Category: Geriatrics

ANDOVER,HAMPSHIRE/UNITED KINGDOM-NOVEMBER 6 2019:A district nurse visits a ninety-four year old patient at his home to treat for pulmonary edema and head/brain injury.

Challenges Facing Home Health Caregivers During COVID-19 Pandemic

The Petrie-Flom Center Staff Leave a comment

By Vicki Hoak

The pandemic has emphasized the value of home health caregivers. Their contribution has been overshadowed for decades, but now it is very clear how important their work is to the well-being of older Americans, people with disabilities, and medically-fragile children.

As families were urged to stay at home to stop the spread of COVID-19, home care agencies and their staff became all the more important for preventing the spread of COVID-19 and protecting the most vulnerable from the disease. Home health aides offer clients one-to-one care and continual monitoring of changes in conditions — all in the safety of one’s own home.

Read More

Senior citizen woman in wheelchair in a nursing home.

Telehealth and the Future of Long-Term Care

Tara Sklar Leave a comment

Join us on Wednesday, April 7 for further discussion of these issues during our virtual event, “Triumphs & Tensions of the Telehealth Boom.“

By Tara Sklar

The COVID-19 pandemic accelerated the trend away from providing health care and long-term care in institutional settings in ways not previously imagined; the result of a reckoning with the massacre that disproportionately killed hundreds of thousands of older adults living in nursing homes or similar congregate facilities, along with the staff who cared for them.

Beyond the immediate staffing and infection control issues at hand, this juncture leads to a larger question, in the U.S. and abroad: how can we best care for an older population in the decades — and not just years — ahead?

The major advances and shortfalls that have surfaced during the pandemic around telehealth and its related technologies in digital home health care are essential to this discussion.

Read More

White jigsaw puzzle as a human brain on blue. Concept for Alzheimer's disease.

Detecting Dementia

Chloe Reichel Leave a comment

Cross-posted, with slight modification, from Harvard Law Today, where it originally appeared on November 21, 2020. 

By Chloe Reichel

Experts gathered last month to discuss the ethical, social, and legal implications of technological advancements that facilitate the early detection of dementia.

“Detecting Dementia: Technology, Access, and the Law,” was hosted on Nov. 16 as part of the Project on Law and Applied Neuroscience, a collaboration between the Center for Law, Brain and Behavior at Massachusetts General Hospital and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

The event, organized by Francis X. Shen ’06 Ph.D. ’08, the Petrie-Flom Center’s senior fellow in Law and Applied Neuroscience and executive director of the Center for Law, Brain and Behavior at Massachusetts General Hospital, was one of a series hosted by the Project on Law and Applied Neuroscience on aging brains.

Early detection of dementia is a hopeful prospect for the treatment of patients, both because it may facilitate early medical intervention, as well as more robust advance care planning.

Read More

Senior citizen woman in wheelchair in a nursing home.

Seniors’ Perspectives on Dementia and Decision-Making

James Toomey Leave a comment

By James Toomey

In order to make a decision recognized in law — to enter into or enforce a contract, buy or sell property, or get married or divorced — an individual must have the mental capacity the law requires for the decision. As people, especially older adults, develop dementia, their decision-making abilities are increasingly compromised, and the law begins to find that they lack capacity for particular decisions.

The standards governing capacity determinations, however, are notorious for being vague, inconsistently applied, and excessively curtailing the rights of those with dementia. Part of the problem, I think, is the lack of an agreed-upon normative theory for when in the course of dementia the law ought to intervene in individual decision-making. That is why, here on Bill of Health, I’ve previously called for understanding the perspectives of seniors — the population affected by the doctrine of capacity most closely and most often — on this normative question.

In my recent publication “Understanding the Perspectives of Seniors on Dementia and Decision-Making” in AJOB Empirical Bioethics, I’ve begun to do so, reporting the results of an empirical study that I conducted with the Petrie-Flom Student Fellowship in the 2018-19 academic year. The study, which involved an online survey of and interviews with older adults, revealed a heterogeneity of ways of thinking about the problem, supporting a flexible legal doctrine that would assist people in making their own choices. Notwithstanding the diversity, however, the data reveal several conclusions and tensions of interest to academics and healthcare and legal practitioners.

Read More

Kirkland, WA / USA - circa March 2020: Street view of the Life Care Center of Kirkland building, ground zero of the coronavirus outbreak in Kirkland.

Why We Must Hold Nursing Homes Legally Accountable for COVID-19 Outbreaks

Laura Karas Leave a comment

By Laura Karas

Immunity from liability disincentivizes nursing homes from expending the time, money, effort, and resources needed to keep residents safe.

The COVID-19 pandemic has highlighted the stakes of the issue: granting legal immunity to nursing homes for COVID-related care is tantamount to leaving our most vulnerable out on the street corner.

According to data from the Center for Medicare and Medicaid Services, there have been over 216,000 confirmed COVID-19 cases and over 53,000 COVID-19 deaths among nursing home residents.  These figures are likely underestimates, as nursing homes have had to adjust to federal reporting guidelines.  Recent data indicate that deaths in nursing homes are on the rise in states with COVID-19 resurgences.

Kimberly Hall North in Windsor, Connecticut, was one of many nursing homes ravaged by COVID-19.  Reports in June of this year cited 47 deaths among its 138 residents, a death toll exceeding one-third of the nursing home’s resident population.

Read More

New technologies are empowering persons with disabilities. But are they Assistive?

Adriana Krasniansky Leave a comment

Consumer tech has reduced daily friction for countless individuals, making it easier to control households, shop for groceries, and connect with loved ones. These technologies can be especially empowering for persons with disabilities, increasing accessibility and resolving frustrations of everyday activities. You may have seen related news in press releases and popular headlines: “Alexa is a Revelation to the Blind,” “Disabled Americans Deserve the Benefit of Self-Driving Cars,” “Amazon Alexa Can Help People With Autism Do More On Their Own.”

But are these technologies assistive? Disability nonprofit Understood.org defines assistive technology as “any device, software, or equipment that helps people work around their challenges.” Classifying a device or software as assistive technology (and/or related regulatory labels) can lead to insurance coverage and tax incentives. It can change how devices are viewed in healthcare settings and impact product research and design. In this article, we speak with bioethicist and disability scholar Dr. Joseph Stramondo about how to define assistive technologies in today’s consumer tech revolution. 

Read More

a home hub featuring icons of all the tasks it can assist with in a thinking cloud

Exploring Elder Care Robotics: Voice Assistants and Home Hubs

Adriana Krasniansky Leave a comment

This article is part of a four-part series that researches how robotics are being developed for aging care and investigates their ethical implications. In our first article, we explored emotional companion robots, which soothe and comfort patients experiencing loneliness, depression, or diseases such as Alzheimer’s. Today, we look at voice assistants and home hubs—robots designed to coordinate and simplify daily tasks around the house. 

What are Voice Assistants and Home Hubs?

Unlike other robots in this series, you are probably familiar with voice assistants and home hubs. These robots, which include Amazon Echo, Google Home, Apple Siri, Samsung Ballie, and Nest, respond to human commands (voice, motion, or input) to complete tasks like preheating the oven, playing a podcast, or refilling a prescription. Several devices also incorporate artificial intelligence (AI) to learn household patterns and anticipate needs.  However, unlike social robots (covered later in this series), voice assistants do not proactively engage with users unless programmed or commanded.   Read More

Illustration of a senior woman walking with modern robot dog

Exploring Elder Care Robotics: Emotional Companion Robots

Adriana Krasniansky Leave a comment

By Adriana Krasniansky

This article is the first post in a four-part series looking at robots being developed for aging care, as well as their ethical implications. In this first article, we explore the rise of emotional companion robots such as the now-famous Paro, which are designed to soothe and comfort. 

What are Emotional Companion Robots?

Emotional companion robots deliver on a very basic definition of the term “companionship:” they provide emotional soothing and a constant presence for users. Many emotional companion robots are modeled after animal-assisted therapy (AAT) pets, which are trained to calm and support individuals with Alzheimer’s, dementia, and cognitive impairments.

AAT in elder care can be challenging; animals risk injury to patients, trigger allergies, and require regular exercise (and bathroom breaks). Animals may also refuse to cooperate, which can further agitate patients. Emotional companion robots have similar demonstrated outcomes to AAT—reducing stress, improving mood, and stimulating conversation—without the logistical hang-ups of animal care.  Read More

Photograph of a doctor holding a headset sitting in front of a laptop

Navigating Sensitive Hospital Conversations in the Age of Telemedicine

Adriana Krasniansky Leave a comment

By Adriana Krasniansky

On March 5, 2019, a terminally ill patient from Fremont, California, learned that he was expected to die within several days. The doctor who delivered the news did so via a robotic video teleconferencing device. 

Ernest Quintana, a 79-year-old patient with a previously-diagnosed terminal lung condition, was taken to the Kaiser Permanente Fremont Medical Center emergency room after reporting shortness of breath. His 16-year-old granddaughter, Annalisia Wilharm, was with him when a nurse stopped by and said that a doctor would visit shortly to deliver Mr. Quintana’s results. 

The video below, recorded by Ms. Wilharm, shows Mr. Quintana’s consultation with a critical care doctor through an Ava Robotics telepresence device—in which the doctor explains Mr. Quintana’s rapidly worsening condition and suggests transitioning to comfort care. Ms. Wilharm and her family chose to share the video with local media and on Facebook, inciting a debate around the legal and ethical challenges of using telemedicine in critical care conversations. 

Read More

Hands of a young doctor wrapping around the hand of an elderly person

C-TAC and Petrie-Flom Center Convene Leaders to Explore New Approaches for Serious Illness Care

The Petrie-Flom Center Staff Leave a comment

By Stephen Waldron

Health care leaders gathered at Harvard Law School on April 26 to discuss opportunities to redesign care delivery for people with serious illness. These efforts are informed by the shift to value-based care, which has been championed by innovators in the advanced care movement.

The event was part of the Project for Advanced Care and Health Policy, a collaboration between the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and the Coalition to Transform Advanced Care (C-TAC). Read More