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Who's watching Mom -- and what is watching the watchers?

Variable care, yes, but no tech in home care.  The NY Times recently published a blog post about the variability of oversight and quality among the unregulated non-medical agency-based home care industry.  Among the many stressed-out comments and observations from readers (“we too had poor home care quality, how awful”), none suggested that this industry should (or will) have oversight technologies injected into it of any type. Yet, according to this just-published Future of Home Care Technology 2012 report, maybe augmenting a labor-intensive industry with just a little bit of overseeing and communication technology is seen by industry insiders as a good idea -- someday.

It could be time for a change – but the survey says industry isn’t ready. From the report: "Experts interviewed agree that the home care industries (non-medical home care, home health care, and geriatric care management) are at the early stages of maximizing benefits of technology. Information about the individual client is not yet passed effectively or electronically between the various locations a care recipient may visit. In this survey of home care managers who collectively are responsible for a total of 34,509 workers, telephone and email dominate the communication toolkit."

Phone and email are the dominant outward-facing technologies. The telephone is the external communication technology of choice, whether it is with family member (81%) or care recipient (80%), followed by email to families (54%). The primary means of communication with families are telephone (91%) and email (54%). Family portals are barely on the radar (6%), with similar low adoption of Skype (5%) and instant messaging (3%). Those who manage RNs are least likely to communicate directly by email with families. Most topics shared with family members -- such as health status, activities of daily living (ADLs) like eating or dressing, therapy status, or recreational activities -- are communicated at most weekly, more typically on request.

Wringing of hands needs to give way to action.  So let's see -- we have an unregulated industry with no standard of care, uneven vetting of caregivers, and a very limited toolkit ("ask 10 questions!") to seek and verify quality of caregiver. And to top it off, families do not insist on the use of any kind of monitoring technology (chronic disease, even) that would reassure them.

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In a world of supply and demand the supply side of the equation in the elder care industry still acts as if they have a captive audience while the demand continues to grow exponentially. Regulation may help but the ability to monitor and enforce requires a bureaucracy that will be costly and marginally effective. The size of the aging population alone should be causing competition which fosters better quality in elder care and with a number of recent firsthand interactions I see no evidence of that. Is this the case of an industry that is impervious to free market dynamics?


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