Excuses, excuses: overcoming barriers to adoption

Geriatric care managers are cautious and waiting. (Warning: rant on). Last week I spoke about technology for aging in place to a room full of New England geriatric care managers (and a few home care agencies and senior housing folks as well).  When I talked about technology, particularly remote monitoring, filling the gap in hours covered by home care aides, they enthusiastically nodded in agreement. But when I ask if any are using this technology, I heard about interest, curiosity and upcoming pilot programs (no vendors picked yet), and the like. Ditto with the home care agencies represented in the exhibit area. What I didn't hear about -- confident or near-term likelihood of advocacy of a specific product.

Market awareness -- is that the problem?  Everywhere I go, I hear from industry insiders about the two key barriers to greater adoption, depending on the product: either lack of market awareness or lack of a compelling business model (aka reimbursement).  Let's take these one at a time. If you have the Google search box and live part of your life online (as do many baby boomers with aging parents), you can find all kinds of technology for nearly every purpose, including motion sensors, PERS devices, telehealth self-care devices, and so on. And senior housing organizations are aware of this technology -- it's shown in every national AAHSA meeting Idea House. Finding is not the same as confidently being able to buy. 

Business model (aka reimbursement) -- is that the problem? The same families that shell out an average of $39,000 per year for assisted living, buy the latest in TVs, computers/tablets, video streaming subscriptions, data plans and smart phones -- apparently these folks may not be ready to spend money on remote monitoring (or PERS or computers/software) of and for aging family members. But I seriously doubt that price is an obstacle to adoption in this market and while we're standing around talking about it, prices are coming down anyway. Meanwhile, if by business model, we really mean Medicare reimbursement, can we just stop talking about that for a while? Medicare does not reimburse for a long list of devices (phone, TV, iPod, iPad, video games, etc.) that folks happily buy -- even in a down economy.  

Proof that products work -- is that the problem?  Who tests this stuff, anyway? Well, actually as far as I can tell, no public website includes any actual, methodical testing for the purpose of verifying that the products in this category match the vendor description. So if you're a GCM or anyone else, how are you going to verify that you a) picked a viable and potentially useful product or b) that it works as described. Consumer Reports has refused to help as of 2008, unfortunately.  Here's their excuse: "Consumer Reports has looked into these services in a preliminary way and found that testing them presents some logistical challenges. The service component—the response from the monitoring company to a signal—likely will vary widely based on location. Compliance with the instructions—for example, will the elderly person wear the pendant at all times?—also is a factor." Give me a break. Every transmitting consumer product (see their GPS testing results) that they test has the potential for its signal to 'vary widely based on location.' And the user's ability to read instructions?  They vary too!

Seniors themselves -- are they the problem? Also in the is-there-an-echo category -- well, still-sharp seniors don't want their privacy invaded and so they want nothing to do with remote monitoring devices in their home. And they turn off their cell phones when not in use, so they can't be called. And they don't wear their PERS devices or they don't press the button because they don't want to bother anybody. To me, the description of these problems always sounds like the describing person is an adult child of a senior ('I can't tell my mother what to do'!)  They don't have the convincing sound of an experienced marketer who can describe a scenario in which someone sees themselves, a seasoned sales person with skill at overcoming objections, or a well-trained customer service rep who can explain at activation time how important it will be for the user to (wear, press, call, respond, charge, keep powered on).

Your thoughts are most welcome! If not Consumer Reports, then who will verify that these products work?  If today's market awareness is an issue, how best to overcome? If cost can be described in such a way that pairs of adult child-and-senior are comfortable, how/what is that description? If there is an effective marketing strategy that overcomes the perceived set of 'seniors themselves' barriers, what is it? 

And if these aren't the barriers, what are the real barriers to adoption?

Rant off.

Applied Gerontechnology - AIP/ In-Home Care Assitance Monitoring

These are interesting and provocative questions. From technology histroy we understand that applying technology to new problems almost always comes with the same set of barriers. Gerontechnology for aging in place (aip-gtech) may have some differences. But the similaties are there.

Once again the giant corporations like GE and Phillips have apparently been working furiously to take advantage of a naturally fragmented early market to work strategies aimed at vertical channel foreclosure; many up-starts are willing to sell out. Expect continued delays in deployment of the technology.

There is some possibility that government funded research might produce a critical enabling technology soon (there are at best two or three critical elements missing, and all are so obvious that the possibility of serendipitous discovery looms).

There is also hope that some sort of government policy changes might occur that would help divert some health care money this way, out of the clutches of politically powerful and entrenched economic interests. Once the enormous cost reduction benefits to the taxpayer are clear, the revenue should stream in.

In the abstrat, the technical solution is simple. But the detailed functions of in-home care need to be properly integrated. I think I will put my money on some sort of grass-roots technology pull through movement organized with Care Managers, care providers and care receivers. They understand the details. They own the problems. They control the solutions. They will have to explain what is needed to the policy makers, and the sercive and product providers. They have the collective cedibility to show all the other players what really needs to be done.

Where should I send the check?

Thanks, JMF

Channels to market: Who sells and installs this stuff?

Great post and comments! Hope you don't mind if I steal some of it.

I'm wondering if there simply isn't an effective channel for getting these products to market -- tested, sold, installed, integrated, serviced and taught to the customer, loved ones and caretakers.

I believe "our" channel of home systems installers (CE Pros) is right for this market (per a Webcast I did recently with Grandcare/Agetek). They have the technical wherewithal and the processes in place.

They just need to establish the right relationships with the health people.

What can we do?

Julie
www.cepro.com

Agreed -- CE Pros should help accelerate this market

What can you do? Host local meetings (provide lunch) that invites geriatric care managers, vendors, council on aging people -- introduce CE folks to them, ask them for best approach to reach a market that needs them. 

Or help launch a coalition like this one in San Diego that has brought the aging-related non-profit world together with tech people.
 

What's needed is a blueprint of what works. Thanks!

Consumer Reports

I can't believe CR doesn't recognize this opportunity. Head in sand. You would seem to be the perfect person to consult, advise them on dipping their toes into reviewing these technologies.

Remote Monitoring

Remote Patient Monitoring

November 26, 2010

As a geriatric care manager, I was surprised when I read your blog titled “Geriatric care managers are cautious and waiting” 11/19/2010. Equinoxe Life Care Solutions, based in Montreal, Canada, has been using remote patient monitoring for over a year in a variety of ways. As a component of care management, we use remote monitoring of blood pressure, pulse, oxygen saturation, weight, and blood glucose, as well as automated medication dispensing. They are not just technological products, but a means of providing more personalized service and allowing clients to remain in their home. I am confident that our additional services are an asset to our company and the clients who use them.

Tracy Heramchuk, RN, BScN
Nurse Care Manager
Equinoxe Life Care Solutions
514-935-2600

Not me! But, how about the dog?

We test everything before we sell it. Had some very surprising results - some of this stuff doesn't work very well.

One of my recurring slightly tongue-in-cheek ideas is to repurpose some of the devices for pets, grandkids/visitors. So, the magical pillbox will help you remember that prescription for the dog. The gps locator tells you where your escaped dog is. The talking clock is a great way to teach the grandkids how to tell time. You can sing and read to your grandkids on Skype and see them growing up. And your friends will love your Kinect.

So, this begins to overcome the "not me" issue -- give older adults have a positive reason to purchase tech, not simply because they are old. Make it sexy and fun and hip for them. Make it a no brainer for their adult children (who we are told are afraid of mom/dad getting mad at them or who
really want to pretend that everything is "just fine" until forced to action.)

We've been deploying a panoply of tech to an elderly relative with dementia. While she can no longer live independently, the technology has given her "control" over some aspects of her life, and she is very appreciative. "independent living is not doing things by yourself...it is being in control of how things are done." Judy Heumann

Excuses, excuses - How about the dog?

Question for Aldea or Happy@Home (Susan or Judy): ref: their blog entry of 11/20/2010 18:10 -
Regarding the "panoply of tech" being deployed to an elderly relative (with dementia), please mention the kinds of technology you tried (unsuccessfully) as well as those your relative is now pleased with and enjoys using.
Also, does Aldea share a list of the technologies already having been researched and evaluated then subsequently dismissed as ineffective? Does Aldea's evaluation of a discrete device rate efficacies for the variety of aging-in-place candidates (non-memory loss, stroke, dementia, et al)? At Aldea, is there a standardized testing protocol originally applied or driven by the maker's claims?

Panoply of Tech

Tech that works for dementia:
Monitored electronic pillbox
GrandCare Homebase for pictures and calendar. Could also use a Sony Dash or a regular electronic picture frame.
In-home sensor system to get ADL understanding and understand ADL changes or shifts.
Wii and Xbox 360 Kinect also work for games, but assistance is needed.
Apple iPad was too difficult.
Skype Videophone is terrific but requires a smidge of assistance.
Presto Email Printer with 3 hole paper and a binder for a new picture book.
Wander risks need additional gadgetry including door or driveway monitors and gps sensors.

We haven't, to date, shared a list of the tech that doesn't work.

When we are testing devices, we look at a variety of issues such as vision, hearing, limited mobility, dementia, fall risk, usability for user and for caregiver, etc. We typically test products against manufacturer's claims first, then overlay other reasonable criteria for the product.

I can be contacted directly at susan@aldea.com.

Not me but how about the dog AND timing of offers of tech

Greg Van der Heiden at University of Wisconsin makes the point that universal computing, something for everyone is the way to make technology "universally" appealing. Few people want something to support a disability--look at the adherence literature. Failures from canes to elaborate computerized devices abound.

My best success is linking technology to hooking up with the grandkids.

Bringing technology into the family circle should happen as early as possible. Having habits of use as cognitive and visual abilities slide will be a real advantage.

Seniors don't think of themselves as old

Laurie
As always you raise important issues. IMHO the problem here is self-perception on the part of seniors. They just don't think of themselves as old. Only old people need assistive devices like PERS. In essence, if they purchase one of these services they are creating an inherent problem in their own mental model. The solution is for vendors to make these products do more than just be assistive. To penetrate the "younger" elderly, these products needs to have wellness components to them. They also need to be sold by trusted healthcare brands.
Michael

Airport screening

To add to the echo, home monitoring is invasive - just look at the current debate regarding airport screening.

A another major issue is device adoption. The current seniors did not grow up with anything - not mobile pohones, and even TVs in some cases - so technology use is not second nature.

Device adopton will increase over time simply because they were introduced earlier in time. For me, it was not until after college for mobile, but for the current kids, its as soon as they are born. These devices for all practical purposes are less than 10 years old!

Once insurers make mobile health data gathering a requirement for coverage of certain conditions, the more invasive home monitoring will phase in.

I believe there are some ways to address these concerns of the individuals, and, like the rest of us, am working in that direction.

History is a Good Teacher on Adoption

I have been involved in medical technology innovation and commercialization since the early 1970s and have brought over 20 new products to the healthcare market during this period. I have observed and/or have been a part of the emergence of micro-surgery, interventional cardiology, interventional neuroradiology, interventional pulmonology, refractive surgery, aesthetic surgery, and more recently ehealth.

Getting the flywheel started (adoption) for ehealth is not dissimilar from my experience in other healthcare technology domains. What is needed is one predicate that shows significant revenues and earnings. Once established, Katy bar the door.

Puzzles in slow adoption of technology

Laurie's statement certainly echoes the puzzlement my students have. Here in Los Angeles where one might think there is great potential, they do not come across applications in place. The problem is indeed complex. One dilemma is that many decision makers are not knowledgeable about the gestalt of health related technology. There are many issues related to violations of privacy and unknown consequences that I think may be hindering progress. This website is new to me and I think, like Telecare Aware, ehealthnews.eu can play an important role in bringing more people into the circle.

Health technology is a complex field and it is hard to see the big picture. Jones and Bartlett recently published my book, Health Technology Literacy: A Transdisciplinary Framework for Consumer Oriented Practice. My goal was to provide a foundation for discussions within the health professions and across key consumer groups.

The Continua Alliance might be brought into the center of this discussion as they are working to certify health technology devices and might consider a "Consumer Reports" role within their scope.

The key is to have information and lively discussion in policy circles, clinical settings, advocacy groups, and those schools preparing the new practitioners and providing updates for current practitioners.

Another dimension highlighted by Phillips at the Connected Health conference is the limitations in the USA tied to our lower broadband capacity.

Thanks for starting the dialogue in this forum.

Remote Monitoring - Improving the Value Proposition

Laurie,

I had hoped to attend the GCMNE conference but was unable to. Coincidentally, our home care agency is working at this moment with a local Massachusetts Aging Service Access Point (ASAPs are regional Massachusetts entities that offer a wide range of state-supported elder services for senior citizens) and several Councils on Aging (local municipal organizations - nearly every Massachusetts town has one) to assemble just the kind of pilot you describe, using two promising vendors we have identified. We will be ready to say more about this publicly soon.

I'll add one more thought to the analysis: I don't think any single remote monitoring system for home elder care provides the full value proposition that is needed. Some focus on enhanced PERS services - responses after an event like a fall. That is clearly an "ambulance down in the valley" approach for seniors living alone, and we'd all prefer a fence up on the cliff. In that category, there are several companies with exciting technologies that help identify and prevent falls, or to intervene earlier at the sign of declining health.

But we need both, and the technology needs to improve a bit. I think the components required for high market adoption are these:

  • Passive effectiveness - requiring the client to wear the device, especially a fall monitor, dramatically reduces adoption (people resist wearing it) and effectiveness (even people who agree to wear one often remove it for logical reasons and the event occurs then). So most sensors need to be in the home but not on the person. This will provide far greater reliability and adoption, especially for Alzheimer's home care. It needn't be any more physically or psychologically intrusive than a burglar alarm system.
  • Both proactive and reactive functions - no system will identify and prevent all falls or health risks. Systems whose only value prop is to monitor for earlier intervention but that do not offer a way to identify and respond in real time to an emergency event offer value but fail to address a critical concern: what if prevention fails and the emergency occurs? The response needs to be quick, not hours later.
  • For special cases when dementia introduces a notable wander risk, optional integrated GPS services will be a key component. Obviously at this point, we can no longer rely solely on passive systems because the subject will wander outside beyond their range. A comfortable, wearable device would be required in these special cases.
  • Remote configuration and monitoring is important, but is usually available. However, I will add that an API for data exchange with other systems is also important. Families and service providers need to be able to pull the relevant data into a single portal.

The problem with prevention as a value prop is it is hard to prove the absence of an event - at least initially. Seat belts and other preventive measures are often resisted until their effectiveness is unquestioned - hence the importance of well-structured pilots with control groups for comparison. (I'll bet the guy who invented the lock with a key had trouble convincing the king that it would keep his treasure safer than posting human guards.)

But ultimately we need both passive and active systems, for both prevention and emergency response. The day will come, soon, when senior citizens and other people who want to remain independent but whose capabilities are declining would no more live in a home without this monitoring than they would live in an urban home without a burglar alarm. The market's resistance demonstrates that we have not yet offered the value it seeks. Let's not blame the market; let's get out there and produce the systems that offer the value we are sure is available.

Jim Reynolds
CEO
Caring Companion Connections
978-254-1305

Home Care for the 21st Century
In-home Alzheimer's care and elder companions
Wellness-focused, family centered
Daily reports on your private, secure web portal

Thanks for such a thoughtful reply

Jim,

Great response -- as your pilots take place, I really hope that you will post experiences with technologies, whether positive or negative.  In a way, I wish more folks would comment about problems with products on this site so that others would learn and avoid repeating same issues.

Vendors who believe your offering meets Jim's criteria above -- please post.

Thanks! Laurie

Great Critique

Jim,

I think your last point was perhaps the most critical - if technology vendors think of themselves as leading businesses in a growing market space, then we should be providing market-driven products and penetration strategies to encourage adoption.

The issues of response and prevention are critical, and without providing both, no support tool is truly meeting the market needs. We've seen success in taking the reporting tools that you mention (that are commonly available to caregivers), and making them more powerful by including automatic alerts when these behaviors are trending towards a potential problem. As Laurie mentioned in her post, I think tech vendors often convince themselves that GCM's and family members are excited to run reports and fully utilize technology. Too often, no one involved wants to change their patterns of delivering care or their lifestyle in general. The families we serve frequently were relying almost exclusively on the automatic calls to our EMT call center and then responding as needed to events or crises - until we created automatic tools for alerting on trends and concerns.

As you say, however, neither piece is effective as a standalone support. If technology is only gathering information for the future and can't provide immediate communication, then families or communities will be dangerously delayed in their response. But if we only provide tools for crisis, we aren't allowing families and caregivers to prepare for the future.

Finally, I would add that consumers aren't being reached with a value AND a price they are willing to pay. Even though we've had success for years with funding from Medicaid waivers and LTCI for individualized technology supports, the $2-3k price tag for these is not one that's palatable for most consumers. Therefore, we've needed to pivot to reach caregivers in the market with better pricing models, services and caregiving reports they understand, and the immediate notifications they demand. As knowledge improves throughout the potential customer base, this will become a requirement for success - growth will be based less in general education and more in person-specific information.

The mistake is to expect a rational response

As usual, an excellent blog posting that gets to core of the problem of technology adoption.

OK, the caveats to my response – I only spend part of my time in this market sector and my viewpoint is from Europe not the US.

The reasons for the lack of adoption you list assume that all the parties in the equation behave as rational buyers and consumers.

I suspect the geriatric care managers’ reason for not adopting the technology is fear of the technology and fear of change. There will always be more pressing issues that excuse postponing investing time and money in ageing in place technology. They are not going to say that and so will find an excuse.

Market awareness - as you say there is a mass of information available about this technology. But, if you don’t really know what you want and why you want it then all you see is technical specs rather than a solution.

Business model – this is always a good fall-back for not taking action. If you want to do something you make the figures stack-up.

Proof that products work – once there are a couple of major care providers using this technology then it makes convincing people a lot easier. Do I really want to be the one to put my neck on the block and make the investment when the downside for doing nothing is zilch?

Seniors themselves – I am sure the resistance of the older person is an over-stated excuse. There will be spectrum of uptake and engagement but right now people will always visualise the reluctant, frightened and probably antagonist senior stereotype rather than the smiling face of somebody who is relieved by the benefits the technology delivers.

How do you get things to change? No real answers to that one. Maybe the next time you present, you give the audience both the rational and emotional arguments.

In the UK the “caring industry” can get too easily self-satisfied and pessimistic. Also, it many of the people workign in it are technophobic. Sometimes it needs a good kick-up-the *** to get it moving.

Again, thanks for such a great blog

Dick Stroud

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