How not to deploy remote monitoring technology

Tech is useful, but deployment approach needs some work.  So here's an article about Senior Lifestyles Corporation and their deployment of QuietCare in a Florida (Fort Pierce) Assisted Living community. Was this a happy experience, like the NY Times article last year about keeping frail individuals longer in their homes through effective remote monitoring? Sadly, no. This one cites a family member describing the additional $200/month charge for QuietCare as 'elder abuse' while contemplating legal action. Another resident circulated a petition protesting the installation, and the local ombudsman has now weighed in and discussed the situation with the press. Hmm. That didn't go well.

Yet the remote monitoring benefit was not disputed.  In the article, the benefit of QuietCare use was stated clearly: "The system records how many times a resident uses the bathroom at night, what time they get out of bed in the morning and other variables, to establish a baseline behavior profile for each resident. Should a resident diverge from that 'normal' behavior — like suddenly making seven bathroom trips a night — it might indicate a urinary tract infection, according to Tom Ostrom, senior vice president at Senior Lifestyles Corp. The system has therapeutic value, he said. “Studies indicate it increases length of stay (in assisted living facilities) by 58 percent. The number of falls in one study dropped by more than 50 percent,” he said."

SLC has triggered an unintentional firestorm. Earlier this year the firm proudly discussed its plans for QuietCare deployment across its 70 communities, announcing in various press releases as rollouts were completed.  In contrast, this website has also received an anonymous comment from an aide who believe that motion sensors like QuietCare also are being used to verify the arrival and departures of aides who may feel overworked and over-watched. The issue: as residents become more frail, assigned resident numbers per aide may go up as costs are cut when occupancy levels go down.

It doesn't need to be this way.  Remote monitoring should not be viewed as a malevolent plot. No one died; no one was even injured. Communication and planning could have avoided this ruckus and presented it as a desirable feature helping residents remain longer in their assisted living residence versus needing a nursing home. How could it have been handled?

Choice a) If an organization only knows how to or must install in all units, they can still turn it off for those who don't need or want it, enabling the device when a new resident moves in.

Choice b) Remote monitoring can be bundled in with higher service tiers that include other aide-based assistance (like help with dressing) -- noting the value when the aide isn't available.

Choice c) It can be bundled into pricing for new residents -- once it is explained as one of the (attractive) features of moving in and feeling safe over time -- right up there with grab rails on the way to dinner, pull cords in the bathroom, or other safety features.

All three of these choices, with proper marketing to families, can be combined with staff training in advance of deployment -- like any other system -- about the purpose, benefit, and usage. But pricing needs to match the perceived benefit in a particular market, not cover the cost and create revenue in one-size-fits-all approaches, independent of location.

Tech deployments are mostly not about technology. Bottom line, if the staff feels mistreated, underpaid, overworked or misunderstood, any change can be viewed as adversarial, especially the introduction of motion sensors that (at first glance) may appear to replace labor -- versus their benefit -- to supplement labor by adding an additional way to help the frailest. In many senior housing communities, management is already skittish about technology deployment -- why self-inflict more pain by sending a letter notifying all of a price increase to cover something residents and families don't understand? Maintaining the one-price-fits all mandatory stance in the face of resident outrage? In the midst of a bad economy? 

What's it mean? In the long run, tech-enabled services should be tactical improvements that residents and their families are willing to pay for. Remote monitoring is an option for those who are still in their own homes as well -- who don't want to move as they age. But the firestorm this time combined with this approach won't help that happen.

Comments welcome.

Someone forgot the marketing essentials....

Here, evidently someone forgot the obvious--you actually need to market the system to the residents and the families paying for it. And you need to internally market it to staff. No one (at least that I can determine) seems to dispute that the QuietCare system works in maintaining a better level of resident health, helping to prevent falls and to lengthen stay in AL. Yet here is an effective technology, undermined by its ineffective introduction in at least several of the SLC communities.

In the larger (as what we can learn from this) sense:

The failure here (as I see it) is that even senior communities and their parent companies who supposedly know all about senior care can turn quite clueless when it comes to the wants, needs, thoughts and opinions of their individual residents and staff when it comes to adopting technology. This is also true of care staff (DONs, social workers, GCMs) who can be surprisingly tech-phobic and reluctant to change.

This is where the 'downstream' part comes in...the hard, usually thankless work of training, IT, marketing and sheer convincing that has to take place (in marketing-land, 'downstream' is not the glamor spot.)

The tech company has the thankless and hazardous duty to attach a 'string' to the sale--the one labeled 'implementation plan'. You cannot leave it to senior management (on both sides, particularly CFOs who have cognitive difficulty with 'marketing' and anything past booking the sale) who think they can wave a magic wand and it all falls into place!

The sales folk call it 'sell-through', the marketers tend to call it 'internal marketing'.

It means the tech company has to fully understand the users and not go on gut or assumptions about them: the older adult residents (and their differing needs and attitudes) and the care staff who must use and take action on the data. Especially this last group has a wide range of attitudes, abilities and knowledge that are not easily discerned until you work with them. The tech company works with management, staff and ideally, residents to develop an implementation, rollout, training and marketing plan--and buy-in. And if they are smart, the tech company assigns a project head to the customer to lead a responsible, accessible project/account management team who will see to this.

The responsibility ultimately is the tech company's to ensure all of this. And they have to be firm about their influence, participation, measure of control and responsibility, even at the risk of losing the sale--because if it is badly implemented it will be lost anyway.

What was that old saying? The sale is not made until the customer is happy--and stays happy!

John Boden comments

This situation is a perfect example of the elders and their families not being involved in decisions about their own care.  What we in the industry are doing is all about patient care and until patients and their caregivers are treated as a respected part of the care giving process, this reaction will be very common.   Another “Last Inch” issue. The attitude that patients and caregivers are a pain in the neck and obstacles that have to worked around must change.

 

John Boden,  ElderIssues

 

John Boden,  CE

ElderIssues LLC

801 N. Swinton Ave

Delray Beach, FL 33444

(561) 265-0016

jboden@elderissues.com

www.elderissues.com

 

QuietCare

Could you please provide a link to the newspaper article you're summarizing in your blog entry?
thank you.

What people forget about technology and people

Your article brings up  key points on technology that everyone needs to pay attention to: the ongoing cost and the overall impact of such systems, actual or perceived( I hate perceptions but they are 'fact' for many people).

Remember when transponders on cars to pay tolls were seen as a way to check on where you were going?  Many people turn off cell phones for the same reason.

Both are perceptions of the 'big brother' syndrome.  Personally, I don't have such a problem but many I know do!

Now the cost.  The best analogy here is the cell phone.  They give them to us for nothing.  We then pay every month for them so it doesn't take one long to see why cell phone providers give them to us.  Can we live without them now?  Try and find a pay phone.  

Take a look at many computer systems.  The cost of the system may seem high but when one looks at the overall cost of such a system that needs monitoring on a routine basis, the 95% to 99% lifetime cost makes the initial hardware expenditure seem trivial.

A PC is what many people think about is NOT a good model in the home environment because most people don't maintain their systems.  Anyone who has worked with these systems in a commerical environment understands the true costs.

My mother is going to be 89 and she has a type of monitoring in her apartment at a retirement community where she lives.  She realized she needed it since she is now alone.  She sees it as maintaining independence.

Building the cost of such a system into a monthly fee or some other kind of service is much better than hitting up someone for $200/month. Take a look at how much medicine costs and look at how much income many retirees have.  Most have no financial cushion. . . you know, pension check to pension check, SS payment to SS payment. In my mother's case, all the interest on one CD for a year could be eaten up in one month.

This is a long winded way of saying that making sure the method for deploying such a tool with the proper education is extremely important.  It may take a long time as many people who will benefit from such a technology can only absorb information in small doses.

Laurie, I know that you are aware of all these points but I'm certain that some who follow you don't so it doesn't hurt to state the obvious at times!! 

viewing technology as a value add

i find this story to be incredibly frustrating and disappointing.
To me, technology like this is something a facility uses to provide the best top-notch care, while saving money. Information is power. Adding a system like this can provide additional relief for staff (save footsteps - not have to provide random check-ins) and keep someone safer and perhaps more independent for longer. However, making families pay for this on top of the 3-9k per month is just too much. This would be like forcing all residents to have a pull cord and charging extra for it. Or perhaps charging residents for the library, fitness center or the security system on the doors. This is just something that the facilities should build into the price as a value they have. We have found that when a facility simply has it in every room (along with the cable box, smoke detector & pull cord/pendants) and residents move in with it already in place, it usually is more widely accepted. The trouble is when its a "new" thing for residents and their family. New tech will always be a hard thing to swallow for families.

This is disappointing to me, as I always like to hear success stories about tech implementation - and these bring me back to reality that we still have a long way to go.

Most think the seniors are the ones that are afraid of tech, but I often wonder if it's their children that are even more afraid...

Our work is cut out for us!!!

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