Healthcare Crisis: Overmedicating of Residents, AI to Rescue?
By PHILIP REGENIE
In 1972 a friend of mine worked in a senior home located in Santa Cruz California. At the time he would horrify our young novitiate minds with stories of what they asked him to administer to the seniors in his care. 40 years ago, polypharmacy and drug abuse of seniors was alive and well.
Today, with the explosion of the pharmaceutical industry, both the effective use of multiple drugs and the abuse of multiple drugs are prevalent in senior care. On average, seniors take six different medications, and more than 15 percent of seniors use at least 10 drugs at the same time. The drugs are often prescribed by multiple doctors for multiple symptoms without a clear understanding of their possible interaction. The point person for drug administration for a senior might change between family members and between staff without clear communication and understanding of the potential problems. Just two nights ago a woman shared with me a story about her husband who has suffered some electrical problems with his heart having fallen and broken his hip due to drug interactions. The societal problem is significant enough that Stanford has researched and developed sophisticated polypharmacy AI to identify risks associated with the interaction of multiple medications.
This is, in fact, the tip of the iceberg. The use of an additional sedative might seem very appealing to a single person on staff, left alone by a staff illness and lack of available replacements, responsible for 50 to 100 residents at 8:00pm. Just meeting the immediate needs of the community in toileting, medications, showers, and calls for help leave staff traumatized for years.
The United States assisted living communities are regulated by individual states. For assisted living communities in California there are no specific staffing ratios. California law requires that facility personnel shall at all times be sufficient in numbers, qualifications, and competency to provide the services necessary to meet resident needs, and to ensure their health, safety, comfort, and supervision. It should be obvious that this flexible standard can be interpreted, and that enforcement is difficult. Staff must be 21 years of age, have at least a high school diploma and receive 40 hours of training within the year of employment. These minimal staff qualifications allow for staff in RCFEs, Residential Care Facilities for the Elderly, to assist residents with medication self-administration.
The bar for being employed as staff in senior care communities is low but so are the wages. The 8th lowest paying job in America is personal and home care aides with institutional positions for senior care not far behind with an average annual income in 2017 of $26,269 a year. It is no surprise that retaining caregiver positions is a difficult task and that there is a widening gap in delivery of service to seniors.
According to an assisted living employee survey the number one retention issue in assisted living communities is manager employee relations. Training managers is an absolute must in ALFs and should include acceptance of measurement of performance and ownership of improvement. Measurement needs to be done without putting an extra burden on management as they are likely taking on staff responsibilities in order to meet service requirements.
Technology can help ALFs maximize the effectiveness of their personnel and keep personnel happier. Technology optimizes scheduled behavior with assessment and just in time delivery of service with improved communication. ALFs can improve performance by employing staff as firefighters who answer technology notifications for help calls, bed exits, and falls allowing other staff to perform scheduled walks, showers, and bathroom assistance to proceed unencumbered. AI is being used to identify the frail who need extra assistance, improve scheduling, performing polypharmacy analysis, and analyze real time data notifying caregivers of emergencies. Integrating it into existing systems is as easy as installing TV Players in rooms with some sensors. The technology does the rest with dashboards, smart mobile clients, and reports of staff effectiveness and resident needs.
We have come a long way since 1972 but still need to ensure quality of care. We can assure quality by establishing legal standards for resident to staff ratios and increase educational standards for management. Staff ratio and management quality should be enforced through technology that does not require human resources such as smart phone check-ins and knowledge of ALFs capacity. Technology is a great equalizer when resources are stretched. ALFs need to adopt in order to meet minimum care standards.
Founder and CEO Philip Regenie established Zanthion after experiencing the challenges his parents faced in their final years of life. His personal experience with the indignity of his parents' deaths inspired him to enter the market and invest his personal finance to build a business based on dignity and care. With 35 years working in IT as a programmer, analyst and project engineer and eventually CEO/CTO in military aircraft systems, IOT (Internet of Things) and electronic medical record management, Regenie was uniquely positioned to understand and solve the complex problems associated with senior care. Realizing that no one else in the industry was providing the solutions he knew, from his personal experience, that seniors and their families need today, he decided to create Zanthion.