured, an effective home health care program that supports a more active lifestyle, positive dietary changes, stress management, and careful attention to your doctor’s treatment plan can slow the progress of the disease and allow you to enjoy life at home.