The REAL acute care: hurricanes, health tech, and what happens when electricity goes out

This afternoon, as this New York-based Editor is observing the light touch of the far bands of Hurricane José’s pass through the area (wind, spotty rain, some coastal flooding and erosion), yet another Category 5 hurricane (Maria) is on track to attack the already-wrecked-from-Irma Puerto Rico and northern Caribbean, thoughts turn to where healthcare technology can help those who need it most–and where the response could be a lot better. (Add one more–the 7.1 magnitude earthquake south of Mexico City)

Laurie Orlov, a Florida resident, has a typically acerbic take on Florida’s evacuation for Irma and those left behind to deal with no electricity, no assistance. Florida has the highest percentage of over-65 residents. Those who could relocated, but this Editor from a poll of her friends there found that they didn’t quite know where to go safely if not out of state, for this storm was predicted first to devastate the east coast, then it changed course late and barreled up the west (Gulf) coast. Its storm surges unexpected produced record flooding in northeastern Florida, well outside the main track. Older people who stayed in shelters or stayed put in homes, senior apartments, 55+ communities, or long-term care were blacked out for days, in sweltering heat. If their facilities didn’t have backup generators and electrical systems that worked, they were unable to charge their phones, use the elevator, recharge electric wheelchairs, or power up oxygen units. Families couldn’t reach them either. Solutions: restore inexpensive phone landlines (which hardwired, mostly work), backup phone batteries, external power sources like old laptops, and backup generators in senior communities (which would not have prevented prevent bad fuses/wiring from frying the AC, as in the nursing home in Hollywood where eight died).  Aging In Place Tech 

It’s another reason why senior communities and housing are supposed to have disaster preparedness/evacuation plans in place. (If you are a family member, it should be included in your community selection checklist and local records should be checked. This Editor recently wrote an article on this subject (PDF) that mentions disaster and incident planning twice. (Disclaimer: the sponsoring company is a marketing client of this Editor.) In nursing homes, they are mandatory–and often not executable or enforced, as this article from Kaiser Health News points out. 

Another solution good for all: purchase 200-400 watt battery packs that recharge with solar panels, AC, and car batteries (AARP anyone?). Campers and tailgaters use these and they range below $500 with the panels. Concerned with high-power lithium-ion batteries and their tendency to go boom? You’ll have to wait, but the US Army Research Laboratory and University of Maryland have developed a flexible, aqueous lithium-ion battery that reaches the 4.0 volt mark desired for household electronics without the explosive risks associated with standard lithium-ion power–a future and safer alternative. Armed With Science

Telemedicine and telehealth are not being fully utilized to their potential in disaster response and recovery, but the efforts are starting. Medical teams are starting to use telehealth and telemedicine as adjunct care. It has already been deployed successfully in Texas during Harvey. Many evacuees were sent to drier Dallas and the Hutchinson arena, where Dallas-based Children’s Health used telemedicine for emergency off-hour coverage. Doctor on Demand and MDLive gave free direct support to those affected in Texas and Louisiana through 8 September, as well as Teladoc, American Well, and HealthTap for a longer period to members and non-members. Where there are large numbers of evacuees concentrated in an area, telemedicine is now deployed on a limited basis. Doctor on Demand releaseSTAT News, MedCityNews 

But what about using affordable mobile health for the thousands who long term will be in rented homes, far away from their local practitioners–and the doctors themselves who’ve been displaced? What will Doctor on Demand and their sister telemedicine companies have available for these displaced people? What about Puerto Rico, USVI, and the Caribbean islands, where first you have to rebuild the cellular network so medical units can be more effective, then for the longer term? (Can Microsoft’s ‘white space’ be part of the solution?)  

One telehealth company, DictumHealth, has a special interest and track record in both pediatric telehealth and global remote deployments where the weather is hot, the situation is acute, and medical help is limited. Dictum sent their ruggedized IDM100 tablet units and peripherals to Aster Volunteers who aid the permanently displaced in three Jordanian refugee camps in collaboration with the UNHCR and also for pediatric care at the San Josecito School in Costa Rica. In speaking with both Amber Bogard and Elizabeth Keate of Dictum, they are actively engaging with medical relief agencies in both the US and the Caribbean. More to come on this.

Technology for Aging in Place, 2017 edition preview

Industry analyst Laurie Orlov previews her annual review of ‘Technology for Aging In Place’ on LinkedIn with six insights into the changes roiling health tech in the US. We’ll start with a favorite point–terminology–and summarize/review each (in bold), not necessarily in order.

“Health Tech” replaces “Digital Health,” begins acknowledging aging. This started well before Brian Dolan’s acknowledgment in Mobihealthnews, as what was ‘digital health’ anyway? This Editor doesn’t relate it to a shift in investment money, more to the 2016 realization by companies and investors that care continuity, meaningful clinician workflow, access to key information, and predictive analytics were a lot more important–and fundable–than trying to figure out how to handle Data Generated by Gadgets.

Niche hardware will fade away – long live software and training. Purpose-built ‘senior tablets’ will likely fade away. The exception will be specialized applications in remote patient monitoring (RPM) for vital signs and in many cases, video, that require adaptation and physical security of standard tablets. These have device connectivity, HIPAA, and FDA (Class I/II) concerns. Other than those, assistive and telehealth apps on tablets, phablets and smartphones with ever-larger screens are enough to manage most needs. An impediment: cost (when will Medicare start assisting with payments for these?), two-year life, dependence on vision, and their occasionally befuddling ways.

Voice-first interfaces will dominate apps and devices. “Instead we will be experimenting with personal assistants or AI-enabled voice first technologies (Siri, Google Home, Amazon Alexa, Cortana) which can act as mini service provider interfaces – find an appointment, a ride, song, a restaurant, a hotel, an airplane seat.” In this Editor’s estimation, a Bridge Too Far for this year, maybe 2018. Considerations are cost, intrusiveness, and accuracy in interpreting voice commands. A strong whiff of the Over-Hyped pervades.

Internet of Things (IoT) replaces sensor-based categories. Sensors are part of IoT, so there’s not much of a distinction here, and this falls into ‘home controls’ which may be out of the box or require custom installation. Adoption again runs into the roadblocks of cost and intrusiveness with older people who may be quite reluctant to take on both. And of course there is the security concern, as many of these devices are insecure, eminently hackable, and has been well documented as such.

Tech-enabled home care pressures traditional homecare providers – or does it? ‘What exactly is tech-enabled care? And what will it be in the future?’ Agreed that there will be a lot of thinking in home care about what $200 million in investment in this area actually means. Is this being driven by compliance, or by uncertainty around what Medicare and state Medicaid will pay for in future?

Robotics and virtual reality will continue — as experiments. Sadly, yes, as widespread adoption means investment, and it’s not there on the senior housing level where there are other issues bubbling, such as real estate and resident safety. There are also liability issues around assistance robotics that have not yet been worked out. Exoskeletons–an assistance method this Editor has wanted to see for several years for older adults and the disabled–seems to be stalled at the functionality/expense/weight level.

Study release TBD

Technology for Aging in Place 2016

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/03/elderly-smartphone.jpg” thumb_width=”150″ /]Laurie Orlov’s updated view of technologies that assist home caregiving/living, and her observations on trends for both boomers and those well over 65, is hot off the (virtual) presses and available here on her website. It is US-market oriented, but the trends explored here will be of interest internationally. The focus in this study is home-based systems for safety, alerts, activity/location tracking (telecare), home care/caregiving tools and what this Editor would call ‘health monitoring light’–med minders and logging apps versus medically-oriented telehealth (vital signs, save for AliveCor) and telemedicine (virtual visits/consults).

Highlights:

  • In communication, internet non-usage among 75+ has declined to 50 percent over the past 15 years.
  • The tablet form factor is losing ground as smartphones get bigger. Older adults and smartphones are beginning to ‘get along’ partly as they grow larger, but also that feature and simple phones are becoming less available.
  • Also losing ground is senior housing–residents are delaying entry to assisted living until they are mid 80s and frailer. Savings and debt in the boomer group is low and high, respectively.
  • Investors are caring more about home care, with large investments ($80 million) in three regional home care worker startups: Honor (San Francisco), Home Hero (Los Angeles), and Hometeam (New York/New Jersey), caregiving apps and chronic care management (CareSync, with an $18 million raise).
  • Dementia care support tools are (finally) developing into its own category.

Surprising conclusions: PERS alerting stays strong, but changes to be mobile-enabled and more cosmetic; a lot of convergence of categories and forms; and the term ‘health tech’ will replace ‘digital health’. Oh my!

Designing housing for the cognitively impaired–where’s the telecare?

Steve Moran’s Senior Housing Forum is hosting a lively discussion on designing communities for what this Editor would term the cognitively impaired, euphemistically called ‘memory care’ here in the States, then often bluntly categorized as dementia care. This concentrates on one CEO’s journey in designing a new memory care community, The Cottages at Cedar Run (Wisconsin) and how he utilized ideas developed in the US (Eden Alternative, Green Houses — Bill Thomas’ work, TTA 30 July) as well as the Dutch Dementia Village [TA 22 Dec 12] The architect’s video still strikes this Editor as full of nice touches (the courtyard a la the Dutch, but not as spacious or a center of activity; the padded window seats) but still institutional feeling (the cottages have a nice look but need more individualization to aid resident identification; how a resident/family can personalize the cottage); all in the right direction. The comments expand upon many points, but what is really missing here is the integration of technology(more…)

The long-term care revolution: two papers

Written for the Technology Strategy Board and published by the Housing Learning & Improvement Network, the purpose of the main study is to “outline the case for a revolution in long term care all to be set in a time scale of 2012, 2020 and 2050. This includes evidence about the views of older people and their carers in the UK, lessons from abroad and the implications for industry/providers.” It is written as a ‘study of studies’ on a broadly-scoped problem; it focuses considerably on issues such as care provision, housing (including co-housing and communities) and putting the older person in more control of decisions, housing and tech design. Telehealth and telecare, while not the focus, have a hefty section (pages 32-41) but their conclusions will not be a huge surprise to our readers such as expanding inexpensive, simple assistive technologies, the need for more research and better design. The fact it is comparative is extremely helpful for those who want to see beyond borders, and there is a large section on ethical issues which is certainly unusual in studies of this type.  We thank the lead author, Professor Anthea Tinker, Institute of Gerontology, Department of Social Science, Health and Medicine, King’s College London, for providing information on and the PDFs of the studies. Assisted Living Platform – The Long Term Care Revolution and A study of innovatory models to support older people with disabilities in the Netherlands

Disturbing program on assisted living (US)

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)

“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]

Specialist housing does not reflect what most older people want (UK)

A thoughtful article in The Guardian by Aleks Collingwood of The Joseph Rowntree Foundation highlights the disincentives that exist at present in the widely-assumed-to-be-desirable downsizing of accommodation by older people to meet their own needs better and to make more efficient use of their larger houses by other families. Among the points made, “There’s a negative framing of the debate – downsizing emphasises loss of status and reduced importance. To interest more people in moving there not only has to be a wider and more attractive choice of housing options, but we need to think carefully how these options are labelled.” Read the comments too: It’s time for a new model of specialist housing for older people.

At least it is several centuries since older people in the UK, unlike their counterparts in Ghana, faced being ostracised as witches. Older people are wrongly accused of witchcraft (GhanaWeb) although one wonders if the underlying impulse to isolate older people from the mainstream of society is not actually the same.

UPDATE 11 June: It seems appropriate to add here an article about housing for older people by Malcolm Fisk, published a few weeks ago: Old age debate (in Inside Housing. See the comments, too “…the disservice we have ‘done to’ many older people by shrinking their lives … to a flat, to a room, to a chair, to a purse / wallet, to a photo.”)

Senior housing behind the times in tech–and more (US)

A short and extremely pointed take on how senior living communities in the US are just plain not up to speed in their management. Technology adoption is the focus, and reasons cited are:

  • Seniors and caregivers are stereotyped as the technophobes–but so are the senior care managers and staff
  • Tech is expensive, the market is small
  • New tech=early adopters, but they are few and must be the brave ones

Senior housing is also behind the times in marketing (invariably meaning sales), web presence, building design and activity programs. You’ll be wondering how they stay in business. Is this your community, or one you are selling to?  Perpetually behind the times…(Senior Housing Forum)