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Could Amazon's Echo and Alexa be useful for in-home care?

Tech-enabled home care isn’t really there – yet.  Okay, there are smart phone apps that reveal a caregiver has arrived. There are back-office offerings like CareTree or ClearCare – in a way, these are the ERP (enterprise resource planning) systems for home care agencies.  And then there are the new entrants, scooping up more money, presumably planning to take over the home care universe with…apps. So what is the device of choice for these folks?  A portal or app that can be accessed through a smartphone or perhaps an iPad.   These are big leaps forward from the no-transparency, telephone-only days of yore, true. But what if there was a multi-purpose device in the home that could enhance the quality of life of the care recipient – and also assist with information flow between the participants, including professional caregiver, agency management, family members?  

True, it is early, early, early for this – but…Today, the Amazon Echo is now in 3 million homes,  perhaps, as some have said, it is paving the way to a ‘screenless future’ where all of the new smart capabilities, voice activated, are added in the cloud, not on a phone. For in-home care, what would we want it to do and maybe already can? Note that 1500 skills have already been created, some of them really stupid. But they could include creating custom agency-oriented skills, not unlike the Alarm.com home security skills.

For Alexa in-home, what's now and what's next? Some of these skills and capabilities are available now, including user-enabled home automation tech for indoor-and-outdoor lights and room temperature settings. But there are numerous add-ons, more coming every day, like the Home Advisor in-home service skills (this utilizes the "open mic" feature to arrange appointments for pre-screened plumbing or other home-related service providers). Some are in beta – like Marvee -- and all augment the play-my-music core skill of this voice-activated product.  These are primitive concepts – and some are fairly broken, apparently like the Uber skill or very new, like the Lyft one). Here is a short list -- innovators will no doubt think of others:

  • Reminders to take meds. Using the set timer capability, a caregiver could set an alert for taking a medication – or setting the med schedule in a Google calendar, med reminders could be spoken: “It’s 9:00 a.m. and time for your blood pressure medication.”
  • Engage and calm an agitated or anxious older adult.  Create a calming music skill that a caregiver can invoke – not unlike the rudimentary Focus skill for meditation or Therapy. Or after it is appropriately configured, have a care worker or family member be able to say “Alexa, play music for relaxing” or read my Kindle book.
  • Enable question sets for early onset dementia.  Beyond the endless ‘what time is it’ and ‘when is dinner’, but also a long list of child-friendly jokes, including ‘tell me a cat joke’ and ‘tell me a riddle’. 
  • Find a backup caregiver.  Note that the Home Advisor in-home service selects from a pre-qualified and vetted list of service providers.  In that same way, collaboration across home care agency businesses or franchises (!!!) could enable finding fill-in caregivers through already-vetted sites like CareLinx or Care.com
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After we met Big Brother (1944) and HAL (1968) it was just a matter of time until computer systems were monitoring our personal activities and having dialog with us.  A seamless voice interface to a cloud based personal assistant system does seem better than staring and poking at a smartphone screen. It should make consumption processes more efficient and automatic. “Hey Seri, please notify everyone on the internet that I purchased a pair of hiking boots three weeks ago and tell them to stop showing me shoe ads.”  I should have used Google Wallet.

The services Google, Amazon, Facebook, Apple, et al, give us ‘for free’ are all designed for the general consumer.  AIP care and assistance consumers are very different.  They consume more personal physical services that require personal and intimate interactions and transactions (ex. ADL assistance and medical assistance). They often need or want assistance when buying things and services (Laurie’s triangle).  Many of the sources for AIP services are non-commercial and have poor digital support. Very personal and private information must be shared with caring intermediaries and suppliers. Digital AIP consumers will always be different from general digital B2C consumers.

Alexa, Google Home, all of the personal assistant systems being developed, won’t work for AIP care and assistance consumers.  They lack privacy, safety, transparency, and collaborative consumption functionality. They will work for the highest functioning AIP consumers who already shop on the internet at the same (normalized) rates as other consumers. 

If the morning comes when you are standing before the bathroom mirror wondering what the thing in your hand is for, you may want ‘My Big Brother’ watching out for you. “It’s a tooth brush, and that is toothpaste. Would you like to see a YouTube video describing how to use it?” Why would you not? Why would you want to trouble your loved ones with something you can do for yourself with a little assistance from your system; From My Big Brother?

We certainly need digital personal care and assistance systems for AIP.  We should each have one as soon as they are available. We need AIP power tools for self-care.  We need something to help us get all of the services and products we need in a safe, private and controlled environment.  If I have a camera in my bathroom, it needs to be My Big Brother, not Amazon’s, or Google Homes’, or anyone else’s.  The technology is now, and soon to be, available off the shelf.  We simply need it configured for AIP use.

How much of the 70% of GDP spent by US consumers is spent by AIP consumers? In the future, if online companies want to do business with AIP consumers, they may need to read, acknowledge and agree to the AIP consumer’s terms and conditions.  Check the box Amazon. Check the box Google. 

Hi Laurie - I met you at Aging in America back in 2011, and attending your talks on technology and aging in place inspired me to transition from more traditional gerontology research into working as a user experience researcher on consumer technologies.  I think the use cases you've described for a voice activated IoT are quite pertinent for products like Echo/Alexa - one of the main goals for voice user interfaces is to help streamline something that would take multiple interactions within a web/mobile app using more conversational, natural language.  In its current state, I'm not sure if Echo is ready to handle more complex medication/management or healthcare/telemedicine type tasks - there's too much room for error with speech recognition, privacy, and data security issues to safely handle the needs of users with dementia.  Not to mention that the phrasing and prosody of users with dementia would be difficult for voice recognition to parse accurately - and you need thousands of hours of data from specific demographic segments to be accurate at an acceptable level. 

The Echo is much better at handling instrumental care/home maintenance tasks given its IoT integration and popularity with more general home service providers, and in this aspect I could see Echo assisting with AiP for future cohorts of users and "younger" older adults (aka the AARP primary audience base) by minimizing the number of interactions needed for users to verify if their smart stove is turned off, or to check when the plumber is coming to fix the sink.

As a side note - Echo originally shipped with a list of multiple family friendly jokes (try asking 'tell me a joke' and you should hear at least 2 dozen different ones).  There are a couple of variations on this phrase, like 'tell me something funny,' that should lead to a joke - but sometimes you have to experiment with the phrasing :)

 I can't wait to see all of the patient care management integration that deploys with the Echo


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