LeadingAge Magazine · July/August 2013 • Volume 03 • Number 04

Technology Enables Independent, Healthy Living

July 01, 2013 | by Dianne Molvig

Technologies that enable seniors to remain at home—or safely return home following post-acute rehabilitation—continue to develop in step with trends toward more home-care services. See how these providers are learning what works to enable more independent, health living for their clients.

Not wanting to give too much away, teenagers are experts at delivering short, evasive answers when their parents ask, “How’s it going?” Fast-forward several decades and the tables have turned. Now it’s the adult children asking that question, and the aging parents are the ones keeping things to themselves.

Maybe it’s because they don’t want their offspring to worry. Or they don’t want anyone to start thinking it’s time for Mom and Dad to move out of their home and into a setting that provides more care.

New technologies provide solutions that give everybody what they want. Mom and Dad can continue to live independently, while their children feel more confident about their parents’ wellbeing.

These technologies include telehealth services, activity sensors, personal emergency response systems, medication dispensers and more. Telehealth or telemedicine—the American Telemedicine Association (ATA) considers these terms to be interchangeable—includes remote monitoring of vital signs, consulting with patients via videoconferencing, delivering health information to consumers and so on.

A January 2013 report from InMedica states that 308,000 patients worldwide use telehealth remote monitoring, with about two-thirds of them in the United States. The report predicts the total number will grow six-fold by 2017.

Usage of remote health monitoring and other technologies “is smaller than it should be, but growing rapidly,” says Jonathan Linkous, CEO of ATA. One hurdle, he notes, is that the major insurers in the United States, particularly Medicare, have been reluctant to embrace technology. “But that’s starting to change,” he says.

Demand for such technologies in aging services will spiral, Linkous predicts. And driving that demand, he believes, will be seniors themselves, contrary to what many assume. “There’s this bugaboo that older people can’t use technology,” he says. “That is ridiculous. They can and they do. It just has to be something that makes sense to them.”

Older adults were receptive to telehealth remote monitoring when Jewish Home Lifecare in New York City introduced the technology in 2002. It was clinicians who balked, perhaps understandably, says Bridget Gallagher, senior vice president of community services, who’s a nurse herself. “The nurses would say, ‘My patients don’t need telehealth units; they have me.’”

But once clinicians saw the benefits of telehealth monitoring for their patients, their attitudes reversed. “They saw that it doesn’t replace clinical care,” Gallagher says. “It enhances the care we give.”

Jewish Home Lifecare’s home-care clients use a telehealth device plugged into a phone line to transmit health data to a remote nurse, along with answers to questions pertaining to the individual’s specific health condition. The success of the in-home devices spurred Jewish Home Lifecare to install kiosks that serve the same function in its day centers.

Even though older adults have been receptive to the technology, they sometimes do need nudging. “Especially with the kiosk,” Gallagher says, “it’s not that ‘you build it and they will come.’ There has to be a sell component. But once people feel comfortable with the technology and see the benefits, they become strong users.”

Indeed, studies at the organization have documented the benefits of telehealth monitoring. For instance, among people with congestive heart failure, the rehospitalization rate fell from 16 percent to below 5 percent. Regular diabetic care in home health care and day center programs had led to improved hemoglobin A1c numbers for 54 percent of people with diabetes. That climbed to 67 percent with the addition of telehealth monitoring.

Most popular among older adults has been medication dispenser technology, which emits visual and audio alerts when it’s time to take medications. A missed dose results in a signal sent immediately to the caregiver or Jewish Home Lifecare nurse. “What people say they like is that this allows them to stop worrying about all their medications all day long,” Gallagher reports.

She adds that Jewish Home does pilot studies with any technology it decides to implement. “Lots of times these technologies are developed by engineers in a lab,” Gallagher says, “and they don’t visit their grandmothers enough.”

She recalls one pilot of a sensor technology in which a pilot participant called to report she’d fallen the day before. The sensor had sent no alert to staff. Consultation with the technology company revealed that the alert only went off after someone had fallen and lain on the floor for three minutes. The company soon got the message that that wasn’t good enough. “It’s always beneficial,” Gallagher says, “to do a pilot so you can see how the technology works in the environment where you service your clients.”

Gallagher adds that she’s having lots of meetings these days with managed care companies, whom she feels are “at the tipping point” in recognizing the value of various technologies and the savings from reducing rehospitalizations.

“That’s another benefit of doing pilots,” she says. “You get data. So Medicare and other insurers start thinking about the potential behind these models.”

Conducting pilot tests of technologies is a major function of the Front Porch Center for Innovation and Wellbeing (FPCIW), one of the “centers for excellence” of Front Porch, based in Burbank, CA.

“We keep our ear close to the ground for all kinds of emerging innovations and technologies,” says Davis Park, director of FPCIW. “Some of them are half-baked, to be honest. What we do is test the solutions we feel have the most promise for helping older adults.”

One of the Center’s largest pilots in its four-year history is the Model eHealth Community for Aging project, just drawing to a close. It involved 15 partners, including other senior organizations, community groups, vendors and academic institutions. The goal of the project was to use broadband-enabled technology to support the health and wellness of low-income residents of Los Angeles’ Koreatown. Many older residents speak only Korean; the project also targeted people with hearing impairments.

The eHealth project had four components:

  • Computer literacy and self-health knowledge: Computer classes in the community gave older adults access to reliable health-information websites in many languages, including Korean.
  • Big-screen health: Health information workshops were provided in Korean and American Sign Language via videoconferencing to affordable housing and senior center sites in Koreatown and other Los Angeles areas.
  • Teleconsultation and remote patient monitoring: Technology connected people with foot problems in teleconsultations with podiatry specialists. For the remote monitoring component, older adults used tablet computers to relay data such as blood pressure, weight, blood sugar and so on to monitoring nurses in Buffalo, N.Y.
  • Electronic health records: Community clinics in Koreatown received help in moving to electronic health records.

A few challenges emerged in the two-year project, from technical issues to difficulties in developing curriculum in Korean. But Park reports highly positive reactions among older adults to the classes, workshops and consultations. The project’s research partner, the University of California–San Francisco, will analyze data on health outcomes. “What we’re looking at now,” Park says, “is how to expand the pilot into a more sustainable model that will capture a larger group of older adults.”

Another FPCIW pilot recently completed involved use of the CyberCycle made by Interactive Fitness. Studies have shown that cognitive function improved over time with use of the CyberCycle, a recumbent bicycle adapted for older adults. It features a virtual reality screen to engage cyclists mentally as well as physically.

FPCIW decided to test the CyberCycle in two of its communities. Residents participated in teams, which competed to meet mileage goals. “That helped get people excited about riding the bike,” Park says. Residents also provided the manufacturer with useful feedback on ways to improve the bike.

Another recent pilot involved testing a cellphone medication reminder program. More than 100 seniors in various residential communities and senior centers participated in the pilot, which was funded by the Center for Technology and Aging. Results showed that two-thirds of participants felt the technology made it easier for them to track their medications.

In these and other pilots, FPCIW seeks technology partners who are receptive to making product changes that genuinely work for older adults. Park says technology developers approach him regularly about testing their solutions. “They want to learn from our experience,” he says, “and from the stories of our residents.”

A key point to remember about the use of health technology is that it’s not about the technology, says Jacci Nickell, vice president of development and operations delivery systems at The Evangelical Lutheran Good Samaritan Society, Sioux Falls, SD.

“A sensor hanging on the wall isn’t going to keep anybody out of a hospital or contribute to his or her well-being,” Nickell says. “We leverage that resource to impact the lives of those we care for. That’s what really matters.”

Good Samaritan has deployed three key technologies in its three-year LivingWell@Home study, which ended June 30. Dr. Leslie Grant from the University of Minnesota, the principal investigator of the study, will analyze results. About 1,600 seniors living in 40 communities in five states (North Dakota, South Dakota, Minnesota, Iowa and Nebraska) participated. An $8.1 million grant from The Leona M. and Harry B. Helmsley Charitable Trust funded the project.

Study participants were older adults who had some sort of formal caregiver, such as in assisted living or home health care. “We provided caregivers with more information about their clients for purposes of care management,” Nickell says.

As for the future, “the vision is to provide coaching and wellness assistance directly to the client,” Nickell says. A small pilot is starting to do that in a senior-housing-with-services environment.

The technologies used in LivingWell@Home included remote health monitoring, activity sensors and a personal emergency response system. Older adults were linked to the monitoring center in Sioux Falls, oftentimes hundreds of miles away. The monitoring staff then could connect with the local caregiver immediately, when needed.

Nickell adds that the technologies provide more information than was previously available about changes in clients’ activities or vital signs. “We’re able to engage clients upstream,” she says, “and assist them in making changes that will help them stay healthy.”

For instance, one morning the remote monitoring nurse notices a sudden weight gain in a man with congestive heart failure. She asks him if he has swollen ankles or difficulty breathing. As a result, his fluid retention levels get addressed, before symptoms worsen to require hospitalization. “We can intervene sooner,” Nickell says. “This is moving from reactive to proactive and preventive care.”

The challenges discovered in the three-year study fell into three areas. One was developing relationships between the local and remote caregivers, so that the latter were perceived as part of the care team.

Also challenging were the technical issues—that is, getting the technology installed in people’s home and resolving connectivity problems in remote rural areas. Plus, the three technologies deployed all are on different platforms. “So our nurses had to draw inferences (about a client’s health) from three disparate data sources,” Nickell says.

A third challenge relates to overall changes in health care practices. Technology provides empirical data, but health care also entails intuition. Using technology “puts the art and science of medicine and nursing together,” Nickell says, “without rejecting the validity of either one.”

She recalls that one of the LivingWell@Home team members summed up his experience by saying his work in the project was the biggest contribution to senior care he’d made in his career. “It was exciting to see that light go on,” Nickell says. “We really could change the way aging is perceived and experienced in our country.”