August 2015: Aging in Place with Assistive Technology

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The Case for Essential Assistive Technology


" "Chapal Khasnabis, WHO Officer with the Public Health and Innovation Team, considers how the global trend toward population aging requires a new health care priority: access to “essential A.T.”

Over the course of the 20th century our health intervention model developed to emphasize preventive and curative measures with a side interest in promotive, rehabilitative, and palliative approaches. Today, however, it is 2015 and we need to add “assistive” to this model. Communicable diseases are on the decline; traffic injuries and noncommunicable diseases (cancer and diabetes) are on the rise, and the biggest trend of all is population aging. Around the world people are living longer irrespective of their health conditions, and yet we are still operating within the 20th century health delivery paradigm.

Our outdated paradigm

Our 20th century health intervention model presumed an under-age-50 demographic. This is because people used to die early. There was a big problem with access to vaccinations and treatment, and as result, health products in the last century were vaccines, medicines, and medical devices. For the 21st century, however, we must presume a population spanning ages 0 to 100+. This is why I’m advocating within the World Health Organization for a fourth category of health products--assistive products--and that health technology should embrace assistive technology now more than ever. We all lose functioning as we age, and if the 21st century is about living long, then we will need access to more products and technologies that can help us to live independently and productively.

"Disability" changes with aging. Services must change too. 

Our 21st century aging population also changes how we commonly think of/experience “disability,” and implicates how we now provide services. Pathology, perception, experience, and morbidity today are unique compared to the last century. In the last century we spent a lot of time making orthotics for survivors of polio. But the experience of someone aging and moving in the direction of disability is very different from someone who has been living with polio or any kind of disability as result of an illness, an event or since birth. With important exceptions, most people living with a disability experience disability within a single domain: physical, sensory or cognitive. As individuals grow older, however, disability becomes multi-domain; loss of function may occur across mobility, hearing, vision and cognition. No longer is it reasonable to send people to different clinic locations to take care of each functional limitation.

Indeed, broadly speaking, we must think differently about the provision of health interventions in the 21st century. We estimate one billion people need assistive products globally. By 2050, however, the need is expected to be felt by two billion. Are we ready for it? Even if we had all the money we needed today, we cannot buy this many products. Indeed, we know the industry and professionals are not ready, and neither are the education or health systems. We say just 10-15% of those who need assistive products currently have access. And very few of the countries that ratified the Disability Treaty (CRPD) make mention of assistive technology in their reported actions taken thus far.
Egyptian pyramid with line designating the tip for current market beneficiaries.

Enter GATE!

This is why, in 2014, WHO created GATE, the Global Cooperation on Assistive Health Technology initiative. GATE’s mission is to further global access to assistive products and services (and help realize article 32 of the CRPD). It convenes leaders from international organizations, service providers, user groups, academia, industry and government. Together, these stakeholders are targeting four areas for action: 
  1. Policy: through research and advocacy;
  2. Products: by promoting the availability of high-quality, affordable, priority A.T.;
  3. Provision of services: by developing a model for local one-stop access to a broad range of A.T.; and 
  4. Training: by developing models for generalized and specialized A.T. training. 
GATE’s mission may look formidable, but there are important lessons to draw on from the past, particularly for creating access to affordable medical products. Current major barriers to accessing AT are lack of availability, high cost, lack of awareness and apathy. It’s similar to the poor access to medicines we witnessed in the 1960s and 70s. At that time there were few pharmaceutical companies, many over-priced products, and medicines accessible only to those with a good income. Then in 1977, WHO introduced the concept of “essential medicines” and created the WHO Model List of Essential Drugs. It has been credited with spurring what amounts to a “peaceful revolution.” The first list identified 208 medicines to treat the majority of diseases, and has since been revised many times as the WHO Model List of Essential Medicines (EML). The EML led to governments investing in pharmaceutical innovation and technology transfer, absorbing research and development costs, and changing the global marketplace. Some product costs came down nearly 80%. It’s one of the key reasons why, today, people are living longer.

WHO's Model List of Priority Assistive Products 

Based on the EML experience, WHO is now promoting a parallel initiative for the provision of AT, and GATE is helping to move it forward. The Model List of Priority Assistive Products will identify the 50 most essential assistive products necessary for basic health care and social welfare. The WHO process for identifying these 50 Priority Assistive Products is research and consensus-based and includes both a Delphi study with experts as well as a global survey to include users. 

Divided into six AT categories, the list will serve as a guide for the development of National Priority Assistive Products Lists by CRPD member states. It is a starting place for the provision of A.T. and meant to establish a minimum provision for access, not restrict potential users from the broader range of products as identified by the CRPD. The list should be adapted to the needs and resources of individual nations, but its philosophy and principals will be relevant to all.

Three women of different ages and nationalities using A.T. for education, employment, and community inclusion.

There’s a common misconception that this trend toward an aging population is a problem for high-income countries only and not a global issue. But there is a little gap among nations and that gap is closing very quickly. The real difference is the time and resources nations have to prepare for this demographic shift. Wealthier countries, like France, have experienced this shift over 100 years. In Thailand and China, however, it is taking just 20 years, due, in part, to the rapid advancement of the health sector. GATE’s approach to providing leadership on policy, products, services, and training can go a long way toward providing guidance to less-resourced countries who will rapidly face these new challenges. And it will help wealthier nations, too, as they prepare for drastic increases to their aging population. 

21st century health provision must include assistive and supportive services and products if we are to respond to the needs of this era. The current model of service delivery will not work for populations that are 25-35% aging. An aging population experiences a gradual multi-functional decline that cannot be prevented, cured, or rehabilitated.  As it stands, 90% of those who need A.T. are living in poor health, unable to participate in their communities, locked in poverty. Establishing a Model List for the Provision of Priority Assistive Products helps create a baseline expectation for the provision of A.T. in support of human dignity.

Chapal Khasnabis is the chief architect of the global initiative to improve access to assistive health technology (GATE). He is a prosthetic/orthotic engineer by profession and currently serves as a technical officer in the Public Health and Innovation Team in the Dept. of Essential Medicines and Health Products of the World Health Organization. ATPN developed this article based on his keynotes for RESNA 2015 and ISPO 2015.

A.T. in (its) Place


" "North Dakota's 
Interagency Program for Assistive Technology (IPAT) Reaches Seniors Where They Live

North Dakota IPAT’s outreach to seniors has evolved dramatically since ATPN last reported on their efforts in 2011. At that time, IPAT focused on providing and setting up devices, like automated medication dispensers using Older American Act funds through an agreement with ND Aging Services. What IPAT found, however, was that even with outreach and coordination via different aging services providers, most seniors still did not understand how A.T. could fit into and benefit their lives.  “Even Hands-on opportunities at IPAT demo centers in Fargo and Bismarck would only go so far,” observed Peggy Shireley, IPAT Senior A.T. Consultant. Seniors, it became clear, needed more than simple exposure to gadgets.  “They needed to see how A.T. could improve their whole environment.” 

The realization led to a new IPAT initiative called Home First. In the following years, IPAT would grow Home First; each program iteration inspired by listening carefully to the seniors they serve.

Home First Assessments

Home First began as a new fee-for-service activity to provide in-home A.T. assessments and identify equipment and strategies that could benefit each individual. Shireley says talking to seniors about A.T. in their homes was profoundly different from IPAT’s centers. “They really got it. We went into their homes and the light bulbs turned on. They told us over and over it makes so much sense now, and that before they hadn't known where to go to learn about all this stuff. And they asked where they could go to learn more!"

Home First’s Fargo Showroom

Those reactions got IPAT staff thinking. Since fee-for-service assessments could only ever reach so many households (and mostly those who could pay), what was needed was a home anyone could visit to see A.T.. Consequently, IPAT made designing an age-in-place showroom a priority. They creatively stitched together resources, and in 2012 opened the IPAT Home First Showroom in Fargo. Laid out like a house, the new space includes a bedroom, bathroom, kitchen, living room, dining room, and den… all equipped with A.T. "Compared with our demo centers, the Ah Ha moments just quadrupled," Shireley reports. “Visitors really understood how devices could work for them once they saw the A.T. in its context.”

Indeed, the Fargo showroom spiked demand for device loans, generating numbers that soon contrasted starkly with IPAT's Bismarck location. And it became clear that a second showroom was needed. Funding for a further expansion, however, just wasn’t available. So IPAT came up with another creative solution...

The Home First Showroom iPad App!

Shireley would like a showroom in Bismarck, but in the meantime the Home First Showroom iPad App offers a stop gap measure in the virtual world. The app allows users to virtually visit each of the six Home First Showroom spaces and click on devices to learn more. And while a second showroom would provide a hands-on experience, the app is proving to be a different kind of age-in-place awareness tool. “It’s free and so we’re promoting it with not only case managers to use with their clients, but also family members to use to start conversations with loved ones.” And with no cost attached, Shireley observes, anyone can use it to learn more about A.T. for aging in place, and that includes A.T. programs in other states. “It’s a tool that can spark ideas with seniors and families well beyond North Dakota.” (Download the IPAT Home First Equipment Listing PDF)
For the future, IPAT intends to keep listening to the needs and wants of ND seniors. “The timing is right for this focus,” Shireley reflects. Back in the early 2000s, IPAT did a study that demonstrated how cost effective A.T. could be toward helping individuals avoid out-of-home placements. "Since then, I imagine those numbers would look even better; the cost of out-of-home placements has gone way up while the cost of technology has come way down." The timing is also right, she realizes, because of the demographic shift that looms with the aging baby boomer generation. "We know that the baby boomers are going to put whole different demands on every service provider, and they're not going to be afraid of technology. They're going to want and expect A.T.! They're going to ask a whole different set of questions, and we'd better be ready."

Statewide Fall Prevention Coalition Opens New Doors for Iowa's Program for Assistive Technology (IPAT)

" "
"AT is a part of everything" Jane Gay, Director of the Iowa Program for Assistive Technology, likes to say. And fall prevention is no different. From grab bars and shower benches to rollators and home modifications, A.T. can make a big difference toward preventing falls among older Americans; and nationally we are wise to pay attention. 

According to the CDC, falls among older adults are the leading cause of fatal and nonfatal injuries, and their cost in direct medical expenses was $34 billion in 2013 alone. Yet while fall prevention has become a national issue drawing public and private funding over the last 10 years, A.T. has yet to emerge as a major strategy.
For Gay, this partial blind spot amounts to an opportunity. IPAT has valuable information and services that fall prevention stakeholders will want to know about and deploy. Back in 2011, Gay became a member of a fall prevention task force in Johnson County that was spearheaded by the Visiting Nurses Association. The partnership led to the creation of outreach displays on A.T. and home modifications for use at conferences and other venues (read the details in this 2011 ATPN article). It also led to new program relationships with the Homebuilders Association and even a plumbing supply company. ("I love to work this way, making new connections," she muses.)
Since then, IPAT has joined Iowa's statewide Fall Prevention Coalition and used this CDC-funded effort to bring IPAT information and outreach to whole new networks of providers and state agencies. The Coalition has been charged with implementing specific evidence-based fall prevention initiatives (the National Council on Aging's Matter of Balance and Stepping On, and the CDC’s STEADI) through lead agencies that include the Dept. of Public Health and the Dept. of Elder Affairs. Gay saw an opportunity to introduce IPAT program materials and fall prevention outreach templates to the national trainers of these strategies as well as those they are training on the state level to carry out the programs. The result was her own break-out session at the statewide fall prevention conference in July, "And introductions to people who are, frankly, hard to get."
These new networks include nurses and home care workers, exactly the providers she wants to make sure know about IPAT services. She has also sparked interest with Iowa Emergency Medical Services for their own IPAT training. ("They are the first providers on the scene after a fall, and see an opportunity to talk to people about home modifications and AT services right from the start!") Additionally, there are the fall prevention trainers who work with hospitals as well as state agencies, relationships that have Gay thinking ahead about policy advocacy. 

Medicaid, she notes, is moving to managed care in Iowa; and the more the statewide coalition understands the impact A.T. can have to prevent costly falls, the more likely they may help to, as she puts it, "sing this [policy advocacy] song with me." At present, she explains, A.T. is covered under Medicaid waivers, but not routinely as covered DME. "Yet a $139 bath bench is a lot cheaper than a fall." In the very least, the hospitals should have a vested interest in making referrals for A.T. and home modifications, if only to reduce the readmissions that bring down their Medicare reimbursement rates.
Most states now have a statewide fall prevention coalition. Creating them has has been an advocacy effort of the National Council on Aging (NCOA) since at least 2005. Fall prevention funding from the CDC's National Center for Injury Prevention and Control doubled in 2009 (and subsequent years) to $2 million. In 2014, $5 million was allocated for fall prevention from the Affordable Care Act's Prevention and Public Health Fund to the Administration on Community Living's Agency on Aging. The state-level grants were announced in the fall of 2014

You can find your statewide fall prevention coalition at this NCOA web page. NCOA has also created a toolkit for the September 23rd, 2015 Fall Prevention Awareness Day.  Finally, email Jane Gay if you’d like to adapt IPAT's A.T. for Fall Prevention poster templates (they are generic and unbranded for use by any state and program).

Gerontechnology for Aging in Place


by Sheena Jaffer, CASP, CAPS 

Sheena Jaffer smiling
Just about every senior I have spoken with in recent years aspires to age at home surrounded by family and memories, while living independently. Indeed, older Americans are increasingly looking to their communities for more support as they age, creating an expectation/ demand for “livable communities,” as well as solutions for “aging in place.” The trend, however, is not only driven by the preference for staying put, it’s also about baby boomers now entering retirement and the reality that many have limited options and/or resources. Indeed, the Census Bureau estimates that by 2030 there will be almost 80 million people over the age 65 in the U.S. alone, and numerous aging resources estimate only 7 to 10% will live in retirement communities, nursing homes or similar facilities. Given our rapidly aging society and this era’s tidal wave of technology, it should hardly be surprising, then, that one fast-developing area of innovation is now known as “gerontechnology.”

The term “gerontechnologies” was first coined in 1988 to designate devices that compliment or supplement the needs of an aging society by ensuring health and wellness, safety, social participation and independent living. As with A.T., gerontechnology can be a low level of technology, such as a grab bar, or a high technological device, such as a wander management or remote patient monitoring system. Recently I had the opportunity to research the breadth of gerontechnologies now emerging for an aging program I undertook at Johns Hopkins University. I was amazed at the range of gadgets aimed to facilitate aging in place, including those related to the Internet of Things (IoT)
The Internet of Things: “The interconnection via the Internet of computing devices embedded in everyday objects, enabling them to send and receive data”
The Internet of Things offers mind-boggling connectability through WiFi on data points such as fridges, doorways, smoke alarms, bed and toilet, even the physical self … all of which may be used for the aging-in-place market to make our lives better. Innovators are also leveraging “connected aging,” a term implying the popularity of Internet and mobile devices that address a range of social, wellness, safety and functional needs of older adults. Many see a huge market looming with aging boomers who are increasingly tech savvy. According to Cisco, in 2013 there were 13 billion Internet connected devices, and this number is expected to grow to 50 billion in 2020.

Some of the devices that I am fascinated with and feel are potentially promising  include safety, health & wellness, and social technologies. Today’s connected gerontechnology marketplace includes devices such as glucose and heart rate monitors, oximeters, medication management systems, fall and wander detectors, remote monitors/sensors, and smart patches. In addition to reducing caregiver costs, these technologies have the capability of providing better care coordination, an enhanced sense of security, prolonged independence, and a better quality of life. 

Below are three interesting examples:

1. Remote monitoring from Healthsense.

Cross section of an apartment mapped with sensor locations. A third of aging baby boomers are expected to need help with activities of daily living (ADLs) by the time they are 80 years old. The Healthsense monitoring platform tracks ADL’s using wireless sensors around the home (bed, doorway, toilet, and more). The sensors gather information and compare daily behavior with expected patterns (such as length of time in bed, an open front door, etc). The system provides updates and alerts to caregivers for proactive action for health and safety issues and claims to have significantly reduced visits to the emergency room in a pilot study.

2. Continuous glucose monitoring from Dexcom

Dexcom receiver and smartphone app. Dexcom includes a sensor worn by the user that sends data to a receiver in the home. The receiver may also be connected to a family member’s mobile device. In this way, glucose levels, trends and data may be shared between the person with diabetes and an interested third party. Continuous monitoring makes it easier to adjust behavior and acute problems may be more easily avoided. 

3. Independa

Woman with remote in front of T.V. with interactive screen displayed.
Social-connectedness technologies is another area of gerontechnology that looks promising and Independa is one unique example. Independa’s platform is TV-based and embeds remote care with tools for social integration. Provided are access to video calling (via Skype), access to Facebook social media, and safety and wellness features such as reminders for medication, appointments, and social engagements. In addition, it has the ability to interface with devices such as glucometers and blood pressure monitoring devices. It even serves as an emergency alert system or a door sensor. Their virtual alert management system will text, email or even call 911.  

Gerontechnology is a burgeoning new marketplace. Today and in the future there will be many competing solutions for the various aging-in-place interventions. But one important factor that must be comprehended by all technical experts, as well as family members, is that each individual is unique, and one size does not fit all. In the end, I believe that every individual is the best person to determine his or her needs, and simplicity and ease of use will always win the hearts of the end users. 

Sheena Jaffer works with the Assistive Technology Program for the District of Columbia, and directs the Assistive Technology Financing Loan Program. 

ATIA Conference Discount!

ATIA 2016

ATIA, the Assistive Technology Industry Association, is holding its annual Orlando conference and expo on February 3-6, 2016 at the Caribe Royale All-Suites Resort and Convention Center. This year there is also an expanded offering of 1 and 2 day pre-conference seminars on February 2nd and 3rd.

Catalyst Project AT Act Entities receive 5% discount off the main conference with discount code: APD6

ATIA's conference and expo features more than 100 exhibitors of the latest products and services as well as valuable educational programs strands.

Learn more about ATIA 2016
Review pre-conference offerings 

New Product Spotlight: SkyBell

Robert Krollman, Assistive Technologist-Aging Coordinator with the Virginia Assistive Technology System writes ATPN that their program is beginning to make use of SkyBell with seniors. 
SkyBell device and smartphone with SkyBell display.
SkyBell is an example of the Internet of Things. It's a doorbell that connects to WiFI and your smartphone. SkyBell incorporates a video camera, motion sensor, microphone and a speaker so that users can see, hear and speak to visitors from an iOS or Android mobile device. Leaping up for the doorbell is one common way that many seniors fall at home. SkyBell can allow users to remain seated as they respond to the door. It may also provide peace of mind for caregivers and family members. Learn more about SkyBell.

Further Resources: Aging/Elderly


From the RESNA Catalyst Project

Consumer brochures, training materials and reports on A.T. for Aging/Elderly are available at this webpage.
Reminder: AT Program News, the RESNA Catalyst Project and the Administration on Community Living (ACL) make no endorsement, representation, or warranty expressed or implied for any product, device, or information set forth in this newsletter. AT Program News, RESNA Catalyst, and ACL have not examined, reviewed, or tested any product or device referred to in this newsletter
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. Content may be reproduced for non-commercial uses!