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.

Technology will help ease, but not replace, rising workforce demand in long-term care: UCSF study

August 7, 2019 | by

A just-published research paper by researchers at the University of California, San Francisco Health Workforce Research Center on Long-Term Care, has come to the not entirely unsurprising conclusion that the current technology targeted to the LTC area is helpful but won’t displace any workers from their jobs in the immediate future. The qualitative study evaluated 13 current health tech technologies in 14 areas for their potential impact on the care of older persons as it affects LTC workforce recruitment, training, and retention. 

Some key findings were: 

  • Technology will not even come close to replacing the LTC workforce. At most it will aid LTC workers.
  • Tools such as data collection and remote patient monitoring systems that distribute data to the care team can improve staff’s understanding of client behavior and manage day-to-day tasks
  • Technology can also address workforce recruitment, retention, and staffing efficiency, such as predictive analytics used in identifying candidate suitability, improved staff management in shift scheduling, work location, and clientele, and real time location tracking, can improve the work environment
  • Technologies that monitor health and activity measurements, integrating with predictive modeling, can benefit clients, family caregivers, and care teams, but may suffer from complexity and duplication in their category. 
  • Educational tools also improve care delivery by instructing on proper caregiving techniques, increasing knowledge on medical or behavioral conditions, and by promoting sympathy/empathy

Some of the barriers included:

  • It comes at a cost which LTC is reluctant to pay
    • Initial and ongoing cost with lack of third-party Medicare/private reimbursement
    • Dependence on unattractive long term subscription-based models 
  • Threats to privacy and the security of health data
  • Potential differences in product specificity or acceptance among diverse racial and ethnic groups
  • Technology lacking user-centered design and not developed/tested in conjunction with real-world LTC 
  • Funding: only two US VCs fund LTC tech is a bit of an exaggeration, but the pool of interest is shallow nonetheless

The overall conclusion struck this Editor as less than enthusiastic, perhaps because We’re Not There Yet and it’s still so far away.

The appendix lists the 13 companies surveyed with summaries of each health tech company interviewed: Alma’s House (Sweden), Arena (staffing/recruitment), Canary Health (education/caregiver education), CarePredict (wearables/alert monitoring), Clear Care (management). Embodied Labs (education), Intuition Robotics (ElliQ), GrandCare (monitoring/client engagement), Honor (staffing), La
Valeriane (documentation), LifePod (voicetech/monitoring), UnaliWear (wearables/monitoring), VisibleHand (documentation/EHR).

The study was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS).com. UCSF summary, The Impact of Emerging Technologies on Long-Term Care & the Health Workforce (full text)  Hat tip to Laura Mitchell of GrandCare via Twitter

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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Will Japan’s hard lessons on an aging population include those with dementia?

October 31, 2017 | by

Japan, with over 30 percent of its population over 60 and with no countervailing trend to stop it, is now facing the scourge of dementia. With a WHO-estimated life expectancy of 84, over 4.6 million Japanese have been diagnosed with it. The Japan Times published an estimate (unfootnoted) that 15 percent of Japan’s over-65 population has dementia to some degree. Will Japan, struggling to implement technology to better manage an aging, shrinking population [TTA 24 Oct], turn out to be a model for Western Europe, the US, and their neighbor China in treating older people with cognitive problems with respect and care –or be a cautionary tale?

Two articles in Canada’s Toronto Star and the Japan Times indicate the struggle and the pressure that dementia has placed on an aging Japanese nation. What makes headlines is an unfortunate 91-year-old man in Obu who wanders onto railway tracks (with the family handed the C$39,000 damage bill), the horrific rundown of pedestrians by a 73-year-old who despite a dementia diagnosis just had his driver’s license renewed, and the violent acts around kaigo jigoku, or “caregiver hell” by both family members and paid carers. This is not readily solvable by robots or Paro seals (although self-driving cars would be one huge help). 

Japan has pioneered innovation for a better quality of life with dementia, which as typical not all of which can translate to a larger country:

  • In 2000, Japan introduced mandatory long-term care insurance, which is paid into starting at age 40. At 65 (or earlier due to disease), you become eligible for a wide range of caring services, with a 10-20 percent service fee attached to discourage overuse. This semi-market-based approached has proven popular with 5.6 million using it in 2013.
  • Dementia daycare, which reportedly is used by 6-7 percent of the over-65 population. Healthy stimulating activities in a local home and small group setting, such as food preparation, art therapy, and storytelling can cost as little as C$10 a day.
  • Dementia search and rescue, which is organized again on a local basis. Community teams of social workers and medical professionals actively look for people with dementia in homes where, for instance, a wife is caring for a husband who is increasingly forgetful, and suggest some alternatives and respite. Sometimes the approach works, sometimes not, but it shows that the community does not forget about the person and, importantly, the caregiver.
  • Short-term stays or respite care (shokibo takino) gives a regular ‘day off’ or a stay of up to 30 days. This also appears to be organized locally.

The Japan Times/Sentaku ‘dementia time bomb’ article is nowhere near as optimistic as the Toronto Star‘s take, advocating instead: (more…)

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…)

Tunstall adopts new Tactio in patient management

November 13, 2014 | by

Tunstall Healthcare is partnering with Canadian mHealth developer Tactio Health Group in what is a distinct first for them: creating a mobile care management system that is 1) smartphone-based for the patient and 2) prominently integrates non-Tunstall apps and devices. The patient uses the smartphone and the Tactio-developed mTrax app to collect a wide spectrum of data–everything from activity, sleep, pregnancy, body fat and mood tracking to the traditional constellation of vital signs. This uploads to the care provider’s tablet mPro Clinical App which overviews, details and reports the data for each patient and patient groups in care. The data comes from well-known mHealth apps outside the Tunstall world: BodyMedia, Fitbit, Fitbug, Garmin, Jawbone UP, Medisana and Wahoo Fitness, as well as connected (presumably Bluetooth) medical devices from A&D Medical, Mio, iHealth, Telcare, Withings and Nonin. Tunstall has also added two-way patient coaching and  health journal features.

Tunstall’s positioning for what they call Active Health Management or AHM is “supported self-management” and “shift(ing) from reactive care to cost-effective active care.” (more…)

‘Game changing’ healthcare robots

October 25, 2013 | by

Healthcare service robots have definitely gone ‘mainstream’ if two are ‘Game Changer’ winners in the industry’s Robotics Business Review. The honors go to the Aethon TUG, a laser and infrared-guided robo-deliverer for medications, lab specimens, food, blood, linens–and remover of trash and waste; and the sumo-like Hstar Technologies RoNA – Robotic Nursing Assistant System to lift extremely heavy patients and minimize nurse/aide injury. Among the finalists were the iRobot Ava using the Cisco TelePresence EX telemedicine platform and (a new one on this Editor) a physician assistant for the delicate work of scalp hair transplantation, Restoration Robotics ARTAS Robotic System. But we could also see healthcare uses for Five Elements Robotics’ Budgee personal transport carrier to assist those who cannot carry heavy loads. RBR’s full list.