There has been a lot of recent discussion about the potential for various home care technologies to allow for aging in place as well as for cheaper treatment of chronic diseases, often through greater patient self-management. A recent Rand report provides a synthesis of the issues surrounding having this vision reach its potential. (Rand Paper) The report is focused on technologies and associated solutions and not on professional services or durable medical equipment. It discusses the experience of six countries: the United States, Germany, France, the UK, China and Singapore.
The report begins by noting several key factors that are creating the opportunity to look at greater management and treatment of health at home. Those factors include the high cost of care in institutional settings, the shortage of many types of health care professionals, the aging of the population, changes in the family which make family caregivers less available and the desire of the elderly to live independently for as long as possible. Key obstacles that may hinder such a transition to more care in the home include the reservations among the current generation of the elderly about use of technology and a lack of familiarity and comfort with technology, concerns about cost, poor training and education, concerns about being isolated and having less human contact, privacy issues and fears of stigmatization.
Providers also have evidenced limited support for these technologies, largely because of unfamiliarity and also because of concerns about clinical effectiveness. They may have economic concerns around being displaced to some extent and about lack of integration into a patient’s overall plan of care. Reimbursement is generally unavailable for many of the monitoring and other technologies which would assist with care in the home, particularly because such use is ongoing as opposed to a set encounter. Payers also are unsure about the impact of such technologies on health and cost outcomes. This report provides a great summary of the issues and lays a foundation for policymakers and others to consider how to remove barriers and enable what appears to be a lower cost approach to treating the needs of the elderly and chronically ill.