Imagine if pills had sensors that transmitted information about when they were taken and what affect they were having soon after they were swallowed. Consider the benefits of a system that could enable residents to attend family birthday parties via live video, get instant medication and appointment reminders, transmit information about vital signs to their clinicians, communicate with caregivers, and call for help when they have a problem—all within their televisions or computer tablets.

 

Or think of how many falls might be prevented if a resident’s gait and movements could be tracked virtually.

If this sounds like futuristic or unattainable technology, it actually is within reach for many senior care communities and long term care facilities. In fact, some organizations already using such technology believe that the senior care industry won’t be able to succeed without it in 10 or 20 years.

“We’ll begin to see more of these kinds of things being integrated into daily life, and more people will expect it,” says Lynne Giacobbe, executive director of Kendal at Home in Westlake, Ohio.

She adds, “We want to be on the cutting edge of this. This way, we will be able to have input into revisions and developments as the technology evolves. It will allow us to help shape what the future will look like.”

Laura Mitchell, vice president of business development for GrandCare Systems in West Bend, Wis., predicts, “In the future, it will be unheard of for aging parents to go to a facility where they don’t have access to video chats, sharing of videos/photos, and devices that can keep them safe and comfortable in their homes.”

Cutting-edge eldercare technology is here, and it is accessible and increasingly affordable. A growing number of communities and care settings are using these products, systems, and programs to solve some of the most pressing challenges eldercare providers face. Technology is helping to prevent resident isolation and promote social engagement and mental stimulation, delay moves from lower to higher levels of care, and avoid emergency room (ER) visits and rehospitalizations.

Ingestible sensors from California-based Proteus Digital Health are made entirely from ingredients found in food and are activated on ingestion. Patients swallow one of these along with their regular medication, and it captures the exact time of ingestion. The sensor links to a patch the person wears—much like a Band-Aid—which captures and relays the body’s physiological responses and behaviors.

The system receives information from the ingestible sensor; detects heart rate, activity, and rest; and sends information to a mobile device. Using a Bluetooth-enabled device, such as a cellphone or tablet, caregivers or clinicians can customize and access data and use them to monitor medications’ impact and adjust or stop prescriptions as necessary.

This product can help improve communication about medications between settings and practitioners, says Proteus co-founder and Chief Medical Officer George Savage, MD. It will help identify patient noncompliance with medication regimens before it causes problems such as acute condition changes.

“Fewer than one-half of patients take medications as directed, often because they feel it isn’t working with them,” he says.

Nonetheless, he suggests that patients won’t admit this to the doctor or confess that they aren’t taking their medications. The ingestible sensor will communicate information to the clinician that the patient can’t or won’t.

The ingestible sensor “closes the feedback loop and enables the physician and others to see what is happening,” says Savage. “The data will show exactly how a patient is taking or not taking medications correctly, and you will see measurements of how well the body is responding to the medications. Then, you will be able to make specific changes that are necessary,” he adds.

Savage stresses that users will not be bombarded with data. He says, “The point is to provide specific information that provides touchpoints to help maximize the effectiveness of medication management. You also have the ability to decide who gets to see what information.”

For example, family members can get the basics—just enough information to let them know if Mom is taking her medications and how she is doing in general.

The physician, on the other hand, gets information that enables him or her to watch for adverse effects or other problems. The physician can choose to get data every day, for example, when a heart failure patient is discharged from the hospital and is at risk of problems that could result in readmission, or he or she can just call up the data during a monthly office visit to assess what, if any, changes are needed in a patient’s medication regimen.

Savage says that this technology is increasingly affordable. He also anticipates that payers will be interested in including it as a covered service once its value in terms of improving outcomes and preventing drug errors becomes apparent.

Technology that connects patients, families, caregivers, and clinicians virtually and seamlessly is gaining fans nationwide. At the center of this are user-friendly, highly adaptable, flexible, practical, and cost-effective systems that bring residents, families, caregivers, and clinicians into a constructive and efficient communication loop. Facilities using them claim they are changing the way their residents live, how their families think and feel, and how staff work to improve outcomes.

GrandCare Systems is one company producing this technology. The GrandCare System is connected to any dedicated Internet connection and communicates with wireless sensors throughout the resident’s home.

These sensors are designed to accurately monitor the daily activities, vitals, and wellness of a resident, without intruding on the person’s lifestyle or privacy.

Designated caregivers log into the GrandCare website to send communications to the resident, view activity graphs, access digital health and medication information, and customize automated rules and alerts. Caregivers may choose to receive a call, email, or text message if specified conditions—such as there is no motion dedicated for several hours—are noted. The caregiver has full control over the actions the system will take when a designated event occurs, such as a phone call to a neighbor if the person’s front door opens during the night.

However, the system isn’t just about medical care and safety. It also includes a calendar feature to post appointments and events in monthly and daily views. Additionally, from an online portal, designated caregivers can add personalized photos, messages, reminders, videos, favorite music, and more right to the touchscreen inside the loved one’s home.

For example, family members can set up a Facebook feed so that their loved one can automatically see specified photo albums. One-button video chats via Skype also can be set up to enable virtual visits and participation in family events.

Each system also comes preloaded with optional stock photos, card and board games, trivia, brain exercises, spiritual programming/content, weather reports, news headlines, word definitions, and music. Family members can add content such as video and music links, specific news and websites, and more.

“We are tethered to our cell phones all day. It seems unfair that we would cut off others from the technology we enjoy and benefit from on a daily basis,” says Mitchell. She adds that this technology keeps family members involved and in tune with their elderly loved ones.

For example, she recalls one client who loved the TV show, “Little House on the Prairie,” and her family adds videos for her to watch. “You can personalize the system, and people can engage with it as much or as little as possible. I have people with late-stage dementia who don’t really interact with it, but their families provide things like photos, videos, and music that they know will bring their loved ones pleasure.
And it makes them feel like they are doing something positive,” says Mitchell.

“We call our systems proactive, predictive, and preventive,” Mitchell says. She explains that it can help identify problems and get them addressed before residents require a trip to the hospital. “A caregiver or family member may notice something—such as slurred speech or changes in skin color—during a video chat. It turns caregivers into super caregivers.”

Mitchell notes that while prospective residents and family members aren’t requiring such systems yet, she expects the demand to grow. Hospitals’ interest in this technology will grow as facilities demonstrate that they can be used to prevent ER visits and rehospitalizations, she says.

Technology designed to improve quality of care while maximizing quality of life can help facilities collect, analyze, and use data more efficiently while enhancing patient and family satisfaction. For example, Chicago-based Caremerge has a quality measures program that enables real-time capture and reporting of clinical data and shares it at the touch of a finger.

At the same time, the program enables organizations to save and organize all communication and conversations with families, send instant and automated family notifications, communicate easily with family members, and see all outstanding family questions in one place.

There also are features to allow facilities to capture, track, and organize activities of daily living (ADLs) and other observations and clinical notes from any mobile device; send instant notifications to staff members; and have immediate access to notes and observations.

At the same time, residents can receive instant reminders about activities and upcoming events, and family members can get notifications about a loved one’s activities. “Systems such as this bring information onto everyone’s radar screen,” says Asif Khan, Caremerge chief executive officer (CEO).

This technology can help keep patients out of the hospital. “It will prompt nurses to ask questions and learn how much a patient understands about how to care for themselves. They will know who needs more education and coaching and what topics to address,” says Khan.

He stresses that Caremerge designed its technology to fit in with caregivers’ workflow. “No one takes the time to walk around with the CNA [certified nurse assistant] and see how many times people hand her a sticky note or how many times she has to find a pen and paper to record something,” Khan says. The key, he suggests, is to give staff something that will enhance their workflow and simplify their lives.

“If people can press one button instead to accomplish something that used to take 10 or even five minutes, they are more likely to embrace and use technology.”

Enabling seniors to stay at the lowest possible level of care is a growing priority as facilities seek to keep apartments and beds filled and adult children seek to control care costs. Toward that end, many technological innovations are designed to keep elders safe and secure, as well as socially and mentally engaged.

For example, California-based Independa has a holistic telecare and social engagement program that uses a suite of wireless health devices and home sensors for remote, passive health and activity monitoring. The program requires no computer skills or knowledge by the resident, and it is user-friendly for professional and family caregivers as well.

The foundation of Independa’s platform is a Web-based application that caregivers can access via standard browser from electronic devices, including a smartphone. This application provides caregivers with access to a dashboard of information, reminders about medications and appointments, health measures, life stories, alerts, reports, and more.

Elsewhere, the Independa Angela program, run on a touchscreen tablet or LT television, is designed to prevent social isolation and keep the resident in touch with friends and family and engaged in the activities and interests they enjoy. Residents can use this system for activities such as video chats, emailing, games, reminders about events and medications, photo sharing, and more.

“Social interaction is a critical part of care that has been overlooked in the past. The value of social engagement isn’t a soft benefit but a real and primary one,” says Kian Saneii, Independa CEO.

“What could be a better platform for this technology than the TV, which is the Holy Grail for many people?”

Information also can be communicated via tablet, so people can take it with them wherever they go. For example, they can take it to the hospital, use it to communicate to staff there what medications they are taking, and the nurse can check it at discharge to make sure it is current and that the patient has “all the information he or she needs to return home safely,” Saneii says.

“We are all about wellness, and this technology fits right in with that,” says Mike Perry, chief operating officer of The WellBridge Group in Michigan, which offers post-acute rehabilitation and nursing care.

“We believe that connecting our guests with family and friends really helps in that overall wellness process.”

For example, one woman came from a distance for rehab, and she was able to Skype with friends and family back home. “This visual contact is important. Everyone feels better about the whole situation. It keeps people from getting anxious, and they can focus on care planning,” says Perry. He adds, “Often, when the family or guest feels anxious, they try to rush progress. And their anxiety can make staff tense and uncomfortable. When the guest and family feel more involved, they relax more, and the whole environment is better.”

Perry says that this technology has great potential to help manage acute condition changes more effectively.

“We had one guest who was Skyping with her daughter, and the younger woman noticed that her mother wasn’t quite herself,” he says. The daughter called and asked the nurse to check on her, and after a quick assessment and some testing, some changes were made to the woman’s medication regimen.

“We don’t know if this prevented a hospitalization, but we definitely were able to catch something early and put a family member’s mind at ease. We expect to see more of this as we continue to use such technology,” Perry says.

Sensors that capture changes in health care also are increasingly popular. “Technology that keeps people in their homes because it tracks early changes has tremendous potential. If we can identify these changes early and correct health problems while they are small, we can prevent catastrophic situations that result in hospitalizations and ER visits. This has been borne out in our research,” says Marjorie Skubic, professor in the Electrical and Computer Engineering and Computer Sciences departments at the University of Missouri.

“We’ve conducted a series of studies over the years that have shown we can use environmental sensors to predict health events weeks before they happen,” she says. “We then can alert health care providers and caregivers so that they can assess for problems.”

Much of this technology is affordable, says Andy Carle, executive-in-residence, assistant professor, and director of senior housing administration at the George Mason University College of Health and Human Services. He stresses that the return on investment more than pays for their costs.

“There is zero reason for facilities not to be able to enable things such as Skyping and other ways for families to interact,” he says. When they implement systems that enable broader interaction and communication, the results are significant.

For example, he says, “It breaks down the domains—physical, cognitive, social—and the activities director becomes a wellness director. And we are seeing positive outcomes.”

“We are getting more requests from adult children who want to buy the system to use in home care or asking how they can get it in Mom or Dad’s community,” says Khan. He adds, “Moving Mom or Dad into a long term care facility creates a great deal of guilt for adult children, and this helps them feel better about it.” They can know when Mom is happy and active. Conversely, they can see when Dad is just sitting around or sleeping all the time, and they can do something about it promptly.

The impact of technology on the lives of elders, particularly those with illnesses or impairments, can’t be underestimated, says Giacobbe. For example, she says, “Skype may not seem like a big deal, but when someone has visual or cognitive impairments, the ability to communicate with family members and friends on a high-definition big screen has a tremendous impact. Technology will be key for us to monitor residents and enable them to stay in their homes,” she says. “It increasingly will enable us to serve people effectively and to ensure that they can have meaningful interaction with their loved ones.” ■