Contents

1    Purpose of White Paper and Executive Summary   
            1.1    Purpose of White Paper   
            1.2    Executive Summary   
            1.3    Disclaimer  
2    Social Isolation   
            2.1    Definition    
            2.2    Prevalence   
            2.3    Cost and Burdens Associated   
3    Types of Social Connectedness and Engagement Technologies   
           3.1    Social Connectedness and Engagement Overview and Definitions    
           3.2    Types of Social Connectedness Technologies    
           3.3    Types of Social Engagement Technologies    
4    Benefits of Social Connectedness and Engagement Technologies    
           4.1    Increase the Social Network and Reduce Loneliness and Social Isolation    
           4.2    Increased Resident/ Client Engagement and Satisfaction    
           4.3    Reducing Depression and Improving Health and Quality of Life    
           4.4    Reducing Health Care Costs    
5    Potential Long-Term and Post-Acute Care (LTPAC) Provider Business Models    
           5.1    Lifeline Program for Low-Income Consumers    
                     5.1.1    Eligibility    
           5.2    Rural Health Care Providers    
                    5.2.1    The Healthcare Connect Fund   
           5.3    Relay Service for Individuals with Speech and/or Hearing Impairment  
                    5.3.1    Subsidy for Communication Equipment    
                    5.3.2    711 Access to TRS    
                    5.3.3    Mandatory Minimum Standards for TRS    
           5.4    Private Pay    
           5.5    Standard of Care/Service and Other Payment Sources    
           5.6    ROI of Social Connectedness and Engagement Technologies    
                    5.6.1    ROI to Residents/Clients and/or Their Families    
                    5.6.2    ROI to Payers    
                    5.6.3    ROI to Care Provider    
                    5.6.4    Online ROI Calculator    
6    Planning for and Selecting Appropriate Social Connectedness and Engagement Technology    
         6.1   Vision and Strategic Planning    
                  6.1.1 Care Setting    
                  6.1.2 Target Population    
        6.2     Outcomes, then Business Goals  
        6.3     Hardware Considerations
        6.4     Software Considerations
        6.5     Considerations for Patient/Resident/Client and Family-Facing Solutions    
        6.6     To HIPAA or Not to HIPAA
                  6.6.1  Who is Involved 
                  6.6.2  What Information is Critical? 
                  6.6.3  How Not to Overthink It
        6.7     Organizational Readiness  
                  6.7.1 Who Are Your Stakeholders?
                  6.7.2 IT Infrastructure, IT Team, and Tech Support
        6.8     Operational Planning and Alignment  
                  6.8.1 Team
                  6.8.2 Workflow
                  6.8.3 Business Model
                  6.8.4 Technology Vetting    
7 Social Connectedness and Engagement Technology Matrix Components    
8 Acknowledgement of Contributors    
       8.1 Contributing Writers    
       8.2 Workgroup Members    
       8.3 Participating Social Connectedness and Engagement Technology Vendors    
9 References and Resources    

1.  Purpose of White Paper and Executive Summary

1.1  Purpose of White Paper

This white paper will help LeadingAge members and other aging services organizations to understand the uses and benefits of social connectedness and engagement technologies. In addition, the white paper and a matrix will help providers plan for, select, and implement the technology solutions that best fit their requirements. 

1.2  Executive Summary

CAST’s Social Connectedness and Engagement Technology Workgroup, consisting of providers, vendors, and consultants, compiled a list of social connectedness and engagement products that currently serve the long-term and post-acute care (LTPAC) market, as well as a list of functionalities and capabilities. The Social Connectedness and Engagement Technology Matrix will help providers choose the product that best fits their business line and functional requirements. It has 18 sections to help organizations narrow their choices.

Why Social Connectedness and Engagement Technology?
Social isolation is consistently associated with reduced well-being, health, and quality of life, as well as negative psychological outcomes such as depression. It can even be life threatening. Recent research found that subjective feelings of loneliness can increase the risk of death by anywhere from 26% to 45%. Social isolation is common; in community-dwelling older adults, rates may be as high as 43%.


These technologies reduce loneliness, improve health and quality of life, and reduce health care costs.


Social connectedness and engagement technology helps maintain and enhance an older adult’s relationships with peers, family, friends, and caregivers. Social connectedness technologies include social networks, video chats, audio chats, photo sharing, activity/event sharing, email, text chat, and picture chats. Social engagement technologies encompass life stories, community activity and event management, physical and mental exercises, games, music, facilitated conversations, companion apps or robots, and virtual reality (VR).

The benefits of social connectedness and engagement technologies include increasing an older adult’s social network and reducing loneliness and social isolation; increasing resident/client engagement and satisfaction; improving health and quality of life and reducing depression; and reducing health care costs.

Potential LTPAC Provider Business Models
Several programs may provide subsidies to help low-income consumers and providers afford the technology. The Lifeline Program for Low-Income Consumers discounts phone service. The Rural Health Care Program and Healthcare Connect Fund bring connectivity to rural health care facilities and providers. The Relay Service for Individuals with Speech and/or Hearing Impairment extends telephone service to people with hearing or speech disabilities.


ROI depends on the care delivery model, the payment/reimbursement model, the technology, and costs.


Payment sources may be private pay or out of pocket. LTPAC and community health providers, special population agencies, self-pay and self-insured organizations, and others, especially not-for-profits, may offer or cover an array of social connectedness and engagement technologies and services. 

The return on investment (ROI) depends on the care delivery model, the payment/reimbursement model, the technology, and costs. Providers can use an online ROI calculator and figure the ROI for residents, clients, families, payers, and care providers.

Visioning and strategic planning are essential components in selecting appropriate social connectedness and engagement technology, and so is viewing the technology as a way to reach business goals.

1.3  Disclaimer

This information is meant to help you understand social connectedness and engagement technologies, but it cannot possibly include all systems that may be available. Products mentioned in this report are only illustrative examples and have not been tested, independently evaluated, or endorsed by LeadingAge or LeadingAge CAST.  Please use this as a general guideline in understanding functionalities and examples of current social connectedness and engagement systems.  Where appropriate, we have included provider case studies.

2.  Social Isolation

Summary: Social isolation is an experienced or perceived lack of personal relationships with family, friends, and acquaintances on which people can rely in case of need.

Research demonstrates that in recent decades, social networks have become smaller, and older adults are more likely to live alone, increasing their chances of becoming socially isolated. In fact, social isolation in community-dwelling older adults may be as high as 43%.

Social isolation is consistently associated with reduced well-being, health, and quality of life, as well as negative psychological outcomes, including depression. It can even be life threatening. Recent research found that subjective feelings of loneliness can increase the risk of death by anywhere from 26% to 45%. 

2.1  Definition

While researchers recognize a variety of definitions for social isolation, it is accepted to define social isolation as: An experienced or perceived lack of personal relationships with family, friends, and acquaintances on which people can rely in case of need.

2.2  Prevalence

Social isolation is not restricted to any age group; however, older adults are more likely to experience social isolation. Current estimates of the prevalence of social isolation in community-dwelling older adults indicate that it ranges from 10% to 43%.1 

Research demonstrates that in recent decades, social networks have become smaller. Consequently, older adults are more likely to live alone, increasing their chances of becoming socially isolated. Risk factors that increase the prevalence of social isolation among the elderly include life course changes, such as retirement and being widowed; poor health and cognitive impairment, which may limit participation in social activities; and poor social skills, which often result in living alone.2 


Social isolation in community-dwelling older adults may be as high as 43%.


Life events and environmental factors such as a diminished social network, infrequent interactions with communities of affinity, the lack of availability of social groups, or the inability to participate in social activities often result in social isolation. Social relationships provide the instrumental and emotional support that are necessary for meaningful interpersonal connections. A lack of these interactions correlates with a range of negative health and psychological outcomes, including depression.3  

Isolation can also result from a perceived deficit in companionship and supportive relationships. The perception of isolation increases with age—with the oldest old reporting significantly higher perceived isolation rates than the youngest old. This perception is likely the result of a diminishing or absent social network, an increased reliance on professionals for practical support, and a decrease in emotional support and companionship. Those who experience poor health are also more likely to report higher levels of perceived social isolation and disconnectedness.4

Recent statistics offer evidence of a growing number of older adults who have reduced personal networks or are socially isolated. About 13% of older adults report being often lonely, and 30% report that loneliness was sometimes an issue.5

2.3  Cost and Burdens Associated

Social isolation is consistently associated with reduced well-being, health, and quality of life.6  Those who rarely or never receive the social or emotional support associated with socialization are more likely to report mental distress, depression, anxiety, insufficient sleep, and frequent pain. Isolated individuals experience higher levels of addiction, debt, and neglect of personal hygiene.7  They also tend to suffer higher rates of morbidity and mortality, infection, and cognitive decline.  

Older adults who report feelings of isolation are more likely to feel lonely, which is often accompanied by psychological distress. They are also less self-sufficient and more dependent on professional forms of care and support when it’s needed.8  


The health effects of prolonged isolation are equivalent to smoking 15 cigarettes a day.


Recent research shows that the negative health consequences of chronic isolation and loneliness, while harmful at any age, are especially so for older adults. According to a study published in Perspectives on Psychological Science, the health effects of prolonged isolation are equivalent to smoking 15 cigarettes a day.9  An earlier report found that subjective feelings of loneliness can increase the risk of death by anywhere from 26% to 45%.10

There is also diversity among socially isolated older people, which must be taken into account when developing appropriate interventions. Most interventions aim to promote social participation in local communities or social events without taking into account the individual’s preferences or other life course problems. In some cases, interventions aimed at social participation may even have adverse effects that lead to further isolation. Interventions to reduce social isolation must meet the needs and preferences of the affected individual. 

3.  Types of Social Connectedness and Engagement Technologies

Summary: Social connectedness and engagement technologies help maintain and enhance an older adult’s relationships with peers, family, friends, and caregivers. These technologies include social networks, video chats, audio chats, photo sharing, activity/event sharing, email, text chat, and picture chats. 
Types of social engagement and connectedness technologies include the following:

  • Life stories.
  • Community activity and event management (community apps, community blogs, activity calendars, digital signage, in-house TVs, smart speakers, etc.).
  • Exercises, mental exercises, and games, including arts and gamified rehabilitation.
  • Music.
  • Facilitated communication and conversations.
  • Companion apps or robots.
  • Virtual reality (VR).

3.1  Social Connectedness and Engagement Overview and Definitions

If the first phase of the internet revolution was to get people and devices online, the second phase has been marked by the emergence of technology solutions and programs that help enhance and improve our connectedness with one another and engagement in group or community events. 

While in-person communication and interactions continue to be critical, technology has allowed for removal of some of the geographic and time constraints that often limit our connectivity and interactions. From video chat to photo sharing, app stores are filled with new and old ways to stay connected. Moreover, engagement technologies help us stay connected, up to date, and in touch with the activities, programs, and events that we can join to socialize with others, including peers, staff, and/or family.  


Seniors are the fastest-growing adopters of both high-speed internet and smart devices.


Traditionally, most of these technologies have been designed for and targeted to the younger generations. However, over the past five years we have seen an explosion of new and enhanced offerings that bring a user-centric design approach. This approach unlocks the value for social connectedness and engagement software for millions of users, including older adults and individuals with limitations or disabilities. Pair this explosion of new solutions with the fact that seniors are the fastest-growing adopters of both high-speed internet and smart devices, primarily tablets and smart phones, and the social connectedness and engagement market is poised for growth and impact.11 

Social connectedness technologies include technologies that help maintain and enhance your current relationships with peers, family, friends, and caregivers. For example, a video chat application is one type of social connectedness technology that may help enhance a relationship with a friend living overseas.

Social engagement technologies include technologies that provide opportunities to enhance and expand your social network by engaging in events and activities and connecting with individuals outside your normal social network. For example, a community app is one type of social engagement technology that may encourage a resident to participate in activities with individuals outside their normal network of friends. 

3.2  Types of Social Connectedness Technologies

The following are different types of social connectedness technologies, in non-mutually exclusive categories:

Social Networks
Social networks are web-based services that allow individuals to construct a public, semi-public, or private profile within a bounded system, articulate a list of other users with whom they share a connection, and view and traverse their list of connections and those made by others within the system.12

As many adults age, they start to lose connection to their existing social circles, and technology can provide a way to nurture and enhance those networks. Whether they are based on common interests or common location, leveraging private networks can be a way to increase social engagement. 

Closed or private networks can potentially limit the risk of fraud, spam, and abuse, which are very frequent issues that arise with open social networks. Keeping activity clubs, interest groups, building assignments, and other information that is relevant for accurate private networks can be a challenging logistical task for operators. Operators will have to make determinations around who moderates and manages these networks and face many of the same decisions with which larger social networking companies have struggled for some time.

Video Chat
Video chats are typically conducted via a computer, tablet, or smartphone device (also called videophone chatting). They may involve point-to-point or one-to-one interaction, as in the case of applications like FaceTime and Skype, or multipoint or one-to-many interaction, as in the typical case of Google Hangouts. 

Well-designed video chat applications can open new avenues for older adults to stay active and engaged with their loved ones despite demographic shifts that are spreading families and communities further apart geographically. A sense of virtual presence and connection can be incredibly empowering for a population that may be experiencing limited mobility and no longer have family close by, or physically close neighbors and peers. 


Social connected technologies range include social networks, video chat, photo sharing, and more.


Audio Chat (including Voice Over IP)
In addition to traditional landline and mobile telephony, the evolution of Voice Over IP (VoIP) technologies over the past few decades has dramatically reduced costs, increased access, and ultimately unlocked a new and improved way to stay in touch with loved ones. For senior living providers, VoIP solutions also play a unique role in lowering overall back office costs and unlocking new value with features such as automatic call routing, mobile transfers, staff messaging, etc.

VoIP solutions leverage existing IT infrastructure to provide a new way to deliver “smart” voice capabilities. By leveraging the internet, these solutions have, for the most part, removed long distance charges (including international) and have provided additional value-added services including clearer high-definition calling.
VoIP digitizes your calling services. While you are still accessible via a more traditional 10-digit phone number, VoIP provides enhanced capabilities such as routing, phone-to-phone hot switching, and computer/tablet/mobile phone app access including visual voicemail, instant conference calls, and much more.

Photo Sharing
Photo sharing references a website or application used to store and share photos. Users upload their pictures to the site, which are stored on the server and made available to friends and family via personal web pages, specialized apps, or social networking sites.  Photo sharing can allow family members or friends to share photos with older adult relatives.

Event/Activity Sharing
Event and activity sharing applications allow users to share their schedule of events and activities with family or friends.  Having access to schedules can help coordinate what day and time is best to visit, call, or engage with an older adult loved one.

E-Mail
E-mails allow users to send and receive usually lengthy messages electronically.

Text Chat
Similar to e-mail, text chat allows users to send short messages electronically. The messages usually only contain one or two sentences.

Picture Chat
Similar to text chat, picture chat allows users the ability to send pictures or emojis through text or chat rooms.

3.3  Types of Social Engagement Technologies

The following are different types of social engagement technologies, in non-mutually exclusive categories:

Life Stories
One of the most rewarding experiences for older adults and their families can be sharing in life stories, pictures, and oral histories. A growing number of technology companies are finding ways to preserve these experiences digitally for the enjoyment of older adults, staff, and family. These programs can strengthen the bond within families and encourage relatives to stay more involved and active with their loved ones. These technologies can also help staff get a deeper understanding of their individual older adult residents or clients. Technology tools that create a vibrant community that leverages the strengths and passions of residents can be a powerful factor in community differentiation.

Older adults often have privacy concerns with any technology that is perceived as monitoring or recording them, so staff and families must help create and frame a positive experience. The sharing of the content that is created must be effectively managed and shared only with appropriate consumers, and residents’ rights must be the first consideration.

Community Activity and Event Management
Community activity and event management technologies may include community apps, community blogs, activity calendars, digital signage, in-house TVs, and smart speakers.

Senior living communities across the country are renewing their focus on differentiating their community and enhancing the experience of their residents through diverse activities and programming.  

Traditional one-directional communication solutions are either evolving or giving way to two-way interactive solutions, which not only provide consumers increased opportunities to actively participate and engage but also give content producers more flexibility and value. While this category in the past has been three separate products (and in some cases companies), the future of these communications channels is now a single solution providing a “publish once, consume everywhere” solution – ultimately using technology to improve both content creation and delivery. 


Social engagement technologies include life stories, community apps and calendars, games, music, and more.


Most communities struggle to keep information current and relevant throughout the community with the ever-changing nature of community operations. Technology provides the platform to push information to residents immediately using in-house TV, digital signage, and resident/family applications. 

Given the extensive printing costs many communities incur to distribute material, this category provides a clear path to an ROI for operators as they look to save money in their efforts to “publish once, view everywhere.”
Many companies in this space have developed solutions that only address one distribution medium and have neglected to consider the critical implications on staff workflow and the error-prone nature of the approach. Direct resident support by the vendor is often critical, as the introduction of new technology for all residents can increase inbound requests of community staff, IT or otherwise. 

Exercises, Mental Exercises, and Games
This grouping includes arts, games, exercises, and gamified rehabilitation applications. Communities have long known that keeping older adults physically and mentally active and engaged with activities and programs is an important element of supporting mental acuity. Today, however, there are new technology solutions that are designed to supplement and enhance community programming with digital games, entertainment, and education for residents. 
Technology can be an excellent tool that supports wellness and mental engagement without requiring staff intervention or one-on-one time. Older adult users can customize their experience and choose their own path and pace for learning to create individualization, while removing any social anxiety created by group settings. 

Games and modules must be customized for older users and ensure that there are not any complicated gestures, swipes, or other actions that are difficult or impossible for those with dexterity issues or limited technological expertise. 

Both the content and the pace of many games can present challenges for older adults, like any technology. Engagement happens only when the user finds the application easy to use and is valuable, with utility and entertainment value. Most gaming companies are focused on users between 15-30 years old and therefore do not anticipate these issues. 

Some applications leverage connected wearable devices that monitor physical activities, steps, heart rate, and sleep tracking as part of a challenge-based games. By sharing exercise activity with others, the collective group of older adult users encourages individuals to achieve their own activity goals.

Other gaming applications can be used along with connected devices, like hand pedals, bikes, and the like, for occupational therapy and rehabilitation. Others provide exercise regimens for various rehabilitation applications and use sensors, including cameras for some systems, to evaluate movement and track progress.

Music
The benefits of music for all age groups have been researched for years, but a newer focus on the positive impacts of music therapy for older adults and individuals suffering from dementia is gaining momentum. Technology can be a simple and inexpensive vehicle for delivering a personalized experience for musical enjoyment.

Previously, the costs of hardware (iPods and other MP3 or CD players) made a personalized experience difficult to deliver, but now music therapy can be just another app or feature within a community’s resident engagement programming. The availability, price, and quality of digital musical content has improved dramatically and will only continue to do so, allowing communities to customize programming for activities, therapy, and group enjoyment. 
Some older adults have tactile issues with headphones – a common way for audio to be shared. Licensing issues are common for most music that is available digitally. 

Facilitated Communication and Conversations
Technology that facilitates communication and conversations includes hearing aids and captioning.   

Companion App or Robot
Companion robots offer the promise of improved socialization and independence. These robots have a physical embodiment, in the form of a stationary or mobile robot. Examples include products like Jibo, Kuri, and Elli-Q. Interactive robotic companion pets have special pet-like embodiments and include products like Paro, the baby seal, and Tabby, Hasbro’s robotic companion cat. These robotic pets are designed to look and feel realistic but at the same time do not require the time and care required with live animals. They do seem to deliver a soothing, joyful experience that inspires smiles, laughter, and fond memories.   

Finally, there are also companion apps that have a graphical representation on a mobile phone, tablet, or computer, as opposed to a separate physical embodiment that companion robots like BUDDY have. 

While very early stage market segment startup companies, in addition to various others, are starting to hit the market,  it’s not just startups that are emerging in this space; in 2016/2017, the technology giant IBM made various announcements around a prototype robot focused on helping older adults age in place more productively and safely.

Virtual Reality (VR)
Today you are hard pressed to walk through the mall or past a mobile phone store without being offered an opportunity to try the latest VR headset and associated software. While the much-hyped VR market continues to be in its early phase, most usage is currently reserved for high-end gamers and early tech adopters/hobbyists. That said, VR has a unique potential role to play in aging and memory care. VR companies are starting to apply virtual reality to allow residents or groups of residents to explore far distant places virtually through this technology. Other applications include gamified or virtualized rehabilitation.  

4.  Benefits of Social Connectedness and Engagement Technologies

Summary: Social connectedness and engagement technologies offer these benefits:

  • Increase the Social Network and Reduce Loneliness and Social Isolation: Social connectedness and engagement technologies can help older adults increase their social networks and reduce their feelings of social isolation and loneliness. A recent study found that internet use among retired older adults reduces the probability of depression by 33%, with the largest reduction in people who live alone. 
  • Increase Resident/ Client Engagement and Satisfaction: Older adults have an opportunity to engage and contribute within their communities using technology—from signing up for a trip with other residents to sharing their satisfaction with their facility.
  • Reduce Depression and Improve Health and Quality of Life: Some technologies target specific depression-related problems for older adults and their caregivers, including challenges associated with effective diagnosis, lack of access to mental-health professionals and services that results in inadequate treatment, perceived stigma on the part of affected individuals, loss of motivation and sense of purpose, and social isolation.
  • Reduce Health Care Costs: Because social connectedness and engagement technologies can alleviate social isolation, feelings of loneliness, and depression, they can reduce health care costs.

4.1  Increase the Social Network and Reduce Loneliness and Social Isolation 

Isolation is too often a part of older adults’ lives and can have serious consequences. A 2012 U.S. Department of Health and Human Services (HHS) report to Congress on aging services technology defined social isolation as occurring “…when an individual has limited contact with others, and perceives that level of contact as inadequate.”13 The report linked social isolation with depression, considering it both a risk factor and a result of depression, which needs to be addressed when preventing and treating this mental health issue.

Social connectedness and engagement technologies can help older adults increase their social networks and reduce their feelings of social isolation and loneliness.  

The internet, for example, has fostered networking technologies such as chat rooms, news groups, and social-networking sites that have created vibrant and growing communities for older adults. These communities provide a multitude of interactive opportunities such as book clubs, interest groups, and support groups. In addition, many sites offer real-time chat capabilities, thereby enhancing the speed and quality of social interactions. 

Although these communities will never be a substitute for in-person interactions, many older adults and individuals with disabilities live far from their family and friends or are otherwise unable to maintain routine contact with loved ones during a hospitalization or a period of institutionalized rehabilitation. In these cases, social-networking sites can help prevent or reduce depression and social isolation by facilitating regular social interaction with family and friends. 

Although well-known social-networking sites such as Facebook do not target a specific age group, some are dedicated specifically to older adults. The potential benefits of these sites were reflected in the findings of one study that found social-networking sites keep older adults active and interested, build mental acuity, and keep them informed about current events.14 


The internet and videoconferencing can be especially valuable for people who are homebound.


The internet and videoconferencing can be especially useful technologies for older adults and people with disabilities who are homebound and thus at particularly high risk of social isolation and depression. Web-based tools such as the Virtual Senior Center aim to connect homebound older adults using computer, video, and internet technology, when limited mobility, vision or hearing loss, or other disabilities might otherwise limit their social contacts and access to resources. 

Instead, this technology allows isolated older adults to connect with their peers and access community services, and it may reduce social isolation and promote wellness in a group of particularly vulnerable older adults.15 

For example, a study in 2011 found that when older adults were randomly assigned to either play Wii or watch television, the older adults playing the Wii had lower sense of loneliness and a pattern of greater positive mood compared to the television group.16  

A quasi-experimental study that evaluated the effectiveness of a videoconference intervention program in improving nursing home residents’ social support, loneliness, and depressive status found the following results:

  • Videoconference program alleviated depressive symptoms and loneliness in older adult residents in nursing homes.
  • Videoconferencing could be used for residents in other types of long-term care facilities, particularly those with better ability to perform activities of daily living.17 

A systematic review of the effects of communication technology on reducing social isolation in elderly found that of the 18 studies, 15 revealed a significant reduction of loneliness among the elderly using information communication technology. Studies using communication programs (landline phones, smartphones, iPads, emailing, and online chat rooms or forums) and high-technology apps (Wii, the TV gaming system, and Gerijoy, a virtual pet companion) consistently reported a positive effect on alleviating loneliness.18 

More recent applications designed specifically for older adults, their family, and care providers, such as a community app or community social online networks, can allow older adults to engage better with peers either through group activities or online social networks.  For example, a community app that highlights residents’ interests, history, and hobbies may help connect and foster a relationship based on shared interests between residents that were not connected before.

4.2  Increased Resident/ Client Engagement and Satisfaction

Older adults have an opportunity to engage and contribute within their communities using technology. Easy-to-use tablet applications can enable older adults to more readily participate in activities with other community members, such as signing up for a trip or reading the latest community news, and even provide near real-time feedback to their communities on the care and hospitality they are receiving. In community settings, seniors can participate in traditional board games such as chess and join in word games via tablets.19 


Apps can let residents give communities near real-time feedback on their care and hospitality.


The latest social connectedness and engagement technologies in senior living can help with gauging resident satisfaction via real-time feedback and input from residents. These tools can also lead to residents being happier and more satisfied.  Resident portals, custom TV channels, digital bulletin boards, and family member access to community news all directly impact resident satisfaction. Families too, feel more connected and satisfied with their loved one’s community.20 

4.3  Reducing Depression and Improving Health and Quality of Life

The severity of depression is strongly associated with decreased quality of life, decline in physical and mental functioning over time, and increase in disability. Depression can also affect symptoms of physical health issues such as arthritis, heart disease, hypertension, and diabetes.21 

The number of older persons with major depression is significant. Researchers estimate that 1-4% of those 60 and older living in the community and 13-25% of nursing home residents are affected, and that 35% of assisted living residents are socially isolated.22 

Fortunately, a number of technologies address problems stemming from the complex interplay of depression, physical health, and social isolation. These technologies target specific depression-related problems, including challenges associated with effective diagnosis, lack of access to mental-health professionals and services that results in inadequate treatment, perceived stigma on the part of affected individuals, loss of motivation and sense of purpose, and social isolation. 

In addition to these problems, the families and friends of depressed individuals often experience their own distinct depression-related burdens as a result of the physical and psychological challenges associated with caring for loved ones with depression. 


Internet use among retired older adults reduces the probability of depression by 33%.


Technologies addressing these problems seek to reduce depressive symptoms, improve access to care among affected persons, and improve social connectedness. Some of these are used in provider settings, some are used by patients at home, and still others work by connecting patients and providers. In some cases, these technologies may not only address problems resulting directly from depression itself, but also from health conditions that occur in tandem with depression.23

The use of such technologies can help reduce isolation and depression. For example, a study in the Journals of Gerontology found that internet use among retired older adults reduces the probability of depression by 33%, with the largest reduction in people who live alone.24 

Finally, a recent two-year project funded by the European Union and led by the University of Exeter in partnership with Somerset Care Ltd and Torbay & Southern Devon Health and Care NHS Trust gave a group of vulnerable older adults a specially designed computer and broadband connection, plus training in how to use them. Training older people in the use of social media improved cognitive capacity, increased a sense of self-competence, and could have a beneficial overall impact on mental health and well-being, according to this landmark study carried out in the UK.25 

As discussed in the beginning of this section, having the ability to stay connected to family and friends is key to having high quality of life. Communication tools, such as video chat, can provide an enriching communication modality that allows residents and older adults to see and hear family and friends. The added value of video allows the user to feel more connected and creates more dynamic conversations than traditions communication modality, such as the telephone.

4.4  Reducing Health Care Costs

In the year 2000, the economic burden of depression was estimated at $83.1 billion, of which $26.1 billion was incurred by direct medical costs and nearly twice that amount ($51.5 billion) was associated with costs incurred in the workplace.26  Other research on depression-related costs in the workplace has shown that depressed workers who underperform as a result of their depression incur $35.7 billion in costs with another $8.3 billion incurred as a result of absenteeism among depressed workers.27 

In addition to direct medical costs and lost productivity, depression is a leading cause of disability. It has been shown that older adults with depression have more physical limitations than do non-depressed adults.28  In a study of the relationship between depression and comorbid illness, the severity of depression was strongly associated with decreased quality of life, decline in physical and mental functioning over time, as well as increased disability.29  

There is also evidence to suggest that depression exacerbates existing physical problems among older adults, which may in turn exacerbate depression. For example, depression can enhance symptoms of arthritis, heart disease, hypertension, and diabetes.30  Loss of motivation resulting from depression can also pose challenges for effective treatment of these conditions because ongoing, active engagement on the part of the patient is critical for appropriate self-management.31  


Older adults with depression incur medical costs that are 50% higher than those without depression.


Moreover, lack of motivation and a sense of hopelessness can contribute to unfavorable health behaviors such as failure to engage in routine preventive care and health screenings, which can exacerbate existing chronic conditions, as well as depression associated with being chronically ill. These unfavorable depression-associated outcomes are observed not only among older adults, but also among people with disabilities. 

Poor self-management can reinforce depression by exacerbating the severity of existing chronic conditions.32  Further, comorbid depression and chronic diseases such as angina, arthritis, asthma, and diabetes can lead to worse overall health than either depression or chronic disease alone.33 

It is therefore not surprising that depression is associated with increased health care costs and utilization. Older adults with depression incur medical costs that are 50% higher than those without depression.34  These higher costs are incurred across a range of health care services, including primary care visits, specialist visits, mental health visits, pharmacy costs, x-ray examinations, and inpatient costs.35  Older adults with depression have been shown to have 30 to 50% higher costs than their non-depressed counterparts, regardless of their level of co-morbidity.36  

These findings point to depression’s independent contribution to health care costs. Although studies have demonstrated clear links between social isolation and unfavorable health outcomes, 37 quantifying the costs associated with social isolation poses some difficulty since, unlike depression, it is not a diagnosable disorder that can be tracked using medical records and reimbursement data.38

One factor that may contribute to the high costs associated with depression is that treatment is often not prioritized in primary care.39  Lack of appropriate depression treatment may eventually generate costs for these patients that could have been avoided with proper treatment. Despite the challenges associated with initiating treatment of depression, it has been reported that antidepressants are prescribed to approximately 14% of older adults over 65 40.

Although broadly effective, there is research to suggest that some therapies may exacerbate depressive symptoms in certain individuals41, and others may increase the risk of falls.42 Although effective pharmaceutical treatments for depression are available, in some cases, these treatments may result in unintended consequences that increase depressed individuals’ costs.

Family and friends provide the vast majority of care for depressed older adults and those with disabilities, and these informal caregivers incur costs and burdens.43  In one survey of depressed older adults, the value of informal caregiving was estimated at $9 billion annually.44  

In addition to the costs associated with providing informal care, caregivers of older adults with depression are themselves at higher risk of illness and mental health problems as a result of the burdens associated with their caregiving roles. One frequently cited study demonstrated that mortality was 63% higher among caregivers experiencing mental and emotional strain caring for older adults than among non-caregivers or caregivers who did not report similar levels of strain.45  

For caregivers of adults with depression, one study found that 80% of caregivers reported distress and approximately 25% of these caregivers sought care themselves in the form of treatment or medication. One-third of the total sample felt able to cope with the patient’s problems, but another one-third felt unable to do so. Caregiver distress was directly related to the severity and acuteness of patients’ depression; the more severe and the more acute, the more likely caregivers were affected.46 

As demonstrated in previous subsections, since social connectedness and engagement technologies can alleviate social isolation, feelings of loneliness, and depression, they can potentially reduce health care costs. However, we have not found peer reviewed studies that evaluated the impact of social connectedness or engagement technologies on health care costs. 

5.  Potential Long-Term and Post-Acute Care (LTPAC) Provider Business Models

Summary: A few programs may provide subsidies for low-income consumers and providers:

  • Lifeline Program for Low-Income Consumers, which discounts phone and internet services
  • Rural Health Care Providers: The Rural Health Care Program supports health care facilities in bringing world class medical care to rural areas through increased connectivity, and the Healthcare Connect Fund provides a flat 65% on broadband expenses and network equipment to eligible individual rural health care providers and consortia. Nursing Homes are eligible to participate in this program.
  • Relay Service for Individuals with Speech and/or Hearing Impairment extends telephone service to persons with hearing or speech disabilities. These services are available for free to individuals with hearing or speech impairments. There are also programs that make specialized equipment, such as captioned phones, available to qualified individuals for free.   

Payment sources may be private payers or out of pocket. LTPAC and community health providers, special population agencies, self-pay and self-insured organizations, and others, especially not-for-profits, may offer or cover an array of social connectedness and engagement technologies and/or services. 

The return on investment (ROI) depends on the care delivery model, the payment/reimbursement model, the technology, and costs. Providers can figure the ROI for residents, clients, families, payers, care providers and use an online ROI calculator

*
Social connectedness and engagement technologies are generally not eligible for coverage under Medicare, Medicaid, or private health insurance. It is generally private pay for consumers or a cost of doing business for providers offering engagement technologies. However, a few programs may provide subsidies for low-income consumers and providers, and we discuss some below.

5.1  Lifeline Program for Low-Income Consumers

Since 1985, the Federal Communication Commission (FCC) Lifeline program has provided a discount on phone service for qualifying low-income consumers to ensure that all Americans have the opportunities and security that phone service brings, including being able to connect to jobs, family, and emergency services. Lifeline is part of the Universal Service Fund. The Lifeline program is available to eligible low-income consumers in every state, territory, and commonwealth, and on tribal lands.


The FCC’s Lifeline program discounts phone service for qualifying low-income consumers.


The Lifeline program is administered by the Universal Service Administrative Company (USAC). USAC is responsible for data collection and maintenance, support calculation, and disbursement for the low-income program. USAC’s website provides information regarding administrative aspects of the low-income program, as well as program requirements.

On March 31, 2016, the Commission adopted a comprehensive reform and modernization of the Lifeline program. In the 2016 Lifeline Modernization Order, the Commission included broadband as a support service in the Lifeline program. The Commission also set out minimum service standards for Lifeline-supported services to ensure maximum value for the universal service dollar, and it established a National Eligibility Verifier to make independent subscriber eligibility determinations.47

5.1.1  Eligibility

Consumers can get Lifeline if their income is 135% or less than the federal poverty guidelines. The guideline is based on your household size and state. Applicants need to show proof of income, like three consecutive pay stubs or a tax return, when applying for Lifeline.

Consumers can get Lifeline if they participate, or someone in their household participates, in one of these federal assistance programs:

  •    Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps.
  •     Medicaid.
  •     Supplemental Security Income (SSI).
  •     Federal Public Housing Assistance (FPHA).
  •     Veterans Pension and Survivors Benefit.
  •     Tribal Programs (and live on federally recognized tribal lands).

Consumers can also sign up for Lifeline if they have a child or dependent that participates in any of the programs listed above.

NOTE: As of December 2, 2016, consumers can no longer use the Low Income Home Energy Assistance Program (LIHEAP), Temporary Assistance for Needy Families (TANF), or the National School Lunch Program (NSLP) Free Lunch Program to prove eligibility for Lifeline.

Tribal Lifeline takes up to $25 off the participant’s monthly bill in addition to the standard Lifeline amount.
Consumers can get Tribal Lifeline if they live on tribal lands, and if they or someone in their household participates in one of these programs:

  • Bureau of Indian Affairs General Assistance.
  • Head Start (only households meeting the income qualifying standard).
  • Tribal Temporary Assistance for Needy Families (Tribal TANF).
  • Food Distribution Program on Indian Reservations.

Tribal lands include any federally recognized Indian tribe's reservation, pueblo, or colony, including former reservations in Oklahoma, Alaska Native regions, Hawaiian Home Lands, or Indian Allotments. Consumers need to show a card, letter, or official document as proof that they participate in one of these programs when they apply for Lifeline.

Limit: One per Household

Consumers are only allowed to get one Lifeline discount (phone or internet, but not both) per household, not per person. If someone at an address already gets Lifeline, a Household Worksheet can help determine if more than one household lives at that address.48 Eligible consumers can follow the instructions to apply.


Three programs support health care providers in rural areas.


5.2  Rural Health Care Providers

The Rural Health Care (RHC) Program supports health care facilities in bringing world class medical care to rural areas through increased connectivity. It provides up to $400 million annually in reduced rates for broadband and telecom services. There are two subprograms in the RHC Program: the Healthcare Connect Fund (HCF) Program and the Telecommunications (Telecom) Program. As of June 21, 2017, skilled nursing facilities can now participate in the RHC broadband subsidy program.49 

5.2.1  The Healthcare Connect Fund

This program provides a flat 65% on broadband expenses and network equipment to both eligible individual rural health care providers (HCPs) and consortia.

5.2.1.1  Eligibility

An HCP must meet three initial criteria to be considered eligible:
The HCP must be a public or nonprofit entity.

  • The HCP must be one of the following types of entities:
  • A post-secondary educational institution offering health care instruction, such as teaching hospitals or medical schools.
    • A community health center or health center providing health care to migrants.
    • A local health department or agency.
    • A community mental health center.
    • A not-for-profit hospital.
    • A rural health clinic, including mobile clinics.
    • A dedicated emergency room of a rural for-profit hospital.
    • Skilled Nursing Facilities (SNFs) (effective Jan. 1, 2017).
  • The HCP must be located in an FCC-approved rural location. HCPs that were deemed rural prior to July 1, 2005, and received a funding commitment from the Rural Health Care (RHC) Program are considered grandfathered. HCPs can determine the rurality of their location by using the Eligible Rural Areas search tool
    Organizations not located in a rural area may be eligible to apply to the Healthcare Connect Fund (HCF) Program as part of a consortium i. Ineligible HCP sites also may participate in a consortium and take advantage of lower contract prices often associated with consortia bulk-buying, but they will not receive universal service funding support.50

In addition, broadband connections associated with off-site data centers and off-site administrative offices that are used by eligible health care providers for their health care purposes are eligible for funding.

Each HCP site or location is considered an individual HCP for purposes of calculating support under the RHC Program. Each site must demonstrate that by itself, it is an eligible entity.51

5.3  Relay Service for Individuals with Speech and/or Hearing Impairment

The FCC covers Telecommunications Relay Service (TRS), which is a telephone service that allows persons with hearing or speech disabilities to place and receive telephone calls. TRS is available in all 50 states, the District of Columbia, Puerto Rico, and the U.S. territories for local and/or long distance calls 24 hours a day, seven days a week. 

The FCC pays for TRS services, through a surcharge collected on consumer phone bills allowing for these services to be made available to individuals who need them at no cost. TRS providers – generally telephone companies – are compensated for the costs of providing TRS from either a state or a federal fund. There is no cost to the TRS user.52

TRS uses specially trained operators, called communications assistants (CAs), to facilitate telephone calls between people with hearing and speech disabilities and other individuals. A TRS call may be initiated by either a person with a hearing or speech disability, or a person without such disability. 

There are several forms of TRS, depending on the particular needs of the user and the equipment available:

Text-to-Voice or Text Telephony (TTY)-based TRS 
This is a "traditional" TRS service using a text-telephony (TTY) to call the CA at the relay center. TTYs have a keyboard and allow people to type their telephone conversations. The text is read on a display screen and/or a paper printout. A TTY user calls a TRS relay center and types the number of the person he or she wishes to call. The CA at the relay center makes a voice telephone call to the other party to the call, then relays the call back and forth between the parties by speaking what a text user types and typing what a voice telephone user speaks.


The Telecommunications Relay Service (TRS) helps people with hearing or speech disabilities make phone calls.


Voice Carry Over (VCO) 
VCO allows a person with a hearing disability, who wants to use his or her own voice, to speak directly to the called party and receive responses in text from the CA. No typing is required by the calling party. This service is particularly useful to senior citizens who have lost their hearing, but who can still speak. 

Hearing Carry Over (HCO) 
HCO allows a person with a speech disability, who wants to use his/her own hearing, to listen to the called party and type his/her part of the conversation on a TTY. The CA reads these words to the called party, and the caller hears responses directly from the called party.

Speech-to-Speech (STS) Relay Service 
STS is used by a person with a speech disability. A CA who is specially trained in understanding a variety of speech disorders repeats what the caller says in a manner that makes the caller's words clear and understandable to the called party. No special telephone is needed.

Deaf-Blind Service (DBS) 
DBS allows individuals with combined hearing and vision loss to place and receive telephone calls. DBS users type their messages and read the other person’s responses, typed by the CA on a braille display. 

Shared Non-English Language Relay Services 
Due to the large number of Spanish speakers in the United States, the FCC requires interstate TRS providers to offer Spanish-to-Spanish traditional TRS. Although Spanish language relay is not required for intrastate (within a state) TRS, many states with large numbers of Spanish speakers offer this service on a voluntary basis. The FCC also allows TRS providers who voluntarily offer other shared non-English language interstate TRS, such as French-to-French, to be compensated from the federal TRS fund.

Captioned Telephone Service 
Captioned telephone service is used by persons with a hearing disability but some residual hearing. It uses a special telephone that has a text screen to display captions of what the other party to the conversation is saying. A captioned telephone allows the user, on one line, to speak to the called party and to simultaneously listen to the other party and read captions of what the other party is saying.
 
There is a “two-line” version of captioned telephone service that offers additional features, such as call-waiting, *69, call forwarding, and direct dialing for 911 emergency service. Unlike traditional TRS (where the CA types what the called party says), the CA repeats or re-voices what the called party says. Speech recognition technology automatically transcribes the CA’s voice into text, which is then transmitted directly to the user’s captioned telephone text display.

IP Captioned Telephone Service 
IP captioned telephone service combines elements of captioned telephone service and IP Relay. IP captioned telephone service can be provided in a variety of ways, but uses the internet – rather than the telephone network – to provide the link and captions between the caller with a hearing disability and the CA. It allows the user to simultaneously both listen to, and read the text of, what the other party in a telephone conversation is saying. IP captioned telephone service can be used with an existing voice telephone and a computer or other web-enabled device without requiring any specialized equipment. See more information regarding IP captioned telephone service.

Internet Protocol Relay Service (IP Relay)
IP Relay is a text-based form of TRS that uses the internet, rather than traditional telephone lines, for the leg of the call between the person with a hearing or speech disability and the CA. Otherwise, the call is generally handled just like a TTY-based TRS call. The user may use a computer or other web-enabled device to communicate with the CA. IP Relay is not required by the FCC, but several TRS providers offer it. Learn more about IP Relay.

Video Relay Service (VRS) 
This internet-based form of TRS allows persons whose primary language is American Sign Language to communicate with the CA in ASL using videoconferencing equipment. The CA speaks what is signed to the called party, then signs the called party’s response back to the caller. VRS is not required by the FCC, but several TRS providers offer it. VRS allows conversations to flow in near real time and in a faster and more natural manner than text-based TRS. Beginning Jan. 1, 2006, TRS providers that offer VRS must provide it 24 hours a day, seven days a week, and must answer incoming calls within a specific period of time so that VRS users do not have to wait for a long time. See more information about VRS.

5.3.1  Subsidy for Communication Equipment 

The National Deaf-Blind Equipment Distribution Program, also known as iCanConnect, provides equipment needed to make telecommunications, advanced communications, and the internet accessible to low-income individuals who have both significant vision loss and significant hearing loss.53 

Similarly, there are state equipment distribution programs that subsidize communication equipment for individuals with hearing loss.54 These programs vary from state to state with varying qualification requirements. They may offer additional products and services, such as internet and telephone, to low-income individuals. 

Individuals who choose to use Captioned Telephone Service may also qualify for a phone at no cost through third-party certification by a doctor or hearing health care provider completing and submitting a Certificate of Hearing Loss/Order Form. 

The telephone is often taken for granted, and someone who has difficulty hearing over the phone may choose to avoid using the phone altogether. This may result in loneliness and isolation – removing the social connectedness the individual once had. Equipment and services can help to maintain healthy, meaningful connections to family, friends, and caregivers, which in turn increases confidence and independence.

5.3.2  711 Access to TRS

Consumers can dial 711 to connect to certain forms of TRS anywhere in the United States, just as anyone can call 411 for information. Dialing 711 makes it easier for travelers to use TRS because they do not have to remember TRS numbers in every state. Because of technological limitations, however, 711 access is not available for the internet-based forms of TRS (VRS and IP Relay). Find more information about 711.


TRS providers must offer service that meets certain mandatory minimum FCC standards.


5.3.3  Mandatory Minimum Standards for TRS

TRS providers must offer service that meets certain mandatory minimum standards set by the FCC. These include the following:

  • The CA answering or placing a TRS call must stay with the call for a minimum of 10 minutes to avoid disruptions to the TRS user (15 minutes for STS calls).
  • Most forms of TRS must be available 24 hours a day, seven days a week.
  • TRS providers must answer 85% of all calls within 10 seconds, but there are different answer speed rules for VRS.
  • TRS providers must make best efforts to accommodate a TRS user's requested CA gender.
  • CAs are prohibited from intentionally altering or disclosing the content of a relayed conversation and generally must relay all conversation verbatim unless the user specifically requests summarization.
  • TRS providers must ensure user confidentiality, and CAs (with a limited exception for STS) may not keep records of the contents of any conversation.
  • The conversation must be relayed in real time.
  • CAs must provide a minimum typing speed for text-based calls, and VRS CAs must be qualified interpreters.
  • For most forms of TRS, the provider must be able to handle emergency (911) calls and relay them to the appropriate emergency services.
  • Emergency call handling procedures have been established for all kinds of TRS.

Users of Voice over Internet Protocol (VoIP) service also can access relay services by dialing 711.

5.4  Private Pay 

Other payment sources for social connectedness and engagement technologies and services may be private payers or out of pocket. 

5.5  Standard of Care/Service and Other Payment Sources 

LTPAC and community health providers, special population agencies, self-pay and self-insured organizations, and others, especially not-for-profits, may offer or cover an array of social connectedness and engagement technologies and/or services. These services may be covered by grants or offered as standard of care/service. The organization may absorb the cost or different revenue sources, including charitable contributions, may cover it. 

5.6  ROI of Social Connectedness and Engagement Technologies

Return on investment (ROI) represents the ratio of the net gains relative to the initial investment over a certain period of time. Subsequently, ROI can be expressed in the following equation:

As discussed above, telehealth and RPM deliver various benefits, including potential financial savings, to different stakeholders, including patients and/or their families, payers, care providers, etc.


ROI depends on the care delivery model, the payment/reimbursement model, the technology, and costs.


However, the financial savings and ROI depend on a number of factors, including the care/service delivery model, the payment/reimbursement model, the technology, and of course costs. The first and most important step in calculating ROI is to consider the different stakeholders, identify the investors, and calculate the gains and savings netted/accrued to each investing stakeholder under each particular care delivery and payment model. 

When calculating ROI, one should only include the gains that accrued to that particular stakeholder minus all expenses, relative to that stakeholder’s own investment/cost. Often the reduction of hospital days is erroneously included in the providers’ ROI, which is not true under the traditional fee-for-service reimbursement model and can be misleading; such a reduction usually accrues to the payer.

5.6.1  ROI to Residents/Clients and/or Their Families 

ROI to patients and/or their families can be calculated as follows: 

For private pay patients and their families, for example, the financial gains of social connectedness and engagement technologies are in prolonging independence by reducing depression and social isolation and remaining active and engaged, which may prevent disability and avoid the need to move into assisted living or skilled nursing facilities. These benefits are significant. The gains may also include savings in co-pays for recurring hospital visits, and of course a higher quality of life, which is difficult to quantify. The patient’s and family’s expenses are the monthly out-of-pocket cost of social connectedness and engagement services, plus any co-pay for the occasional physician office visit, lab tests, and prescriptions. 

5.6.2  ROI to Payers 

ROI to payers can be calculated as follows: 

5.6.3  ROI to Care Provider 

ROI to care providers can be calculated as follows: 

The care provider who makes investments in information and communications technology infrastructure, social connectedness and engagement technologies, and preventive wellness services, may reap the following benefits:  

  • Lower costs in delivering the same services, including staff efficiencies and staff travel costs (if the payer covers the remote services, rather than just the in-person visit).
  • Higher payment from the payer or strategic partner in terms of incentive payments for avoiding more costly care settings, procedures, events, or penalties.   

LTPAC Provider Partnering with a Physician Group ACO
For example, an LTPAC provider partnering with a physician group accountable care organization (ACO) to engage and manage a chronically ill patient population can potentially get a percentage of the incentives or shared savings payments the ACO receives from the payer for reducing hospitalizations and hospital readmissions, which can be significant for certain populations.  


The LTPAC provider’s net gain is the sum of all gains accruing to the LTPAC provider.


The LTPAC provider’s net gain is the sum of all gains accruing to the LTPAC provider in staff efficiencies, increased referrals from the ACO, traditional fee-for-service payments, and additional incentive payments received from the ACO, minus the costs of leasing the home telehealth equipment and actual costs of services delivered. 

The physician group ACO’s ROI is the portion of the payer’s incentive payment that they get to keep plus any additional fee-for-service payments due to more frequent office-based services, minus the actual costs of services they deliver (for example, in medication reconciliation or care coordination), relative to the portion of incentives they pass through to the LTPAC provider. 

LTPAC Provider Partnering with a Hospital Under Fee-for-Service Model
A contrast is a partnership between an LTPAC provider and hospital under the traditional fee-for-service model. For example, the LTPAC provider may help its hospital partners reduce 30-day readmission rates for pneumonia, congestive heart failure, and heart attack patients, helping the hospital avoid Medicare’s payment penalties under the Hospital Readmissions Reduction Program. 

The hospital may contract with and pay the LTPAC provider a percentage of the penalties saved for delivering telehealth that reduces 30-day readmissions for patients discharged from the hospital after being admitted for one of the above-mentioned three conditions.  

  • The LTPAC’s net gain is again the sum of all gains accruing to the LTPAC provider in staff efficiencies, increased referrals from the hospital, traditional fee-for-service payments, and additional payments received from the hospital, minus the costs of leasing engagement technologies and actual costs of services delivered. 
  • The hospital’s ROI is the portion of avoided penalties it gets to keep, plus any additional fee-for-service payments it gains for more referrals due to improved quality ratings. This amount is minus the actual costs of services the hospital delivers, relative to the portion of avoided penalties it passed through to the LTPAC provider, plus any additional costs incurred for staff time in care coordination, medication reconciliation, or health information exchange.
  • An online tool can help calculate ROI for person-centered care coordination.

5.6.4  Online ROI Calculator 

Once individual investors have been clearly identified, an estimate of the ROI to the different stakeholders can be calculated. The SCAN Foundation has recently published a white paper on making the business case for person-centered care with instructions for using an ROI calculator it developed.


The business case for person-centered care involves weighing the costs against the benefits in dollars.


This ROI calculator is designed to quantitatively assess the business case for person-centered care (PCC) programs that serve older adults with chronic conditions and functional limitations. PCC programs are ones where individuals’ values and preferences are elicited and, once expressed, guide all aspects of their health care, supporting their realistic health and life goals. This type of care is achieved through a collaborative relationship and decision-making process among the person, their chosen supports, and their medical and social service providers. 

As discussed in detail above, the business case for PCC involves weighing the costs of offering this approach to care against the benefits expressed in dollar terms. Benefits accrue principally in the form of avoided medical utilization, but also potentially in the form of higher revenues.55

The ROI calculator has a number of practical features:    

  • Risk Stratification: The population that is suitable to receive PCC can be segmented into high and moderate risk categories. The ROI will be likely higher (i.e., a higher percentage) for the segment that is at higher risk for medical utilization. The calculator can show how limited the offering must be if a specific return were being sought. 
  • Potential Revenue from PCC: The calculator allows for PCC program offerings to incorporate possible revenue enhancements in addition to the more probable benefits resulting from reducing costs.    
  • Slider Bars: This feature allows the user to compute instantaneous “what-if” calculations by changing values of inputs and immediately viewing these new inputs' influence on the ROI.   
  • Flexibility in Expressing Variables: All variables can be entered by the user in terms of their convenience – per person, per month, or per year. Hospital admissions, for example, are generally reported on an annual basis whereas encounters with a social worker or nurse practitioner are often expressed on a monthly basis. The calculator automatically converts rates and volumes, no matter how expressed, into a common per member per month measure.   
  • Scenarios: This feature allows ROI comparisons across different programs as well as varied constellations of input values. For example, the user can create optimistic and pessimistic scenarios and compare the results. Sometimes even the pessimistic scenario can yield an acceptable result for the ROI.  
  • Accounting for Uncertainty: Admittedly, some key determinants of the ROI are not known with certainty. Therefore, a “Monte Carlo” simulation that accounts for uncertainty with respect to the magnitudes of key variables is an optional part of the tool. This simulation recognizes this uncertainty and displays accordingly a reasonable range of results for the ROI rather than a single deterministic value. The tool also quantifies the strengths of the separate influences each variable has on the resulting ROI.
  • Other Metric – Payback Period: In addition to the ROI result, the calculator displays the payback period – defined as the number of months the PCC program would need to operate, assuming a positive operating margin, for any initial investment to be recouped. This metric may be useful for programs involving substantial up-front launch costs.    
  • Threshold Analysis: The tool provides the ability to conduct threshold analysis, whereby the user can query the calculator on questions such as the following: What is the maximum amount that can be spent on PCC so that the program does not lose money? Or for a given cost of delivering PCC, how effective must it be in reducing certain events such as hospital readmissions in order to generate a required (hurdle) level of ROI?  

To access the calculator tool, go to The SCAN Foundation.  

6.  Planning for and Selecting Appropriate Social Connectedness and Engagement Technology

Summary: Visioning and strategic planning are essential, as is viewing the technology as a way to reach business goals. When planning a strategy, consider the following:
  • Care settings.
  • Target populations.
  • Outcomes.
  • Hardware and software. 
  • Patient/Resident/Client/Family-facing solutions such as assessment of needs and ability to pay.
  • The Health Insurance Portability and Accountability Act (HIPAA).
  • Organizational readiness.
  • Operational planning and alignment, including the team, workflow, and business model.
  • Technology vetting.

*
To plan for, select, and implement the right technology for social connectedness and engagement, we need to set the stage. Increasing the communication between people increases engagement in community activities, events, and other social settings. Although many factors determine what a great connection means to us personally, technology can play a major role in reducing the friction or distance and ultimately increase meaningful connections with our aging loved ones.

6.1  Vision and Strategic Planning

Visioning and strategic planning are key foundational steps to the success of a social connectedness and engagement technology. The technology should be viewed as a tool to achieve specific organizational goals and be part of a well-founded overall organizational strategy.

Consider the following areas as part of an organization’s initial vision for social connectedness and engagement technologies.

6.1.1 Care Setting

It’s important to point out that connections happen wherever we are. Although providers may serve a great number of individuals in housing or health care centers, we need to think more broadly about care settings. We are not only discerning the best solution of our aging loved ones wherever they call home, but also providing this solution to their families, friends, caregivers, support network, church, or affinity groups.

6.1.2 Target Population

Have a vision for the population that the social connectedness and engagement technology will impact. Different populations of patient/resident/client and those they connect with have different needs and may require different solutions. Having the flexibility to match proper technology to the targeted population, their abilities, limitation, preferences, is a key factor to success. See section 6.5.


Build a business case so that stakeholders recognize the value in engagement services.


6.2 Outcomes, then Business Goals

Let’s flip this from the typical thinking of business goals first, and start with the potential outcomes of a successful social connectedness and engagement technology solution. More-frequent connections lead to increased engagement in social settings and improved mental, spiritual, and even physical well-being. 

Knowing these outcomes, how might we build a business case for the stakeholders, including family members, to see the added value in your new service? There are a myriad of family caregiver products and services on the market today doing this. Learning from their value proposition may guide you in designing your business goals and programs for social connectedness and engagement technologies.

6.3  Hardware Considerations

The solution needs to meet the person, both aging loved one and their connections, which means it should have a mobile component for family or staff. Additionally, the threshold for technology acceptance is low with all, especially those with declining sight, hearing, and mobility. So you will need hardware that is frictionless and extremely usable.

If the hardware is heavy, it can limit usage. Hardware that requires cables can be cumbersome and dangerous, such as controller cords and wires for VR displays. Some devices take up a lot of space or require some room for moving around, such as the Wii. Consider the use of mobile carts, shared or dedicated space, and wall-mounted components.

6.4  Software Considerations

Software also needs to be extremely usable. Software that focuses on doing one thing rather well, instead of having lots of features, is often best. For example, you might not want to introduce an iPad with 50+ apps where your app becomes lost in the mix. A simple big red button that sends out a pre-built text message asking for someone else to start the conversation is better (bt.tn does this well).

It’s important to consider how the software interacts with the user.  Does your target population need a special user interface with several different ways of interacting with the device, such as a touch screen and audible prompts? Is there a need for certain accessibility accommodations? 
You should also consider the support provided by the software provider. Are there multiple ways to request help or resolve issues? Lastly, it is helpful to make use of instructions cards or quick references that may be provided by the software provider.

6.5   Considerations for Patient/Resident/Client and Family-Facing Solutions

  • Assessment of Issues/Needs, including special needs
  • Assessment of Interests
  • Assessment of Competencies/ Abilities
  • Assessment of Personal Preference
  • Ability to Pay
  • Provider Services and Responsibilities

6.6   To HIPAA or Not to HIPAA

6.6.1  Who Is Involved?

The only Health Insurance Portability and Accountability Act (HIPAA) violation that can happen is if a medical professional is involved. By leaving the medical professional out of the care circle using your technology, you remove the potential breach of privacy. So who will be involved from your side? Does adding a medical professional to the care circle add enough value to slow you down with HIPAA overhead? 


Leaving the medical professional out of the care circle using social connectedness technology removes the potential breach of privacy.


6.6.2  What Information Is Critical?

Good conversations do not necessarily have a critical piece of information. It’s good to maintain focus on only providing a conduit to encourage connectivity, not transfer critical information of any kind. The only critical piece of information needed to make a connection is the location of the person or ID of their preferred device, such as a phone number.

6.6.3  How Not to Overthink It

We hope the information above has simplified the process and provided a new guide to not overthink it, but rather to focus on what matters most: the new connections.

6.7  Organizational Readiness

6.7.1  Who Are Your Stakeholders?

Have you identified a key stakeholder? Doing so is crucial to building out the best possible strategy. Generally this person should have a customer engagement or communications role within the organization. This type of talent will focus on the connections with people in different social or non-social settings rather than the technology first. 

An IT professional should be involved in the group. Additional stakeholders that may be beneficial are executive leadership, activity directors (especially for engagement technologies), operations management, and business development. It is good to keep your initial strategy group small, and request resources when implementation begins.

6.7.2  IT Infrastructure, IT Team, and Tech Support

Selecting the appropriate social connectedness and engagement technology will depend on an organization’s IT infrastructure and needs. Typical options include the following:  

  • Purchasing and locally hosting the care planning and coordination software on-site at the organization’s data center.
  • Purchasing the software and hosting it in a third party’s data center.
  • Having the vendor host and offer its own Software as a Service (SaaS).    

Each has pros and cons depending on an organization’s size and current IT infrastructure. Some things to consider when evaluating these options are as follows: 

Consider the implications of the type of solution on the existing IT infrastructure, including network, internet access, speed, and bandwidth. Remember that you need to start your project implementation with updating your IT infrastructure. 

Your technical team should have a few stakeholders as part of the implementation team.  The technology vendor could provide you plenty of implementation and troubleshooting support. Internally, your implementation team should be comprised of a technology lead (decision maker in IT) and an implementation coordinator that is able to manage the relationship with the technology vendor and play a vital role in the initial implementation measures at the very least. Additional support technicians might be needed internally, but this step comes at a considerable cost if not kept small.

It is a good idea to engage the IT team early in the process. They may have ideas, be familiar with new solutions, and be more enthusiastic this way.

6.8  Operational Planning and Alignment

6.8.1  Team

Operations team members will play a key role in implementation success, as they are the most connected to the people they serve. Ensure that operational leadership has buy-in early, and work alongside of them to identify the best individuals in the field to become your evangelists. The key to engaging field operations as appropriate to the goals of the initiative—such as nurses, therapists, CNAs, activity directors, and administrative staff—is that they are not sales people; they are your connection evangelists. 


A simple workflow and training model will position your team for success.


6.8.2  Workflow

Workflows can vary depending on the chosen technology. If you can reduce the complexity of your workflow and maintain a simple model of training, supporting, and evangelizing use of your new connection tech, you will be putting your team in the best possible position to succeed. A suggested workflow would be train the trainer, then provide online and physical materials to train field ops. Once trained, continued engagement through the technology among your own team can help build awareness, evangelism, and support. Creating key trainers from your activity or therapy staff would likely be a good start.

6.8.3  Business Model

The best business model would be a value-added technology your clients and others in the community can access. This can build new public relations, customer engagement, and market differentiation. With the right key performance indicators (KPI), you can determine the value of your investment easily. See section 5 for more details.

6.8.3.1  Goals Based on Strategies 

If your strategy’s goal is to increase connections or add new ways to stay connected from long distances, it’s important to revisit your initial strategy when defining goals. Once you determine it’s the “increased connections from family members to their aging loved ones,” a simple KPI can be derived. Setting KPIs ahead of implementation will also ensure you don’t lose sight of your goals.

6.8.3.2  Focus on What Matters Most

Maintaining focus on the connections between people will serve you well. More-frequent connections will lead to improved engagement in other social or non-social settings. Technology can help us build stronger relationships and more frequent connections, but at the core of the work we need to maintain sharp focus on the human connection. Who are the best connectors in your organization? They might be vital to making this initiative a success.

6.8.4  Technology Vetting

Once an organization has completed the visioning and strategic planning exercise, assessed organizational readiness, assembled the project team, set the project’s goals, and designed the program, then the team needs to develop a set of detailed requirements to use as criteria to review and select the appropriate social connectedness and engagement technology solution.  


Detailed requirements will help you select the appropriate technology solution.


Setting
The planning process would help identify key requirements that should include the care setting(s) where the organization wants to deploy the care coordination solution; this should be the primary setting for the targeted population (independent living, assisted living, skilled nursing facility, housing with services, etc.). 

Outline the target population and the types of communications, social connectedness, and engagement issues the organization wants to improve.

Social Circle
In addition, the organization should determine the parties with whom the older adults need/desire to engage. These may include peers, family, professional caregiver, or an activities facilitator.     

Socialization Modalities
The team should also consider the social connectedness modalities preferred/desired by the targeted users, which may include one or more of the following: 

  • Social Network
  • Video Chat
  • Audio Chat
  • Photo Sharing
  • Event/Activity Sharing
  • E-Mail
  • Text Chat
  • Picture Chat

The team should also consider and hone in on the social engagement modalities preferred/desired for the users, which may include the following:

  • Life Stories
  • Digital Signage
  • Community App
  • Community Blog
  • Activity Calendar
  • In-House Television Channel
  • E-Reader/Electronic Books
  • Art
  • Games
  • Exercise
  • Rehabilitation
  • Music
  • Facilitated Communication and Conversations (such as Hearing Aid, Captioning)
  • Companion App
  • Companion Robot
  • Virtual Reality

System Embodiment
The operational team should consider the desired system embodiment, which may include the following:   
Tablet

  • Desktop Computer
  • Laptop
  • All-In-One Computer
  • Smart TV
  • TV Set Top Box
  • Fixed Touch Screen
  • Captioned Phone
  • Smartphone
  • Wearable
  • Head-Mounted Gear
  • Voice Activated Technology (such as  Amazon’s Echo) 
  • Robot

In addition, the team should weigh whether the system embodiment should be for a single user or geared to multiple users.

Front-End User Interface - Types of Prompts/Controls/Accessibility Features Support
When selecting a social connectedness or engagement technology for older adults, consider the characteristics and special needs that the system’s front-end user interface should support. These needs may include the following prompts/controls: 

  • Touch Screen
  • Haptic Prompts
  • Audible Prompts
  • Voice Control
  • Visual Prompts
  • Gesture Activated Control
  • Motion Activated Control
  • Facial Expression Activated Control
  • Eye Gaze Control 

Also, the target population may require one or more accessibility features to provide support for the following:

  • Hearing
  • Vision
  • Dexterity

These criteria should inform the types of social connectedness and engagement systems that may help the organization achieve its goals. 


The available resources, capabilities, and expertise in program design and operationalization would inform the development and support you need.


Program Development and Vendor Support
The available resources, capabilities, and expertise in program design and operationalization would inform the type and level of development and support you would need from the prospective vendor. These may include the following:  

  • Program Development (planning, business model templates, etc.) 
  • Content Development
  • Staff Engagement Services  
  • User Education 
  • User Engagement 
  • User Therapy
  • Family Engagement

Program Support Services
The support services that vendors may offer include the following: 

  • Equipment Delivery/Pick Up 
  • Site/Home Installation 
  • IT/Network Troubleshooting and Support 
  • Front-End System Set-up/Customization 
  • Back-End System Set-up/Customization 
  • On-site/Online Staff Training 
  • On-site/Online User/Patient Training 
  • Equipment Cleaning/Refurbishing

Legal and Regulatory Requirements
Of course legal and regulatory requirements are important. The two most important legal and regulatory requirements that might be relevant to social connectedness and engagement technologies include compliance with the following: 

  • The Health Insurance Portability and Accountability Act (HIPAA), which sets national standards to protect individuals’ medical records and other protected personal health information.
  • The Health Information Technology for Economic and Health (HITECH) Act, which sets additional standards to demonstrate meaningful use of security technology to ensure the confidentiality, integrity, and availability of protected electronic medical records and electronic personal health information.  

Programs must comply with HIPAA and the HITECH Act. As discussed in subsection 6.3, these legal requirements would only apply if (a) health care staff is engaged, and (b) identifiable protected health information might be discussed, communicated, or exchanged using the system.

Hardware and Software Requirements (Back-End)
Finally, hardware/software requirements that could guide the selection process include how software is offered: 

  • Local Model, which means that it needs to be installed on servers local to the care provider, or 
  • Third-Party Hosted Model/Software as a Service Model (SaaS), where the software is hosted somewhere else and the provider pays licensing and hosting fees or pays for usage, as opposed to maintaining local servers’ infrastructure.   

Other important hardware and software requirements include remote access functionality support, off-line functionality support when running third-party hosted or SaaS software, and mobile device support, such as for smartphones and tablets.  


Use the CAST Social Connectedness and Engagement Online Selection Tool to narrow your selection.


Use the CAST Social Connectedness and Engagement Online Selection Tool to narrow down the selection to a few shortlisted candidate systems and vendors that meet the must-have high-level requirements.  

The CAST Social Connectedness and Engagement Selection Matrix outlines many additional options and detailed features and functionalities. These details will help drill down into these shortlisted products and narrow the selection to a list of two or three vendors who can be invited to submit a response to a request for proposals (RFP).  

During the RFP process, providers are encouraged to interview prospective vendors and engage many staff in the interviews and product evaluation: older adult residents/clients, families, front-line staff, activity coordinators, and representatives from management, finance, and IT teams. Please check provider case studies with the vendors, including those collected by CAST, and conduct appropriate due diligence including reference checking. In addition, providers may want to use the LeadingAge CAST/Technology Listserv to ask peers about the shortlisted products and their experience with these vendors. 

7  Social Connectedness and Engagement Technology Matrix Components 

Summary: CAST’s Social Connectedness and Engagement Technology Workgroup, consisting of providers, vendors, and consultants, compiled a list of social connectedness and engagement products that serve the LTPAC market, as well as a list of functionalities and capabilities that would help providers choose the product that best fits their business line and functional requirements. 

The Social Connectedness and Engagement Technology Matrix has 18 sections to help organizations narrow the possible products:

  • Business Line/Care Applicability
  • Socialization Modality
  • Social Circle Type
  • Embodiment
  • Program Development and Support Offered
  • Front-End Hardware Unit Patient/Client/Resident/User Interface and Communications
  • Hardware and Software Requirements – Front End
  • Front-End Unit Support
  • Status Reports, Communication with Care Team, Access
  • Alerts
  • Interfacing, Integration, and Add-Ons
  • Program Support Services
  • Interoperability, Interoperability Standards, and Certification
  • Technical Supportability
  • Legal/Regulatory/Cyberliability 
  • Hardware and Software Requirements – Back End
  • Company’s Experience and Viability 
  • Assessments

The Social Connectedness and Engagement Technology Matrix has 18 sections to help organizations narrow the possible Social Connectedness and Engagement products.

CAST’s Social Connectedness and Engagement Technology Workgroup, consisting of providers, vendors, and consultants, compiled a list of social connectedness and engagement products that serve the LTPAC market, as well as a list of functionalities and capabilities that would help providers choose the product that best fits their business line and functional requirements. 

Each of the social connectedness and engagement vendors then received the opportunity to complete a self-review of the workgroup’s pre-determined questions. Some of these vendors chose not to participate. Those who participated then could nominate a case study from a provider’s perspective on the use of the vendor’s social connectedness and engagement product. 

The Social Connectedness and Engagement Technology Matrix includes the following sections:

Business Line/Care Applicability
Business line/care applicability illustrates the various business lines to which the social connectedness and engagement product is applicable, including the following:

  • Acute Care Settings (Physicians’ Offices, Emergency Department, Hospitals, Attending LTPAC Physician).
  • LTPAC and Other Settings (Home Health/Home Care, Hospice, Housing with Services, Community-Based Programs, Adult Day Care/Senior Centers, Assisted Living Facilities, Acute Rehab Facilities, Long-Term Acute Care Hospitals, Long-Term Care Rehab Facilities, Skilled Nursing Facilities, Intermediate Care Facilities, Intellectual Disabilities/Mental Retardation/Developmental Disabilities (ID/MR/DD) Facilities, Life Plan Community (Formerly CCRC), Program of All-Inclusive Care for the Elderly (PACE), Accountable Care Organizations (ACO)/Integrated Delivery Networks (IDN), Multiple Site Integration).

Socialization Modality
Socialization Modality illustrates the different product types, including the following:

  • Social Connectedness Tools 
    • Social Network
    • Video Chat    
    • Audio Chat    
    • Photo Sharing
    • Event/Activity Sharing
    • E-Mail    
    • Text Chat
    •  Picture Chat
    • Other

Social Engagement Tools

  • Life Stories
  • Digital Signage
  • Community App
  • Community Blog
  • Activity Calendar    
  • In-House Television Channel    
  • E-Reader/Electronic Books
  • Art
  • Games
  • Exercise
  • Rehabilitation
  • Music
  • Facilitated Communications and Conversations (such as Hearing Aid, Captioning)    
  • Companion App    
  • Companion Robot    
  • Virtual Reality 
  • Other

Lastly, we also asked vendors if their system is for a single user or multiple users.

Social Circle Type

  • This category includes the following options:
    • Social Connectedness
    • User-to-Peer(s)
    • User-to-Family
    • User to Professional Caregiver    
    • Facilitator-Mediated
  • Social Engagement
    • User-to-Peer(s)
    • User-to-Family
    • User to Professional Caregiver    
    • Facilitator-Mediated

Embodiment
This category includes the following options:

  • Tablet    
  • Desktop Computer
  • Laptop
  • All-In-One Computer
  • Smart TV
  • TV Set Top Box
  • Fixed Touch Screen 
  • Captioned Phone    
  • Smartphone    
  • Wearable    
  • Head-Mounted Gear    
  • Voice Activated Assistant Technology (such as  Amazon's Echo)    
  • Robot    
  • Other 

Program Development and Support Offered
This category includes options for the following:

  • Program Development (Planning, Business Model Templates, Workflows, Change Management, etc.)
  • Content Development    
  • Staff Engagement    
  • User Education 
  • User Engagement    
  • User Therapy
  • Family Engagement
  • Other (Please list)

Front-End Hardware Unit Patient/Client/Resident/User Interface and Communications
This category includes the following options:    

  • Types of Prompts
    • Login Modality 
    • Touch Screen
    • Haptic Prompts    
    • Audible Prompts
    • Voice Control
    • Visual Prompts
    • Gesture Activated Control    
    • Motion Activated Control
    • Facial Expression Activated Control
    • Eye Gaze Control    
    • Other (Please list)
  • Accessibility Features/Support
    • Hearing     
    • Vision    
    • Dexterity
  • Communications Modality
    • Plain Old Telephone System (POTS) Line
    • DSL Internet Connectivity
    • High-Speed Internet Connectivity    
    • Wi-Fi Connectivity    
    • Cellular Connectivity
    • Minimum Internet Connectivity Speed Required

Lastly, vendors we also asked if their content is customized based on users.

Hardware and Software Requirements – Front End
These requirements list the required desktop/laptop specifications for software-only solutions, including requirements for the following: 

  • Minimum Processor Speed, Hard Drive Storage, RAM requirements if applicable 
  • Operating System (OS) – Windows 
  • Operating System (OS) – Apple 
  • Operating System (OS) – Chrome
  • Operating System (OS) – Unix/Linux 

Other features compared include the following:  

  • Network Specifications
  • Wireless Specifications 
  • Modern Browser Support 
  • Minimum Internet/Bandwidth Specifications 
  • Miscellaneous Software/Applets Needed (i.e., Citrix) 
  • Miscellaneous Reporting Specifications (i.e., Crystal Reports) 
  • Scalability 
  • Local Model 
  • Hosted Model 
  • Software as a Service Model (SaaS) 
  • Remote Access 
  • Off-Line Functionality 
  • Support Ability to Store/Handle Attachments (Insurance Card, Historical Notes, etc.) 
  • Available for Lease 
  • Available for Purchase
     

Lastly, mobile options are listed as the following: 

  • Cellular Carriers that Support Solution 
  • Mobile OS – Android 
  • Mobile OS – Blackberry 
  • Mobile OS – iOS 
  • Mobile OS – Unix/Linux 
  • Mobile OS – Mobile OS - Windows (Win 10 Mobile, Windows Universe, Both, No) or
  • Mobile-Optimized Interface (through dedicated app or mobile-optimized webpages) 

Finally, we added a tab for additional notes on hardware and software requirements.

Front-End Unit Support
This category includes the following options:

  • Educational Materials (On-Screen Educational  Material,     Educational Audios    , Educational Videos)
  • Front-End Unit Multi-Language Support (English, Spanish, Mandarin, Cantonese,Korean, Russian, French, German, Hindi, Urdu, Portuguese, Arabic, Hebrew, Other (Please specify)
  • Remote Updates
  • Remote Configuration Capability

Status Reports, Communication with Care Team, Access
This element includes whether reports/records can be the following:    

  • Customizable Alert    
  • Customizable Reports    
  • Ability to Schedule Automatic Reports 

Report Access Provided to the Following External Parties (User's Physician    , User’s Nurse/Other Licensed Clinician    Activity Director/ Life Enrichment Supervisor/ Wellness Director,     Other Professional Caregiver,     User,     Family, Other (Please specify))

Alerts
This category includes the following options:

  • Alerts Can Be Sent to the Following External Parties (User's Physician,     User’s Nurse/Other Licensed Clinician    , Activity Director/Life Enrichment Supervisor/Wellness Director,     Other Professional Caregiver,    User    , Family,     Other)
  • Alerts Sending Modality (Pager, Telephone, Voice Messages, E-Mail, Text Message, Other)

Interfacing, Integration, and Add-Ons
This category includes options for the following:

  • EHR (Electronic Health Record)    
  • PHR (Personal Health Record) or Patient Portal
  • Telehealth    
  • Medication Adherence Monitoring Dispensers    
  • Safety Monitoring Systems (such as  Personal Emergency Response Systems (PERS))
  • Functional Assessment and Activity Monitoring    
  • Customer Relationship Management (CRM)    
  • Printing Supported    
  • Dashboard Views    
  • Analytic Tools; Please list (such as  Relationship or Engagement Management)    
  • Explain Integration Modality; Please List (Single Sign-On (SSO), LDAP, etc.)    
  • Other (Please list)

Program Support Services
This section includes options for the following:

  • Equipment Delivery/Pick Up    
  • Site/Home Installation
  •  IT/Network Troubleshooting and Support
  • Front-End System Set-up    
  • Front-End System Customization 
  • Back-End System Set-up
  • Back-End System Customization
  • On-site Staff Training
  • Online Staff Training    
  • On-site User Training
  • Online User Training    
  • Equipment Cleaning
  • Equipment Refurbishing
  • Other (Please List)

Interoperability, Interoperability Standards, and Certification
This section begins with type of interoperability and exchange capabilities supported, which include the following:

  • None, Export Data Only, Import Data Only, or Bi-Directional Data Import and Export

This section also includes options for the following:

  • Supported Interoperability Standards (HL7 Personal Health Monitoring Report, Other)
  • Back-End EHR/PHR Certification ((2014 and 2015 ONC-ATCB Certification (Complete (Please provide link); Modular (Please provide link); No)    
  • Front-End Certification
  • API and API Notes

Technical Supportability
This category includes options for the following:

  • Phone Support--No, Yes (limited hours), Yes (24 hours)    
  • Web Support--No, Yes (limited hours), Yes (24 hours)    
  • E-Mail Support    
  • Listserv and/or Usergroup    
  • Online Training    
  • On-site Training    
  • Other 
  • Warranty Information (Length of Product Warranty, Parts, Parts and Labor,     Parts, and In-Field/On-Site Labor)

    
Legal/Regulatory/Cyberliability
This area touches on the following:                                

  • Safety of Electrical Medical Equipment IEC 60601 Certification
  • FDA Clearance/ Listing – Cleared, Listed (This category may include Medical Device Data System (MDDS)), Pending, or None
  • FDA Classification (Class I, Class II, etc.)
  • HITECH    
  • HIPAA    
  • Security – List HIPAA & HITECH Act Requirements Met    
  • List Applicable Regulatory Requirements Met    
  • Provide a Link to Company's Cyberliability Policy    
  • List Any Other Legal Requirements    
  • Provide Link to Sample Contract

Hardware and Software Requirements – Back End

These requirements list the required desktop/laptop specifications for Software-Only Solutions, including requirements for the following: 

  •  Minimum Processor Speed, Hard Drive Storage, RAM requirements if applicable 
  • Operating System (OS) – Windows 
  • Operating System (OS) – Apple
  • Operating System (OS) – Chrome 
  • Operating System (OS) – Unix/Linux 

Other features compared include the following:  

  • Network Specifications
  • Wireless Specifications 
  • Modern Browser Support 
  • Minimum Internet/Bandwidth Specifications 
  • Miscellaneous Software/Applets Needed (i.e., Citrix) 
  • Miscellaneous Reporting Specifications (i.e., Crystal Reports) 
  • Scalability 
  • Local Model 
  • Hosted Model 
  • Software as a Service Model (SaaS) 
  • Remote Access 
  • Off-Line Functionality 
  • Support Ability to Store/Handle Attachments (Insurance Card, Historical Notes, etc.) 
  • Available for Lease 
  • Available for Purchase

Lastly, mobile options are listed as the following: 

  • Cellular Carriers that Support Solution 
  • Mobile OS – Android 
  • Mobile OS – Blackberry 
  • Mobile OS – iOS 
  • Mobile OS – Unix/Linux 
  • Mobile OS – Mobile OS - Windows (Win 10 Mobile, Windows Universe, Both, No) and/or 
  • Mobile-Optimized Interface (Through dedicated app or mobile-optimized webpages) 

Finally, we added a tab for Additional Notes on hardware and software requirements.

Company’s Experience and Viability

  • This area includes the following: 
  • Number of Years in Business 
  • Release Date of Current Version 
  • Number of Patients Served 
  • Core Customer Base/Focus of Line of Business 
  • Links to Additional Case Studies 

Assessments
The last section of the matrix is dedicated to the following: 

  • Strengths 
  • Areas for Improvement 
  • Ongoing Development 
  • References

8  Acknowledgement of Contributors

8.1 Contributing Writers

  • Brad Edwards, The Evangelical Lutheran Good Samaritan Society
  • Dave Blanchard, Hamilton CapTel
  • Juliet Kerlin, It’s Never 2 Late (iN2L)
  • Majd Alwan, LeadingAge CAST
  • Martha Bader, formerly K4Connect
  • Scott Code, LeadingAge CAST

8.2 Workgroup Members

  • Brad Edwards, The Evangelical Lutheran Good Samaritan Society
  • Beth Sanders, LifeBio
  • Dave Blanchard, Hamilton CapTel
  • David Dring, Selfhelp Community Services, Inc.
  • Frances A. Ayalasomayajula, HP
  • Gail Hunt, National Alliance for Caregiving
  • Jack York, It’s Never 2 Late (iN2L)
  • Jeremy Mercer, Netsmart
  • Joe Savery, Kendal
  • Jon Sanford, Georgia Tech
  • Josh Hansen, It’s Never 2 Late (iN2L)
  • Juliet Kerlin, It’s Never 2 Late (iN2L)
  • Majd Alwan, LeadingAge CAST
  • Martha Bader, formerly K4Connect
  • Olga Jewusiak, Caremerge
  • Peter Kress, Acts Retirement-Life Communities
  • Rich Hoherz, Westminster-Canterbury on Chesapeake Bay
  • Scott Code, LeadingAge CAST
  • Sharon Ashcraft, Yardi

8.3 Participating Social Connectedness and Engagement Technology Vendors

  • Breezie
  • Caremerge
  • Connected Living
  • Cubigo
  • Eversound
  • Care.Coach
  • Hamilton CapTel
  • Hasbro
  • HP
  • Independa
  • InTouchLink
  • Intuition Robotics
  • It’s Never 2 Late (iN2L)
  • K4Connect
  • LifeBio
  • Life-Assist
  • LifeLoop
  • LifeShare
  • Linked Senior
  • LivWell Health
  • MyGait
  • Orbita, Inc.
  • Oscar Senior
  • Rendever
  • Senior Portal
  • Telikin
  • TouchTown
  • Selfhelp Virtual Senior Center
  • Wellzesta

9 References and Resources

i. Both rural and non-rural entities may receive funding in the Healthcare Connect Fund (HCF) Program as members of a consortium (two or more HCPs applying together as one entity to take advantage of the program). The consortium must be comprised of more than 50% rural sites within three years of the filing date of its first request for funding (FCC Form 462). Find out if an HCP is located in a rural area by using the Rural Health Care (RHC) Program's Eligible Rural Areas Search Tool.
1. Nicholson, N., Molony, S., Fennie, K., Shellman, J., & McCorkle, R. (2010). Predictors of social isolation in community living older persons. Unpublished PhD, Yale University, New Haven, CT.
2. Cornwell, B., Laumann, E. O., & Schumm, L. P. (2008). The Social Connectedness of Older Adults: A National Profile. American Sociological Review, 73(2), 185-203.
3. Biordi, D. L., & Nicholson, N. R. (2013). Social Isolation. In Lubkin, I. M., & Larsen, P. D. (Eds.) Chronic Illness: Impact and Intervention, Eighth Edition (36). Burlington: Jones & Bartlett Learning.
4.Cornwell, E. Y., & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health & Social Behavior, 50(1), 31-48.
5. Machielse, A. (2015). The Heterogeneity of Socially Isolated Older Adults: A Social Isolation Typology. Journal of Gerontological Social Work, 58(4), 338-356.
6. http://www.pnas.org/content/110/15/5797.full 
7. Biordi, D. L., & Nicholson, N. R. (2013). Social Isolation. In Lubkin, I. M., & Larsen, P. D. (Eds.) Chronic Illness: Impact and Intervention, Eighth Edition (36). Burlington: Jones & Bartlett Learning.
8. Biordi, D. L., & Nicholson, N. R. (2013). Social Isolation. In Lubkin, I. M., & Larsen, P. D. (Eds.) Chronic Illness: Impact and Intervention, Eighth Edition (36). Burlington: Jones & Bartlett Learning.
9. Loneliness and Social Isolation as Risk Factors for Mortality (2016) Available at: http://journals.sagepub.com/doi/abs/10.1177/1745691614568352
10. Social isolation, loneliness, and all-cause mortality in older men and women.  Available at: http://www.pnas.org/content/110/15/5797.full 
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