May 14, 2020|advocacy, aging, Aging Parents, anxiety, Bridge Generations, caregivers, Cognition, confinement, coronavirus, COVID-19, COVID19, customs, dementia, Depression, distance, Eldercare, elders, Fulfilling Life, Generations, Grandchildren, Grandparents, Intergenerational programs, Isolation, Loneliness, long term care, nursing homes, person centered care, Quality of Life, Sadness, Skilled Nursing Facilities, technology, Well-Being, wellbeing, Wisdom
Several weeks ago, I watched a webinar sponsored by McKnight’s Long-Term Care News entitled: Person-Centered Technology in Long Term Care. The webinar was given by Jack York, CEO and founder of iN2L, a clever acronym for: It’s Never Too Late.
I was fascinated by the ingenuity, creativity and opportunities that are available for our elder citizens in long term care, whether they be in assisted living facilities or nursing homes. Of course, the technology is certainly available for use by elders living independently in the community. These tablets go beyond use of smart phones or traditional tablets.
What is person-centered technology? Essentially it enables residents to stay connected in the simplest way possible, not only with their friends and families but also to their interests and passions, cultures, customs in a very individualized and personal way. This level of personal engagement can stave off loneliness, depression and isolation from what they used to know. Is technology the solution to personal engagement? Certainly not. But it’s a big step in the right direction. The current crisis with COVID-19 has highlighted the issue and the importance of connection for everyone, but especially for seniors in assisted living facilities and nursing homes. SENIOR CONNECTIONS MATTER!!!!!!
My recent article in McKNight’s Long Term Care entitled: Person-Centered Care is More Than A Buzz word, https://www.mcknights.com/blogs/person-centered-care-is-more-than-a-buzz-word/ addresses the concept of person-centered care. While it seems intuitively that this would be the case, this is not always how the situation plays out for many, especially our nursing home residents. The 1987 Nursing Home Reform Law (OBRA ’87) states that “each individual should be able to achieve their highest practicable level of function”; however, the delivery of care in skilled nursing facilities does not always live up to the full meaning of the phrase. It may have to do with time and staffing, or the fact that it is based on a medical model of care. Nevertheless, we need to find ways to put into practice the full meaning of person-centered care. As per OBRA ’87, individualized care plans are developed to address the needs of the individual from medical, to activities and psychosocial needs. Oftentimes these areas are addressed in routine ways and don’t fully take into consideration, or find ways of meeting, the person’s individual needs.
The Centers for Medicare and Medicaid Services (CMS), took this into account when restructuring the reimbursement to nursing homes from one based on volume and quantity of services delivered to one based on individual performance. The Patient Driven Payment Model, known by the acronym PDPM, which went into effect October 1, 2019, reflects this refocus away from the volume driven reimbursement system to one based on the functional outcomes of the individual.
The impact and spread of the virus on the elderly, and especially in our nations nursing homes, has garnered national attention. Up to that point, the residents of the 15,600 US nursing homes have been largely forgotten. It’s kind of out of sight, out of mind. They are “tucked” away in a facility, waiting out their last years or days; not given much thought or attention, albeit in cases of national emergency: i.e., Hurricanes, floods, reports of horrific abuse). These situations are usually related to a particular region where the situation occurred and therefore become part of the news cycle.
However, the pandemic became an issue in every state and thus, thrust the situation of the virus in nursing homes to one that is of national concern. As per a decree by CMS our grandmothers, grandfathers, mothers, fathers, husbands, wives, uncles, aunts, friends could no longer receive visits from their loved ones. In addition, communal activities and communal dining were discontinued. Thus, in addition to being isolation from family and loved ones, residents were now isolated from the friends and relationships they may have developed within the facility. Isolation and loneliness became a more prominent and devastating issue. How could this be addressed? CMS declared that facilities had to do their best to provide facetime interactions with families and loved ones.
Many facilities have an iPad on the premises, some residents may have smart phones or iPads, in some cases staff members may use their own devices to connect residents with families and loved ones. Because of the limitations, families oftentimes had to schedule their FaceTime calls according to staff and device availability. Depending on the number of devices available, and the number of staff available to assist with these interactions, in many cases appointment availability was limited. This situation created more anxiety and stress.
What can the iN2L tablet do and how does it facilitate person-centered care in unique and creative ways?
Firstly, the video chat application much more easily initiates a video chat between residents and families/loved ones. It is simple and easy to use through a one touch system that can save valuable staff time. Residents can not only connect with family and loved ones, but also with friends within the facility in which they are residing. An idea that hadn’t come to my mind until I listened to the webinar.
Each tablet is also preloaded with personalized 1,000 games, puzzles, movies, audiobooks and more. In this way the residents can continue to learn, have fun, relax and thrive. It can add a dimension of fulfillment, enjoyment and quality of life which truly addresses the person’s individual area of interest, cultural differences and preferences. Our multicultural elder population often do not have access to the activities from their culture which bring them joy. In addition, many of our nations nursing home residents are without friends or family. These people are isolated in unimaginable ways. The access they have to their personal preferences can have immeasurable impact on their psychological and emotional well-being. This can translate into a tremendous positive impact for the facility in general as well as for caregivers.
Residents can share special moments and stay connected with personal photos, videos, and messages sent by family members and friends. Can you imagine a resident receiving a daily AM greeting or PM message from their family or loved one, especially in their native language? Or virtually sharing a holiday meal or attending a special event?
In addition, through telehealth, residents and facilities may also offer residents the ability to interact with their healthcare provider without having to leave a facility, especially during situations as we have seen with COVID-19.
Another application for the use of the device would be for persons with dementia. A person’s like’s dislikes from food to clothing, to personal custom preferences, interests, occupation, hobbies, would be available to unfamiliar or new caregivers. This could go a long way in assuring the care the person prefers and needs and help to avoid unnecessary conflicts. This can be used in lieu of the “All About Me” or “Getting to Know Me” books that I've been advocating for residents, especially on their memory care units, or for those with reduced ability to communicate.
This is a technology approach to person-centered individualized care at its best. For those residents that may need more help learning the technology, When the time comes for nursing homes to reopen to visitation, facilities may consider initiating partnerships with high schools or middle schools so that students who would like to volunteer, or need community service credits, can help seniors either load information onto the tablet or help them learn how to use the technology.
What better way to foster intergenerational relationships. The older adults will learn valuable information from the younger person, the older person has the opportunity to pass on insights and life lessons to younger persons, and the younger person develops an understanding and appreciation for our elder “wisdom” keepers.
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