Home is Where the Innovation Is: Keeping the patient as the nucleus of an interdisciplinary team

Eliza Pippa Schulman Eliza_Shulman@atriushealth.org
Mary Ann O' Connor MaryAnn_O'Connor@vnacare.org
Richard Rakowski rrakowski@medicallyhome.com
Pamela Ressler pkressler@gmail.com

Abstract

“In your home you’re safe, you’re free…home means happiness, quietness, protection. If you’ve been away and walk into your home there’s a feeling there, especially if you come from a hospital, when you step in that door…I can’t explain it…maybe it’s like going to heaven someday.”

Research suggests that for many chronic conditions, the care patients can receive at home or in the community is of higher quality and safer than what they would get in a hospital, particularly for acute exacerbations of chronic disease. Yet, despite a common desire and strong preference to age and receive care at home, adults over 65 are frequently hospitalized; a third of Medicare spending is related to hospital costs.

Patients are at the center of the work to transform home care, and bringing their voices into the design of novel models of collaborative care is critical. Interviews, focus groups, and published research with older adults routinely show that people want to avoid hospitalization and stay at home to maintain autonomy, independence and functional status. Unfamiliar routines associated with hospitalization exacerbate cognitive and physical decline; being home ensures mobility and cognitive engagement. Keeping people connected to the elements of normal life – whether family, pets, or familiar settings – maximizes patient dignity and engagement in their own care. Institutionally-based sites of intervention (e.g. hospitals, rehab facilities) are alienating and enhance patient views that someone else is “in charge” of their recovery.

This conversation will spark discussion on the home as a site of innovation, the need to move beyond monitors and sensors and into smarter relationship-based care supported by technology and the need for patient led, interdisciplinary, and technology supported teams.

Panelists include:
• Everyone Included will take on expanded meaning as we virtually bring in a homebound patient with a fierce desire to age in place. She will join us from her living room alongside her nurse
• A venture capitalist launching his second home-based startup, driven by the experience of caring for aging parents in a harmful medical system
• A CEO of a leading home care agency and former home care nurse who sees the opportunity available for care system transformation, and
• A primary care physician and geriatrician who has come to understand that you can never really know your patients until you can see them at home.

Innovation in home care must address key needs for older adults while using smart tools to provide scalable solutions. As one of our patients said “I didn’t know I was old until [hospital admission] …I’d rather die than go back.” The multi-billion dollar smart home market is targeting older people, often without including them in the design process or understanding what their needs truly are. We believe it’s worth turning our attention and our resources towards the home if we want to truly improve one’s quality of life.
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