(Baker et al., 1997; Scott et al., 2002), although baby boomers may prove to be an exception, as they are better educated than previous generations (Cutilli, 2007; IOM, 2004) and may be more proactive in their own health care (CBO, 1993).

While there is evidence that getting older patients engaged in their own care results in improved clinical outcomes and higher patient satisfaction (Bodenheimer et al., 2002), there are a number of barriers to educating and training patients in their own self-care. Many self-management programs, for instance, are limited to a single disease or lack information on either basic principles of self-management or the long-term benefits of actively managing chronic disease. And while there is evidence that case managers and others can successfully train frail elders in self-management skills (Chodosh et al., 2005; Ersek et al., 2003), this type of education and training is not currently reimbursable under most insurance plans, including Medicare and Medicaid (Quijano et al., 2007). Nevertheless, supporting these types of programs is important because if patients are able to manage their conditions more effectively, they are likely to use fewer health care resources and thereby reduce the strain on the health care workforce.

Assistive Technologies

As the number of older Americans with ADL or IADL limitations increases over the coming years, one likely result will be an increase in the use of assistive technologies (Tomita et al., 2004). These devices help with many of the issues that commonly lead older adults to leave their homes for care institutions, including the need for medical monitoring and medication management, decreased mobility, caregiver burnout, dementia, and problems with eating, toileting, safety, isolation, transportation, housekeeping, money management, shopping, and wandering (Haigh et al., 2006). Assistive technologies are designed to support and extend the independent functioning of older adults, which can in turn reduce the need for support from direct-care workers and family caregivers. These technologies can also help lower rates of injury among direct-care workers and caregivers by reducing their physical strain. For example, these technologies can assist with tasks such as lateral transfers, repositioning patients up or side-to-side in bed, and bed-to-chair or bed-to-wheelchair transfers (Baptiste, 2007).

The Institute of Medicine (IOM) report The Future of Disability in America refers to assistive technology devices as “items designed for and used by individuals with the intent of eliminating, ameliorating, or compensating for individual functional limitations” (IOM, 2007). These items include a broad range of tools and technologies that help individuals perform ADLs and IADLs and thus reduce their need for personal assistance. Several studies demonstrate, for instance, that the use of assistive devices

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