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4 The Health System Landscape
Pages 33-46

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From page 33...
... . Lisa Gualtieri, assistant professor of public health and community medicine at the Tufts University School of Medicine, addressed whether technology deployed by a health care system can facilitate or serve as a barrier to care for older adults.
From page 34...
... Using a broader definition of LTSS need that includes difficulty with two or more activities of daily living, requiring help with one or more activity of daily living, or severe cognitive impairment and needing help with one activity of daily living or three instrumental activities of daily living, the estimate soars to more than 20 percent of the population, or more than 7 million older adults, that requires LTSS. Having a need for LTSS, added Tumlinson, comes with a doubling of one's health care costs (Windh et al., 2017)
From page 35...
... SOURCES: As presented by Anne Tumlinson at the workshop on Health Literacy and Older Adults on March 13, 2018; Windh et al., 2017.
From page 36...
... The bottom line, said Tumlinson, is that the nation is financing long-term care primarily through the unpaid care provided by family caregivers. In addition to providing hands-on caregiving that family members are providing -- helping with bathing, eating, and dressing -- they are also doing a significant amount of management and coordination, as well as making decisions about and handling challenging financial, legal, and family issues (see Figure 4-4)
From page 37...
... SOURCE: Adapted fromLTSS leads to a wide range of decisions to make. workshop on Figure 4-4 a presentation by Anne Tumlinson at the Health Literacy and Older Adults on March 13, 2018.
From page 38...
... "Consumers are not ready to pay out of their own pockets for navigational assistance, despite the fact that they so clearly need it," said Tumlinson, and selling these applications to employers, providers, and even financial services firms has proven difficult. TECHNOLOGY AS A FACILITATOR OR BARRIER FOR OLDER ADULTS2 In the last workshop presentation, Lisa Gualtieri discussed RecycleHealth, a nonprofit organization she founded in 2015 to collect fit 2  This section is based on the presentation by Lisa Gualtieri, assistant professor of public health and community medicine at the Tufts University School of Medicine, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
From page 39...
... She and her colleagues have been using them to conduct research primarily with older adults to learn if they would accept them, use them, and, as a result, increase their physical activity level. Her organization has also worked with community-based organizations to distribute trackers to underserved populations including developmentally disabled adults and veterans with post-traumatic stress disorder.
From page 40...
... "We would provide them guidance based on their current activity level of what might be a good starting point and show them it was easy to change this setting," said Gualtieri. Her conclusion was that while smartphones are being widely adopted, that does not mean people are adept enough at using them to access the wealth of available digital health tools.
From page 41...
... DISCUSSION Crews began the discussion by asking Tumlinson to list some of the barriers she sees to further innovation in the space of long-term care support. One barrier, Tumlinson replied, is that the need for information to navigate the health care system is often not connected to the need for infor
From page 42...
... Crews then asked Gualtieri for her ideas as to what would make the older adult market attractive to manufacturers and developers. Gualtieri replied that this issue comes down to one of perspective in terms of whether it is more important to make as much money as possible or to help more people achieve their health goals and still profit.
From page 43...
... "More support for the family helps it do a better job and creates better outcomes," said Tumlinson. Koss noted that the Consumer's Checkbook in Washington, DC, and San Francisco both list local resources with provider ratings, as well as an Angie's List–type service for several health care services.
From page 44...
... "He simply did not have the skills he needed to care for her." Lindsey Robinson from the American Dental Association noted that many medications older Americans take can have a significant effect on oral health. She wondered if families and caregivers are aware of the relationship between oral health and medications and if they have a hard time finding dental care for their loved ones, particularly given that Medicare does not include a dental benefit.
From page 45...
... She noted that who pays for care is a critical issue. In San Francisco, for example, ride-sharing services are starting to bill Medicaid for ride shares to medical appointments, and that a service called GoGoGrandparent allows an older adult to call someone who will then order a ride share using preloaded information.
From page 46...
... "You need people who like each other and have something to talk about because that is motivating, and it makes it fun instead of just exercise," said Gualtieri. "You need people who have similar schedules and who walk at similar paces for something like this to work well." One thing she suggested to members of one of the senior centers where she worked was to organize car pools for walking sessions at the mall when the weather was bad.


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