This series focuses on how the health care and senior care industries are enabling more autonomous living opportunities for all ages while improving and expanding care in face of the exponential growth of the senior population. These industries face labor shortages and a strain on existing systems that must evolve and scale while meeting information security and privacy requirements.
In the fifth episode of this series, Matthew D Edwards and Brent Willett, President of the Iowa Health Care Association, discuss opportunities for humane technology to improve care and increase interaction with caregivers and family for patients in long-term care.
Brent Willett is President & CEO of the Iowa Health Care Association (IHCA). IHCA’s more than 1,000 member organization spans the continuum of long term services and supports health care in Iowa. In his role, Willett is responsible to the IHCA Board of Directors for overseeing the strategic vision for IHCA and the Iowa Health Political Action Committee.
IHCA and its affiliates and divisions, the Iowa Center for Assisted Living, Iowa Center for Home Care, Iowa Center for Post-Acute and Long-Term Care, Extended Care Services of Iowa, and the Iowa Health Care Foundation, serve the long-term services and supports the profession as a nonprofit trade association.
00:05 Matthew D Edwards: Welcome to the long way around the barn, where we discuss many of today's technology adoption and transformation challenges and explore varied ways to get to your desired outcomes. There's usually more than one way to achieve your goals, sometimes the path is simple, sometimes the path is long, expensive, complicated and or painful. In this podcast, we explore options and recommended courses of action to get you to where you're going now.
00:36 Announcer: The long way around the barn is brought to you by Trility consulting for those wanting to defend or extend their market share, Trility simplifies, automates and secures your world, your way, learn how you can experience reliable delivery results at Trility.io.
00:58 Matthew D Edwards: This episode continues a series focused on how technology can improve the lives of our aging population and those in our population who require long-term care, in particular, we focus on the use of monitoring and remote monitoring technology solutions using the Internet of Things or connected things technologies, while also ensuring purposeful, comprehensive privacy and information security practices along the way. Brent, welcome to the show. Thank you for being with us today. So Brent, you are the President and CEO of the Iowa Healthcare Association, and we're here to learn from you. That's the summary. So thank you for being with us today. What we'd like you to do is start off by teaching us about your organization, your product services, where you've been, where you're heading, teach us, and I know there's a whole lot to that, but you probably have a practiced… A message that you could pass along just to teach us about your house and your vision, your future, please and thank you, sir.
02:01 Brent Willett: Matthew, thank you for the opportunity to come on and talk with you. I'm privileged to help lead an organization called the Iowa Healthcare Association, and what we are is an association of healthcare providers that work in the long-term care healthcare space, that means we're providers of skilled nursing care, assisted living care, home care, so folks receiving healthcare in their home, as well as a number of other constituency groups which participate in that sector, we tend to call it post-acute care, so really anything that happens after the hospital, the hospital and the docs take care of you when you are acutely ill and need immediate service we're there to support your typically longer journey, hopefully back to health, but also in situations that lead to compassionate end-of-life care, and so our association is fairly broad in that sense, we're the only association in the country that represents what we call the full continuum of care.
03:13 Brent Willett: Meaning starting in the home, receiving medical care in your home from dedicated nurses and physicians through a potential next step being in assisted living environment where you may need some assistance with activities of daily living, maybe some assistance with your medication, maybe some assistance with shopping, maybe some assistance with getting around and socializing with others, and then into skilled nursing care, which is a more medically intensive model where folks need medical care on a regularly routine basis. And so we operate in all 99 counties here in Iowa and about 254 cities and towns, and we are a state affiliate of the American HealthCare Association, which is a national group, which does a lot of what I just described.
04:05 Matthew D Edwards: You, having been involved in all of these different areas of the healthcare industry, all of these different facets and segments, you're probably aware of all different types of operational challenges that people have, a lot of forward-thinking companies are trying to create new technology solutions to be used in senior care, long-term living solutions organizations, so remote monitoring, geo-fencing, predictive analytics, wearables, medication management, so forth, you've probably heard all of these things and are probably doing… Many of them are heading there in some way, shape or form, are there types of technologies or innovations that are actually exciting to you today, where you're like, Hey, that is something we wanna go explore, that's something we need to be doing yesterday… Teach us about that.
04:56 Brent Willett: Yeah, no question, Matthew. Probably 10, 15 years ago when we were talking about innovation, technology innovations for long-term care, we were talking about how do we install ramps on to people's homes so they can get in and out of those homes if they're in a rehabilitation situation and maybe on crutches or a wheelchair. Things are obviously quite a bit different, a lot more exciting now in terms of using technology to enable a better experience for folks that are going through some of the most difficult times in their life. They need long-term care. A couple of things, areas that I know my members and as a result, we are very interested in and we think holds a lot of promise, and I think we're gonna hear a lot more about in the coming years.
05:36 Brent Willett: One of those is very top of mind, I think for everyone right now with respect to what's going on with the COVID-19 situation, what we sort of call diagnostic analytics is something that clearly has a huge future here, and what I'm talking about when I say diagnostic analytics, I'm talking about moving from a model, even in some of the most sophisticated healthcare environments that we know today, which is collecting what we call vitals or medical information about a patient, we're recording that now probably in electronic chart at least, but in a lot of cases, we're not mining that data to understand particularly well, what might be happening in the future with that patient, or more importantly, what might be happening from an infectious disease standpoint for that community or for that facility itself, and so obviously the COVID-19 situation has brought that home in terms of how can we anticipate, how can we get ahead and identify markers. Which are leading us to an expectation that we are facing an enhanced risk of the spread, for example, of a disease.
06:45 Brent Willett: And so there's a ton of work being done on that right now. Epic Systems is a company that's doing a lot of that work nationally and internationally, but a lot of players in there, and really we've taken the first step, meaning that we moved everything into electronic health records by now, but now it's how do we actually leverage that data to tell us what's going on in a way that human beings just can't do from a processing standpoint. So I think that's really exciting. Another one I'll mention, and then kick this back to you, wearables is kind of a niche term, and I'm the furthest thing from a technology person. Forgive my layman's terms, but in a long-term care situation, particularly for someone who lives in a nursing home facility, in many cases, 30, 40, 50% of the folks who live in a nursing home have some level of cognitive decline, whether that is a diagnosis of Alzheimer's, disease, another dementia diagnosis. And unfortunately, for a lot of reasons, we don't have time to talk about today, folks today are being diagnosed in developing symptoms of cognitive decline much earlier in life, meaning that we have folks that are entering nursing facilities a lot earlier in their 40s, in their 50s, which really breaks your heart.
07:58 Brent Willett: But they're gonna be living there for a long time, and one of the primary things that happens with someone with cognitive decline, is they begin to wander, they don't know exactly where they are all the time, and so if we can enable, for example, them with a wearable… So that not only do we know where they are in a facility, but in a worst case situation, if they were to get to a point where they're outside the facility without supervision, or if they were on a visit with another supervisor or a family member who doesn't do a great job of keeping track of them, we can not only track them down, obviously, that's really, really important, but we can understand what's going on with their vitals at that moment, and we think that that's exciting not only just protect them from a security standpoint, but to improve their quality of life, because it probably means that they can have more visits, they can probably spend more time with loved ones outside the facility, as long as we can have a good handle in real time on what their medical vital signs are doing.
08:54 Matthew D Edwards: So the wearables, that has a lot of possibilities for you, do you see that that could also apply for in-home care solution or are you thinking on-prem stuff primarily? What's your thought on that?
09:07 Brent Willett: Absolutely. In an in-home situation, I'd expand that even from a wearables standpoint for in-home because… where I think maybe perhaps where you're going from an in-home standpoint is, can we make sure that these folks are equipped with something that's not invasive, but something can give us a really good handle on what their medical condition is in a dashboard situation. I'd also say one of the primary obstacles to being able to stay at home, which is where we want everybody to be as long as you can receive care at home… That's where we want you to be. That's where you wanna be. That's where I wanna be, that's where I want my family to be. If they need that kind of care, one of the primary obstacles is medication taking, so folks that have complex medical conditions typically have fairly complex medication regimens, and they can be very confusing, and they can vary in application the way to take these medications, those kinds of things now, if we can develop a program which not only educates that individual on how to take their medication, when to take it, but monitors that they're doing it correctly, is a game changer for folks to be able to stay at home.
10:11 Brent Willett: And I just caught my eye, I have no idea if this has actual applicability, but I saw the announcement maybe last week, maybe a couple of weeks ago, Amazon has its in-home echo product that looks like at certain times and actually exit the stand that it sits and fly over to an area of the home and record something, that's the kind of thing that I can see being used in combination with a number of other things to actually physically record to ensure that person has taken that medication at the right time and enable… Less visits from a nurse or a doctor, enable them stay at home.
10:47 Matthew D Edwards: Those are examples of how you could possibly influence the lives of our aging population, or those people who are post-acute care, they require some attention and need… How do you think technology or how do you anticipate or what are you excited about as it relates to how technology could actually change the lives of healthcare workers, the people who are providing the services, loving these people, where they are enabling them to get their jobs done well, what are your thoughts on that?
11:16 Brent Willett: Absolutely, I think we all look to technology in terms of how can technology serve us, serve humanity, serve the folks that we're caring for in a way so that we can maximize our time. And we want caretakers that work in long-term care and healthcare in general to maximize their time by taking care of people, and so if we can ask technology and develop technology to take care of a number of the tasks that are non-care-centered, that means more time for direct care for those residents, for example, things like sorting medication, that's a very, very time-intensive, and right now, from a regulatory standpoint, really, really requires human beings to be involved in, I could see that going away with the right kind of technology and making sure those nurses that are spending time actually helping that individual take that medication or care for them at the bedside, and those kinds of things, and the other thing from a caregiver's, and that's what… By the way, that's what caregivers wanna do, that's why they're in the space, these folks are not in long-term care for the money or the hours they're in it, 'cause they're a very, very special type of person who is a caregiver in their heart, and that's what they wanna be doing.
12:33 Brent Willett: And again, when we… It's very difficult to put anything through a prism that doesn't involve the current state of the world right now, we need to do, we need to develop technology to protect our healthcare workers in a better way. We've had 57 individuals who work in long-term care in Iowa die of COVID-19 since February. That's certainly 57 too many. And those are folks that were doing their job, they were exposed to the virus and ultimately succumb to it. Many, many more have developed symptoms. How can we look to technology, again, going back to predictive diagnostics and some of those other things to keep healthcare workers safer, not only so that they can be on the job because we have a serious healthcare worker shortage, but their job can be more fulfilling, more dignified and doing more of what they were there to do in the first place.
13:21 Matthew D Edwards: That's outstanding. And when you talked about the analytics predictive conversation, is that something that your organization is explicitly pursuing and doing and implementing, is that something that… Do you anticipate all of the different facets of the world that you're living in the organization that you're leading, would be leveraging as predictive analytics, the dependency of courses, EMR, as you mentioned, but then the dependency after that is ongoing data collection as well, that's some place you wanna be, it sounds like.
13:53 Brent Willett: We are pursuing it absolutely where we wanna be, and we're working with a number of partners to figure out how this looks in terms of a product category for our members to take advantage of one of the challenges and opportunities simultaneously with this kind of thing is what pipe does all this data come from? Iowa is a state that about 90% of nursing homes use one particular product for their Electronic Health Records, it's a company called PointClickCare, great company. And so we're interested in products obviously that can interface with that particular system, so in some ways, little associations like us, we're somewhat dependent on these folks figuring out how the handshake works, but we're working to prepare the ground for our members for the eventuality of this kind of thing rolling out, I'd say in the next six to 12 months. And I really think it's gonna be a game changer, and it's a perfect role for an association because our members are fighting a fire right now, they don't have time to think about the future, and we're working to do that for them.
15:07 Matthew D Edwards: So one of the things you mentioned earlier too was the number of healthcare workers that have passed away since earlier this year, due to the pandemic experience that we've been going through all of us, so a more difficult conversation maybe contextual to that is Dying with Dignity and my original thought on that conversation was, as a customer, client patient, does someone that your organizations are taking care of, and it hadn't occurred to me to also discuss the healthcare worker themselves. Do you see… How do you see technology helping enable… That's a tough conversation, but how do you see technology enabling people to die with dignity better tomorrow than we're able to enable today.
15:52 Brent Willett: How do we help people pass through the other side in the most dignified way? And I think that if we suggested that technology has no role in that, that we don't have our eyes open… One of the things that our hospice caretakers, our hospice nurses tell, and by the way, you wanna meet the most incredible people in the world, talk to a hospice caretaker. These people are incredible. One of the things that they tell us routinely is that folks that are… What they would say, actively dying, so folks that are dying is a process, it's a biological process, for some people it happens more quickly than others, but it's a process… One of the things that people that are actively dying tend to do is if they're able to, they have the physical strength to do, they will hang on until they get what our hospice care takers would say, until they get permission or until they get the okay from the loved ones that they care about the most, to pass on and to, and no one knows exactly how this works cognitively, but to make the decision to let go, and that's very, very difficult in an interconnected world where family members and loved ones more and more live farther away, are less able to be present physically, and so I'm not talking about a Zoom meeting to family members, but I think there's some amazing things that could be done to…
17:20 Brent Willett: I mentioned 50% of the folks that are dying probably have some level of cognitive decline and they have memory issues, how can we… How can we help them reconnect with their past as they're moving through the dying process, how can we create an experience for them that's human and real, but also enabled by technology to leverage those tools to remind them of their past, I don't know exactly how that looks… But I think that certainly… We never wanna get away from a day where an individual is surrounded by loved ones as they're dying, but unfortunately that doesn't happen for everyone. For lots of reason. And so how can we probably address the folks who are having the most lonely dying experience, a little bit less lonely. I think that's a good place to start.
18:11 Matthew D Edwards: So I suppose it may make more sense for me to say that technology is not a solution, and that you're looking for to replace a human connection, the human care, the humanity part of this, but rather the technology that you're interested in enables the humanity… It enables us to be more human with each other, enables us to focus on more of the contact, more of the experience, more of the journey, so not a replacement of people in order to provide care and not an automation of things in the care, but rather to enable more opportunities for humanity, which probably then leads to more dignity on the journey.
18:54 Brent Willett: That's right. I think the tech now… I mean, this is somewhat existential topic, but I think technology is with us and designed to serve us if we do this correctly, and we should ask and design technology to do the things that have the lowest level of human utility for us. Delegate those tasks to technology solutions so that we can spend more time being humans with each other, and I think that a long-term care, healthcare situation is a perfect example of the kind of benefit that technology can produce because it would allow people, caregivers to be closer to the folks that they're giving care and less of those… As you said, less of those, more automated task.
19:46 Matthew D Edwards: It's an interesting conversation to have, and we don't need to get lost on the existential part of what I agree with you. It's easy to create technology and it's easy to tell or communicate, "Hey, this technology exists, therefore, it's useful," but it's a really hard conversation that people often… That may be lost in excitement sometimes when people say, "Ah, this is interesting technology, but what's it good for." And those are hard conversations. So just because technology exists doesn't mean it's useful, and just because someone has created it and tried to sell it to you, doesn't mean it's actually going to solve a problem for you. As it relates to your company and the industry itself in context of adoption readiness, the pandemic certainly has changed people's perspectives on adopting technology solutions, how do we rethink companies, how do we rethink operations? Do you think that long-care industry… How does the long-care, I guess how does the industry itself even find out about new technology opportunities that, are you guys constantly forced to invent, are you so busy that you don't often get to see some of the newest ideas and figure out how they might be applicable? How does it actually work for you on a regular basis? How do you even find out that something's out there that might be useful?
21:06 Brent Willett: I'll be honest with you, long-term care for many years has been, I think, at the back of the bus when it comes to technology adoption. I think there's a lot of reasons for that, one of the reasons in a state like Iowa, where we have about 300 nursing homes that are independently owned and managed, which means that it's a single facility in a very rural area in most cases, it was built by a collection of community members who had the wherewithal to build a nursing home. And they don't have a lot of connective tissue to the greater sort of healthcare system, with the exception of the association. So we do see the association as a linchpin and as sort of a mesh to pass these opportunities through, and so we have invested in the last few years at our association in solutions to bring and do a better job of really vetting vendor and technology opportunities that are presented to members and be the vetting mechanism and then pass that on based on our findings.
22:09 Brent Willett: That has taken a pronounced new role for us in the last six, seven months because of the shortage, for example, of personal protective equipment, which you wouldn't particularly consider to be technologically advanced, but when you have hundreds of thousands of new vendors coming online claiming to have a line on this critical equipment, we've seen a role for the association to vet that out and make sure who's who and who is relevant. I would say that with increased… Look, there are certainly downsides to increased consolidation in any sector, one of the benefits as more of the long-term care facilities become connected in families of companies is that, there's a little bit more weight, there's a little bit more technology-focus at a corporate level that's being pushed down to those local facilities, but it's still really hard in a state like Iowa with a lot of small places that are… If they're not relying on the association, they're just reading about it on the internet.
23:13 Matthew D Edwards: So to some extent, that puts you in the position, you and your organization's position where somebody has to be looking for and paying attention to on purpose, you may even have someone who… And that could be you on your sleepless nights maybe, or there may be other people in your organization, they have to think about how to invent or innovate on purpose on a regular basis, is that… That's pretty much what you're saying, I think is, this has to be done on purpose, it can't be accidental.
23:42 Brent Willett: Absolutely. It's a healthcare setting because it's long-term post-acute care, it means everybody typically has a fairly complex medical condition, and so everything has to be done, as you say on purpose, and it can't be particularly experimental because, not only because we don't want to experiment with folks' medical conditions, we haven't talked a lot about this, it's a fairly dry topic, but the regulatory environment around healthcare has the potential to be a net positive for technology integration in the long-term care, but it also has the potential to be a huge barrier, and so navigating those waters is another challenge.
24:28 Matthew D Edwards: So, historically, and for good reason, to your point, the long-term care industry has been pretty conservative on adopting new technologies, new ideas, not because they're opposed to new ideas, but rather, hey, first and foremost, we're talking about people's lives, and second then, that probably suggests that your adoption curve is long on purpose, am I characterizing that correctly?
24:57 Brent Willett: Yes, I think you hit it spot on.
25:00 Matthew D Edwards: But you do have to go find out new ideas on purpose, you do have to innovate, invent or otherwise explore and test on purpose, but it's in a moderated pace because people are first and technology is supposed to enable. That makes sense to me. So, different question for you is, in organizations since the technology is changing, the need is changing, the desire to enable and equip healthcare staff continues to evolve, the needs of people you've mentioned even with different forms of dementia has changed, the profile's changed, everything is changing all of the time in these organizations, that suggests then that your risk exposure risk profile is changing in terms of what data you collect, how much of the data you collect, how is it being handled, how is it being shared? And one of the things you mentioned earlier too, was that, for example, in the system PointClickCare, one of the things that is a positive is if you're able to take additions or modifications to your operating environment and it integrates with PointClickCare.
26:07 Matthew D Edwards: So your profile, your operational profile is continuing to change as we would all hope it would be, and it would be evolving as we would all hope it would be. Are you finding that organizations need to hire things like Chief Information Security Officers, Privacy Officers, have they already existed, or do you see this changing now where there's a more data privacy confidentiality focus in the org and somebody's hired for it?
26:32 Brent Willett: Yeah, I think that for a long time, organizations have had privacy security folks, and those are typically folks that are in compliance work because the dictates of HIPAA, so the Health Privacy Act that we're all under, highly complex and really drive most decisions as it relates to technology integration and privacy protections. So folks have been in that space for a long time. I think that some of the larger companies that are perhaps a little bit more forward-facing, you are starting to see Chief Information Officers, you're seeing Chief Security Officers who are in that C-suite level participating at the same level as an operations financial type of person, but it's been slow. I think that's still a lot of smaller business, smaller companies are trying to do this with the existing staff that they have. I think that we probably run the risk, not only of an increasingly complex regulatory environment that's hard to comply with, unless you're really pay attention to things, but also missing out on some opportunities.
27:46 Matthew D Edwards: Yeah, agree, the profile changes a little bit, and to be a regulatory compliance-focused individual is of course required and spectacular, so where is my organization in relation to where it should be according to this standard, this expectation, when you start adding more and more of the technology in there that forces the compliance person to first acknowledge, but then second to either become savvy and what's actually going on in the technology side, indoor, you may have to consider when you need to hire an additional or different technology experienced person. 'Cause it does change a little bit. There is a technical regulatory compliance conversation as well as a general operational, and I'm curious if you've been seeing that or how you anticipate that happening in the future, the two seem to be the same, but they're actually not… What are your thoughts on that?
28:44 Brent Willett: I totally agree they're not the same at all. They're equally important, but compliance is about complying with the now and complying with what exists, and it's purely a risk management endeavor. When we're looking for folks to enhance the technological profile of a facility or of a company, we're naturally asking them to reach forward and they have to collaborate with those folks in compliance and regulatory, but we always… Even around here, we've got great compliance people at our association, we've got attorneys, lawyers are gonna lawyer, regulators are gonna regulate, and innovators are gonna innovate. This is not the same thing.
29:27 Matthew D Edwards: There's a lot, you have a lot of fun things to work on and evolve and improve and enable and equip and a lot of organizations, you've mentioned a couple of times, a small organization like yours, but you led this conversation by talking about the breadth of the responsibility, which pretty much spans the entire State of Iowa at multiple levels of healthcare as well, so I'm sure that there's an amazing reason why you say a small organization that could just be humility, but it doesn't sound small to me, it sounds pretty darn important and it sounds huge. So I'm curious, how could technology companies approach you or come alongside you to add value, in other words, if somebody shows up and says, Hey, I have this idea, what do you view as a good interaction, what do you view as a poor interaction, and they just shouldn't show up?
30:24 Brent Willett: A poor interaction is, Here's a product I developed. Would you like to sell it to your members? The sector is far too… It's very cliche, but no provider is the same, has the same needs, so that's a poor interaction, we're probably not gonna be very… We're not gonna do a lot of work together. A good interaction is, we're aware of this opportunity or this challenge in the sector, and again, I'll go back to predictive diagnostic analytics, we're aware of this opportunity, tell us what your members are telling you and let us work on something and bring it back to you, not because we're some kind of king maker we're the farthest from it, our members are voluntary, they can be members of ours, they can listen to us if they want. Sometimes they do, sometimes they don't. But from a technology standpoint, and I think Matthew you… And I appreciate your approach to this, or your philosophy on this, is that just because something exists doesn't mean it's good, and we've made that mistake here at the association just to operationally here, and we've invested in technology that was a waste of time and money. And so it's very difficult to find the interface between technology and healthcare right now.
31:39 Brent Willett: That's absolutely changing. I spent this, I took a few minutes this morning, I voted for the top 100 most influential people in healthcare by a publication called Modern Healthcare, which is like an industry publication. You know, some of the people that are on that list. Jeff Bezos, the head of healthcare at Google, Warren Buffett… Names you wouldn't typically run into in a list like that, and so it was telling to me when I saw those… So it's changing, but finding somebody who's willing to say, Look, I know technology, but I don't know healthcare, or I know healthcare, but I don't know technology. Those are the people that I think can actually get work done if you're pretty dyed in the wool. It's probably not gonna work.
32:22 Matthew D Edwards: Are there any things that I haven't asked you that you think is important to talk about or you wanna augment or revisit anything and particularly that we've talked about so far.
32:32 Brent Willett: I guess the only thing I would add because it surprises so many people when you don't think about long-term care until you need it… Right, I get that. Why would you… Everybody's busy, everybody's got lives, when you need it is when you need it, or when a family member needs it, and the thing that we run into a lot with families is how shocked they are at how complex the environment is, how dynamic long-term care can be have the number of choices like building a house, or it ends up being 100,000 more choices than you thought from door knobs to floor tiles. And so doing what you can to begin as soon as you sort of have the feeling, if you have parents that are just starting to get older, I have parents that are starting to get older, start thinking about the kinds of decisions you're gonna need to make as a family and getting yourself ready because it's a very, very complex… We can innovate ourselves into oblivion, but it's still gonna be a very complex and very difficult decision matrix for families, and so beginning to educate yourself about the sector is something I would advise, certainly not everybody in the world to do, because I'm realistic and everybody has lives to live but if you have a reason to, it's gonna be more complicated, more challenging and more expensive than you expected, and there's a lot of resources out there to educate yourself. I just encourage people to do that.
34:00 Matthew D Edwards: If people wanted to learn more about you, your organization and the services that you provide, where would they go.
34:06 Brent Willett: They can just go to iowahealthcare.org. We're an open book over there, everything about us, and a lot more for members as well, but that's a great way to start iowahealthcare.org.
34:18 Matthew D Edwards: Brent, thank you for your time. This has been an outstanding teaching conversation, I very much appreciate it.
34:24 Brent Willett: Had a blast, Matthew, thanks for having me on.