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Nursing homes for all: why aged care needs to reflect multicultural Australia

Do nursing home staff know and respect your cultural background or language? Here’s why that’s important.
from www.shutterstock.com

Helen Rawson, Deakin University

This week, the aged care royal commission looks at diversity in aged care, an issue becoming increasingly relevant to both residents and the staff who care for them.

Diversity includes gender, sexual orientation, religion and social background. The issue is important because if we aim to offer older people and families choice and control in aged care, we must meet the diverse needs of all older people.




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Our culture affects the way we look after ourselves. It should shape the health care we receive, too


Australia’s rich diversity is reflected in its older population. In 2016, more than one-third (37%) of Australians aged 65 and over were born overseas and one-fifth (20%) were born in a non-English speaking country.

These figures have increased continually since 1981, when one-quarter (25%) of older people were born overseas.

Diversity within diversity: culture and language

Culture is important for every person. It indicates a way of life based on customs, beliefs, language and experiences shared with family and a wider community or group.

According to the Federation of Ethnic Communities’ Councils of Australia, many people from culturally and linguistically diverse backgrounds don’t want to move to a nursing home. This is for a number of reasons.

They may not want to be away from family and community, they might speak a different language to staff and other residents, and homes may not understand or meet their individual cultural needs.

Our previous research showed living in an aged care facility could make some older people feel disempowered. Language and cultural diversity can further add to that disempowerment. For the older people we studied, communication, companionship, and staff knowing them as individuals was very important.




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Language is particularly important for older people’s physical health and well-being. Many culturally and linguistically diverse older people say they speak English well. However, with age and cognitive decline, they may lose the ability to communicate in English and revert to their first language.

And as more than half of nursing home residents have dementia, with the associated deterioration in language and cognition, communication can be more difficult still.

Appreciating someone’s cultural background can help residents make friends.
from www.shutterstock.com

Being aware of their peer’s culture and language can help residents build relationships with each other, family and staff.

Different cultural expectations and language barriers can create misunderstanding and resident and family dissatisfaction. This can affect residents’ care and quality of life.




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How to check if your mum or dad’s nursing home is up to scratch


How can we support appropriate care?

Aged care needs to be responsive, inclusive and sensitive to a person’s culture, language and spiritual needs. So it is important for nursing homes to understand those needs.

For those who are culturally diverse, government-funded support and culturally specific nursing homes can help. These include services for Greek, Italian, Dutch, Jewish and Chinese older people, reflecting post-war migration.

However, organisations like these cannot meet everyone’s needs. So all residents need care that respects cultural and social differences, works with older people and family, and supports choice.




Read more:
What do Aboriginal Australians want from their aged care system? Community connection is number one


What might appropriate care look like?

Staff need ongoing cultural competence training to deliver appropriate and supportive care.

Staff cannot know everything about the many cultural and language groups in Australia. They can, however, practise in way that is culturally appropriate, by:

  • never making assumptions about someone’s culture, heritage, language or individual needs. No two people are the same, even if they are from the same culture and language background

  • talking to the resident with an interpreter, if needed

  • learning what is important to the resident. For example, staff could ask family members or close friends to bring in photos or mementos important to the older person

  • talking with family of residents who are unable to communicate in English to make a list of key words or phrases for staff. This could include how to say “hello”, or how to ask “are you comfortable?”, or “are you in pain?”

  • making sure the older person isn’t isolated in the nursing home. This could involve working with the local community of the person’s culture, and asking for volunteers who could come and visit the older person.

Family members can be a huge help to staff in understanding the resident’s language, culture and preferences.
Nadya Chetah/Shutterstock

Appropriate and respectful aged care is a human right

Culture and language diversity in aged care is a fundamental human right. Embedding diversity in all aspects of aged care is also recognised by government, and in how the quality of aged care is assessed.

New aged care quality standards, which came into effect this July, include being treated with dignity and respect, with identity, culture and diversity valued, and all residents able to make informed choices about the care and services they receive.




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Nearly 1 in 4 of us aren’t native English speakers. In a health-care setting, interpreters are essential


If the outcomes of this royal commission are to benefit Australians now and especially in the future, older people from culturally and linguistically diverse backgrounds must not be an afterthought in the aged care discussion. They must be part of the planning.The Conversation

Helen Rawson, Senior Research Fellow, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

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Joseph Ibrahim, Monash University

As of July 22, the total number of COVID-19 infections nationally was 12,896, with 128 deaths. This figure includes 43 aged-care residents.

In Victoria, at least 45 aged-care facilities have now reported outbreaks, with about 383 positive cases in the sector overall (including among staff).

St Basil’s Home for the Aged in Fawkner and Estia Health in Ardeer have the largest number of cases: 73 and 67 respectively.

Although these outbreaks don’t compare to what we’ve seen internationally, the rising case numbers within Victorian aged-care homes are of grave national concern.

We’ll need a concerted community effort to arrest this looming disaster.


Read more: Why are older people more at risk of coronavirus?


Aged care was in crisis even before COVID-19

The interim report of the Royal Commission into Aged Care Quality and Safety laid bare the system failures in the provision of aged care in Australia.

These deficits include workforce and skill shortages. A report on the sector’s performance between October and December 2019 found around 20% of facilities audited did not meet standards in “safe and effective personal and clinical care”, while 13% fell short on the measure of a “safe, clean and well-maintained service environment”.

This makes aged-care homes highly vulnerable to any external disaster.

Several other factors set the scene for infection transmission in aged care, including its design. Residential aged care is intended to provide a home-like physical environment. While this serves an important purpose, it means aged-care homes may be missing some clinical features needed for optimal infection control, such as prominent placement of multiple hand basins.

Aged-care homes are designed differently to clinical settings like hospitals. Shutterstock

Communal spaces and a high volume of foot traffic (residents, staff, external contractors and visitors) also increase the risk of infection, while some residents have shared rooms and bathrooms.

And residents have a range of cognitive and physical disabilities that can make it difficult to adhere to the fundamental infection control measures of social distancing and handwashing.

COVID-19 and the elderly

We had early warning of the catastrophic effects of COVID-19 in aged-care homes in March and April from countries like Spain and Italy, which saw widespread outbreaks and deaths in nursing homes.

While roughly one-third of COVID-19 deaths in Australia so far have been aged-care residents, a review taking in 26 countries found this group has accounted for almost half of coronavirus deaths.


Read more: Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers


Severe illness and death from COVID-19 is more likely in older people because they tend to have lower immunity, less biological reserve and higher rates of chronic conditions such as type-2 diabetes, high blood pressure, heart failure and renal disease.

One study found the case-fatality rate — the proportion of people who get COVID-19 who will die — is 33.7% for aged-care residents.

Avoiding disaster

We need a coordinated, standardised, compassionate, supportive response to prevent premature deaths, and to minimise psychological harm to residents, families and staff.

Different aged-care homes will need different strategies to suit their varying circumstances. For example, facilities located in areas without community transmission, such as South Australia, will be different to those where there’s community spread, like in NSW and Victoria. And the needs of those homes with an active outbreak, such as St Basil’s or Estia Health, will be different again.

But broadly speaking, I believe these four key pillars are applicable to all aged-care homes.

1. Stop COVID-19 entering

In areas where there’s community transmission, all aged-care homes should be put into lockdown, with tight controls at entry and exit points. This should be done as humanely as possible, for example by creating teams to keep residents connected to family and community, and with exceptions for essential visitors.

Staff should be tested routinely and counselled about limiting contact with other people outside the workplace. Staff should also only work in one facility, and be allocated the same group of residents (to minimise the number of contacts in the event of a confirmed or suspected infection).

Finally, the development and provision of specific guidance, training and support around the use of personal protective equipment (PPE) is essential. Individual homes should be supported to engage experienced infection control nurses to train staff if possible on site.

We’ve known since early in the pandemic that older people are more susceptible to COVID-19. Shutterstock

2. Be prepared in case it does

Every aged-care home in Australia should have a “risk and readiness” rating to determine the likelihood of a COVID-19 outbreak and the facility’s ability to prevent and manage an initial infection.

This would include factors such as the experience and size of the aged-care provider, location of the facility, the size and structure of the building, ventilation, access to open spaces, the residents’ profile, staff numbers and skills, and past performance in accreditation audits.

And each home should have designated vacant rooms to be ready for isolation of any suspected cases.

Finally, the government should establish a national rapid response and advisory team dedicated to the management of aged-care homes during COVID-19. This would strengthen existing public health response units and should include clinicians with expertise in aged care.


Read more: Our ailing aged care system shows you can’t skimp on nursing care


3. Respond quickly and decisively when an outbreak occurs

Aged-care homes along with public health units should have protocols for coordination of their on-site response, with clear lines of accountability for action and escalation.

They should rapidly separate residents when an outbreak occurs, rather than relying on a continued usual model of care with the addition of PPE.

Aged-care homes require productive partnerships with hospitals to ensure residents can get the specialised care they need. Wherever possible, all confirmed cases should be sent to a clinical setting such as an acute or sub-acute hospital.

And importantly, all homes should have dedicated communication channels to keep family members informed.

4. Learn from past experience

The two major aged-care outbreaks in NSW, particularly the one in Newmarch House, attracted national attention. But we’re still awaiting a public statement from government about the lessons learned.

There are also ongoing inquiries into COVID-19 in aged care by a senate committee and the Royal Commission. But neither are due to report for some time.

The government should release interim reports into the investigations of recent outbreaks which might give us valuable information about reducing transmission.

Eliminating COVID-19 outbreaks from aged-care homes reduces community transmission, the need for hospital care and reduces premature death. This benefits the whole nation.


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Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

‘Ageing in neighbourhood’: what seniors want instead of retirement villages and how to achieve it

Photo by Şahin Sezer Dinçer on Pexels.com

Caroline Osborne, University of the Sunshine Coast and Claudia Baldwin, University of the Sunshine Coast

The COVID-19 pandemic has brought into sharp focus the need for connection to our local community and the health challenges of the retirement village model.

We know that, as we age, most people prefer to stay in their own homes and communities instead of moving to retirement villages. Some have gone so far as to say retirement villages have had their day. However, the reality is not quite that simple.


Read more: Retire the retirement village – the wall and what’s behind it is so 2020


The challenge is that seniors are not well informed on what they could demand of the market. Planning schemes could also do more to create incentives for the changes we need now.

The challenges are complex and urgent as the global population grows and ages. Yet our housing supply reveals a bad case of the tail wagging the dog. Finely tuned financial models and development processes are driving the housing products available in the market.

What’s needed instead is adaptable housing and neighbourhoods to help people as they move through life’s stages.

Are the days of the retirement village numbered?

Many individuals and families struggle to find the right “fit” between the supported living options of retirement villages, independent living lifestyle villages and staying in the (often unsuitable) family home as their needs change.

Such villages offer viable products in the market as an important part of the housing mix. The models have some advantages in that they:

  • are thoroughly costed and provide a good return for developers
  • offer a range of living options to suit most budgets and level of care needs
  • promise security, activities and a sense of community.

Seniors are best placed to say what they need

However, our research with seniors in south-east Queensland revealed a desire to “age in neighbourhood” and to have neighbourhoods with a mix of ages and building forms.

Planning schemes could drive this now by giving priority to, and providing incentives for, sustainable and accessible housing close to transport and other services.

We worked with more than 42 seniors in south-east Queensland to design a series of housing types. These were based on what they told us were important to them in a home and a neighbourhood.

The table below summarises the key features that they told us make a neighbourhood and a home a good place to live as they age.

The resulting principles and housing types paint a vivid picture of what older people in a subtropical environment find appealing and supportive as they age.

Many participants preferred an accessible home on one level. Ideally, it should have two bedrooms and a study. This means it can easily be adapted to changing needs.

An essential component for our participants was to take advantage of the mild climate by having both private and shared outdoor spaces. Here they could socialise, relax and enjoy pleasant outlooks from the home. Cutting planning requirements for car parks by 50% could add more shared outdoor space and cut housing and living costs for residents.

Homes should be sustainably designed. This means they capture natural light and prevailing breezes for through ventilation, take into account privacy and noise considerations in higher-density areas, and have solar and rainwater harvesting systems to save resources and money.

Also important was a neighbourhood with a variety of green, clean and safe public open spaces. This includes flat, well-maintained and shaded walkways for exercise and easy access to shops, facilities and public transport.

We then showed how all these housing types could be incorporated into one Brisbane suburb, as the image below illustrates. This would mean seniors could remain in their neighbourhood in more suitable housing, reducing the stress of moving to unfamiliar surroundings.

How to make it happen

As with all complex challenges, everyone has a role to play in achieving these goals. However, local government planning reforms can act as a catalyst for the market to change and innovate.

Planning schemes could, for example, reduce application fees for developments that include accessible or universal design within 400-800 metres of key services, facilities and transport.

Carpark allocation could also be uncoupled from housing in locations close to transport and services. This would reduce the cost of housing and encourage greater used of active (cycling, walking, etc) and public transport.

This research clearly signals to local and state government, developers and small-scale property investors how houses, duplexes and mid-rise apartments could be put together in an age-friendly suburb. This transition to mixed-density infill development would support what we call “ageing in neighbourhood”.

Further, this research suggests planning “priority zones” could give the market the incentive to invest in the future-focused neighbourhood development it should be providing to keep people connected to their community.


This article was co-authored by Phil Smith, Associate Director of Deicke Richards at the time of publication of the research report. Phil Smith is Director of Gomango Architects.

Caroline Osborne, Postdoctoral Research Fellow, Office of Community Engagement, University of the Sunshine Coast and Claudia Baldwin, Professor, Urban Design and Town Planning, Co-director, Sustainability Research Centre, University of the Sunshine Coast

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in International Policies, Research & Best Practice, The Built Environment

Why some nursing homes are better than others at protecting residents and staff from COVID-19

Life Care Center in Washington state was at the center of the U.S. outbreak back in early March.Photo/Ted S. Warren, CC BY

Anna Amirkhanyan, American University School of Public Affairs; Austin McCrea, American University, and Kenneth J Meier, American University

The coronavirus pandemic has posed a serious threat to the U.S. long-term care industry. A third of all deaths have been nursing home residents or workers – in some states it’s more than half.

Yet some long-term care facilities have managed to keep the virus at bay. For example, veterans’ homes in California have seen only a handful of cases among roughly 2,100 residents. And preliminary results of our research on COVID-19 cases and deaths in nursing homes also support the idea that some homes are doing better than others at protecting clients and staff from COVID-19.

Why might this be?

As scholars of public management, we have found that three factors likely play the biggest role in determining how well a nursing home responds to a disease outbreak: whether it operates for profit, the degree of government regulation and the quality of management.

Profit versus quality care

More than 15,000 nursing homes currently operate in the U.S. Most of them are for-profit facilities backed by private investors, but a small share are operated by nonprofits or government.

For-profit companies selling the same product or service typically perform optimally in what’s known as a perfect market in which there’s plenty of competition and consumers have comprehensive information. More importantly, consumers are able to act on the information.

The nursing home industry, however, is far from a perfect market. Residents – who require constant assistance due to serious physical and cognitive limitations – are often unable to differentiate between good and bad care, advocate for themselves or choose a better facility. Their care is often arranged and paid by others.

As a result, for-profit homes, which are motivated to keep costs low and profits high, tend to be understaffed and, on average, provide lower-quality care compared with public and nonprofit homes.

In contrast, nonprofit and public homes tend to put higher emphasis on patient-centered care and reinvest their profits into better physical spaces, equipment and responsiveness to clients’ needs.

The numbers back this up. Our ongoing research shows that government inspection of for-profit homes found nine violations in an average regulatory inspection cycle, compared with 6.4 at nonprofit homes and 6.8 at government homes. These trends have largely remained constant during the past two decades.

As we examine the data on COVID-19 cases in nursing homes reported by states in real time and link them to the federal data on regulatory violations, we are observing more COVID-19 cases per capita in for-profit than nonprofit or public homes. So far, we’ve looked at homes in Illinois, Nevada, Colorado, South Carolina, Oklahoma and Oregon.

While it is too early to draw firm conclusions, it appears likely that fewer regulatory violations will correlate with success in managing the outbreak.

Government regulation is critical

Federal and state government regulation aimed at protecting residents is another critical factor that influences nursing homes’ ability to combat infection.

All nursing homes that accept Medicare or Medicaid must comply with federal regulations, while states are able to set their own rules for all facilities in addition to the federal minimums. A closer look at the variation among states offers strong evidence that more stringent regulation leads to better care quality.

That is a key finding of our recent study on a voluntary federal program that provides biometric criminal background checks of front-line care workers such as nurses and health care aides. About half of U.S. states have signed on to the National Background Check Program. Nursing homes in those states have fewer deficiencies and higher 5-star ratings.

Staffing requirements in nursing homes are regulated too. We looked at the impact of having more high-skilled nurses on the quality of care in counties hit hard by Hurricane Katrina in 2005. Facilities with a higher share of registered nurses on staff experienced little to no impact on residents’ health outcomes, such as mobility or personal hygiene, as well as on the number of regulatory violations, while most that witnessed significant evacuations saw a large increase in violations and deteriorating health.

The federal government sets a minimum requirement of one registered nurse on staff at least eight hours a day. States are allowed to set their own higher standards – yet even these are considered insufficient by experts.

One key problem is that many state regulations emphasize staffing levels, rather than staffing mix, which means there is little incentive for homes to hire more skilled and expensive personnel. While federal rules issued in 2016 would have strengthened staffing requirements, including one that required homes to have an infection specialist on staff, they have yet to take effect, and the Trump administration has taken steps to weaken them.

Better management

Our research also suggests that management plays a critical role in determining the level of care quality – and ultimately a facility’s ability to withstand COVID-19. Specifically, we have identified several key factors that make a meaningful difference and are certainly worth considering by those looking for a home for their loved one.

For example, nursing home administrators who are more innovative and constantly looking for new ideas tend to run better homes, keep costs lower and address organizational flaws. In addition, homes with managers who have been around for longer periods of time usually deliver better quality of care because this makes it easier to buffer external threats – such as a disease outbreak.

We’ve also found that homes that engage residents and their families and apply their feedback in decision-making boast higher ratings and fewer health violations.

Understanding the pitfalls

Billionaire investor and philanthropist Warren Buffet is credited with saying that it is only when the tide goes out that you discover who has been swimming naked.

COVID-19 seems to be having this kind of effect on nursing homes, exposing which ones were in a better position to handle a pandemic. And that’s why it’s essential for more states that are not publicly sharing their COVID-19 cases or deaths in nursing homes – such as Alaska, Hawaii and Idaho – to begin doing so.

This will allow more research to be done and ensure that the U.S. nursing home industry is adequately prepared for the next pandemic when it inevitably comes.

[Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

Anna Amirkhanyan, Associate Professor of Public Administration and Policy, American University School of Public Affairs; Austin McCrea, Ph.D. Student, American University, and Kenneth J Meier, Distinguished Scholar in Residence Department of Public Administration and Policy, American University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Ageing & Culture, Caregiving

How coronavirus exposes the way we regard ageing and old people

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Shir Shimoni, King’s College London

The elderly have come to occupy a central place in our news bulletins these days. Headlines were quick to inform the public that the highest mortality rate from COVID-19 is in people aged 70 and over. Experts have repeatedly announced that the pandemic is severe and the virus is especially dangerous for the elderly. This has frequently been delivered as a kind of reassuring message to the public – as long as they are under 70.

This news coverage not only emphasises that the elderly are at much higher risk but also describes them as a passive and vulnerable minority. This kind of portrayal ultimately strengthens the idea that old people impose an undue burden on society and more specifically on the health system, and that addressing their needs might endanger younger people.

In times of public emergency, social truths are revealed. The coronavirus crisis is one such emergency, and it reveals that the lives of the elderly appear to matter less and, in some cases, are even deemed disposable. Some went so far as to commend the virus, calling it a “boomer remover”.

Against this backdrop we must also understand a number of other recent cultural trends that have helped to engender a heightened ambivalence towards old people. My research into cultural representations of the elderly has demonstrated a striking increase in this group’s representation in popular and mainstream media.

The crisis, however, has drawn attention to the dramatic global increase in the number of ageing people relative to the general population, the economic resources necessary to ensure their well-being, and the fact that many occupy positions of power in the political, economic, social and cultural landscape.

Visibility of the elderly

As a researcher studying the representation of the ageing in popular culture, I have found the depiction of older people has shifted over the last decade, reflected not only in the way their lives are more visible in everything from film and television to social media, but also in terms of a more positive representation.

Hollywood’s interest in the lives of older people is reflected with ever greater frequency, with a whole host of films from 2003’s Something’s Gotta Give to 2011’s The Best Exotic Marigold Hotel, to Scorsese’s 2019 epic The Irishman, and in the proliferation of TV series such as Netflix’s Grace and Frankie and The Kominsky Method.

This trend is also noticeable in a wide range of newspapers and magazines, while books designed to inspire people to view their “third act” as an opportunity to finally realise themselves have become instant bestsellers. Social media sites such as Twitter and Instagram have participated in this celebration of older people too, where many have transformed into social media stars, attracting thousands of followers to their dynamic and upbeat profiles. Across these media, ageing people are presented as happy, resilient self-starters.

The reality for many

This is clearly informed by the widespread understanding that they constitute potential consumers, often with considerable buying power. However, this positive representation cannot be understood simply as a reflection of commercial interests.

It is also aims to conceal the impact of neoliberal policies – which have eviscerated the social safety net through deregulation, privatisation and regressive taxes – on the vast majority of older people. As the ageing population has grown in size, the responsibility for health and wellbeing has been deflected from the state on to individuals through austerity measures and the erosion of social welfare.

Ageing people’s “third age” is presented in popular culture as a time to reinvent themselves, and as a phase of new opportunities. By depicting older people as self-reliant, popular culture encourages them to focus on their self-care and to constantly enhance their individual qualities, whether these qualities are aesthetic, emotional or professional.

In short, as market logic has led to reduced state investment in welfare infrastructure and the care economy, we have witnessed a cultural response that encourages ageing people to assume responsibility for their own health and happiness. This is a position that might be tenable for the more affluent, but it is unfeasible for the vast majority of elderly people.

It is precisely in this context that we need to understand the representation of older people in a time of COVID-19. The warnings delivered to the elderly since the coronavirus outbreak expose our culture’s ambivalence and profound denial of ageing. It also highlights the government’s refusal to acknowledge frailty since such an acknowledgement would mean admitting that years of slashing programmes designed to safeguard the elderly have amounted to an abdication of its responsibility.

Austerity policies in the UK have meant that the safety net for old people has been eroded. Shutterstock

As people are living longer, there has been an explosion of positive portrayals of older individuals which focus on good health, affluence and independence. Meanwhile, the entrenchment of neoliberalism and austerity policies have meant that states like the UK are much less able to cope with the pandemic, while forcing those on the frontlines to make impossible choices.

While COVID-19 clearly reveals to all of us how much we need and depend on each other, the social imperative aimed at the ageing population remains the same: defy ageing for as long as possible and avoid becoming socially superfluous.

Shir Shimoni, PhD candidate, Culture, Media and Creative Industries, King’s College London

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in The Built Environment

Better design could make mobile devices easier for seniors to use

If all of these devices really work together, they can be a bigger help than any one of them alone. Pro Image Content/Shutterstock.com

Edward Henry Steinfeld, University at Buffalo, The State University of New York

A loud “bing” sounded as we drove onto the highway access ramp. I didn’t see a message on our car’s screen. Was it my phone or my wife’s? Was it a calendar alert, or did one of us receive a text message? Was it the low battery warning on one of our hearing aids? Was it our home security system? Maybe the car needed an oil change or lost tire pressure? Should we stop in heavy traffic or ignore it?

Younger people may take this kind of thing in stride, but it often frustrates us older folks. It’s not our fault, though. The problem is really that these systems require people to adapt to them – rather than adjusting themselves to accommodate what people need and want. And when products share information with each other, they often create unexpected and indecipherable events.

Many current hearing aids can connect to smartphones with Bluetooth. Africa Studio/Shutterstock.com

These situations are particularly interesting to me because I am a design researcher and gerontologist who likes to try out new technologies. Over the past two years, I have used two smartwatches, a mobile phone, two sets of Bluetooth-enabled hearing aids and several Bluetooth-enabled cars. I have found that these devices bring huge benefits that can help compensate for age-related health and function issues. One smartwatch app, for example, can detect if I fall or have an irregular heart rhythm; it may even one day save my life.

Each device is complex in its own right, and trying to use them together in many different settings makes things even more complicated. If technology designers paid more attention to how these gadgets work with each other, they could help customers of all ages – but particularly older people – explore and enjoy greater benefits of mobile computing. They could also help to reduce seniors’ reluctance to purchase new devices that could benefit them.

A litany of confusing encounters

That experience driving with my wife is far from my only confusion about how my many devices are supposed to interact. Other technophiles likely have similar stories, too.

When I got my second smartwatch, which had built-in mobile service, one of the first things I did was try to answer a call. I read the instructions and tried three times, but it didn’t work. When I called the support line, I learned that I had somehow inadvertently activated a “Theater Mode” that turned off call notifications. A tiny blurry icon on my watch face was supposed to alert me that this mode was on, but I’d had no idea what it meant or whether it was important. And, I could barely see it.

The ‘Theater’ mode icon on the watch face, at left, is too small to see with aging eyes. A larger icon, at right, would be better. Screenshot by Edward Henry Steinfeld, CC BY-ND

As a bicycle commuter, I sometimes get phone calls about work while riding. To answer the call on my watch, I would need to release my right-hand grip on the handlebars, reach across and press the “answer call” icon, while looking at the watch to make sure I don’t press cancel by mistake. Then I’d need to regrip the handlebars with my right hand and hold my left wrist close to my head to talk and listen. It is not a good idea to do all this while trying to avoid potholes in an urban street.

I can route phone audio to my hearing aids. This avoids having to hold the phone close to my ear to hear, but it works only when it is relatively quiet around me. When there is lots of background noise, my hearing aids amplify the noise and drown out the phone’s audio signal.

If I get a phone call while driving, there are four places I can direct the call: my car, my smartwatch, my hearing aids or the phone itself. But the phone seems to default to my hearing aids – even my millennial-aged hearing aid supplier cannot figure out why. That choice doesn’t activate the car microphone, though, so I still can’t talk without taking my hands off the steering wheel. I can turn off the hearing aid option, but it requires drilling down six levels on my phone.

The setting controlling which device receives the audio is buried six levels deep in the phone interface. Screenshots by Edward Henry Steinfeld, CC BY-ND

Handling complexity with design

In many ways, advanced technology is inherently complicated: If users want devices that can do incredible things, they need to deal with the complexity required to deliver those services. But the interfaces designers create often make it difficult to manage that complexity well, which confuses and frustrates users, and may even drive some to give up in despair of ever getting the darn things to work right.

Older users may be particularly prone to finding their gadgets exceeding their limits of agility, vision, hearing and cognitive capacity. All the mobile devices I use are reasonably usable by themselves and have accessibility features like interfaces with hearing aids and text magnification. But they’re not really designed to be easily used together.

My vehicle infotainment display shows only the status of the phone, not of other connected devices. Background images and reflections create perceptual clutter. Edward Henry Steinfeld, CC BY-ND

It would be helpful if designers in the mobile technology industry thought broadly about how their devices might be used by a more diverse population, including those with mobility and sensory limits. My co-author and I explored this prospect, and its significance, in a book called “Universal Design, Creating Inclusive Environments.”

Overall, the mobile computing industry could adapt key principles of universal design, a philosophy that seeks to empower all users and enhance all users’ experiences. The best news is that our research shows that designs that work for older people will work that much better for everyone else.

Based on our knowledge, I’d recommend the mobile technology industry improve user experiences by ensuring every connected device with a screen has a personalized dashboard with direct access to all settings. Mobile devices should use a combination of easy-to-perceive icons, text and sound cues (which are coming to be called “earcons”) to give users clear information not just when they are standing still in the middle of the day, but also when they’re outdoors, at night, driving or bicycling.

They should also design accessories to be integrated with other equipment, such as microphones for talking on hearing-aid devices and touch-sensitive controls that could be mounted on walkers, canes and bicycles to avoid the need to release hand grips or divert attention from the path ahead. In addition, device makers should use their gadgets’ sensors to detect when the user is moving and automatically activate hands-free use, including canceling, answering and terminating telephone calls. With manufacturers’ help, more seniors could enjoy the benefits of advanced technology, without the frustrations.

Edward Henry Steinfeld, SUNY Distinguished Professor of Architecture, University at Buffalo, The State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Posted in Caregiving

The home hospital model of care reduces costs and improves quality of care

News Release
December 2019| Brigham and Women’s Hospital: Home Hospital Reduces Costs, Improves Care

First randomized controlled trial of home hospital model in the U.S. reports improvements in outcomes meaningful to health systems and patients – sets stage for transformation of acute care delivery

Boston, MA — The home hospital model of care — in which select patients receive hospital-level care for an acute illness from the comfort of their own home instead of in a traditional hospital — has become increasingly popular across the United States. A pilot study conducted by investigators at Brigham and Women’s Hospital indicated that the home hospital model has the potential to lower costs and improve care. Now, the results of the investigators’ randomized controlled trial with more patients strengthens the evidence, showing that home hospital care reduced cost, utilization, and readmissions while increasing physical activity compared with usual hospital care. Results are published in Annals of Internal Medicine.

“This work cements the idea that, for the right patients, we can deliver hospital-level care outside of the four walls of the traditional hospital and provides more of the data we need to make home hospital care the standard of care in our country,” said corresponding author David Levine, MD, MPH, MA, a physician and researcher in the Division of General Internal Medicine and Primary Care. “It opens up so many exciting possibilities — it’s exciting for patients because it gives them the opportunity to be in a familiar setting, and it’s exciting for clinicians because we get to be with a patient in that person’s own surroundings. As a community-minded hospital, this is a way for us to bring excellent care to our community.”

Levine and colleagues enrolled 91 adults into their trial. Each patient had been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with a select acute condition — including infection, heart failure exacerbation, chronic obstructive pulmonary disease exacerbation and asthma exacerbation — and lived within five miles of the hospital. Patients were randomized to either stay at the hospital and receive standard care or receive care at home, which included nurse and physician home visits, intravenous medications, remote monitoring, video communication and point-of-care testing.

The team measured the total direct cost of care, including costs for nonphysician labor, supplies, medications and diagnostic tests. They found that for patients who received care at home, total costs were 38 percent lower than for control patients. Home hospital patients had fewer lab orders, used less imaging and had fewer consultations. The team also found that home hospital patients spent a smaller portion of their day sedentary or lying down and had lower readmission rates within 30 days than control patients. Because of the strength of its positive findings, the study was stopped early.

Levine notes that payment remains a challenge for the home hospital model, in part because most insurance companies do not yet recognize the home as a place where hospital-level care happens, although Brigham is making headway with insurers. With the conclusion of the trial, the Brigham is now increasing home hospital capacity to make it clinically available to more patients.

Levine and his colleagues are continuing to test and improve the home hospital model.

“We know there’s always more work to be done, and so we pride ourselves on being a continuous learning and innovation shop,” he said. “We’re now launching trials that include remote patient care, we’re adding artificial intelligence to home hospital care and we’re even exploring ways to bring home hospital care to rural settings. We’ll continue to refine and spread this model so that even more patients can get home hospital care.”

This work is supported by the Partners HealthCare Center for Population Health and internal departmental funds. Levine reports grants from Biofourmis outside the submitted work. A co-author reports consulting income from Verily, GreyBird Ventures, and Atlas5D outside the submitted work. A co-author reports grants from Mallinckrodt Pharmaceuticals and Portola Pharmaceuticals outside the submitted work. Disclosures can also be viewed here.