CASE STUDIES IN ENGAGING PATIENTS AND

FAMILIES TO SELF-MANAGE USING IN-HOME

TECHNOLOGIES

April 16, 2015Home Care Association of Washington

Annual Conference

Dew-Anne Langcaon, CEO iHealthHomeBrian Greenlee, RN, Program Mgr, EvergreenHealth

LEARNING OBJECTIVES

1. Understand the potential for improving the health and lives of patients through the use of in-home technologies.

2. Learn what has worked and what has not worked in real life patient case studies.

3. Identify the key elements of a successful, sustainable program

AN AVALANCHE OFIN-HOME TECHNOLOGIES

IN-HOME TECHNOLOGIES

• Personal Emergency Response (PERS)

• Tele-Health Monitoring

• Motion and Activity Monitoring

• Wearables

• Smart Homes

• Cueing and Reminders

• Robots

• Virtual Patient Education

• Individual Self-Entered Information

WHERE TO BEGIN?

CASE REAL STUDIES

3 Real Life Case Studies- Complex Care Coordination

- Home Health Remote Monitoring

- Home Care Agency

What Was the Problem to be Solved

What In-Home Technologies were Applied

What were the Outcomes

CASE STUDY #1 – MRS. BCOMPLEX CARE COORDINATION

Ho’okele Health Navigators

Honolulu, Hawaii

CASE STUDY #1: MRS. BCOMPLEX CARE COORDINATION

• 68 years old female in Hawaii

• COPD, CHF, Diabetes

• English is her second language

• Lives in public housing

• 5 hospitalizations in last 14 months – 100 days

• Unable to work

• Inconsistently follows up with PCP & Pulmonologist

• Poor medication compliance

• Lack of understanding of her diseases

• Never used or owned a computer

MR. B

• 70 years old

• Primary caregiver

• Landscaper

• Frequent reminder calls to Mrs. B from work to eat, take meds, walk,etc

• At risk for losing his job due to excessive personal calls on the job

Mr. B’s Employer• Doesn’t want to terminate Mr. B

knowing Mrs. B’s situation

• Concerned about the cost of Mrs. B’s care and impact to his premiums

• Mandates that his insurance carrier do something to help them

• Carrier pays for in-home monitoring by a private care management service

Mr. & Mrs. B’s Family

• Family lives in the Philippines

• 14 Grandchildern Mr. & Mrs. B haven’t seen in several years

• Mrs. B unable to travel due to her chronic conditions

• Mrs. B depressed and hopeless

• Family is worried Mrs. B has lost her will to live

TECHNOLOGY-ENABLED INTERVENTION

(OVER 12 MONTHS)

• Telehealth Monitoring• Bluetooth blood pressure, weight scale, glucometer

• Mrs. B taught to take her own measurements

• Remote RN regularly monitors & coaches her real time

• Cueing reminders • Audible voice reminders

• Recorded Mr. B’s Voice in Ilocano

• Timed audible reminders replaced Mr. B’s phone calls

TECHNOLOGY-ENABLED INTERVENTION

(OVER 12 MONTHS)

• Activity sensor on medicine cabinet• Tracked medication compliance and logged adherence

based on prescribed frequency and time of day

• Virtual Patient Education• Food plate with Filipino food examples

• On-Line Food Logging

• Weekly Video Coaching with RN

MRS. B’S GOALS

• Minimize readmissions due to respiratory infections

• Medical Goals Set by PCP:• Blood glucose range– 110 -130 mg/dl• HgA1c- < 6 %• Weight range– 135-137 lbs• BP range – 130/70 – 138/78

• Increasing independence with respiratory treatments, cleaning, medication adherence and biometric monitoring

• To travel to her home country to see her 14 grandchildren

MRS. B – OUTCOMES

Improved Health:

• Blood Glucose –Goal Met- 50% improvement

• HbA1c – Goal Met - decreased 8%

• Weight – Goal Met - lost 12 lbs

• BP Goal Met

• Lipids – Goal Met – 6% improvement in total cholesterol

MRS. B – OUTCOMES

Improved Self-Management and Quality of Life:

• Travelled to see her grandchildren after 6 mos

• Sustained self-management

• Walks daily

• Improved nutritional literacy & changed diet

• Learned to pre-pour own medications

• Reduced distractions for husband at work and better attendance for employer

• Able to go back to work part time

MRS. B – OUTCOMES

Improved Cost:

• First 6 months post intervention - reduced hospitalizations 20%

• 44 days (45% reduction)

• No ER Visits – 100% improvement

• Second 6 months post intervention - No Admissions

CASE STUDY #2: MRS. WHOME HEALTH

EvergreenHealth - Home Health

Kirkland, Washington

CASE STUDY #2 – MRS. WHOME HEALTH

• Mrs. W. is 91 years old

• Lives alone

• Recently discharged and receiving home health

• Hospice benefit offered, but declined by Mrs. W and family

• CHF

• 2 hospitalizations in the past year

• Son is a physician who lives in another state, Daughter lives 2 hours away

• Family hires and manages a team of caregivers privately

TECHNOLOGY ENABLED INNERVENATION

• Telehealth Monitoring• Bluetooth blood pressure and weight• Family is actively committed to keeping Mrs. W at home• Biometrics report forwarded to Cardiologist prior to

appointment• RN Coaches Mrs. W

• Timeclock Feature• Simple Clock In / Clock Out working well

• Flowsheets in the Home• Caregivers complete flowsheets from the home

to keep the family informed of all activities being completed to their expectations

OUTCOMES

• No hospitalizations for 4 months

• Seamless transfer from Home Health service to In-Home Technologies

• Monitoring RN checks Mrs. W’s biometric readings daily

• Family peace of mind with ability to monitor caregivers in the home remotely

• Mrs. W takes her own blood pressure daily and is learning to self-manage her condition

CASE STUDY #3: MR. ZPRIVATE DUTY HOME

CARE

People TrueCare

Auburn, Indiana

CASE STUDY #3 PRIVATE DUTY HOME CARE

• Mr. Z is 73 years old

• Alzheimer's

• Very physically able

• Healthy – no chronic conditions

• Lives alone on a very, large property

• Lots of heavy equipment, a wood shed, and a swamp on the property – safety concerns

• Just lost his wife of 50 years to cancer – she was his main caregiver

CASE STUDY #3 PRIVATE DUTY HOME CARE

Mr. Z’s Family

• Mr. Z’s wife had masked the severity of his Alzheimer's for years until she passed away

• 3 Kids – in Chicago, Portland & Indiana (1 hr away)

• Had no clue of Dad’s needs but knew he could not go to a facility – he loves the outdoors

• Thought he needed help during the day

• Safety is their main concern

Mr. Z’s Caregivers• Agency RN Navigator and

nurse aides

• Privately hired nurse aides

• Buddies of Mr. Z take him outside

TECHNOLOGY-ENABLED INTERVENTION

• Motion Sensors:• Learned his activity patterns

• Found he was most active at 3am and 5am

• Staffing was at the wrong times of day – adjusted and Mr. Z’s cognitive skills improved

• Virtual Communication Log:

• Agency, private hires and volunteers all documenting on a virtual communication log to collaborate and keep family informed

• Agency Personnel Documenting on Mobile Flowsheets keeping RN Navigator Informed

OUTCOMES

• Mr. Z remains safe at home for nearly 12 months after his family thought he needed to go to a facility

• Medication was changed from Respiradol to Trazadone based on patterns of behavior that caused the need for higher caregiving hours when on Respiradol

• Family peace of mind as they can view his progress on line and see his behavior patterns for themselves

• Family is able to manage the budget by mixing volunteer friends with paid caregivers all coordinated by the RN using in-home technology

ACTIVITY

• Think of a person you know who is living at home and could benefit from in-home technologies

• Fill out and Activity Sheet

• Describe your person

• What are their and their caregivers needs

• What are their personal goals

• What in-home technologies could you use to help

• What outcomes would you use to measure success

COMMON SUCCESS FACTORS

• Person-Centric Approach

• Understanding the goals of the Individual and their family

• Matching the right in-home technologies to fit the need and achieve their goals

• Family Engagement

• Include the family in the use of the technology

• Integration of Service with Technology

• It’s not about the gadgets

• Using in-home technologies as a tool for the service provider

• Simplicity of the technology – minimal training

PROGRAMMATIC LESSONS LEARNED

• Technological Issues

• Broadband connectivity – access and cost

• Medical device ease of use

• Programmatic Issues

• Work flow challenges with patient identification process

• Consent process – educating patient & families

• Staffing Issues

• Lack of time to learn and use something new

• Training

• Apprehension of change

• Legal Issues

• Security, Privacy, Confidentiality Outside the Four Walls

• Quantity, Frequency & Type of New Data Available

• Medical Legal Risk Management

KEY ELEMENTS OF A SUCCESSFUL, SUSTAINABLE

PROGRAM

• Clear Identification of Population to be Served and Quantifiable Goals and Objectives

• RNs or Care Coordinator’s Willing to Learn About the Breadth of Technologies Available and be Creative based on their Assessments

• Management Commitment to Provide the Resources

• Cost of Technologies

• Dedicated of Staff Time To Learn & Be Creative

• Training, Training, Training

• Simplicity of Use of the In-Home Technology

• Appropriate written consents

YOU CAN DO IT!

• Start Small

• Clearly Understand Your Patient’s Goals

• Dedicate A Resource

• it doesn’t have to be a lot, but must be focused

• Learn

• Be Flexible

• Pick the Right Vendor

• Just Get Started

CONTACT INFORMATION

Dew-Anne Langcaon, CEO, iHealthHome

dewanne@ihealthhome.net

(206) 317-8103

Brian Greenlee, RN, EvergeenHealth, Program Manager

bcgreenlee@evergreenhealth.org

(425) 899-3300

THANK YOU

QUESTIONS?