Why medication adherence is important and how to improve it
Most adults with chronic health disorders are treated with medication, vitamins and minerals, or hormones. However, 50% of adults in the US living with chronic disorders do not take their daily medication (or other self-administered oral or IV therapies) as prescribed. According to a research article in The Permanente Journal, this results each year in around 100,000 preventable deaths and $100 B in preventable healthcare costs. Forgetfulness is not the only reason that medication nonadherence is so widespread, but this is a particular problem for the homebound elderly. Besides leading to worsened health status, not taking medication as prescribed is contributing to a worldwide public health problem.
Impact of antibiotic nonadherence and drug-resistant infections
The diagnosis of a skin, urinary tract, respiratory, or other bacterial infection often requires treatment with an oral antibiotic for five to seven days to eliminate the infection. However, people typically begin to feel better earlier than the last prescribed dosage day, so discontinue taking the prescribed antibiotic pills. Consequently, the bacteria that cause human diseases are becoming more drug-resistant. The Centers for Disease Control (CDC) reports that 2.8 million drug-resistant infections occur in the US per year, and with an estimated 35,000 resultant deaths. Therefore, the common occurrence of patients not taking a prescribed antibiotic for the full course prescribed to them has led to more bacteria becoming resistant to all antibiotics.
Methicillin is an antibiotic that is a derivative of penicillin, and people afflicted with Methicillin-Resistant Staph. Aureus (MRSA) infections are 64% more likely to die from this type of antibiotic-resistant infection. Since Staph. aureus is one of the most common skin infection-causing bacteria (as it is commonly found on our skin), the increasing ability of this bacteria to survive all antibiotic treatments is causing tremendous medical concern. Meanwhile, surgical patients remain the ones at highest risk for developing a Staph. aureus infection in the incision site, but MRSA can also be transmitted by an infected person to someone else through hand-to-skin contact. In 2019, 27,314 MRSA-infected people in high-income countries alone (and 93,767 elsewhere) died due to their antibiotic resistance.
Nonadherence to blood pressure medication and consequences
Nearly 66% of people diagnosed with hypertension who are prescribed drugs to lower their blood pressure are nonadherent to medication treatment, per an article in Medicine in 2017. Since 70% of adults aged 65+ have hypertension – and hypertension is strongly linked to a heightened risk for heart attack and stroke – lessening the prevalence of hypertension (high blood pressure) has been a major US healthcare goal to curb national healthcare costs. Meanwhile, heart disease is the foremost chronic health disorder in the US, and the leading worldwide cause of death in adults.
Diabetes Type-2 and nonadherence to medication
Study findings published in Patient Preference and Adherence revealed that 45% of adults with diabetes (Type-2) are not able to maintain glucose control, and poor medication adherence is a major reason. The lack of taking medication aimed at glucose control can result in diabetes-afflicted people developing diabetes complication such as peripheral neuropathy (nerve pain), heart disease, and kidney failure. In turn, these complications can result in permanent disability and a far lower overall “quality-of-life”.
Reasons for medication nonadherence
Described in a medical research article in 2019 are the following five dimensions that affect patient adherence to their prescribed medication:
- Social and economic factors (such as ability to afford the prescribed drugs);
- Therapy-related factors (such as understanding why the drugs are necessary);
- Disease-related factors;
- Patient-related factors;
- Healthcare system-related factors
For adults aged 65+ who are enrolled in a Medicare Part D drug plan, there are wide variations in the cost of a prescribed medication that must be borne by the enrollee. If not enrolled in a Part D drug plan (or without any other drug coverage), the older-aged person may be faced with paying for the medication “out-of-pocket”.
The average annual cost of taking an oral glucose-lowering medication to manage diabetes (Type-2) in 2017 was $2,727 – which had increased by 147% from 2015. It is well-recognized that the cost of prescribed medication to control diabetes (Type-2) is high, and this is a main reason that diabetics do not take the prescribed medication that could preserve their health and prevent premature death. Therefore, seniors – many of whom are living on fixed incomes – often fail to take their prescribed medication.
A tremendous problem for elderly people is polypharmacy – which is the daily taking of many prescribed drugs aimed at different health disorders. For example, a senior living with diabetes (Type2) may also need to take medication for heart disease, nerve pain, a scrape on the foot that has become infected, low thyroid level, and many other health problems. Consequently, mixing up pills (and taking too many of one drug and not enough of another) can easily occur.
Cognition worsens during aging – even in elderly adults not living with Alzheimer’s Disease – so remembering whether a given pill was taken or not with breakfast every day can become difficult. This type of forgetfulness can leave any older-aged person who has been prescribed multiple medication feeling extremely frustrated. Furthermore, the Alzheimer’s Association notes that around one in nine adults aged 65+ has Alzheimer’s Disease, so forgetting to take prescribed medication (and/or mixing them up) is even more likely in these senior-aged adults.
Strategies that foster improved medication adherence
Physician office phone calls to remind older-aged people to take their prescribed medication have been found to be effective in promoting medication adherence, as have daily text messages and automated reminders on digital wearables. Meanwhile, calls from pharmacies – and especially if an existing medication prescription is not re-filled – have been found to be effective, as well.
Besides reminders, physician-initiated discussions about the financial impact on a patient of a prescription can enable recognition if cost is the main factor. In that case, helping the patient to learn about ways to reduce the cost (such as through enrollment in a clinical trial where drug cost may be covered) can boost adherence to prescribed treatment.
Learning that a different Medicare Part D plan covers the cost of a specific prescribed drug (and then switching plans during Medicare’s “open enrollment” period) may be all it takes for a person with a history of medication nonadherence to change that behavior. The ease of comparing health insurance plans is increased for seniors through access to computer training in combination with ownership of a computer, so independent and assisted living facilities geared to older-aged adults can be part of the solution by engaging their residents in utilizing technological devices.
The Ōmcare Home Health Hub is an all-in-one home telehealth device aimed at senior-aged adults, and that can be used to promote medication adherence.
Senior care facilities: How to encourage age-tech adoption
Learning new skills helps seniors to maintain cognitive abilities such as problem-solving. Since most adults aged 65+ did not grow up utilizing technology, it is not something that many senior-aged people feel is necessary for them. Nevertheless, the gap in digital device use between the 18-29 year old age demographic and adults aged 65+ has closed by 53 percentage points since 2012, per the Pew Research Center. At least six in 10 adults aged 65+ now utilize the Internet to acquire some type of information. Assisted living facilities, rehab centers, and nursing homes can aid senior-aged people to preserve mental faculties and reduce symptoms of depression and/or anxiety by improving senior-oriented tech device understanding.
Why senior-aged adults have difficulty learning to utilize technology
The language of technology is unfamiliar to many older-aged adults, so tech support instructions that make sense to a younger adult can sound like gibberish to an elderly person. Even telling a senior-aged person to click on an “icon” on the computer screen can make utterly no sense, as this is not the definition of that word in the dictionary of their childhoods. Therefore, online instructions to aid technology learning can be totally ineffective. Instead, a person teaching hardware and/or software skills on a one-to-one (or small group) basis works best for older-aged adults.
Providing “in-person” training and classes is just one way to boost interest in age-tech adoption, as family members and senior care facility employees may also be able to teach the older-aged person some desired tech skills. By increasing the size of fonts (so that the senior using the tech device can more easily see what is on the screen) and enabling voice-activation, the common problems of decreased eyesight and arthritic fingers to manipulate a tech device can be greatly minimized.
Findings published in Frontiers in Psychology in 2017 revealed that lack of guidance plus lack of confidence and/or feelings of inadequacy were key reasons for seniors’ disinterest in using digital devices.
Enabling seniors to utilize videoconferencing for clinician visits
Socialization and communication with others are a strong motivator for elderly people to learn to utilize videoconferencing software on digital devices. However, another motivator is reducing the need for travel to an office appointment with a physician (or other clinician) through the utilization of videoconferencing software on a digital device to participate in a “telehealth” visit. According to Fierce Healthcare, telehealth utilization has increased by 340% among Medicare-eligible senior-aged adults since the onset of the Covid-19 pandemic. One major reason is that it decreased the likelihood of contracting Covid-19 (or some other respiratory infection) in the physician’s office or hospital setting.
For a senior care facility to appear attractive to a person aged 65+ in comparison to some other facility, demonstrating a willingness to aid seniors in acquiring and learning technological devices can be an important factor. Loss of former mobility and/or symptoms of dementia are major reasons that elderly people (and their family members) choose to relocate to assisted living facilities and other senior care facilities. Consequently, senior care facilities that offer computer rooms, tech-related classes, and the ability to engage in a telehealth visit with an on-site clinician are more appealing to elderly people than ever before.
The Population Research Bureau estimates that nine million senior-aged adults in the US will be living with dementia by 2030, and 12 million by 2040. Many of them will require placement in a senior care facility, so embracing the utilization of technology by seniors can aid them in remaining as functional in their usual daily living activities as possible.
Ōmcare provides technology solutions for both consumers and providers, and inclusive of senior care facilities.
Employee Spotlight: Abiola Adimi
Name: Abiola Adimi
Title: Senior Software Engineer
Education: Bachelor of Science in Computer Engineering from University of Minnesota Twin Cities
Time at Ōmcare: 5 years
One personal fact about you: Big Fan of Japanese Anime (Favorite: One piece has been running for 20+ years)
1. What led you to Ōmcare?
I joined Ōmcare in July 2018 as an intern because of how impressive the original product PetChatz was and how welcoming the engineering team was — they had no prejudice and were willing to help where I was lacking.
2. What’s the most rewarding part of working at Ōmcare?
The most rewarding thing about working at Ōmcare is the opportunity to be part of a dynamic and innovative team that consistently strives for excellence. Ōmcare fosters a culture of collaboration and encourages employees to bring their ideas to the table. This open and inclusive environment empowers me to contribute my unique skills and perspectives, knowing that my input is valued and appreciated.
3. What is your favorite current project you’re working on?
I’m currently working on testing the software infrastructure on the new hardware that will be used for our next generation project Hub 2.0. Using an iMX 8 devkit, I have begun the preliminary work to port our existing software and test new features.
4. Pick out a core value that means a lot to you. How have you seen this lived out in your time at Ōmcare?
We boldly go where no one has gone before: This value is one of the reasons I wake up to work every morning with a new goal to achieve. Since my internship days, I have always been encouraged to think beyond conventional solutions and traditional approaches. With a culture that promotes curiosity, creativity, and entrepreneurial opportunities, I am never bored or uninterested in my work. Every new challenge is an opportunity for me to grow in different aspects. By stepping out of our comfort zone into unknown territories, we have always achieved extraordinary outcomes to deliver an excellent product to our customers.
5. What are you most proud of accomplishing throughout your time at Ōmcare?
Having been part of the development of our current Hardware/Software development infrastructure, my proudest accomplishment while at Ōmcare would be my growth as an experience and almost all-rounded Computer Engineer, who is not afraid of new challenges. Computer Engineers deal with a lot of unknowns while dealing with the hardware and software aspects of a product. During my time at Ōmcare, my analytical and creative skills are always being sharpened to implement new features that our customers will be able to experience seamlessly and with a smile on their faces.
6. Why should someone work at Ōmcare?
Work plays a vital role in our lives, providing us with numerous benefits and opportunities for personal growth. Ōmcare is a company that offers a lot of opportunities for growth. To grow, people need challenges and a sense of adventure. Thus, I believe that as a startup company where everything is fast paced and riddled with unknowns, people should work at Ōmcare if they believe that they are in a stage of their lives where they would like to make a difference in the healthcare world without any fear of challenges.
Managing the rising costs of healthcare: Your Medicare options
Medicare coverage is aimed at adults aged 65 and older, as well as younger disabled adults. While some senior-aged people are not insured by Medicare, it has enabled most adults aged 65+ in the US to acquire health insurance coverage. There are four distinct parts to this federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS), and these are Parts A, B, C, and D. Unlike Parts A and B, Medicare Advantage health insurance (Part C) is administered by private health insurance companies through CMS subcontracts. Meanwhile, Part D covers prescription medications (and is also offered by private insurers). For this reason, enrolling or switching coverage options can be extremely confusing for most adults.
Enrolling in Part A versus Part B
Original Medicare’s Part A covers primarily hospitalization, whereas Part B covers outpatient healthcare visits. At three months prior to becoming 65 years of age, a senior can enroll in Original Medicare (and coverage then becomes effective at age 65). Part A enrollment does not result in a monthly premium cost for most seniors, so it makes sense to enroll unless covered by some other health insurance. While Part B does have a premium cost linked to it, coverage via this part can make a huge financial difference since most seniors need outpatient medical care even more than younger adults. Since Parts A and B do not cover all healthcare costs, it is important to plan for future medical bills upon needing either inpatient or outpatient services. For example, both Parts A and B have annual deductibles that must be met before Medicare covers the rest of the billed dollar amount.
Understanding Part A costs for the hospitalized enrollee
The deductible for Part A is $1,600 per benefit period in 2023. Besides factoring in this cost as something that is the enrollee’s financial responsibility, it is crucial to realize that the enrollee’s cost is $0 through Day 60 of the hospitalization, but increases to $400 per day for Days 61-90 (with a maximum out-of-pocket cost that may be changed annually by the CMS). The average (mean) hospital stay in the US is 4.7 days, with a mean total cost of $11,700 per day. Thus, a lack of health insurance can quickly lead to a tremendous debt-load for an adult in the US.
Part B co-insurance and deductible costs
Part B costs more for enrollees above a specified annual income threshold. However, $164.90 was noted by the Medicare.gov website as the typical monthly deductible cost for 2023. Furthermore, Part B covers only around 80% of the billed amount for each outpatient visit or service, so 20% of the cost is the responsibility of the Medicare-enrolled senior. On the other hand, Part B does not require the enrollee to have a Primary Care Physician (PCP) and allows the enrollee to receive Medicare-covered care from any doctor that accepts Medicare.
Original Medicare versus Medicare Advantage
The Kaiser Family Foundation (KFF) in 2022 reported that enrollment in Medicare Advantage has continued to grow over the past 20 years, and around 48% of Medicare beneficiaries are now enrolled in a Medicare Advantage plan. Although most Medicare Advantage plans include prescription drug coverage, they also usually limit the choice of physicians and hospitals to those that are “in-network” (plus include selecting an “in-network” PCP). However, many Medicare Advantage plans include dental coverage (which is not an included benefit under Original Medicare). Yet others include reimbursement for taxi rides to physician appointments, optometry exams, and annual gym memberships. If choosing to enroll in a Medicare Advantage plan, the enrollee still needs to pay the monthly cost of Original Medicare’s Part B – even though those covered services are already included in the Medicare Advantage plan.
Comparing the cost of different Medicare Advantage Plans
Monthly premiums and annual deductible costs differ tremendously between Medicare Advantage plans. While there are plans with no monthly premiums at all, these often have higher annual deductibles. More than 4,000 Medicare Advantage plans nationwide were offered to seniors in 2023. Since the CMS rates Medicare Advantage plans for enrollee satisfaction on a scale of 1-5 (as well as Part D drug plans), checking the CMS “star” rating for a Medicare Advantage plan can help a senior to determine whether to enroll in that particular plan or a different one.
Supplemental (Medigap) Plans, Part D Plans, and Travel Health Insurance
Due to the diverse costs accruable to people enrolled in Original Medicare, many seniors enrolled in Medicare’s Parts A, B, and D choose to also buy supplemental (Medigap) insurance. This is offered by private insurance companies, and can cover the deductibles and co-insurance not normally covered by Original Medicare. The monthly cost of a Medigap plan varies, but generally depends upon how much of the uncovered costs will be paid by the Medigap plan. As of 2018, 34% of people covered by Original Medicare purchased supplemental (Medigap) insurance. (If enrolled in a Medicare Advantage plan, the CMS disallows simultaneous enrollment in a Medigap plan.)
Similar to the diversity of Medicare Advantage and Medigap plans, there are a huge number of Part D drug plans offered by private insurance companies to seniors. The determination of which is best depends upon the financial circumstances, usual daily medications, and pharmacy preferences of the senior. Monthly premiums and annual deductibles differ between Part D drug plans, and the cost of a monthly prescription of a specific drug can also differ widely between plans.
For a senior that lives for a few months each year somewhere other than the state of permanent residential address, Original Medicare may be preferable. On the other hand, a senior taking a three-week vacation overseas – especially if afflicted with a chronic health condition such as diabetes – may find that purchasing travel insurance (which is not included in Medicare coverage) may be a good idea.
Telehealth coverage and medicare
Consequent to the federal Covid-19 public health emergency declaration, telehealth “virtual” medical visits are covered by Medicare through December 31, 2024. Many Medicare Advantage plans have broader coverage for utilizing telehealth than Original Medicare. Additionally, an ever greater number of Medicare Advantage plans are covering the cost of digital devices and wearables for patient monitoring and telehealth visits. Since the CMS does not include language in its Original Medicare parameters that expressly covers digital health technology, a Health News article in 2023 concludes that such technology is more likely to be covered by Medicare Advantage plans than Original Medicare.
Consider purchasing the Ōmcare Home Health Hub® to enable remaining in the home environment in later life, rather than relocation to a Skilled Nursing Facility (SNF) or elsewhere.
How telehealth can cut your healthcare expenses
Providing health insurance to employees costs businesses, but so do preventable chronic health disorders leading to excessive absenteeism and/or lost productivity. Businesses in the US with 50 employees or more are required to offer health insurance to them or face federal tax penalties. Meanwhile, research findings published in Preventing Chronic Disease in 2016 noted that annual absenteeism costs ranged from $16 - $81 per employee for a small employer, and $17 - $286 per employee for a large employer. For this reason (and many others), managing healthcare-related expenditures is vital for businesses in order to remain profitable. Increasing employee access to telehealth is a strategy that can aid businesses to reduce employee healthcare service needs while curbing business healthcare expenditures.
Unhealthy employee lifestyles and the link to increased business healthcare costs
Obesity, smoking, and alcohol abuse are all widely recognized to be damaging to health. Among the 23% of all employed adults who smoke, 37% smoke 20 or more cigarettes each day. Obesity, smoking, and alcohol abuse are all linked to a significantly increased risk for heart attack (per the American Heart Association). Additionally, alcohol abuse is a contributing factor for obesity. Besides heart disease (a leading cause of disability and premature death), obesity, smoking, and alcohol abuse all are linked to a heightened risk for diabetes (Type 2).
The average (mean) cost for hospitalization due to heart disease is $10,737 - $17,830 per hospitalization (according to an article in 2022 in the Journal of Managed Care & Specialty Pharmacy). The annual cost for the treatment of solely diabetes in an adult afflicted with diabetes (Type 2) is around $9,601. Therefore, enabling employees to receive health education and participate in health prevention workshops via telehealth to address unhealthy lifestyles that can lead to a chronic disorder – which can then result in disability that increases workplace absenteeism – makes good sense for a business.
For the large number of employees living with diabetes (Type 2), utilizing telehealth in combination with digital health devices can promote better diabetes control. In turn, this can prevent worsened overall health and the development of such diabetic complications as neuropathy (nerve pain) and kidney failure.
Group health insurance rates for businesses and employee healthcare utilization
The annual rate that a business pays for group health insurance is largely determined by the insurers’ prediction of the costs associated with healthcare utilization (by employees of the business) that will be borne by the insurer. This is also the case for disability insurance rates. Therefore, businesses that have a high percentage of employees with diagnosed chronic health disorders (such as diabetes or hypertension) are more likely to be charged a higher annual rate for group health insurance (as well as disability insurance) coverage. This is yet another reason that preventing employees from developing chronic disorders is important for curbing annual business expenses.
The Milken Institute reported in 2018 that the following are the most expensive chronic health conditions in terms of national direct costs:
- Diabetes ($189.6 Billion in total)
- Alzheimer’s disease ($185.9 Billion in total)
- Osteoarthritis ($115.5 Billion in total)
Mental health distress is also linked to the development of chronic health disorders (as well as an increased risk for workplace injury and overall lowered productivity). Therefore, enabling employees at increased risk for a diagnosed mental health disorder to talk to a therapist is an excellent strategy to curtail related healthcare service costs. By reducing the need for employees to travel to appointments with clinicians (requiring a greater time period away from the workplace than a telehealth visit), maintaining usual workplace routines and overall productivity is more likely.
Lowered cost of telehealth versus in-person physician office visits
Insurance billing for an in-person office visit can be for more than just the visit with the physician or other clinician. A “facility fee” may be charged if the physician does not own the facility (and this is a common practice among hospital-run outpatient offices). In contrast, telehealth visits do not incur this added cost. However, a primary reason that telehealth can result in lowered healthcare expenditures by businesses is that acquiring help from a healthcare provider via telehealth for an illness/injury experienced by an employee while not at work (such as in the home environment) is more likely to lead to taking the correct action to prevent it from worsening.
For example, an employee who has sprained an ankle may learn through a telehealth appointment (using videoconferencing software) that applying ice right away and then wrapping the ankle with an ace bandage can speed up healing. In this way, the employee may not need to remain away from the workplace to heal for as long as otherwise. Likewise, an employee unsure of whether to take a daily medication with (or without) food can acquire an answer utilizing telehealth, rather than incorrectly taking the drug and consequently developing an untoward symptom.
Digital devices that keep track of glucose level, heart rate, sleep quality, daily calorie intake, and prescribed medication adherence – and that enable a person’s healthcare provider to receive the recorded data – can be combined with telehealth visits to maintain (and improve) health.
Contact Ōmcare to learn more about our digital health solutions, and how these can help your business.
Home care and medication management: How technology can help
Chronic disease management frequently involves the patient requiring more than one daily prescribed medication. According to medical research findings in Patient Preference and Adherence, heart failure patients after hospital discharge are typically prescribed eight drugs for long-term use. For adults living with Type-2 diabetes, five is the average number of daily medications utilized. Among senior-aged adults with early (or later-stage) dementia, differentiating between different daily drugs so as not to take them at the wrong time each day can be difficult. Since many adults also take daily vitamins and/or naturopathic supplements, confusion as to which pill is which can lead to a preventable mix-up that worsens overall health.
Managing medications with pill boxes: Why this is not a solution
Placing pills in a plastic box with plastic dividers denoted for each day of the week is the usual way that senior-aged people have kept track of their daily medications (with one of each prescribed drug placed in a separate compartment for that day). The problem is that the pill needs to be placed correctly in the pill box for this manual system to work (and most pill boxes do not enable the person to remember what time of day is correct for taking that pill). Meanwhile, around one-third of all senior-aged adults lives alone, so there is often nobody else in the home to quickly notice if that senior placed the wrong medications in the pill box. Additionally, 40% of adults aged 65+ have some short-term memory impairment.
Study findings published in Health Services Research showed that each additional drug taken daily by an elderly person can increase the risk for a visit to a hospital Emergency Room (ER) by 4% (and hospitalization by 3%) specifically due to mistakes related to multiple medication use. Therefore, an increased focus on utilizing technology to aid medication management has occurred over the past decade, with automated phone calls from home healthcare providers’ offices as an early technology-driven method.
Phone apps, videoconferencing, and technology
The frequent use by senior-aged people of face-to-face videoconferencing with healthcare providers has increased as a consequence of the Covid-19 pandemic, and resultant from fear of Covid-19 infection due to close proximity to others in a healthcare setting. In addition, 50% of all adults aged 65+ (and 73% of all adults aged 50-64) used social media regularly as of 2021 – so comfort with using an app on a computerized device has hugely increased among older-aged adults. Consequently, many software development companies have focused at least some attention on designing technological ways that can enable senior-aged adults to better manage medications.
There are diverse phone apps that can be utilized alone – or in combination with – other technological methods for aiding seniors to keep track of what they are taking each day to improve health. Besides reminders to take the drug at a specific time, these can include all or some of the following medication adherence aids:
- Health education (such as explaining why the medication is needed, as well as the risks to health of not taking the medication as prescribed).
- Medication side effects and drug interactions (such as explaining possible side effects of each prescribed medication, and the possible drug interactions between them) and what to do if experiencing a medication-related symptom.
- Display of an enlarged photo of the medication (as a visual reminder of that specific pill, so that a person with memory impairment can distinguish one pill from another in order to utilize the correct one).
- Capacity to ask questions and receive answers (either from a chat bot or a healthcare provider in “real-time”) regarding medications.
- Ability to enable designated loved ones to receive the same health information provided to the senior-aged adult living at home (which can be vital for a dementia-afflicted person to remain living independently at home).
- Online interactions with healthcare providers and home health agency clinical staff regarding physical and mental health issues inclusive of medication discussions.
Not only can apps and other technological approaches aid senior-aged adults in taking the medications (plus daily vitamins and supplements), it can also aid healthcare clinicians to understand the medication adherence issues affecting their patients in order to better address them.
Age-appropriate solutions for medication management
The majority of senior-aged adults have eyesight problems, with 12% of those aged 65-74 (and 15% of those aged 75 and above) afflicted with total vision loss. Moreover, 4% of community-dwelling adults aged 65+ have both vision and cognitive impairments (such as short-term memory loss). Thus, pressing keys on SmartPhones and reading tiny print on small digital screens can be frustrating and error-prone for elderly people. Due to this reality, cell phones specifically designed for senior-aged adults were developed (such as the Jitterbug in 2006) that have larger-than-normal screens and simpler user interfaces.
The Centers for Disease Control (CDC) notes that the foremost causes of vision problems in adults aged 40+ are cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration. While voice-activated SmartPhone commands can be helpful for severely visually-impaired people, these are not always sufficient to enable acquisition of appropriate online information regarding medication side effects or drug interactions. The capacity to talk to a clinician about a medication if anxious about the correct dosage, a drug side effect, or any other medication issue is preferable.
Recently, there have been a wide variety of apps and other technological solutions developed that are geared to medication management. Some include various aspects of patient monitoring (such as glucose or sleep apnea monitoring) aimed at home-based seniors. Yet others are geared to the management of a specific chronic health disorder (such as diabetes, heart disease, or kidney disease), while some others are useful to seniors with a broad range of health issues.
For technological solutions to function as intended, Internet connectivity is necessary – and some people in rural geographic areas in the US still do not have the capacity to connect to the Internet from their homes. Nearly 25% of all people residing in rural areas in the US lack still access to fixed broadband service (per the Federal Communications Commission). Anyone considering the purchase of a technological device for medication management (or recommending it to a senior-aged person) does need to make sure that Internet connectivity is available prior to the actual need to utilize the device.
The Ōmcare Home Health Hub® can assist with medication management, plus has many other features that can aid senior-aged people to remain healthy.
Chronic disease management: Best virtual healthcare options
Middle-age is when most adults are diagnosed with a chronic health disorder such as hardening of the arteries and diabetes (Type-2). Once a chronic disease has been diagnosed, it requires lifelong management so symptoms do not worsen. Healthcare check-ups to see whether medication prescribed to manage the disorder is actually working are common. For senior-aged people and other adults with disabling symptoms, virtual healthcare offers a way to have physician check-ups, request prescription re-fills, and obtain answers to questions without having to visit a doctor’s office.
According to the Centers for Disease Control (CDC), 37% of adults used virtual healthcare in the form of telemedicine in 2021. Virtual healthcare options differ tremendously, and some are easier for senior-aged adults to use than others. A Forbes magazine article in 2021 described six of the best virtual healthcare options available at that time. Topping its list was Teladoc, which is an “on-demand” service that connects a caller to a healthcare clinician and is covered by various health insurance plans (including some Medicare Advantage plans). Meanwhile, advances in Artificial Intelligence (AI) are enabling the design of apps focused even more specifically on supporting adults living with chronic health diseases.
Four types of telehealth available on apps for patient care
There are four different types of telehealth that are available either separately or in combination with each other (per the Center for Connected Health Policy). These are most often called:
- Live video (which uses teleconferencing software, and enables “real-time” interaction between a patient and healthcare provider).
- Store-and-forward (which involves electronic transmission of medical information such as documents, digital images, and pre-recorded videos).
- Remote patient monitoring (which involves personal health and data collection that is transmitted to a healthcare provider for use in providing care and support to that patient).
- Mobile health (which are basically healthcare and public health “best practices” and education supported by mobile technological devices such as Smart Phones).
For people with chronic health disorders, the utilization of all four types may be advisable in order to prevent the necessity of frequent “in-person” healthcare visits. In particular, receiving daily reminders to take medication (or to remember an upcoming “in-person” or virtual appointment with a clinician) can be beneficial for elderly people with cognitive impairments. In this way, receiving virtual healthcare can potentially enable a person with mild dementia to remain in the home environment for more years, rather than be relocated to a nursing home.
Encryption, virtual telehealth services, and videoconferencing
A medical research article in 2022 in Clinical Liver Disease noted that healthcare providers need to comply with the federal law called HIPAA that is focused on protecting patient privacy. For this reason, it specifies that platforms such as TikTok, Facebook Live, and Twitch are not acceptable for telehealth interactions. While Zoom (which is frequently used for social group events and business meetings) is among the most popular videoconferencing platforms, it lacks the encryption required for HIPAA compliance. In contrast, some platforms such as Doxy.me are HIPAA-compliant.
Health insurance and virtual healthcare
Consequent to the Covid-19 pandemic, more health insurance companies than ever are covering the cost of virtual healthcare visits. Medicare coverage for telehealth was flexible during the declared federal Covid-19 public health emergency ending on May 11, 2023 (but with an extension of many Medicare telehealth coverage provisions through December 31, 2024). Moreover, an increasing number of Medicare Advantage plans are offering broader coverage for telehealth, including covering the cost of certain digital devices. Meanwhile, mental health therapists are typically paid 20-30% less for virtual therapy sessions as compared to “in-person” sessions, which is a likely reason that many health insurance companies are now covering the cost of virtual therapy sessions.
Low-income senior-aged people are far more likely to be affected by chronic health disorders than their higher-income counterparts (per a medical research article in Healthcare). Yet, Medicaid plans (that are state-administered) do not cover virtual healthcare as extensively as Medicare or private health insurance plans. Therefore, low-income seniors may not be able to afford the “out-of-pocket” costs in the form of co-pays for virtual healthcare that is required of them.
Mental health and substance abuse treatment: How virtual healthcare can save lives
Federal law (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 [MHPAEA]) basically specifies that group health plans and health insurance issuers that provide mental health or substance use disorder benefits cannot limit these benefits to an extent greater than the limits on the medical/surgical benefits. It is well-recognized that adults with chronic health disorders are more likely to experience mental health disorders (such as clinical depression and anxiety) than adults without chronic health disorders.
Early intervention for a mental health disorder can prevent development of dependency upon a substance (such as alcohol) for self-medication. Since a mental health disorder and/or substance abuse problem is linked to decreased self-management of chronic health disorders, access to virtual mental health therapy and substance abuse treatment for adults with chronic disorders may lessen the likelihood of worsened overall health status. Thus, this type of virtual care may be life-saving.
Partner with Ōmcare
With the Ōmcare Home Health Hub’s open API integration, you can run your telehealth services directly on the Hub – eliminating the need for disparate solutions that account for hardware. Partner with us to reach more people and ensure better health.
Employee Spotlight: Danielle Wiek
Name: Danielle Wiek 
Title: Accounting & HR Manager
Time at Ōmcare: 6 years
1. What’s the most rewarding part of working at Ōmcare?
I love being part of a team that is developing a product that will truly help people have a better quality of life, with the right medication at the right time.
2. What is your favorite current project you’re working on?
Onboarding our new team members is always rewarding for me. I get the chance to make connections and assist them in being more comfortable when transitioning their careers to Ōmcare.
3. Pick out a core value that means a lot to you. How have you seen this lived out in your time at Ōmcare?
WE are a Team; It’s fun to watch when collaboration happens. The different views and ideas that everyone has brings our product to a new level.
4. What are you most proud of accomplishing throughout your time at Ōmcare?
Throughout my time at Ōmcare, I am most proud of the growth and knowledge I have acquired from wearing multiple hats including Accounting, HR, Administrative, and Customer Care. All these responsibilities have brought me a unique perspective into each part of the company and allow me to look at everything in a bigger picture context.
5. Why should someone work at Ōmcare?
Ōmcare is a small but mighty company that has good benefits, flexibility, values, and amazing coworkers.
34% of consumers are digitally inclined: Implications for the healthcare industry
An analysis of healthcare-focused survey data revealed that 34% of the entire US adult population is now digitally inclined, and interest among the senior-aged is surging. While preventing infection with Covid-19 prompted many Medicare-aged adults to schedule telehealth physician visits, there are other reasons that adults aged 65+ are more willing than before the pandemic to utilize technology-based healthcare services. From reminders to take medications to disease-specific health education – and individual wellness checks to answering patient questions – the use of wearable devices and digital healthcare platforms by the elderly is significantly growing.
Due to the potential for improved overall health status, senior care facilities and Medicare providers (including Medicare Advantage providers) are focusing more attention and resources on this trend. As of 2021, at least one in five nationwide healthcare leaders reported that their organization/practice offers remote patient monitoring. Described below are some of the different digital approaches to improving senior health status that are being embraced by senior caregiving facilities and clinicians, as well as by more healthcare payers. Diverse ways that digital healthcare delivery approaches can reduce costs are also discussed.
Digital health education as a chronic disease management tool
The American Diabetes Association notes that 29.2% of all adults aged 65+ in the US have diabetes. Even more have a condition termed pre-diabetes that – with lifestyle changes – may be controlled such that progression to full-blown diabetes (Type 2) does not occur. Since obesity is highly linked to developing diabetes, digital wearables can calculate both the total calories consumed in the food eaten and the reduction in weekly caloric intake needed to lose a targeted amount of weight (in pounds).
While Fitbit and similar fitness trackers can aid in enabling a plan for weight management or loss, other types of digital wearables are more focused on aiding people diagnosed with prediabetes or diabetes to understand their daily glucose (blood sugar) intake from the foods eaten – so can promote both weight loss and lowered glucose intake. Moreover, they can include a “chat” feature to answer questions about caloric and glucose content in a specified amount of a desired food item, so that the individual can decide whether to consume it or not.
Other chronic disorders such as heart disease and Chronic Obstructive Pulmonary Disease (COPD) can also require major lifestyle changes. By utilizing a wearable that offers digital health education, the afflicted person can learn how to better manage a newly-diagnosed condition or acquire informative reminders if a medical provider’s instructions are forgotten.
Medication management: How digital platforms and digital wearables are useful
Many senior-aged people take more than one prescribed medication each day. Two of the most common are cholesterol-lowering medication and antihypertensives (that control blood pressure). More than four in every 10 elderly people take at least five prescription drugs per day – which is a three-fold increase as compared to 20 years ago. Although this has enabled many to live “better” and enjoy a far longer lifespan, it can also be confusing for these people to keep track of all of their daily medication. Therefore, more intensive medication management by the individual (or that person’s personal caregivers and medical providers) is needed to reduce medication intake mistakes.
For adults aged 65+ residing in assisted living facilities as well as alone, recognizing negative effects from skipping a medication or accidentally taking more than the prescribed dose can be problematic. Meanwhile, elderly people with early dementia (such as early Alzheimer’s Disease) can tremendously benefit by a digital device that provides real-time reminders of which prescribed drug to take and when to take it.
Furthermore, patients with a history of nonadherence to their medication can benefit from a digital call from a member of the healthcare team (or even a nurse care coordinator from that person’s insurance plan) to ensure that the needed medication are being utilized. (This is particularly useful for a senior-aged person with a past history of stroke prescribed a daily blood-thinning drug to prevent another stroke, but who forgets to take the drug due to forgetfulness resulting from the stroke.)
Wellness and safety checks to relieve stress on caregivers
Around 28% of community-dwelling senior-aged adults live alone, and that number sharply increases after age 75. According to Harvard University’s Joint Center for Housing Studies, the number of people aged 80+ who are living alone is set to soar to an estimated 10.1 million by 2038. “Slip and fall” accidents are the most frequent causes of bone fractures and death in adults aged 65+, and over 800,000 are hospitalized annually due to a fall-caused injury. One of the most common reasons is waking in the middle of the night to use the bathroom, and then losing balance due to suddenly standing up from a lying-down position with resulting light-headedness.
Utilizing a wearable digital device to dial for assistance in the event of an emergency is just one way that an elderly person who has fallen can obtain immediate aid. Another is a periodic call from someone (to ensure that the elderly person does not need immediate aid) in the form of a wellness and/or safety “check”. Through the capacity for periodic contact from a paid caregiver, family member, designated friend, or healthcare provider, prevention of a worsened healthcare outcome for the senior-aged person can be enabled. Likewise, it can also alleviate the anxiety and fear on the part of loved ones as to the health status and/or safety of that senior-aged person.
The federal Agency for Healthcare Research and Quality (AHRQ) in 2020 reported that preventable hospitalizations among adults as of 2017 cost the US $33.7 Billion, and such hospitalizations occur most commonly among senior-aged adults. Therefore, insurance companies and healthcare organizations/facilities alike (as well as the patients themselves) are bearing preventable costs that digitally-initiated wellness and safety checks may curtail.
Focus on Dementia: The importance of digital wearables to support patient functioning
An estimated 6.5 million adults aged 65+ in the US were living with Alzheimer’s Disease as of 2022. That number is expected to triple by 2050 (and one in three seniors is living with some form of dementia by the final year of life). Since dementia is highly associated with failure to take medication as prescribed, “slip and fall” accidents, and preventable hospitalizations, it is also linked to the overall increased cost-burden on the national healthcare system.
When Alzheimer’s Disease is diagnosed at an early stage, interventions to promote cognitive functioning (such as engagement in online “brain health” games and programs) can be initiated to help prevent the afflicted individuals from experiencing a more rapid decline in cognitive functioning than otherwise. As noted in an article in Frontiers in Neurology in 2020, lifestyle modifications and enhanced social support may delay the need for nursing home care, while also reducing the patient’s overall healthcare costs resultant from living with dementia. In particular, involvement in visual art-making activities has been shown to improve cognition and relieve anxiety in people with Alzheimer’s Disease (and other forms of dementia), per a medical research article in Cochrane Database Systemic Reviews.
Physical fitness and health status: Changed insurer attitudes toward fitness wearables
Reducing healthcare costs is a persistent issue for private health insurance companies targeting the senior-age demographic, as well as the US Centers for Medicare and Medicaid Services (CMS). Since physical fitness has been linked to both preventing numerous chronic diseases and decreasing the rate of age-related bone loss (osteoporosis), coverage of the cost of fitness trackers has been embraced by an increasing number of health insurers, as described by AARP.
Meanwhile, a Fierce Healthcare article in 2022 reported that Humana is using wearable fitness tracking devices it distributed to enrollees to track data on their chronic conditions in order to encourage embracement of healthy behaviors. Likewise, United Healthcare in 2023 is rolling out a financial rewards program for its enrollees using provided wearable digital tracking devices who meet their daily exercise goals (or other healthful activity goals).
By utilizing the data obtained from health-related digital wearables, insurers are better able to predict (and adjust for) upcoming year costs related to preventable chronic disorders. (While Medicare does not specify technological devices or wearables in its coverage language, it does cover “medically necessary” Durable Medical Devices [DMEs) – so it is likely that more digitally-driven DMEs will be covered in future years.) Meanwhile, a Health News article in 2023 suggests that current coverage of digital wearables as an added plan benefit (such as a fitness tracker or personal emergency alert system) are far more likely under Medicare Advantage plans.
Digital wearables, telehealth, and teleconferencing
Talking to a clinician as needed is a way that patients can stick to action plans for recovery at home following different types of surgeries (and also action plans for addressing early symptoms of disorders that require medical attention). For example, patients that are recovering at home following hip or knee replacement surgery – and are participating in post-surgery Physical Therapy (PT) sessions – may benefit from initiating a video call with their physical therapist to boost the likelihood of daily performance of the prescribed exercise regimen.
Since mental health can affect overall health and well-being, it is also a way that clinicians can remain abreast of their patients’ mental health status. Especially for patients with cognitive impairments, being able to talk to someone via a digital device can improve compliance with medical (and allied) provider recommendations for maintaining overall health.
Visit Ōmcare to learn more about our digital solution that provides a one-touch access point to provided services through our digital hub.
How to make telehealth more accessible for seniors
Driving to a healthcare appointment can be more difficult for a senior-aged person, as can acquiring a ride to a doctor’s office. Difficulty with mobility, decreased eyesight, and increased fatigue can all pose an obstacle to keeping appointments with medical providers. For this reason (and many others), telehealth has been a viable and welcomed option for many seniors and their family members. According to the Journal of Applied Gerontology in 2022, older adult utilization of video-based telehealth in place of “in-person” primary care physician visits has increased by 21% since the beginning of the Covid-19 pandemic.
Additionally consequent to the Covid-19 pandemic has been an increased interest on the part of older adults in acquiring online communication skills. The Pew Research Center (PRC) in 2022 reported that 95% of all adults aged 30-49 (and 44% of all adults aged 65 and older) now own a Smartphone. Meanwhile, the PRC also reported that 44% of adults aged 65 and older own a tablet computer (as compared to 53% for those aged 50-64). However, telehealth is inaccessible to many seniors for reasons other than lessened mental sharpness (although decreased cognitive ability can lessen telehealth accessibility for affected elderly adults).
The following are five ways to make telehealth more accessible to adults who are senior-aged:
1. Simplify Interface Interactions to Only Pressing One or Two Keys to Start the Telehealth Communication
Joint pain in the hands and fingers due to arthritis is common in older-aged adults, and around 47% of seniors aged 65+ have been diagnosed with arthritis. This can make manipulating keyboards and pressing buttons on computerized devices painful and difficult. Likewise, the common vision disorder of presbyopia – that makes reading small print more difficult – affects most older-aged people. When there are many keys or buttons to press to turn on (or turn off) the telehealth communication, this can increase the likelihood that an incorrect key or button will be pressed. Due to the frustration experienced in starting the software program, utilizing a wearable device, or needing significant manual dexterity to engage in the telehealth communication, a senior-aged person may simply give up.
2. Set the Audio to the Loudness Required by the Senior to Hear the Telehealth Communication
Hearing loss affects one in every three people aged 65-74 in the US, according to the National Institute on Deafness and Other Communication Disorders (NIDOCD). Many adults aged 65 and older wear hearing aids, but these can increase the overall decibel level without enabling a better ability to hear words over background sounds. Therefore, hearing a telehealth communication (whether it is an interactive video call with a medical provider or just a reminder to take a particular daily medication) can be problematic for some seniors. In order to decrease the likelihood that a hearing impairment will interfere with utilizing telehealth, it is important that the Smartphone, tablet, or computer be able to be set as loud as needed by the senior-aged person.
In addition, captioning should be enabled so that the senior-aged person with hearing loss can utilize this if necessary. Moreover, the ability to read the caption while hearing the words spoken may improve the understanding of the verbal message during the telehealth visit.
3. Ensure that the Technological Device is Working Properly Prior to Any Telehealth Interaction
Whether the technological device is a desktop (or laptop) computer, tablet, or wearable, checking it intermittently to ensure that it is actually functioning is essential. Since many senior-aged people are not technologically savvy and insecure about their high-tech abilities, they may think that they are utilizing the telehealth-related software incorrectly when the problem lies in the computer hardware or merely a “low” battery that needs re-charging.
While it is better for someone who has an adequate enough level of technology skill to check the computer for the elderly user to ensure it is working properly (and especially that it stays on after the power button is pressed), an alternative is to “walk” the senior periodically through the steps of this hardware check, to ensure that a telehealth interaction can actually occur.
4. Do Not Change the Appearance of the Computer Screen after Installing Software Enabling Telehealth Utilization
People who are not highly familiar with using computers (such as many elderly people) can learn to use them, but the confidence level can be shaky due to unfamiliarity with high-tech devices. If learning has occurred on a screen with a specific appearance (such as the icon for the telehealth-related software and other icons in certain positions on the screen), moving them can cause confusion for the elderly computer user.
According to a medical research article in Seminars in Hearing, cognitive changes occur during later-life aging that often impact the nimbleness of that elderly person to adapt to changed information to make a decision. Therefore, a changed computer screen appearance can create doubt in the mind of an elderly person with a minimal level of computer skill as to how to use that computerized device. Furthermore, this confusion can lead to not realizing that the icon to connect to a clinician for a telehealth interaction is actually the same as always – but just appearing in a different place on the screen!
5. Ensure that Seniors have Access to a Reliable Internet Connection
Thirty-nine percent of all adults aged 75+ have lived in their current home for more than 30 years (per the Urban Institute). Therefore, the Internet connectivity capability may not be sufficient for that necessary to engage in a telehealth interaction. Meanwhile, there are diverse other causes of “spotty” or nonexistent Internet connectivity. One major cause is residing in a rural geographic area, where broadband lines can be distant. Meanwhile, 43% of adults living on an annual income of less than $30,000 in the US do not have at-home broadband, and around 10.3% of all seniors are living below the poverty line.
Whatever the reason for the lack of reliable Internet connectivity, telehealth requires that a person be able to depend on such connectivity. Otherwise, a telehealth visit may be scheduled by a physician or other healthcare provider but the patient not be able to participate in the virtual visit due to the Internet connection not functioning. On the other hand – if basic Internet connectivity is not a problem – enabling senior-aged people to understand how to acquire an Internet Service Provider (ISP) and a connectivity speed appropriate to their circumstances/needs can improve the likelihood that they will be interested in utilizing telehealth services.
The Ōmcare Home Health Hub® is a technology product that includes a mobile app and the capacity to engage in telehealth video calls for check-ins and check-ups, so can aid seniors while aging at home.