On the Record: Majd Alwan, Executive Director of LeadingAge CAST

With technological advancements tied so closely to the future of senior care, Senior Housing News recently interviewed Majd Alwan, Ph.D., the Senior Vice President of Technology and Executive Director of the Center for Aging Services Technologies (CAST) at LeadingAge, an association of not-for-profit, long-term care providers of senior services.

At any given time, CAST is involved in multiple projects, ranging from conducting research and writing reports on available technological solutions and their impacts on senior living providers’ business and financial models, creating a reward-based competition recognizing pioneers in technology-enabled services and support, and advocating for the inclusion of long-term post acute care (LTPAC) providers into federal initiatives.

Senior Housing News: What’s LeadingAge/CAST doing in terms of senior care technology development and implementation?

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Majd Alwan: Our mission is to accelerate the development, evaluation, and adoption of appropriate technologies by long-term and post-acute care providers to improve the quality of care and life for seniors, reduce the burden of care on providers, and reduce healthcare costs without compromising quality. Our mission is to change the aging experience through technology, but we don’t necessarily develop technology.

CAST brings developers—big ones like Phillips and Intel-GE Care Innovations, all the way to small start-ups—together with forward thinking and pioneering service providers who understand the value of technology and are exploring technology-enabled care models and implementing them in their communities, and researchers. These three coming together under the umbrella of CAST to accelerate the adoption and development.

We do research to create awareness of available solutions. We’re partners on a study funded by the Department of Health and Human Services looking at evidence of the cost-effectiveness and experience of other countries with aging services technology, and the barrier to the development and adoption of these technologies, which we’re expecting to wrap up by April.

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SHN: A study about mobile health technology was recently released that included a report on some countries who have run pilot programs implementing remote monitoring of seniors. Do you think this will catch on in the U.S.? Who’s already doing it, and doing it well?

MA: Absolutely. Remote patient monitoring, or telehealth—whether using mobile devices, home-based devices, or kiosk-based telemonitoring technology—has significant potential. The most successful example is that of the Veteran’s Administration. They have the largest telehealth program in the U.S., and they’ve demonstrated impressive improvements achieved in outcome and impressive cost-savings.

We have conducted a feasibility study on telehealth in nutrition senior centers. The technology basically uses remote patient monitoring, but rather than giving each older adult a mobile internet device, or deploying a telehealth station in their home, it’s easier to use a telehealth kiosk deployed in natural congregation areas. This is a lot more cost-effective mechanism to manage chronic conditions than individualized-based solutions.

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Many or our members are looking at deploying kiosks in senior housing, retirement communities, assisted living, etc. There are several examples in LeadingAge’s Preparing for the Future report (an aging services technology study), including Jewish Home Lifecare and SelfHelp. One of the chapters of the HHS-funded study we are partners on is on the management of chronic conditions and telehealth.

SHN: What’s your sense of providers’ attitudes toward technology within LeadingAge?

MA: There are over 5,400 aging services providers who belong to LeadingAge, and each has its own set of priorities and challenges. The report “Preparing for the Future” highlighted 18 case studies, and these are only a sample of LeadingAge members who are exploring or implementing technology.

It looks at care models that are likely to emerge or become more mainstream in the near future, given the current challenges we have, and the limitations on funding streams and current reimbursement systems, which is unsustainable.

You also have providers who are stuck with legacy systems, legacy payment or reimbursement systems.

Some of providers get some reimbursement for telehealth, remote monitoring, etc. They’re forming strategic partnerships with hospitals, for the management and stabilization of conditions of newly-discharged patients so they don’t experience a readmit, enabling the hospital to avoid a readmission penalty.

This is similar in principle to Accountable Care Organizations, but not the same, because only select organizations become ACOs, whereas penalties for hospital readmissions are going to apply to all hospitals whether they choose to become an ACO or not.

SHN: How have providers’ outlooks changed in the past few years?

MA: The adoption of technology is on the rise, on the increase, especially with respect to Electronic Health Records (EHRs) and telehealth technology. This is a direct effect or result of the significant federal investment in the national Health Information Technology (HIT) infrastructure and CMS incentives program, even though this incentive program and the vast majority of the federal HIT initiatives have been aimed primarily at hospitals and physicians, and not at LTPAC, per se.

But this has shown the importance of having EHRs in LTPAC to improve, for example, the likelihood of getting referrals from hospitals. Especially within the long-term care, not-for-profit sector, we see higher adoption of EHRs, potentially because of the impact that these providers see directly on the quality of care, and their ability to better coordinate care with their healthcare partner system. It’s a direct impact they see on their residents, and it’s aligned with their mission, despite the fact that there is no financial incentive.

SHN: Who is investing in senior care technology?

MA: There are several technology companies who are investing in or making significant investments, including Intel and GE. And it’s not only funded research; for example, Ireland’s Technology Research for Independent Living, co-funded by the Irish government, is jointly invested in creating joint venture with Intel-GE Care innovations.

Phillips is continually investing in technology;  private equity firms are providing venture capital; venture firms are also providing capital in this space.And, of course, you have the federal government primarily investing in the national HIT infrastructure, and also through several research programs, including the National Institute on Aging.

There are also private foundations, such as the Helmsley foundation, which gave an $8.1 million grant to the Evangelical Lutheran Good Samaritan Society to help find ways to keep seniors out of nursing homes.

SHN: What influence is technology going to have on policy regarding staffing/patient ratios at a state and national level within the next 18-24 months? In the next five years?

MA: There are regulations in place right now regarding these ratios. As these models are still emerging, as they mature, there may or may not be a need to revisit those regulations.

There was a study that showed that behavioral monitoring improves efficiency of care staff at assisted living, and reduces the burdens of care, but this was a small scale study. Once it’s done in a larger scale demonstration, and there’s a better sense of the kind of efficiencies the monitoring could produce, it might be a better time to pose these questions. For right now, it’s too soon.

SHN: Is technology the silver bullet for staffing issues in senior care?

MA: It’s not going to be the silver bullet, no. I believe that technology could be an efficiency tool. It could significantly improve, after the first few months, the learning curve… it definitely can improve or help with the shortage of caregivers.

For example, with telehealth—with mobile or home-based devices, you can have a nurse coordinator/case manager/home health nurse sitting in a call center manage up to 200 patients with chronic conditions such as diabetes, congestive heart failure, or hypertension, without having to get behind the wheel and drive somewhere.

It’s the same with monitoring activities of daily living. Potentially, based on monitoring activity levels, sleep patterns, and deviations, you can identify potential health issues.

Early detection and better management mechanisms would reduce the workloads on healthcare professionals and would also improve the efficiencies of these healthcare professionals.

Similarly with EHRs, there’s the ability to share this information among providers, and they’ll have the ability to reduce unnecessary procedures. But it’s not going to be a silver bullet.

I believe that if we adopt technology in the long-term and post acute care industry, we would probably be able to attract additional, new talent to become front-line staff, as well.

Editor’s note: In an earlier version of this article, we mistakenly quoted Majd Alwan as saying there were over 1,500 aging services providers in LeadingAge; there are actually more than 5,400.

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