The "Human Touch" in Aging in Place Planning

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Laizer Kornwasser, writing for HomeCare Magazine, reminds that although technology can improve health outcomes, human hands are still needed.  In his article entitled, The Importance of the Human Touch, Kornwasser, President and Chief Operating Officer at CareCentrix, a post-acute benefits management company, suggests that "the future of better health care in this country is not people versus machines," it is in fact, "just the opposite."  

Kornwasser concedes that a "future of improved health outcomes and lower health care cost comes when health care providers use technology to not only inform diagnoses, but also to catch early signs of medical problems, create the most effective treatment plans and recommend the most appropriate post-acute care environment for the patient:"  

"One of the latest health care advancements currently being tested is the use of sensors to track the activity of elderly people in their homes and in their cars, as part of an effort to enable them to live longer and more safely in their own homes. The Collaborative Aging (In Place) Research Using Technology (CART) initiative is a national study currently in progress that tracks seniors’ pill consumption, weight, computer use and movement in and around their home and in their vehicles to generate real-time activity and monitor for any health changes, such as cognitive decline or increasing frailty issues, so that intervention can happen earlier to help prevent or shorten a potential hospital stay.

There are a number of commercially available sensor-based products that can monitor individuals at home, but no company has mastered the logistics of installing and configuring the sensors so an alert can be acted upon, as CART is pursuing. Sending up a red flag with no one to interpret what the red flag means and how to best intervene is like creating a computer system without a backup."

The "human touch" necessary involves connectivity, communication and collaboration among providers, patients, payers and caregivers utilizing technology intelligently and humanely:

While a machine can be programmed to perform given tasks more efficiently and extrapolate needed and advanced learnings better than its human counterparts, the artistry is in the execution of the information and in being able to adjust to the subtleties that may be required in a given situation.

The CART study is an excellent example of the exciting new research being conducted in the “technology meets touch” space, but there are many examples where the practice is already in use. Consider the task of getting prescriptions filled at a pharmacy. What was once an onerous paper-based process that was often filled with roadblocks and safety concerns due to lack of information, multiple providers and polypharmacy is now streamlined through electronic health records, real-time benefit checks and e-prescribing capabilities that allow physicians to make better prescribing decisions for a patient at the point of care.

Within the home health industry, technology is consistently opening new paths that deliver improved patient outcomes, while achieving lower overall health care costs. Nowhere is this transformation more evident than in the adoption of artificial intelligence (AI) and machine learning technology, which is quickly changing the face of patient care.

Using petabytes (1 million gigabytes) of data, clinicians can quickly analyze past results of clinical settings and providers to recommend future paths for better care. For example, a physician can now match the characteristics of an individual in need of a hip replacement to a facility and/or provider with measurable success in caring for patients with similar clinical and socioeconomic characteristics. Matching patients with the right provider at the start of care improves outcomes, increases patient satisfaction and provides cost-saving solutions that can avoid hospital re-admissions.

AI and machine learning, combined with new modes of communication, are making it possible to create smart networks that match the patient’s needs with the best-possible providers. But, it is still the uniquely human ability to deliver on those care needs, once identified, that brings to fruition the highest quality of care, while lowering health care costs.

As technology continues to evolve and predictive analytics advance, we need to challenge the industry to develop products that not only improve the machine learning process, but also seamlessly connect a patient’s clinical care team with real-time medical and pharmacy claims data that will help the team make more informed care decisions.

By teaming technology with the human touch, we will be able to place patients in the center of the care team—whether they are in the hospital, a post-acute care facility or healing at home.

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Even more tangible than the "Human Touch" about which Mr. Kornwasser writes, is actual physical contact. Research suggests that the physical contact plays a fundamental role in human communication and  physical and emotional health.  Lack of human touch is a real concern for the medically frail elder, leading to feelings of isolation, anxiety, poor trust in caregivers, insecurity and decreased sensory awareness. 

Older adults living with serious conditions are often especially receptive to touch. Unfortunately, they are also among the least likely to receive expressive human touch from health care providers. Nursing students have been shown to experience anxiety about touching older patients. Yet elders report that touch communicates safety, care, reassurance and makes them feel more trust in caregivers.

For individuals with dementia, human touch plays an important role in promoting overall well-being. Since touching the hands is so familiar, hand massage may be gladly accepted by elders living with dementia. Even five-minutes of hand massage have been shown to elicit a physiological relaxation response and decreases cortisol levels. Cortisol is a stress hormone that is produced by the adrenal glands during prolonged stress and is often used as an objective marker of stress. When cortisol levels are lowered it enhances sleep quality and the immune system. Massage has also been shown to increase serotonin levels. Serotonin is a neurochemical that regulates mood; feelings of calm; and subdues anxiety and irritability.

A five or ten-minute hand massage protocol has resulted in:

• Significantly decreased agitation immediately and sustained the decrease for up to one hour;
• Decreased the frequency and intensity of agitated behavior during morning care routines;
• Strengthened the relationship between the person with dementia and their family care partner.

One study evaluated the effects of hand massage on physical and mental function and behavioral and psychological symptoms consistent hand massage protocol. Both aggressive behaviors and stress levels decreased significantly.

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Slow-stroke back massage (SSBM) uses effleurage, moving the palm of the hand in long, rhythmic, firm strokes. One method applies effleurage in a figure-eight formation on both sides of the back. Massage stimulates production of endorphins which are compounds produced by the body that suppress pain and uplifts mood. Massage also has a generalized effect on the autonomic nervous system, producing a relaxation response.

Three-to-five minute protocols have shown slow-stroke back massage to:

• Help people fall asleep;
• Decrease anxiety;
• Decrease physical expressions of agitation such as pacing, wandering and resisting care;
• Ease pain;
• Decrease blood pressure and heart rate indicating a physiological relaxation response.

One study investigated the effect of SSBM on anxiety and shoulder pain in hospitalized elderly patients who had suffered a stroke. The study compared scores for pain, anxiety, blood pressure and heart rate of two groups of patients. The intervention consisted of 10 minutes of SSBM for seven consecutive evenings. The results revealed that the massage intervention significantly reduced the patients' levels of pain perception and anxiety and blood pressure and heart rate changed positively, again indicating relaxation.

While institutional nursing is employing these techniques in an effort to  to reduce unnecessary use of anti-psychotic medication by replacing or supplementing them with non-medicinal approaches and strategies, home care, too, should incorporate these techniques.  "Touch" initiated by family by hugs, pats, and simple hand holding or affectionate touching,  initiated as greeting and comforting touch by professional caregivers, or scheduled hand, back, or foot massage, can go a long way in comforting an elder, and contributing to positive physical, emotional, and psychological health outcomes.  

"Human Touch," as it refers to both the human component of collaborative information gathering, consideration, decision-making, and implementation, and to human tactile communication and care, is undoubtedly an important component of an Aging in Place plan. 

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