Weekend reading: contact tracing in assisted living/LTC facilities via sensor-based ADL technology raises ethical issues

October 24, 2020 | by

Contact tracing for COVID-19 is still ‘not quite there’ in many countries, especially those countries like the UK which had created centralized models and were slow to move to the decentralized systems based on Apple and Google’s APIs, the (Gapple? AppGoo?) Exposure Notification system now in use in Ireland and Germany. For the most vulnerable in assisted living, who aren’t using smartphones that ping adjacency to other smartphones and are moving around most of the time within the residence, other approaches have been developed. Already in place in many communities are sensor-based trackers for activities of daily living (ADLs) for both safety and predictive health analytics, as well as provide conveniences such as apartment entry for residents.

As we noted in July, a number of ADL and location trackers have repurposed themselves into highly accurate contact tracers since they retain the history of resident and staff movement. Profiled are CarePredict (ADLs), ZulaFly (location tracking), and CenTrak (location tracking). Residents in many facilities with these systems are early adopters of contact tracing, even if they don’t know it.

While the article is detailed and fairly laudatory about how these systems can assist residents and staff in arresting the spread of COVID-19 which has ripped through nursing homes and senior living, it then diverges into other issues, some worth considering even if some of the verbiage is over the top:

  • These location monitoring systems haven’t been used for infectious disease outbreaks before, but the article admits that the pandemic has presented extraordinary circumstances
  • Use of these systems cannot substitute for effective infection control: staff and resident handwashing, mask wearing, and staff PPE. (Something like wearing a used mask and not washing your hands for the rest of us)
  • These systems are dependent on facility-wide internet/Wi-Fi. Many LTCPAC facilities do not have it, thus creating a digital divide in care even in residences proven to have high-quality care.
  • Resident rights and privacy. Residents apparently have only limited choices in using these technologies, even if they are restricted to their rooms. Not all see the need for monitoring technology for their safety and intrusive ‘alarms’ that bring in staff. There is a real issue around older adults’ autonomy and privacy rights which tends to be forgotten in the balance of privacy and safety, with prediction of illness based on behavior a step further.

Interviewed for this article, Laurie Orlov of Aging in Place Technology Watch, believes “It’s pretty darn useful if you’re in independent living, and you decide to go for a walk. If it’s night, and there’s ice, having a full detection capability that knows where you are is really useful. I think with fall detection, and anything that can help when you’re alone, the benefits exceed the cost of the privacy — assuming that you’re with it enough to opt in.”  Senior Sensors (The Verge)  (Disclosure: Editor Donna consulted for CarePredict in 2017-18)

A counterpoint to this article is also by Laurie Orlov and published on her website, reviewing the future of remote care technology and older adults in 2020. It’s a preview of a to-be-released later this year report.

Themes and trends at Aging2.0 OPTIMIZE 2017

November 10, 2017 | by

Aging2.0 OPTIMIZE, in San Francisco on Tuesday and Wednesday 14-15 November, annually attracts the top thinkers and doers in innovation and aging services. It brings together academia, designers, developers, investors, and senior care executives from all over the world to rethink the aging experience in both immediately practical and long-term visionary ways.

Looking at OPTIMIZE’s agenda, there are major themes that are on point for major industry trends.

Reinventing aging with an AI twist

What will aging be like during the next decades of the 21st Century? What must be done to support quality of life, active lives, and more independence? From nursing homes with more home-like environments (Green House Project) to Bill Thomas’ latest project–‘tiny houses’ that support independent living (Minkas)—there are many developments which will affect the perception and reality of aging.

Designers like Yves Béhar of fuseproject are rethinking home design as a continuum that supports all ages and abilities in what they want and need. Beyond physical design, these new homes are powered by artificial intelligence (AI) and machine learning technology that support wellness, engagement, and safety. Advances that are already here include voice-activated devices such as Amazon Alexa, virtual reality (VR), and IoT-enabled remote care (telehealth and telecare).

For attendees at Aging2.0, there will be substantial discussion on AI’s impact and implications, highlighted at Tuesday afternoon’s general session ‘AI-ging Into the Future’ and in Wednesday’s AI/IoT-related breakouts. AI is powering breakthroughs in social robotics and predictive health, the latter using sensor-based ADL and vital signs information for wellness, fall prevention, and dementia care. Some companies part of this conversation are CarePredict, EarlySense, SafelyYou, and Intuition Robotics.

Thriving, not surviving

Thriving in later age, not simply ‘aging in place’ or compensating for the loss of ability, must engage the community, the individual, and providers. There’s new interest in addressing interrelated social factors such as isolation, life purpose, food, healthcare quality, safety, and transportation. Business models and connected living technologies can combine to redesign post-acute care for better recovery, to prevent unnecessary readmissions, and provide more proactive care for chronic diseases as well as support wellness.

In this area, OPTIMIZE has many sessions on cities and localities reorganizing to support older adults in social determinants of health, transportation innovations, and wearables for passive communications between the older person and caregivers/providers. Some organizations and companies contributing to the conversation are grandPad, Village to Village Network, Lyft, and Milken Institute.

Technology and best practices positively affect the bottom line

How can senior housing and communities put innovation into action today? How can developers make it easier for them to adopt innovation? Innovations that ‘activate’ staff and caregivers create a multiplier for a positive effect on care. Successful rollouts create a positive impact on both the operations and financial health of senior living communities.

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The ‘right package of care’ sought for ‘bed-blockers’, home care (UK/US)

September 7, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /]’Bed-blocking’ as a signal failure of transitional care. Here is a term that may be unique to the UK, but not the problem: older people who cannot be discharged after an illness because there is no plan and no suitable place for transitional care and/or a safe return home with care. According to the Guardian, the term originated among UK healthcare managers and economists as early as the late 1950s as a marker of system inefficiency. The writer, Johnny Marshall, director of policy for the NHS Confederation, correctly notes that it should be a marker of “(a) system that has failed to move quickly enough to put together the right package of care to enable the person in the bed to return home” and that unfairly blames the patient. He gives examples of programs across Britain with home assessment and care, particularly for older people post-fall injury, that reduce or eliminate hospital days.

In the US, transitional care is pointing to a blend of home care tech/services. Some of the indicators for LTC support that Laurie Orlov points out in Tech-enabled home care — what is it, what should it be?: 

  • Assisted living growth is flat as this past weekend’s open can of soda–housing is chasing residents (though cost doesn’t seem to be following the usual supply/demand curve), the average resident is 87 years old and staying 22 months, and their net worth can’t afford present AL
  • There’s a huge and growing shortage of home care workers for an ever-increasing number of old and old-old
  • Yet finally big investment is taking place in tech-facilitated home care locating and matching: Honor.com, Care.com and ClearCare–a total of just under $150 million for the three

But can technology–front and back end–make up for the human shortage? And there’s a value in wearing the Quantitative Self hat here. (more…)

Guest blog: Health and Social Care Innovation – are we really learning our lessons?

May 31, 2016 | by | 2 Comments

Hazel Harper, Programme Manager, Health & Care, at Innovate UK has kindly offered readers this guest blog (which is also available on the Innovate UK website).

Delivering Assisted Living Lifestyles at Scale (dallas) is the largest innovation programme in Health and Care to date. With an ambitious target of touching the lives of over 160,000 people, just exactly what can we learn from this ambitious programme?

 It was no mean feat. With no blueprint combined with delivering business as usual and only 3 years to deliver there are plenty of lessons but the question is how many of them will we really learn or will our incessant need to do things our way or no way remain the longest running barrier to progress we’ve known in this space?

lessons learnt

Insight in to some of the lessons learnt (in no particular order)

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Legrand adds Jontek to assisted living and healthcare businesses (UK)

May 6, 2016 | by

Jontek Ltd, a Stockport-based developer and provider of monitoring software and response centers for telecare, telehealth, lone worker and mCare, is being acquired by Legrand, a specialist in digital building and electrical infrastructure. Jontek will be joining Tynetec in Legrand Electric Ltd’s Assisted Living & Healthcare Business unit. Like Tynetec, Jontek is one of our Grizzled Pioneers of telecare, having started their business over 20 years ago. Currently they provide services to over 60 organizations in the UK and are a Government Procurement Supplier.

Looking at the release, Legrand sees an opportunity to complement Tynetec’s current lines in at-home alarms and assisted living call systems with Jontek’s Answer-link monitoring software, which is a system integrating database queries/reporting, document management, emailing and incident logging. (This Editor also sees potential for these systems to enhance Tynetec’s telehealth RPM systems and Intelligent Care.) Managing Director Chris Dodd: “Historically, both Jontek and Tynetec have been committed advocates of an open protocol philosophy. This will continue to remain one of our primary considerations when developing integrated digital solutions and innovative IP care platforms of the future.” Legrand release.

Two important takeaways: We continue to see consolidation of health tech businesses with an eye to enhancing and widening capabilities. Companies with established businesses are moving to make their products more accessible and user-friendly with mobility and enhanced response–BYOD and call centers. In design, they are incorporating secure data integration and reporting capabilities to make the data useful to clinicians and to prove worth, reducing the number of time-consuming steps to obtain data–or fall inevitably behind other digital health competitors. The other is ‘open protocol’ which this Editor interprets in this context as the ability to integrate sensors, peripherals, software and other kit which are not proprietary–in other words, to play nicely in the sandbox. Another indicator that the ‘walled garden’ is coming to an end. Not that it is going to be easy for those firms which have invested in a certain way of doing business–a challenge that many heretofore successful companies are facing. Ed. disclosure: Tynetec is and has been a long time supporter of TTA.

Tech, approaches for caregiving at a distance falling behind

February 17, 2015 | by | 1 Comment
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/8001846820_6d2df50ffa_z.jpg” thumb_width=”175″ /]There’s plenty of telehealth systems and apps that remind older adults of their meds, appointments and take their vital signs–but where are the ones that take care of the reality of ‘aging in place’: the loneliness of the man or woman who lives alone, how that person can communicate with family with their own lives 50 or 2,000 miles away, how family members can better oversee or coordinate her care? The problem hasn’t changed when first addressed over a decade ago by the earliest telecare systems. The technology, while more abundant, is largely uncoordinated, putting the burden on the caregiver. Laurie Orlov points out that ‘finding care is not the problem’ but that the care is at extremes: either too light (daily non-medical assistance) or a move to assisted living housing (average move-in now 80+). No company has truly organized a larger solution (more…)

Mapping assisted living and integrated care & support work in the UK

February 14, 2014 | by

We don’t normally draw readers’ attention these days to items of news unless we have a comment to make, as Twitter, and most notably Mike Clark’s excellent & timely tweets (@clarkmike), fulfils that role well.

However the Assisted Living Capability Map is just so good it perhaps merits an extra mention to readers. Click on any region on the map and it will give you details of all assisted living activities in that region known to the HealthTech and Medicines KTN.

The same is true of the Integrated Care & Support exchange (ICASE) map with shows integrated care & support pioneers, initiatives & case study exemplars. It is not, sadly, designed with the 10% of men who struggle with red/green colour blindness in mind, although that’s a small criticism of an excellent piece of work.

Legrand “joint venture” with Neat

February 9, 2014 | by

A press release on Legrand’s website and (in Spanish) on Neat’s website, both just published, confirm the forming of a joint venture between the two.  This of course is the Legrand that took over Tynetec last year and Intervox in 2011, making it, they claim, now the  “second-largest player in the promising assisted living market.”

Neat’s products, distributed through Possum, have been finding favour across the UK because of their attractive prices. How, one wonders will the tie-up with Tynetec’s organisation now work, and will Possum now lose this attractive distribution arrangement, particularly in the major rollout in Cornwall where Neat are preferred suppliers?

All comments, anonymous or otherwise, will be gratefully received.

Finally, just to be clear, there is no connection between Neat, the Spanish supplier of assisted living equipment and Newham’s NeAT programme  (which originally stood for Newham Advanced Telecare and it so happens at one time I managed).

Telecare-assisted AL resident monitoring: study

October 25, 2013 | by | 1 Comment

Research on telecare in the US has been rare of late. Thus this qualitative analysis of focus groups with twelve housing managers from twelve different Evangelical Lutheran Good Samaritan Society (GSS) assisted living communities in the LivingWell@Home (LW@H) program should be looked at carefully for both benefits of and issues with sensor-based monitoring of residents’ significant activities of daily living (ADLs). On the ten most prevalent themes, the most positive were:

  • Benefits: marketing in bridging home to AL and enhanced quality of care; validation of information helping with resident medical status and overall safety; proactive detection of health events
  • Sleep patterns: quality of sleep was perceived as important, and disturbance as an advance indicator of a change in resident health
  • Family member assurance: family members understand the value of technology-assisted care in advanced alerting to potential health problems. In fact using the system at home was possibly more attractive to them than in AL.

However, issues with the LW@H program ranged from perceptual ones (resident privacy)  (more…)

Disturbing program on assisted living (US)

July 30, 2013 | by

The other (and darker) side of how many live out the last years of their lives and the poor (but expensive) quality of care will be televised tonight in the US. PBS’ Frontline will air what is termed in Forbes a ‘powerful exposé’, Life and Death in Assisted Living, premiering Tuesday 30 July at 10 pm Eastern Time. It focuses on major problems in assisted living housing, especially at market leader Emeritus. For our many readers who cannot view PBS, the ProPublica investigative journalism group who worked on this series is also publishing a series online with the same title over the next few days and as a Kindle e-book. One case taken up is a woman with advanced dementia and chronic medical conditions who would have been previously in a nursing home or skilled nursing facility (SNF). Your Editor noted that assisted living was developed as an alternative (see next article) to nursing homes in the late 1980s, ironically by the founder of Emeritus who is no longer with the company.

LeadingAge, the association representing US non-profit aging services providers (AL, SNF, home care) and the US branch of IAHSA, has wisely prepared a heads-up for members and press talking points differentiating themselves from for-profit operators like Emeritus, starting with “The Not-for-Profit Difference: Unlike for-profit communities, the leadership at our organization does not “push to fill facilities and maximize revenues.” We are not driven by bottom lines.” On point advice on talking to the press here including a communications lifeline from the association.

‘Green Houses’: a better model for senior living (US)

July 30, 2013 | by

“Let’s abolish the nursing home”–Dr. Bill Thomas

In the US, the ‘Green House Project’ model has made tremendous progress in developing homes for older adults as an alternative to nursing homes. A ‘design for living’ for 10-12 residents, a Green House is a home-like model built from the ground up with private rooms, bathrooms and community living. Currently 260 homes are open or under development across 32 states. From their website, the intent is for “Those who live in, work in, and care about a Green House [home] share the duty to foster the emergence of late-life development within the daily life they create together.” The care ratio is also much higher; care teams are organized on self-managed work teams to care for the mostly high acuity residents (including dementia). Yet costs, according to NPR, are about the same as the median for nursing homes nationally (many residents are on Medicaid) and in quality of life, it respects residents habits, privacy with the outcome that it supports residents longer in a level of independence.

The Green House concept came from the work of Bill Thomas MD, a geriatrician who also developed the Eden Alternative and frequently writes on ChangingAging.org. The news is the backing of the Green House Project by the prestigious and well-funded Robert Wood Johnson Foundation and NCB Capital Partners. The Project provides the model and guidance to independent organizations for organization, implementation and certification of these homes. MedCityNews was wowed by it (Wall Street Journal link does not work, however). See the video from RWJF on what they saw as ‘a catalyst for significant social change’.  Green House Project website   RWJF page on their support of this ‘force multiplier’.

What if you added non-intrusive health tech to these homes? The opportunities could be as varied as the ELSI Smart Floors and alert system for safety (Charles)…fitness bracelets/wearables to monitor basic vitals and ADL/activity (Jawbone, Misfit, AFrame)…biosensor ‘tattoos’ (Toni). Tablet/PC based socialization/brain stimulation (GeriJoy, GrandCare, It’s Never 2 Late). Could this humane environment move to a higher level with a touch of tech?

[This video is no longer available on this site but may be findable via an internet search]