Part one of a two-part series:
In 2006, the first of the roughly 79 million American baby boomers hit age 60, representing the vanguard of a feisty demographic group moving inexorably toward its final confrontationold age.
Boomers, who are half again the number of the "greatest generation" that gave birth to them, constitute a socio-economic glacier that has scoured a host of cultural norms in its path and is currently bearing down on the long-term-care industry, scaring the wits out of healthcare policy planners.
Last month, the Washington-based not-for-profit Alliance for Health Reform held a forum that emphasized the boomer-driven necessity of changing the culture and improving quality in long-term care. Edward Howard, the alliance's executive vice president, set the stage with some sobering numbers.
Today, there are 1.6 million Americans in nursing homes, but "there are 37 million baby boomers who will soon be aging into the territory where greater long-term-care need is expected," Howard says. Between Medicare and Medicaid, state and federal governments finance about 69% of nursing-home spending, he added.
Overall, national expenditures for long-term care reached more than $143 billion in 2005, according to data from a June report by the Long-Term Care Financing Project at Georgetown University. As the baby boomers age in the next four decades, the report noted, the number of people older than 85those who are most likely to need long-term carewill more than triple.
"When the baby boomers start turning not just 65 but 85, we're going to need a whole new system," Howard says. "The good news is the statistics tell us disability rates continue to decline, but just the sheer numbers tell us we're going to have a growing population that is going to need care. So we better figure out something else that is going to help us cope with one of the biggest unrecognized healthcare problems."
Where's the IT?
From the standpoint of healthcare information technologytools many healthcare policy experts insist will be vital to coping with the boomersthe long-term-care industry is in no better position, and some say, in much worse shape, than ambulatory-care practices or inpatient facilities in terms of IT adoption. Thus the quality improvements and the financial efficiencies expected from widespread IT adoption remain as remote and theoretical in the long-term-care sector as in other healthcare settings.
Likely the best available data on IT use in the long-term-care sector come from a survey conducted jointly by the American Health Care Association and the National Center for Assisted Living, trade groups for operators of nursing homes and assisted-living facilities, respectively.
Taken in August and September 2006, with a report completed last December, the survey gathered responses on IT status and plans from operators of 916 long-term-care facilities and 166 assisted-living facilities. Respondents were asked to select from six descriptions of IT usage the one that best fits their current circumstances and also to predict where they would be in three years, in 2009 (Note: The 345 long-term-care facilities of Golden Gate National Senior Care, formerly Beverly Enterprises, were reported by the company to the AHCA "in bulk," skewing the survey results, so the study authors reported survey results both with and without Golden Gate's numbers).
Not quite half of long-term-care respondents (416 out of 916, or 46%) reported that they still do most of their work on paper while only 23 facilities (2%) identified themselves as completely computerized and are at least beginning to communicate or are fully communicating with their business partners using computer tools. Survey authors noted those numbers were skewed upward by the largest long-term-care facility provider participating, Golden Gate National Senior Care, San Francisco, which reported its 345 nursing homes together "in bulk." Golden Gate reported all of its facilities in the category, "We do most of our work on a computer." Not counting Golden Gate, better than 73% of survey respondents reported doing most of their work on paper.
The outlook for the future in long-term care is only somewhat brighter. Slightly more than one in five respondents (194 out of 907, or 22%) projected that they still would be doing most of their work on paper in 2009 while better than half (570 out of 907, or 55%) projected theyd be largely computerized by then. However, those percentage shifts were affected considerably by Golden Gate, which expected all 345 of its facilities would be well on the way to full computerization in three years. Back them out of the calculations, and the percentage of facilities that still expect to be paper-dominated by 2009 jumps to 35% and the percentage of facilities that project to be well-computerized drops to 28%.
Assisted-living center operators were even farther behind the IT adoption curve. Out of 166 respondents, 107, or 64%, were doing all or most of their work on paper in 2006 and just three, or nearly 2%, were fully or almost fully computerized. In three years, one-third (33%) projected they would still be using only or mostly paper while just 19% expected to be using computers for most or all records and communications.
The authors of the report note that while many large, national, multifacility companies are undergoing "aggressive computerization ... independent facility owners are moving into the computer age, but at a far less aggressive pace." This pattern, where size correlates to IT adoption, is mirrored by IT trends in ambulatory care and in hospitals, based on multiple surveys in those areas.
Rather diplomatically, the authors also conceded that "nursing facilities ... particularly among independent companies and regional multifacility companies, may be further behind in transitioning to HIT than conventional wisdom may have suggested. Today, there remains a predominant reliance on paper communication as opposed to digital communication among a majority of the nursing facilities." And while multifacility companies are leading and will continue to lead in IT adoption, "Clearly, three years from now, the majority of (all) companies will still be in the early stages of transitioning to HIT."
What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.