Senior housing sensor adoption - more work needed

A ‘seismic shift’ or real slow crawl? In a recent article in Senior Housing News, the article opined that sensor based home monitoring was going to become widespread and ubiquitous over the next few years in senior housing organizations. But there is no evidence that would support that premise unless you were interviewing technology vendors, of course, which the author was. In this case the vendor was Care Innovations, a spinoff from Intel and GE that was formed two years ago. In fact, evidence to the contrary, telehealth/remote patient monitoring (assuming that included any sensor-based technology) was last on the investment priority list for this year among CFOs surveyed within LeadingAge senior housing organizations.

However, recent trends will boost focus on safety. The residential population in senior housing is older than it used to be – today, the average age of assisted living residents is 89. The greater frailty of this population means their risk of falling is greater – rising to as much as 50% by age 85 – a fall that may occur while they are alone in their rooms.  Combine that phenomenon with aging layouts of many senior housing facilities – long halls, nurse’s station at one end; the nurse may be away from the station distributing meds, the resident does not or cannot call out or signal for help.  Now add the efforts of hospitals to keep senior housing residents from readmission following a discharge that could result in penalties and long-term loss of business.  Also factor in downward pressure on Medicaid/Medicare reimbursements for nursing home rehab and long-term stays.  It would certainly make sense for them to consider sensor tech that monitors activity and lack of movement - and can create patterns of information that are useful in predicting pending illness.

Pursuit of pilots must give way to buy-and-deploy – but first, who pays? For the prediction of a 'seismic' shift to occur, a number of barriers must be overcome: Pilot initiatives must take into account those pilots that may have already demonstrated success, for example, Volunteers of America reported success of their multi-year pilots of Wellaware and then moved on to deployment. Concerned no doubt about whether the company would survive through those lengthy pilots, VoA invested in the company. Efforts have been made to legislate the use of remote patient monitoring – from reimbursement for the use of health-related sensors to activity monitoring -- but within the home health care industry. But, an understatement, that may take a while. In the private pay arena, LivHome and UK’s Saga are promoting/deploying GrandCare in client homes served by home care aides. And more vendors – like Independa and BeClose -- will likely be announcing deployments this year.  They will be just in time to partner with the changing PERS industry: some vendors have both the technology and see the opportunity to move from a one-size-fits-all emergency button to an intelligent pattern-detecting sensor-based home monitoring system.

What’s needed for senior housing organizations to participate.  First, an inside champion (maybe the CEO or COO) must stand up, someone who sees the opportunity, then collects the supporting study results, speaks with both vendors and their customers, gets buy-in on the budget to deploy – which must always include the time and effort to change current work flow and train staff. Because this will, in the near term, continue to be private pay, enhanced service level pricing must already include the technology component, likely with some health monitoring features, explained to the customers as a benefit associated with that service's level of care. In addition, getting the nursing staff on board with teleheath monitoring is a workflow change and training process of its own. Without that bundling – and  the opt-in capability for the monitoring it implies -- it is unlikely that consumer family members will know enough about the market to ask for a sensor-based monitoring system. And call me crazy, but wouldn’t residents and families be more excited about using the technology at all if they could also use it to communicate with long-distance sons and daughters?

 

Families need to stand up and shout

I've been watching this type of technology for 3 years now and I'm a big fan. It can save lives and make living life safer.

But, I'm pretty sure that senior living environments are not going to deploy it unless families and residents insist on having it.

First, it costs real money to deploy these devices, money that senior facilities don't want to spend unless there is a reimbursement scenario (family, government, etc.)

Second, it is not simple to interpret the results of an individual's behavior unless you know them well. My guess is that many assisted and memory units are essentially food and drug providers, not ADL monitors. There are, of course, exceptions to that. But, since the sensors are not person-specific, and many of the memory units have shared rooms, there is not a real benefit.

Third, there needs to be a third-party "analyzer" that can learn the habits of the individual (it takes about a week or more based on our testing) and then set up the right notifications for the individual. Assuming that a professional like a geriatric care manager needs to do the assessment/analyzation, it would cost a fair penny to get this going.

Care Innovations has a product that would work on senior campuses, but the campuses need to leap into the 2000s. Many don't even have WIFI everywhere yet. We are kidding ourselves if we think that any of these services will get traction until some nationwide organization deploys it, gets all the customers and threatens the business models of the other providers.

On a personal note, I have used these type of systems in the past on real people. They work and they work very well for informing families with real data. Some day, senior facilities will recognize that presenting real data to families is a key feature of their business strategy, especially when it is time to "graduate" from independent to assisted to memory care. As Neil deGrasse Tyson so eloquently stated, "The good thing about science [data] is that it's true whether or not you believe in it."

Sometimes the truth hurts.

Retirement Homes for the Future

It's quite a coincidence that I've seen this post now. About a week ago, I had an in-depth discussion with my colleagues about the implications that current retirement homes have with regards to how prepared they are for the future residents and non-baby-boomers. The needs are very likely to be different to the of the current seniors and I believe it will be heavily technology centred and reliant. On top of that, the technology that is being introduced now; I will agree will prove to be very effective - but just not yet. Human behaviour is a very difficult aspect to monitor and they need to produce 'adaptable' technology before it can be a tool we can rely on. If a device can learn the behaviours of it's owner (or whoever it is meant to cater to), then there will be much more reliability in it's decisiveness. Otherwise, we're going to continue going back and forth on ourselves and making inefficient judgements.

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