In-home activity monitoring telecare trial launched in the US

A year-long trial to monitor the day-to-day activities of elderly Medicare members is being launched in the US. The 100-participant trial [grow_thumb image=”” thumb_width=”150″ /]will monitor eating, sleeping, physical activity and toileting according to a press release from Humana. The trial appears to be a collaboration between Humana and a sensor provider Healthsense.

The idea of using bed occupancy sensors, weight triggered rugs,  sensors to monitor movement, door and window opening and use of lighting and stoves is not new but it is not widely deployed. They would typically be configured to raise an alarm when the usual pattern of activity is not taking place (e.g. the occupant is not rising at the usual time) or if a danger is detected such as a hob being left on for a long period of time. In this way they can provide the confidence for a lone occupant to continue an independent life longer than otherwise.[grow_thumb image=”” thumb_width=”150″ /]

The trial announced by Humana is to take place across Florida, the Carolinas, Kentucky and West Virginia. Although the press release hypes it as a telehealth trial “to reduce unnecessary readmissions”, my reading of it is that it is really a telecare trial.

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  1. My work over the past 15 years has indicated that activity monitoring of this type can detect illness and a decline in an individual’s well-being at least as rapidly and effectively as monitoring vital signs. It is not surprising therefore that people are beginning to realise the potential of this form of monitoring for prevention of hospital admissions and for managing chronic diseases. I too would have called it telecare – so perhaps we are finally prepared to admit that telehealth services that only consider remote vital signs monitoring as a rather narrow approach which might well become redundant as the standard peripherals (such as spirometer and pulse oximeter) are replaced by continuous sensor technologies that are embedded in furniture, clothing and camera-based devices? I have always called services that use remote monitoring in the home telecare – but I don’t really mind if they are all called telehealth, which is certainly the term that is likely to be used in Europe to cover a wider group of technologies including video interaction.
    The great attraction of activity monitoring is that it doesn’t need expensive medical devices that need to be calibrated every so often. It also allows baseline measures to be based on experience, and thresholds for intervention determined by common sense rather than by clinicians who may struggle to understand the impact of multiple morbidities on physiological parameters in older patients.

    • Chrys Meewella

      I was glad to see you mention that you too would have called it telecare and I am not trying to devalue the trial by categorising it as telecare. As you rightly point out this form of monitoring can have great benefits including better health outcomes, possibly even reducing hospital admissions. In my mind though, “hospital readmission” has a narrower definition – trying to keep a patient discharged from hospital from having to be readmitted (e.g. due to wound infection, poor post-discharge management of treatment etc). The trial doesn’t seem to be particularly addressing that.
      This raises some other interesting issues. For instance there are some technologies which straddle both telecare and telehealth. As for using video and communication technologies for managing or enhancing health remotely (a good example is Lancashire’s Telestroke), I do think they fall into the telehealth category.

  2. Video from the home to the surgery, the hospital or anywhere else is 3rd generation telecare in my book. Telestroke could be between between a GP surgery or minor injuries clinic and a hospital – so I’d call that telemedicine (as I would an orthopaedic surgeon at a District General Hospital sharing a scan with a specialist in a tertiary centre)!

  3. Donna Cusano

    Telecare does include activity monitoring in the home, and back in my LIG/QuietCare days we had abundant reporting and evidence that activity changes off the norm could be predictive of negative changes in health–circa 2008. We didn’t call it telecare–usually passive behavioral monitoring.

    The fact that Healthsense has a 100 person in-home trial with giant Humana (via their Senior Bridge homecare division) is good in the sense that finally a pacesetting company like Humana is taking a serious look at monitoring aimed in keeping older adults in their home and independent. The bad is that it’s taken THIS LONG.

    That it is not Intel/GE’s Care Innovations’ QuietCare must be a kick in the head to CI–with QuietCare being the pioneer in the field and their largest, best known service.

  4. It might be useful to stand back from the ongoing Telecare/Telehealth discussions for a moment and look at what is actually trying to be achieved.

    In simple terms we are trying to improve the efficiency with which “care” is delivered.

    In a world of tighter budgets and smaller families this has to happen – the name we use for it may be significant to all us “insiders” – but to the actual “users” – it’s as confusing as trying to buy a PC. They don’t want “8G of RAM and a 64 bit graphics card” – they want to type a document or surf the web.

    There is another interesting comparison with the PC world – it’s fast becoming redundant.

    Replaced by all the services the users actually want being available on the ‘web and accessed by a simple to use “interface device” – the tablet.

    I think this is also the way forward for our industry – the concepts of “tele anything” will rapidly fade and be replaced by a mass of open data available from many different sources from within the home and being worn by the person.

    I’m a big fan of Kevin and his work – particularly the value of ADL in monitoring wellbeing.

    However I think it’s time we had some new labels to better connect with our users.

    There are two types of data in this area – general such as ADL and specific such as health.

    Can I suggest something like “Ambient Wellbeing” for ADL type to kick off the discussions?

  5. Thanks Paul
    I too believe that smart sensors, cloud computing and cool interfaces will be the way of the future – and it will enable health and activity data to merged both for DIY healthcare (i.e. self-care) and for physician-guided support. The challenge remains making people aware of what’s out there and what can be done. This means avoiding confusion – so the fewer the number of terms the better in my opinion; after all, it’s taken a decade for 10% of the population to know what we are talking about!
    So I guess that I’m suggesting that we don’t try to introduce any more terms, and instead try to work out how we can slip from one generation of telecare to the next. Backward compatibility could be the key to this as far as new solutions are concerned.
    Incidentally, I’m still waiting for someone to tell me what ambient means – so I can’t really see it catching on whether it’s used before assisted living or before well-being! But a debate sounds like a good way to stimulate interest.
    Merry Christmas everyone – and let’s hope that telecare really takes off in 2014.

  6. One of the barriers to introducing greater use of technology within the home to help support users to remain independent, has often been the technology and terminology itself. The user being a little mystified or confused and perhaps a little in awe or even frightened. Paul touches on this.
    I have often had comments such as “I don`t want my home to look like a disabled persons home”, when I have assessed some clients for AT at the request of family. There is also the issue around privacy in the use of this type of monitoring which some users may perceive as an intrusion.
    Compared to the total numbers of basic pendant systems presently in use, additional usage of extra Telecare sensors within the home are still in the minority. There are no doubt many reasons for this, not least the additional cost charged to monitor/service these.
    I believe home monitoring has an important role to play in supporting people at home but how we introduce and expand take up needs careful consideration, remembering we are providing it for the end user`s needs and benefit.
    Good client assessment and family involvement as ever, is the basis of a successful outcome and as mentioned, I believe we should approach it from a non-technology jargon approach.

  7. Great conversation on the need for “de-jargoning” in the healthcare field. One aspect that is not mentioned in the conversation so far is the need to engage with consumers to embrace these new technologies and actually want and use them..this is the hardest work of all and I think one that most healthcare companies struggle with..a build it and they will come attitude just doesn’t work. Not only do Seniors not want their home “to look like a disabled persons home”, they also don’t want to feel like they are losing their independence or privacy. Their kids may want these technologies to keep tabs on mom or dad but the seniors themselves do not as they are currently being pitched. I believe there is a real need for much deeper and wider conversations with seniors themselves on what they want and need and will use and WHY so that meaningful progress can be made in Telecare.

  8. Chrys Meewella

    Kevin, Mike, Karissa, I absolutely agree with your sentiments about removing jargon when ever possible – and particularly so when talking to or producing wrtitten material for end-users. In the UK we have the Plain English Campaign and I am a supporter of their aims and am pleased to see their Crystal Mark being sought after by those producing user communications. One does, nevertheless, have to call things by some name – if only to avoid confusion. They say “call a spade a spade” but when the spade was invented it was probably jargon to call it a spade until most people had one. Most people wouldn’t think of WiFi or mouse or satnav as jargon today but jargon they are. My take is that jargon is a way of making it quicker for people working on a specialist subject to communicate quicker between themselves. Jargon must be well defined so there is no confusion. Don’t use jargon with end-users if at all possible – jargon is not meant to be used to impress the end users how clever you are!
    Karissa has another very useful point – how do we persuade older people who are rightly proud of their independence that the technology is there to keep them so and is not a sign that they are beginning to lose it? I have come across this myself and I think it is a difficult nut to crack.