Thriving in Place: Strategies to Postpone Long-Term Care

Overview:

We will begin by examining the epidemiology of chronic disease in America, the biggest source of morbidity, mortality, and healthcare costs in our nation.

We will evaluate and the advantages and disadvantages of the housing alternatives currently open to seniors. None of the options is perfect; each carries associated medical and legal risk; yet each has something to offer. We will then consider whether there may be advantages to utilization of alternative approaches, such as expanded reliance on home telehealth and telemedicine. Telemedicine, the provision of health care at a distance by electronic means, can greatly expand access by decreasing reliance on patient mobility.

We will evaluate the potential of remote patient monitoring to expand the independence of seniors. Current technology allows distant nurses to keep an eye on seniors’ blood pressures, heart rates, blood glucose levels, and other variables, and to intervene from afar when needed.

Another concept with considerable potential to aid older Americans is community paramedicine. Ambulance companies can more efficiently utilize the time and talents of their medics by expanding their scope beyond traditional “scoop and run.” Medics trained to handle a wide variety of emergencies can now visit patients in their homes, equipped to deal as well with chronic illness, including with telemedicine support the management of acute exacerbations that so often necessitate ED visits and hospitalization.

These forms of care, though force multipliers for the provider community, raise many legal questions concerning licensure, creating the doctor-patient relationship, the privacy and security of medical records, medical malpractice, informed consent, product liability, and reimbursement, among other topics. We will consider whether, given this plethora of potential legal problems, distance care is a practical solution to the needs of seniors as they grow older.

We will also introduce the concept of New Urbanism, an approach to land use and real estate development that strives to re-create the ambience and social characteristics of authentic communities that populate small-town America. Emphasizing walkability, good will, and the interdependence of neighbors, New Urban communities mix residential and commercial development so as to curb dependence on automobiles and to enhance the appeal of town centers. The homes tend to be relatively small, for easier maintenance by empty nesters, and to be constructed so as to encourage interaction among neighbors. The objective is not only to make it possible for a homeowner to postpone or even delay long-term care, but to make doing so as simple and attractive as possible while avoiding age segregation.

We will also examine the concept of universal design, a method of construction that anticipates the changing needs of older homeowners. Without making a private home look like an institution, designers skilled in this field equip homes not only with wider hallways and concealed grab bars, but with cabinets with pull-out shelves, kitchen counters at several heights to accommodate different tasks and postures, walk-in showers that can accommodate wheel chairs, and a wide variety of other features to eliminate barriers and make homes suitable for anyone regardless of age, ability, or status in life.

What this presentation hopes to do is to make the case that for older Americans, it is not only feasible, but preferable, to live whenever possible not in some institution, however well-staffed, however well-equipped, but instead in the privacy and comfort of one’s own home.

Why should you Attend: The US population is rapidly aging. Today, there are more than 46 million Americans aged 65 and older; by 2050, that number is expected to grow to almost 90 million. Between 2020 and 2030 alone, the time the last of the Baby Boomers reaches age 65, the number of older adults is projected to increase by almost 18 million. This means that by 2030, 1 in 5 Americans is projected to be 65 years old and over.

With age often comes wisdom, but also chronic health problems and their attendant limitations on mobility, vision, and physiologic function generally. Seniors often lose the ability to independently perform one or more activities of daily living. They often require multiple medications to manage an array of illnesses, none of which is curable. The medicines are often indispensable, but each comes with its own set of side effects, effects often aggravated by the interactions each drug has with the others.

Age segregated, institutional long-term care is a multi-billion dollar industry aiming to help solve these problems, but its expense is becoming unsustainable, and its appeal to seniors is likely to decline further as Baby Boomers cross the threshold of eligibility. Such facilities will always be necessary, but their desirability will likely shrink as their affordability already has.

Our society needs to develop fresh approaches, and “thriving in place” is one. That path is not a panacea, however, and it does not cure the illnesses afflicting so many older Americans. If we are to develop better methods to manage these problems, we must do so with full appreciation of both the risks and the benefits of the alternatives. This presentation will concentrate on the medicolegal issues framed by the growing trend of facilitating aging at home.

Areas Covered in the Session:

• The growing need for long-term care
• The basic nuts-and-bolts of remote patient monitoring
• The advantages and limitations of telehealth services to the home
• The drive to provide community paramedicine
• The fundamental principles of universal design
• The features of new urbanism and its track record to date
• The economics of shifting care away from institutional facilities and into the home
• The legal issues pertinent to “thriving in place”

Who Will Benefit:

• Community developers and home builders
• Managers and administrators of long-term care facilities
• Hospital administrators
• Leaders of ambulance companies and services
• Remote patient management services
• Nurses and physicians who care for older adults
• Financial planners focused on seniors
• Managers of healthcare facility REITs
• Lawyers representing any of the above

Speaker Profile
Joseph P. ("Joe") McMenamin is a physician-attorney with McMenamin Law Offices in Richmond, Virginia. His practice concentrates exclusively on the law of health care, with special emphasis on digital health. With respect to the legal issues pertinent to this form of care, he has advised providers, hospital associations, consultancies, private equity firms, insurers, telecoms and several organizations facilitating telemedical services. The decisions of several digital health clients to enter the field of AI stimulated Joe's immersion in the subject and his decision to join AAIH, the Alliance for AI in Healthcare.

Before being admitted to the Bar, Joe practiced emergency medicine at hospitals in Pennsylvania and Georgia on a part-time and full-time basis over a seven-year period overlapping his specialty training in internal medicine and his legal education.