Sticking Points from Aging Innovation Challenge

Among the many working to develop aging in place solutions, a group of stretch thinkers joined facilitators, scholars and experts in late November 2018 for the first HeroX New York State Department of Health Aging Innovation Challenge. A handful of finalist products highlighted the need to assist with essential life functions such as eating, hygiene and grooming, mobility, transferring and general self-care.

New York State’s Commissioner of Health Dr. Howard Zucker, aging in place industry analyst and founder of the Aging in Place Technology Watch Laurie Orlov, State University of New York Chancellor Kristina M. Johnson PhD, and HeroX CEO Christian Cotichini judged the event, each bringing their unique experience for advice, discussion and questions.

ON-DEMAND: Laurie Orlov’s, “Technology-Enabled Homecare in the 21st Century,” exploring the status of current technology offerings and how to make them more accessible and functional for all. 

Innovation Challenge Points of Interest

• Basic assistive devices enable people to ambulate and take care of themselves through activities that can sometimes be taken for granted, such as bathing, toileting and dressing, even raising a fork, spoon or glass. Without assistive devices, many older adults would be unable to live independently.
   
• The challenge brings awareness to issues that older adults and their caregivers face and aims to attract bright minds in order to solve a problem that will continue to grow in the coming years. 
   
• Looming is a crisis of caregiver support with the ratio of caregivers to clients 80 years old and up projected to fall from seven caregivers for every one person today to four caregivers for every one person by 2030. Considering hourly wages, homecare companies are competing with Walmart for staffing, and Walmart is a lot less strain than being a caregiver.
   
• Lack of innovation in HME products comes at a high price for both patient or client and caregiver in forms such as unmet needs and safety risks.
   
• If you have a product idea, don’t get started until you learn what has already succeeded and failed. When you invent a gadget, there is no such thing as a gadget that stands alone. Gadgets become part of solutions and, in the case of technology, systems. Research the market to see what exists to help. Learn all you can about your product category of interest.
   
• We are seeing an unprecedented level of technology innovation. So you have a prototype: Expect immediate rejection of your patent application. Prepare yourself to go back and prove how and why your idea is unique.
   
• Start thinking about the problem of dementia for there is big opportunity there.
   

Top Performing Products

Top performers at the HeroX New York State Department of Health Aging Innovation Challenge include:

SUNY Corning Community College, GripM8: a versatile grip with multiple slots for various tools from kitchenware to a shaving razor or knitting needles. Best qualities: simple, versatile, multi-use. Potential drawback: ease of use in application. Team: Christopher Hermann, Anna Leonard, Bridget Von Bevern, Samantha Orr, Stephen Epp and Advisors Rosemary Anthony and Dr. Siri Kamesh Narasimhan.

Syracuse University, Pneu-Strength: a transferring aid that inflates to assist a person from seated to standing position. Best qualities: simple, may help prevent caregiver injuries associated with lifting and transferring. Team: Ruby Batbaatar and Kalia Zizi Barrow.

Other Prototypes Presented

Cornell University, StairPro: a walker modified to assist with using the stairs; also features a smart alert system that provides sound and light signals to alert older adults of stairs, objects and obstacles to prevent falls, as well as an automated flashlight for low-lit environments. Safety and stability in functionality and ease of use for those with dexterity issues were noted as potential concerns.

University of Buffalo, mRehab: a hub for motivating and collecting data as it relates to home-based rehab involving use of an in-home upper limb rehabilitation tool for lifespan eating self-management utilizing 3D printing and mobile smartphone technology. Team: Chen Song, Matthew Stafford, Zhuolin Yang, Dr. Wenyao Xu, Dr. Jeanne Langan, Dr. Lora Cavuoto, Mr. Heamchand Subryan and Dr. Sutanuka Bhattacharjya.

Cornell University, PediCure: an automatic toenail trimmer, designed to address hygiene needs. Best qualities: potential for health care savings in reducing podiatrist visits, affordable. Potential drawback: ability to handle uneven nails. Team: Jialin Ke, Jonathan Pao, Joshua Zhu and Stacey Wong.

Products were judged on innovation, impact, usability, implementation and feasibility. As part of the nearly year-long challenge event, participants explored impact on market and recorded user testing and feedback.

Audience Perspectives

Medicare beneficiaries rely on HME, including durable medical equipment, prosthetic devices, prosthetics, orthotics and supplies (DMEPOS), to treat their illness or injury and to allow them to remain in their homes, as opposed to seeking care in an institutional setting. DMEPOS as a category comprises a large number of products that vary in cost and complexity, ranging from complex power wheelchairs to diabetes testing supplies to knee braces.

Some say there are two schools of thought when it comes to research and development, policy and payment for HME/DME products, and the objective to keep people simply alive versus living life has helped to create a fleet of limited-use equipment.

The cost of under-designed HME is borne by the older adults using this equipment and supported by policy and payment which suggests that benefits better than base minimum are considered a perk, not a necessity, according to Peg Graham, a 66-year-old longtime resident of New York City and a retired public health professional who now advocates on behalf of older adults aging with mobility-related disabilities and their family caregivers. Graham, who gave feedback during the innovation challenge, recently submitted comments to the New York State Assembly’s public hearing on Healthy Aging as well.

Graham’s perspective: Through coverage determinations, Medicare requires “medical necessity,” traditionally covering only the “cheapest” products available, seeing any design improvements as “convenience” to the care recipient/caregiver and therefore, not covered by insurance. The result has been to discourage innovation in these basic assistive devices.

“I came to appreciate the importance of providing ‘the right equipment’ as a key component of successful aging in place and take this opportunity to make the case for establishing functional independence as a public health goal,” according to Graham.

Graham, who has developed a potential solution for toileting challenges, wants to see a workgroup convene to advise New York State on policies and practices that have grown up for decades around HME, “that need to be reexamined as part of this answer to aging,” she said, and she recommends three immediate actions:

1. Establish functional independence as a unifying goal across agencies, providers and payers in the “aging” space.
    
2. Convene an expert panel of HME manufacturers, suppliers and distributors; older adults aging with mobility-related disabilities; family caregivers and researchers. Charge them with conducting a one-day public workshop to create an overview of current policies and practices that hinder or promote the achievement of the highest level of function by older adults aging with mobility-related disabilities.
    
3. Establish an “innovation fund” that will provide seed funding to support rapid cycle testing of innovations in the home, led by New York State-based academic leaders.
    

“We’re living under a regimen that grew up under a time when no one cares if people were functioning at home. We need to go back and take look at some policies that have created a behavior and a lack of R&D within the HME community that you will run into,” she told Innovation Challenge product designers. “The state would be well-served to bring together the experts that have been looking at the questions for a while. These are the advocates for the disabled, the advocates for the aging, the New York Statewide Senior Action Council. We know that the managed care plans underway at the state level are doing things, but they are not rising to Medicare, not getting to the commercial insurers yet.”

Efforts to bring innovative products to market need to take on a review of the larger environment in which they will soon find themselves, Graham said. She urges the needs of older adults who use HME/DME be considered in all “Healthy Aging” efforts.

Change on the Horizon?

An increasing number of older adults (people at or older than 65 years old) lives with functional decline. The problem becomes most pronounced as people reach 80-plus years.

The Centers for Medicare & Medicaid Services (CMS) is standardizing patient functional assessment across all post-acute care providers via Section GG, focusing on the degree to which patients can independently perform activities of daily living. For more information, CMS updated its Function page in August 2018. An updated Home Health Quality Measures page was posted in late November 2018. In addition, CMS is changing reimbursement for nursing homes, home health agencies, long-term care hospitals and in-patient rehabilitation facilities to focus on patients’ conditions and resulting care needs.

Knowing that more adults can successfully age in place if the “right” HME products were available, Graham said she would like to convene a group of equipment manufacturers to work with her on a Small Business Innovation Research (SBIR) Grant. Graham can be reached at [email protected].