Hi-tech homes will allow seniors to stay independent longer

The ageing population in the United States is leading to an increased investment in home-based healthcare: encouraging seniors to maintain their independence for longer means lower costs to the sector than keeping them in long-term care homes or worse still, in hospital. A variety of specialised sensors have been developed to that end, and are actively helping to keep an elderly population in place, including patient tracking solutions to pick up on early warning signs of problems, even before the patient can. Sensors have been developed that can alert emergency services, doctors and hospitals to an increase in seniors' trips to the bathroom, or if there has been a recent absence in detected movement, allowing a rapid response. Trials of these connected homes are ongoing, but companies such as HealthSense are seeking to expand from pilot projects to commercial offerings soon. 

SHREWSBURY, Mass. — Violette Roberts’ home is full of sensors. There is a device under her pillow to record how many hours she sleeps. Wires stick out from her toilet tank, transmitting how many times she flushes. Little white rectangles, about the size of matchboxes, count how many times she opens her fridge and her medicine cabinet. And there are motion detectors in every last room.

Together, these gizmos know the daily patterns of Roberts’ life inside out. And when they pick up on a change — be it a sudden lack of movement, or a gradual increase in the senior citizen’s trips to the bathroom — a nurse gets an email alert. The goal: to pick up on early warning signs of illness even before Roberts notices them herself.

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If that sounds like sci-fi, think again. Devices and apps are popping up to monitor every aspect of your health: pill bottles that know whether you’ve opened them, socks that track the rhythm of your gait, and little skin-like stickers that keep constant tabs on the state of your blood.

And with nearly 13 million seniors living alone in the United States, companies are pouring millions of dollars into the idea that this kind of technological surveillance will allow the elderly to maintain their independence for longer, while also reducing health care costs.

“This is all part of this mega-trend of health care moving into the home,” said Geoffrey Nudd, chief executive of ClearCare, a San Francisco-based maker of software for home care agencies.

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A sensor detects every time Violette Roberts opens her medicine cabinet. Kayana Szymczak for STAT

But this patient tracking-at-a-distance comes at the expense of privacy, and experts worry about the ripple effects for elderly care.

“One danger of all this monitoring is that we actually turn normal life into a disease,” said Dr. Ken Covinsky, a geriatrician at the University of California, San Francisco. The elderly have good nights and bad nights, just like younger folks, he said, and those fluctuations don’t necessarily predict serious health problems.

Steven Albert, an expert on aging at the University of Pittsburgh, noted that some older adults feel more independent when they rely on technology instead of nurses or aides. But, like many researchers, Albert worries about replacing human caregivers with machines.

That worry is not completely far-fetched. Roberts had originally asked if a nurse could call her every day to check in. “I didn’t want to be in a coma for three days without somebody knowing about it,” she said.

A deliveryman brought her meals-on-wheels, and she called her nieces every day, but she was still concerned. She’d had heart trouble and kidney stones. And, a few years ago, after a fall, she’d been unable to get up, and had to drag herself across the floor for hours until she reached the phone.

But the nurses at Fallon, the company that manages Roberts’ health care, are typically each in charge of around 80 patients. They didn’t have time to call her once a day. Instead, they offered her a spot in a pilot project to test out monitoring systems from a company called Healthsense.

According to Bryan Fuhr, president of the senior living division of Healthsense, the company’s system is currently in place in assisted living communities across the country. “We’re monitoring over 20,000 lives on a daily basis now,” he said.

They now want to expand into private homes — which is where the pilot project comes in. Although study subjects like Roberts aren’t paying for the systems themselves, it usually costs around $150 per month, Fuhr said.

“I didn’t want to be in a coma for three days without somebody knowing about it.” Violette Roberts

The devices have been picking up fluctuations in Roberts’ habits for a little over two years now. So far, none have signaled a health problem.

Once, her care manager, Maureen Brenner, called after being notified that Roberts hadn’t put her head on her pillow all night, but she’d just stayed up knitting a scarf for the local senior center. Another time, Brenner called because Roberts hadn’t been opening her pantry; it turned out that she’d just been eating mostly fruit from a bowl on the table.

For some elders, these kinds of false alarms were enough to turn them off the Healthsense project. “They were saying, ‘It’s causing me anxiety,’” said Brenner. But many loved getting the calls, even when nothing was wrong — suggesting that, as useful as the sensors may be, they wouldn’t be nearly as satisfactory to patients without a real human being responding to their notifications.

The data from the pilot project look promising. A cohort of 34 older adults who used the Healthsense monitoring system had around 50 percent fewer emergency room visits and hospital admissions than those with similar health issues who didn’t have the sensors.

At Roberts’ home, a monitor records every time she opens and closes the door so health care workers can assess if she needs assistance based on those patterns. Kayana Szymczak for STAT

That benefit isn’t necessarily all due to the sensors, said Al Lewis, an independent consultant who was hired to crunch the numbers. He explained that those who opt into this kind of project tend to have better health. Even so, he said, “it appears to be working very well. The monitoring system is triggering the nurses to get in touch with these folks and get them in to see the doctor in a timely way.”

Economists aren’t sure how those rates would hold up on a larger scale. But Fuhr argues that these systems of sensors are the only real option for seniors who want to stay independent but need more intensive care. “The best way to keep them out of a nursing home is to stay on top of their chronic conditions and their risk behaviors,” he said.

For Roberts, at least, it seems to be working. She feels safer now, knowing that her hours of sleep and her trips to the bathroom are being tallied. “They’re really watching,” she said. “Doing their job.”