A ‘seismic shift’ or real slow crawl? In a recent article in Senior Housing News [3], 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 [4], a spinoff from Intel and GE that was formed [5] 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 [6] list for this year among CFOs surveyed within LeadingAge [7] 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 [8]. The greater frailty of this population means their risk of falling is greater – rising to as much as 50% by age 85 [9] – 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 [10] 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 [11] 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 [12] – 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 [13] and UK’s Saga [14] are promoting/deploying GrandCare [15]in client homes served by home care aides. And more vendors – like Independa [16]and BeClose [17] -- will likely be announcing deployments this year. They will be just in time to partner with the changing PERS industry [18]: 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 [19] 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 [19]?