IBM, along with its ad agency Ogilvy, produced this four-minute, expensively produced ‘ad-doc’ (umentary) on the trial of (drum roll) a remote monitoring technology for elder care in Bolzano, Italy as part of their Smarter Cities initiative. Yes, it’s telecare, brushed up, dressed in blue and looking spanking new again! The story of Zita, a elderly woman and seamstress who lives in a lovely apartment in a hill town your Editor wouldn’t mind moving to, is the exemplar of both Italy’s growing aging population (23.5 percent are over 65) and how to accomodate both the older person living at home to ease the hard realities of aging cost impacts on local social services. IBM’s system and sensors (blue sensor box perched on the refrigerator at 2:34) appear to be unique in design. The rest will sound familiar. At about 3:00, “The sensor’s job is to recognize any abnormalities you can understand if someone could show signs of illness and eventually send an alarm to social services personnel.” Even the malapropism on the sensors recognizing abnormalities (see the web platform graphing at 3:14) and Nicola Palmarini of IBM’s remark “Preventing events means we avoid catastrophic events–dangerous for people…” were features/benefits your Editor worked with for QuietCare back in 2006-7. There’s nothing really new here except that IBM is trying what Care Innovations, HealthSense and GrandCare already have. But will IBM’s backing of telecare, which has been largely sidetracked to assisted living in the US and pushed to the side by consumer mobile health and apps, gain a new lease on life? Can we hope? Or are we back to the Same Old Struggle? Adweek article on IBM’s ad-doc.
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So The technology isn’t that new but alerting S/Services directly is interesting. I’d like to know who follows up & how quickly? Can’t imagine our L.A.’s offering such a service response directly. Here FACS stops proactive action, as we have to wait until things reach critical/substantial levels before we do anything anyway. Again technology is only as good as the services(responses) that sit behind it. Good luck Bolzano residents – be interesting to see what happens beyond the trial.
I wonder whether activity monitoring is designed to provide an early warning of a critical decline in function (such as a fall, or being stuck in the bath) or of a chronic medical condition which is slowing a person down, or both. Perhaps it is as well that we should focus on the responses to work out who should be responsible for a preventive intervention. As Lynda points out, it’s not going to be the local authority who monitors people who are below a threshold of risk that increases every year due to financial constraints. If it isn’t the relatives then it has to be the health service. This is appropriate because it is surely the health service that benefits first and most from telecare – so we end up wondering who will invest in this technology. Without an appropriate response, relatives are not going to want to be responsible.
Maybe the subject of response will now rise up the agenda.
Be aware that the culture in Italy is still largely for families to take care of their own. In at least some regions up to, I think it is, the third generation of descendent can be liable for care home fees for an elder Italian – families therefore have a vested interest in being responders?
Italian Social Services also have a vested interest in adopting technologies that will avoid the huge deficit that could open up with cultural change as family demographics alter.
NB This is based on discussion two years ago during a European partners conference around care provision in Scotland, two baltic states and two southern European countries.
Linda and Jo are both right in identifying the “what can we do about it?” problem with next generation telecare systems in general. It is clear that there can be protocols in place to deal with identified emergencies; these need to be robust and will probably combine the resources of the family, the service provider, the NHS and the emergency services according to the particular circumstances. However, because the telecare system should have been provided initially to manage a particular identified risk, the response protocol should be clear and, furthermore, the service should not have been provided unless such protocols were confirmed and in place.
Next generation systems provide us with a lot more information, though not necessarily the nature of an emergency unless built on an alarm telecare platform. It should then be possible to look at trends and to start predicting both increasing needs and risks. One problem then is that the thresholds required have not been validated. Is a 10% reduction in activity levels over a week or so significant? If not, what reduction would be consistent with an inability to perform a specific Activity of Daily Living? More generally, does such a reduction mean:
(a) the person is under the weather with an infection but will recover when the antibiotics kick in?
(b) they are suffering a gradual decline in physical function due to ageing (or a progressive long term condition)?
(c) their family carer is away on holiday (or suffering from an illness) but will be restored next week? or
(d) their new home care assistant isn’t as fast around the property and spends more time talking to the person that they are caring for?
In practice, it matters not why activity levels are changing; the question is how are we going to respond? In a perfect world, this evidence would be used to increase either the level of reablement or of home care assistance provided – but is the customer prepared to pay for this, and does the provider have the capacity to deliver it?
In the hands of a service provider (or a partner organisation) this is great information for selling more care products. In the hands of a family member who is monitoring the situation remotely (perhaps thousands of miles away), it could be used as ammunition to try to force Social Services or the NHS to provide additional resources that they simply don’t have.
Prevention must ultimately be the only way of managing long term health issues, and we will undoubtedly have the data and the mining tools that will enable us to predict and prevent emergencies – but because of the financial squeeze, I believe that the onus must lie with the individual, their families and their communities to intervene. I predict that the most successful approaches will be the ones that make use of these resources in innovative ways – at least until intelligent and practical machines come in to provide the timely responses needed to avoid hospitalisation or a rapid decline into long term care.
Thanks for sharing. The video is very well done. I would like to see the analysis that IBM has to warrant this level of involvement. They must believe there is a market opportunity here. Things like demographics on aging population across the globe, geographical spread of families, insight into the monitoring capabilities of the solution that they are featuring in the video. Is this a fit for single payer/NHS? Can it compete with LTC/AL facilities? Perhaps we will see this type of imitative take off with the bundled payment exercises in the US.
@ Michael, excellent points. The demographics are all there and have been since the early 2000s, which is when the foundational research on telecare was done (the Glascock/Kutzig patents, the UVA research etc.) But is IBM going into the telecare (remote behavioral monitoring) business? I sincerely doubt it. My prediction is that it’s research platform only.
There’s a 10 year track record on telecare. The business model on straight ADL home monitoring and alerting did not succeed. All the systems either diversified or became part of a larger offering. QuietCare is just one part of Care Innovations’ product line (disclosure–I worked for the original developer Living Independently Group), Healthsense sells nurse call systems, telehealth and IVR in addition to eNeighbor, WellAWARE went into sleep monitoring, GrandCare into socialization and interactivity. They are all IL/AL market except for GrandCare’s tie-ins with the high end home automation/residential electronics market for their Como and HomeBase models. BeClose is, I believe, the last of the ‘plain jane’ home telecare systems.
Update 24 April: Please note TTA article on Live!y for an updated take on ADL home monitoring.