As more medical care shifts to residential settings, patients and families find themselves managing sophisticated equipment originally designed for use by licensed clinicians. The devices often are not user-friendly, especially for lay caregivers or people in poor health left to solve problems on their own.

In Massachusetts, a health system that provides comprehensive medical and social services to elderly people living at home in Cambridge and greater Boston finds that coordinated care can help.

ECRI recently put this challenge at the top of its 2024 list of Top-10 Health Technology Hazards. ECRI, which provides research and risk management guidance to hospitals and technology providers, last year raised awareness of another hazard related to in-home use of medical devices — gaps in notification for medical device recalls, which rarely reach individual consumers.

In-home hazards elude system solutions

Hazards encountered in the home are difficult to address with system solutions. Care is often fragmented, even when provided through an organization, and medical equipment may be supplied by different vendors or, in many cases, patients or their family members.

In a “challenge to industry” issued in the Top-10 list, ECRI urges manufacturers to offer end-user support and make devices more intuitive to use and instructions easier to comprehend. Those improvements may help, but they still depend on the initiative and capabilities of patients and families doing their best with what they have.

Coordinated care offers a safety net

Kate Mooney, Occupational Therapist and Rehabilitation Manager for the PACE program at Cambridge Health Alliance, is well-acquainted with challenges posed by equipment and devices used in the home and has seen how a coordinated team approach to care can help.

PACE stands for Programs of All-inclusive Care for the Elderly, a joint federal and state initiative that provides health care and social services to elderly people living at home; most receive Medicare and/or Medicaid benefits. PACE patients qualify for nursing home care but can safely live in the community with support from a PACE care team. There are eight PACE programs in Massachusetts.

CHA’s PACE team uses several strategies to mitigate equipment issues:

• All durable medical equipment orders from PACE providers for in-home use are processed by the rehabilitation department.
• Patients’ homes are regularly checked for known safety hazards and equipment is tested annually.
• Medical providers use a shared electronic health record system for communication.
• Education and training for staff is standardized.
• Individualized training for patients, family members or home health aides is provided on-site in patients’ homes as needed.

Mooney says that because she knows PACE patients and their living arrangements, she can sometimes anticipate problems when processing equipment orders.

Recalling an order for an in-tub sitting bench, Mooney says, “I knew it wouldn’t fit in the patient’s bathroom because I'd been in that building seeing other patients. It was nice to be able to say, ‘It has to be this other tub bench. I know it will fit in the tub and be safe for the patient.’”

Mooney suggests that knowing what will work best for individual patients is an advantage of the PACE approach. “It's a preventative care model, which I think speaks to the safety issues,” she says. “We're going in preventatively, trying to figure out the safety risks before they happen. We try to fix them and problem solve in real-time, with and for the person in front of us.”