Using Tech to create Smart Walls and Tables for Dementia Care

Dementia care – it’s 4:00 and what’s happening?  In a nearby memory care unit in an Assisted Living community, the movie has ended, the credits rolled. Next up – visitors hear loud yelling and observe a staff member separating and redirecting an able-bodied resident. Count the number of residents in wheelchairs -- nearly half of the unit -- awaiting some physical care before dinner. These residents seem ever-more frail -- likely because they are delaying move-in until the need is urgent. Often it appears that staff is supplemented with home health or companion services -- note that these providers are assigned to individual residents, not the group -- just like the resident-specific role played by visiting hospice workers. It may appear that there are many staffers around, but minus the one-on-one folks, there aren't enough staffers to keep everyone else occupied. Now consider the dependency on staff to engage these otherwise-bored and idle residents. Soon it will be dinner time and the activities person will have left for the day. Staff members (who earn a national average of $11.10/hour) get busy with ADL-related chores before/after meals and before bed.

After the group activity – what’s left? With the puzzles are put away, the movie done, the staff is busy, now what’s for residents to do?  A visitor stops by to show a resident a tablet-based slide show of cats and a Youtube video about kittens. This is also mesmerizing to staff members. Of course, if there was an actual animal present, even a horse, that would be even better – but most dementia care units, probably wisely, do not have cats, dogs or, as in that video, the space for a horse. Visiting family members can offer distractions and interest, but when they’ve left, why couldn't there be something else (besides TV) as well? This is where smart tables and walls would be intriguing additions to physical space. 

Smart surfaces are yesterday's news for a limitless number of applications.  Soon touch screen interactive maps for travelers will be placed everywhere, meaning that the barrier to entry with this technology is low and moving lower. Already demonstrating smart tables a few years ago, now called PixelSense, Microsoft recently patented smart walls. One presumes numerous commercial uses for interactive walls and tables (see the Chili's example), but what couldn't you do with these approaches in dementia care? Look at the large screen version of  the IN2L system, in the process of being deployed in dementia care units nationwide by Brookdale. Watch a few more demonstrations of the role that tech can have in dementia care. Watch someone touch a picture of a therapy game – and see how the resident engages.  Now picture smart tables in dementia care units, linking to video and still pictures residents can select, see, touch -- versus wander around and get into spats with other residents.

Transforming the lunch table and the hallway wall. Picture a resident sitting at a smart table waiting for the next activity: they look at the table where they are seated and touch their own face. The table fills with pre-loaded photos from their life -- collected and scanned on move-in day.  Or even easier, no scanning required, the resident’s picture links to a location shown (perhaps via Google Earth) of the city they wish they could visit or the town where they grew up? With tablets providing all of this today navigated in a browser at the swipe of a finger, the barrier is the need for a person to guide. But it is possible to envision the tablet becoming a table, the browser writ large, now just touch your picture to begin. So what company will create and demonstrate a dementia unit smart table or wall at ALFA or Leading Age next year? Or has someone has already done this project and applied it to dementia care? Please advise.

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By Regina Ford, MBA, CAPS - From ASA LinkedIn

This looks great, but with many dementia care clients there would still need to be someone present to initiate the activity and assist while it is being done. There is often not enough caregivers to allow this. Perhaps volunteers could assist. Also, there is opportunity to spread disease unless proper cleaning techniques are employed between uses (another task that personnel would be needed for).

Human-driven virtual companions

That's a great point, Regina: some kind of human intervention is generally required for dementia care. That's why with the GeriJoy virtual companion, everything is done through our live staff, who actively engage residents with true intelligence and compassion, far beyond what is possible with a simple "smart" wall or tablet. In fact in the second video from the top at http://gerijoy.com/video the dementia patient you see there has been good friends with his GeriJoy Companion for almost a year now, and he lives by himself at home -- in person caregivers drop by on a part-time basis but they are free to do their jobs rather than facilitate interaction with a piece of technology.

In-person caregivers are expensive, and their time and effort should be spent where they are most needed. And as has been mentioned here, volunteer hours are scarce. The "virtual" aspect of the GeriJoy Companion allows us to complement traditional in-person care with 24/7 availability of companionship, supervision, and non-physical care at very low cost. If you'd like to learn more or see a demo, please let me know!

From Sharon Dickol, ASA LinkedIn

The advances in technology can add tremendously to one's quality of life, especially when it comes to dementia patients. But, we don't always need to think "high tech." I have found that coffee-table books containing photos of people and places around the world can provide enormous pleasure to an older adult. Quite often, an image will trigger a memory that opens the door to conversation and social engagement. Thanks for sharing this article! 

From Ethelle Lord (LinkedIn)

I've been there and seen the same situation many times. I assist my husband as I have retained the role of primary caregiver for him even after placement in long-term care. I know how he feels and how it must feel when I'm not able to be there. It is rather primitive in the way we care for others. I think it is time to "put a new show on the road" and train volunteers and family caregivers to extend services from home to long-term care, don't you?

My caregiver partnership agreement program includes an entire inter-professional team that also involves the family caregivers. That way there is a continuum of care and we can maximize the quality of life for everyone involved, not to mention the quality of work for the regular front-line workforce.

~ Ethelle

Dr. Ethelle Lord
www.Remembering4You.com
Pioneer in Alzheimer's Coaching
http://www.remembering4you.com/alzheimers-coaching-program-philosophy/

By Ethelle Lord, DM (>3,000 contacts)

 

From Renu Kumar (LinkedIn)

I enjoyed reading this article and I can see so many uses in dementia/memory care units especially using the photos that seniors could remember (what is stored in their long term memory). Thanks for sharing the article.
 
 

First things first...programming

Technology in the area of recreational therapy or activity management first must start with effective programming. If an organization does not have effective planning of activities and a person centered design, adding technology is just puts some interesting eye candy in a long-term care facility. You need to train the activity professionals and hire quality staff to plan and deliver any kind of meaningful activity first. Given the state requirements are low for these roles and the pay for these individuals are substandard we have a long way to go before adding cool technology will make a measurable and meaningful impact with residents in long term care.

Agreed

Again, although it's depressing, I have to agree. Imaginative uses of technology will be employed when skilled, trained, professional caregivers are appropriately incentivized to engage residents in using them. The problem probably lies more in the people who must implement them than in the thinkers and dreamers who invent them.

Learning new tech with dementia

As time goes by, the "old old" will be more tech savvy than the current generation of residents in dementia units. But it may be some time before touchscreen technology is useful to occupy them. Once dementia sets in, learning anything new becomes very difficult, because short-term memory is the gateway to long-term memory. We've found that elders who already understand how to swipe, search, touch, type, etc. on a touchscreen are able to continue using that knowledge a long time after dementia sets in. But it's pretty hard, if not impossible, to teach it to someone who's not already familiar with it. That doesn't mean we shouldn't be developing it, though! Thanks, Laurie for suggesting all these possible uses.

Values

Hate to say it, but I see it's too often about values. As one CEO at a for-profit care facility recently told me - "Bells and whistles are to get people in the door - but no one uses them after they get in so we don't spend much time with them. Their cost goes into my Marketing Budget!" Isn't it your role to help your residents to have a high QoL? I guess not. The BOD likes the CEO attitude because the CEO is maximizing their profit. So where are their values placed? Additionally, this CEOs attitude certainly is not "leading by example" to the employees on showing any personal value on using things/stuff to improve their residents QoL. And yes, staffing is so low they spend most of their time doing ADL's for residents. So any new QoL stuff really needs to try to be "self-used" (if that's a term) by residents, but caregivers could remind/initiate their use.

To succeed, any new product/services in this space can't depend on any caregiver to facilitate its use. And yes, I know a growing percentage of residents in these facilities need support to do things. Entrepreneurs/Innovators are creating more and more things with very simple interfaces to engage the user. Love the Smart Table and Smart Wall examples above...Think about self checkouts at the grocery store. It engages you when you approach it. Why not do this when someone with dementia sits in a chair? Stands next to a spot on the wall? Technology is definitely there, we just need people/organizations who have the means to make it happen and who really value solving these needs to want to make it happen. It seems we are putting this environment in the same position as we have done our educational space (in particular elementary education) where the teachers spend their own money to get side items that can have a big impact on their ability to teach students. Not sure to what degree caregivers in these facilities have caught on to this practice (even if it would be allowed or have any time to use or if realistically they can't even afford to do this on their low pay scale). God bless these people...to be there to help the elderly. I've been there many times - I know how much most of these people care. Just like teachers!

As for non-profit facilities, the technology adoption curve for non-profits in general is ridiculously low. Most non-profits just look for more and more creative ways to get more volunteers to solve their needs. Until we crack this mindset, we are going nowhere fast. Today gov't funding and services in this direction is also not looking favorably in any way, shape or form, so no help in this direction anytime soon. Think Fed. & State budget battles! Who holds these care facility organizations accountable to providing certain levels of QoL? The resident, the family, gov't? Is it working? How should we measure it? Tech is, like you say, available. Sadly, our current culture in general doesn't provide enough value on QoL as we get older as we do for our younger generation. I'm hoping for this to change. Globally some cultures do value their older population highly. We don't here in the US.

I think creative relationships by for-profit companies (and in particular their executive management) and their channel partners and partnering with non-profits to enable the "aging in the home" mindset is the answer. My push is to drive more Meaningful Innovation from these types of relationships. We need companies that want to take on an ownership of making positive improvements in peoples lives. Creating and managing a value chain all the way down to individual consumers that values QoL is how its going to happen. It might go a variety of paths: from for-profit, thru a non-profit, thru a NGO, thru a gov't agency, to a family member then to the individual. We have to be creative. The fact there is a growing percentage of the population getting older is not going to go away! It's not a problem, its an opportunity for people to have a longer and even more fulfilling life. Individual families can and will benefit!

non-profits and volunteers

It doesn't matter whether it is care facilities or museums. Volunteers just are not out there like the used to be. It's the economy, stupid. How many who want to volunteer are either unemployeed or are underemplyed and working 60 hours/week at minimum wage just to eat and hopefully pay a bit of rent.

I know this is a bit off topic but we'll probably run out of volunteers before most of the 501c3's run out of money. You either get high school kids for a few hours, just enough to cover their public service requirements or you get older people who run out of gas, can't drive or have very restricted schedules. It seems like I spend 1/2 my time training them and that takes up 1/2 of the hours they have. This applies to most types of non-profits unless they are HUGE in my humble opinion!

Volunteers

This is depressing, but I agree. Volunteers flock to the few glamorous arts & charities that attract "ladies who lunch," and there are a few other very passionate people who are motivated by personal experience, but it's very hard to attract and maintain a stable population of volunteers who do unglamorous work like caring for the aged.

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