A few minutes with Majd

An “Idea House” resident room equipped with technology upgrades.

Last month I was privileged to meet with Majd Alwan, PhD, director of the Center for Aging Services Technologies (CAST), affiliated with the American Association of Homes and Services for the Aging (AAHSA), during the association’s annual meeting in Los Angeles. Dr. Alwan has been with CAST full-time since 2007, and he is a leading expert in the field of emerging technologies for the senior care market.

Dr. Alwan and I met in the courtyard of the “Idea House,” on the AAHSA conference show floor. In its second year as a center stage feature of the show, the house serves as a think tank for senior living, showcasing aging-in-place design, utilization of technology, sustainability, and landscaping solutions that promote healing, wellness, and socialization. The house bustled with a steady influx of attendees and vendors touring the prototype bedroom, bathroom, kitchen, and outdoor areas.

Dr. Alwan’s main message is that these technologies have moved beyond the prototype stage and are finding practical applications and adoption in senior living settings. Here’s an excerpt from our conversation:

Sheehan: What is CAST’s message at this year’s AAHSA conference?

Dr. Alwan: Our message this year is that technologies that were a vision five years ago are no longer just visions or prototypes-they are real products on the market that service providers and seniors can integrate. And part of our contribution to the Idea House is to let consumers, seniors, and aging service providers experience these technologies-not just see them on an exhibit table but see them and experience them in a live setting. We can move beyond the imagination hump and start thinking about how we can deploy these technologies in our homes and facilities and how we can integrate the data that the technologies provide into streams of services to support independence and improve the quality of life and care for the senior population. There’s a push for broader adoption of appropriate technologies that address real needs for seniors and their caregivers.

Sheehan: Which technologies are starting to take off in terms of practical application?

Dr. Alwan: I look at this from two perspectives: From the consumer perspective I think we’re seeing the products that keep the older adult socially engaged and entertained-mentally as well as physically stimulated-these are taking off very quickly. From the provider perspective, we see technologies that are more needs-driven-to help in the management of chronic conditions. We see remote monitoring of behavior and activities of daily living as well as monitoring for safety-for wandering, falls, forgetting to turn off the stove, etc. From the provider perspective as well you see the increased adoption of electronic documentation, telehealth, and electronic health records.

Sheehan: Do you find this market resistant to adopting new technologies?

Dr. Alwan: I think there are two things: Initially some of the products and prototypes did not really take into consideration some of the nuances and characteristics of the older population in terms of usability, ease of installation, etc., so that definitely has been an aspect. Another factor has been the cost and who pays for these technologies. For some of these technologies-especially the ones aimed at healthcare-there is a sense that they need to be covered by insurance or by Medicare or Medicaid and that’s not only the technology part but also to cover healthcare professionals’ time at the back end reviewing the data and recommending appropriate interventions.

Sheehan: How do you work with technology vendors? Do they come to you or do you seek them out? And, does CAST confer some kind of seal of approval for featured vendors?

Resident bathroom within AAHSA’s Idea House outfitted with various technological improvements.

Dr. Alwan: We reach out to vendors who are producing technologies that target this market segment, both the consumer as well as their caregivers, their care professionals, and aging service providers who are part of AAHSA, which interacts with many of these stakeholders. In some cases vendors or new players who come on the market identify us and want to work with us. We do not really provide a seal of approval. What we do is generally raise awareness of available technologies, identify the applicability of these technologies to certain issues that the senior population may experience, and identify the suitability and capability of those types of solutions to the different care settings. We also conduct research to show or document the efficacy and effectiveness of these technologies and identify barriers to their adoption while advocating to remove these barriers.

Sheehan: Can you describe some of the barriers?

Dr. Alwan: I think with the healthcare-oriented technologies, one of the bigger barriers of course is reimbursement for not just the technologies but for the time of professionals who will be engaged in reviewing activities. The other barrier is of course the consumer market; it will require starting with the want rather than the need, because if people want something they will pay for it out of pocket. You are not waiting for the reimbursement or for somebody else to say they’ll pay for this. And that could be a strategy for getting these technologies out-and that’s why you see that the fastest growing segment on the Internet are seniors-they are adopting smart phones and iPads as fast as the younger generations. In one of our studies we found 80% of participants use a cell phone regularly-and the average age is over 73 years. And those are low-income seniors who go to a senior center for nutrition assistance. But they have cell phones.

Sheehan: Are there some specific technologies you find exciting and innovative for the long-term community?

Dr. Alwan: Yes. In the Idea House there are three major technology categories. One is aimed at safety; you’ll see the quick-stop solutions-for example, a device that detects an unattended stove and automatically turns it off. Another category offers solutions aimed at improving social connectedness-basically, software applications with super-easy user interface for audio/video calls, e-mail, Web access, and in some cases they also connect with the caregiver and allow the administration of basic wellness questions and medication reminders. The third area: As you know, with seniors, there is a significant denial of need. So if you want to give someone a personal emergency response system or a monitoring system they’re not going to like it. But these types of engagement and social connectedness applications are really fun, easy to use, and they [seniors] get used to using them and then they become sticky-meaning they become a want-and they use them regularly. So some companies are actually using that paradigm to layer or integrate the social capabilities with the safety and wellness and health monitoring capabilities.

Sheehan: What do you see as CAST’s role in the long-term care industry as 2010 draws to a close?

Majd Alwan, PhD

Dr. Alwan: As we wrap up 2010 we have made significant accomplishments, including advocating for a national study to evaluate the potential benefits of aging services technologies and identifying barriers to their development and adoption. We look at the experience of other countries with these technologies-what innovative development models they’ve employed and what innovative utilization, reimbursement, and payment models they have in place that we can learn from. That [study] was part of the American Recovery and Reimbursement Act last year. The study will end with recommendations to the Department of Health and Human Services and in turn recommendations for Congress on strategies to remove the barriers.

There are some interesting lessons to be learned from other countries. The European Union has made far more significant advancements in the research of these technologies over the past few years. The United Kingdom has a national initiative to integrate technologies into operational models. There’s a lot to be learned from them.

Sheehan: Any final thoughts?

Dr. Alwan: My message is that these technologies are here. The landscape of healthcare and service delivery is changing; that’s evidenced by healthcare reform and the push for electronic health records, etc. And the change is going to accelerate, especially since technology is becoming more pervasive, it’s becoming part of everyday life, it’s becoming cheaper, and it’s becoming faster, so the adoption of technology and the data floating around us is accelerating. We need to talk seriously about changing the way we do business. Seniors desire to remain at home. We need to be thinking about enriching our service offering with technology-enabled home-based services and care delivery models.

Long-Term Living 2010 December;59(12):23-25

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