Book: Home Telehealth

We've added a book to our virtual shelf on the right.

Home Telehealth, published by the Royal Society of Medicine, is one of the first comprehensive reviews of the medical treatments that can now take place in the home thanks to advances in telemedicine technology, including disease management and wellness programs, home monitoring capabilities and the use of consumer electronics to connect patients and clinicians. This book also provides a practical guide to setting up a home care facility and remote interactions between patients and healthcare providers. Joseph C. Kvedar, director of Telemedicine for Partners HealthCare is an editor of this book.

Aging's Upside

This Wall Street Journal article talks about new research that found some brain functions improve with age:

But it's not all doom and gloom. An emerging body of research shows that a surprising array of mental functions hold up well into old age, while others actually get better. Vocabulary improves, as do other verbal abilities such as facility with synonyms and antonyms. Older brains are packed with more so-called expert knowledge -- information relevant to your occupation or hobby. (Older bridge enthusiasts have at their mental beck-and-call many more bids and responses.) They also store more "cognitive templates," or mental outlines of generic problems and solutions that can be tapped when confronting new problems.

The article concludes:

More research is coming. Although studies on aging have long focused on diseases such as Alzheimer's, scientists are increasingly investigating healthy aging, trying to discover which factors allow some people to resist the usual ravages of time, and to get a better sense of how well older adults can function.

You could imagine the parenthetical-- "how well older adults can function (while remaining in their homes)...."

Baby Monitor: Electronic Tether

People magazine spotlights "Heroes Among Us," and in the 10/02/2006 issue, described next-door neighbors Jim Sherman (age 55) and Annie Smith (age 85). The two long-time friends live in Conroe, Texas, and are both blind.

Smith's daughter, a nurse, gave Sherman a baby monitor so he could keep an ear out for Smith, who has Alzheimer's disease in addition to being blind.

On March 27th, 2006, Sherman began to hear odd sounds over the baby monitor in the middle of the night, and heard Smith say "Jim, the house is on fire!"

Springing into action, Sherman entered Smith's house through the frontdoor and followed the sound of her voice, finding her near the bathroom. Taking her hands, he led her out of the house to safety. The fire gutted Smith's house, killing her cat and three kittens.

It takes a family

This poignant NY Times article (free registration required) speaks to how a young lady can help a disabled sibling-- or in this case, two siblings. Tarah is 14, and her autistic twin brothers are 16:

Yet while she may call them names and run off to church dances, Tarah also wonders whether she might one day become her brothers’ caretaker. The Perrys haven’t made concrete plans for Justin and Jason, and since the boys are still maturing, it remains to be seen just how independent they’ll become. “If they end up living with me, I’m going to make them get a job and have some responsibility,” Tarah says. “That way, they wouldn’t be just sitting around the house playing video games all the time. Then I’d take what they earn, and some would go to keeping house and some to buy them more video games.” They could maybe work at Gamestop, their favorite store, she says.

There's a lot of focus on the "Sandwich Generation" seeking better ways to care for elderly parents, preferably helping them live independently as long as possible-- "aging in place" as it's called.

But another story is how siblings and other family members help disabled adults-- young to old-- also live safely yet with some independence, and most of all with dignity.

WSJ mention of Alarm.com

At the core of the SimplyHome is the Alarm.com technology, and it received a mention in today's Work & Family Mailbox in the Wall Street Journal, in response to this question from a reader:

Q: You wrote earlier this year that in-home electronic monitoring systems, with sensors that track a resident's movements, will soon be available to consumers as an aid in overseeing frail family members living alone. Where can I get more information?

The article was a follow-up from a prior Work & Family Mailbox piece that had this description:

Overseeing Mom or Dad from afar will get easier.

Two vendors are about to begin marketing in-home electronic monitoring systems to consumers. The systems track a resident's movements through wireless sensors mounted on walls, switches, doors, medicine cabinets or appliances, and alert 24-hour emergency-response workers of irregular activity patterns. Caregivers can monitor the systems via the Internet or request notification of irregularities via email, phone calls or text messages.

Funding for "Aging-in-Place"

This article in Utah's Deseret News spotlights a state legislative issue that we're seeing around the USA:

Current health department policy follows the federal government's requirement that long-term care be delivered in institutions such as nursing homes. The state has received permission from the federal Center for Medicare and Medicaid Services to allow some Medicaid recipients to remain in their homes. To receive one of the few waivers, however, qualified Utahns must first live in a nursing home for 90 days.

In Utah, a Senate committee killed a piece of legislation called HB249, which would have required lawmakers, when making their annual budget priorities, to consider funding for programs that provide in-home or community-based care for the elderly or disabled.

However, it seems the movement afoot across America is to allow funding for what are called "Assistive Home Technologies." Formerly this was called Telehealth, and some today call it Digital Home Monitoring. Whatever appellation it carries, it has great momentum despite momentary losses like the above.

Paying for Long Term Care

Here is a microsite by the American Health Care Association and The National Center for Assisted Living with good info on "Paying for Long Term Care."

Excerpt:

When it comes to long term health care, many Americans incorrectly assume that Medicare, supplemental policies or standard health insurance policies will cover the expenses. Consequently, many people do not plan ahead financially to provide for their care in the event of infirmity or extended illness. Costs of services provided by a nursing facility can exceed $50,000 annually, or more than $4,000 per month. Costs for residing in an assisted living facility average $24,000 annually, but can cost much more in urban settings or if a resident needs a high level of services.

As these figures show, paying for long term care calls for financial planning for your health needs, especially as you approach retirement. The following information is designed to give you a better sense of the financial programs and options available, as well as the benefits you can expect.

Senior Living Independently: NASCAR driver, age 72

Per NASCAR.com, the senior referenced in yesterday's blog entry came close:

DAYTONA BEACH, Fla. -- With six laps to go in Thursday's first Gatorade qualifying race, James Hylton was squarely in position to complete his seemingly impossible dream. At 72 years of age, he was in the 2007 Daytona 500.

Hylton was running eighth overall in his No. 58 Chevrolet and in the top two among those who hadn't already earned qualifying spots when Reed Sorenson blew an engine, bringing out a caution flag that ultimately squashed Hylton's chances.

72 year Old NASCAR Driver

In this Washington Post article, you can read about a senior citizen who not only drives...but drives at 4x the highway speed limit:

DAYTONA BEACH, Fla., Feb. 14 -- If he could have gotten NASCAR's approval, James Hylton says he would have outfitted his No. 58 Chevrolet with blinkers and flashed them nonstop during Thursday's qualifying race at Daytona International Speedway. What's the harm of having a sense of humor, Hylton figured, even though he's serious about the task at hand?

At 72, the silver-haired Hylton will strap into a racecar Thursday afternoon and battle at more than 180 mph for the right to compete in Sunday's Daytona 500.

His sponsor is Retirement Living TV (www.rl.tv), which has a superb Health & Wellness section.

Love & Money Podcast

Jeff Opdyke writes eloquently for The Wall Street Journal; his column is called "Love & Money."

On 1/28/2007 he penned this:

At some point, age does not come gently.

For the past year, my wife, Amy, has watched as her 94-year-old maternal grandfather has grown increasingly feeble. After 93 relatively healthy years, his mobility -- and ability to care for himself -- has taken a drastic turn for the worse.

Click here to learn more, by listening to his riveting podcast on the subject.

New York Times Article: "In Elder Care, Signing on Becomes a Way to Drop By"

A February 4, 2007 article in the New York Times by Christine Larson said:

About 19 million Americans, aside from paid providers, are caring for someone over the age of 75, according to the National Alliance for Caregiving. With the number of older Americans growing rapidly, products and services to help adult children care for their parents are on the rise.

The article went on to say:

Of course, not everyone wants someone looking over their shoulder. “There are privacy and ethical issues,” Ms. Stone said. “Where’s the line between motion sensors and Big Brother?”

She emphasized the need for aging parents to consent to the sharing of their information. She also pointed out that home health monitoring systems are in the very early stages, and that sometimes a friendly neighbor who notices, for example, that your mother has not retrieved her morning newspaper can be as effective as a motion detector. “Technology can be a complement to human resources, but many of these do not obviate the need for humans,” she said.

Unfortunately, many adult children live too far from their parents to fill that need at times. But finding help may be becoming easier, thanks to geriatric care managers, who can take on some of the higher-level care duties that home health aides do not cover, like attending doctors’ appointments or evaluating nursing homes.

To date, however, the geriatric care industry is largely unregulated-- care managers require no accreditation. Only a few states require care managers to be licensed, although care managers who are also nurses or social workers may have state licenses.

Starting in 2010, the National Association of Professional Geriatric Care Managers (GCM) will require all its members to hold one of four specific certifications in care management or social work.

Geriatric care managers typically charge $80-$200 an hour, depending on the services provided.

The GCM provides referrals to members at www.findacaremanger.org.

Telehealth Growth Factors

This 2006 article Study: Medicare, Insurers Reluctant to Pay for Telehealth pointed out two impediments to wide adoption of what they call digital monotoring, or "telehealth" as it's often been labeled.

Appropriate equipment is a huge barrier. Remote monitoring units typically cost between $3,000 and $5,000 and most organizations interviews felt that the price needed to drop to below $1,000 to spur adoption.

People living in remote areas tend to have noisy phone lines or use dial tones that can't allow collected information to be sent over telephone wires, and many elderly patients do not have broadband connections.

With SimplyHome, both these problems are eradicated. The equipment cost is < $1K already. And there is neither a phone line or broadband requirement. The service sends its data on a two-way basis in real time using the Cingular wireless network.

The article says that 65% of health care organizations interviewed were investing in remote monitoring equipment for high-risk, high-cost patients with multiple chronic diseases (called "frequent fliers" due to the many doctor visits per year they require). All indications are that this percentage is going up by the month, and increasingly organizations and families alike are contemplating digital monitoring for residents with lesser risks and health challenges, such that they can live at home longer.

And here's a compelling statistic regarding telehealth relating to just one chronic illness: A professor at the University of Tennessee Graduate School of Medicine has published estimates saying that remote monitoring could bring national costs of caring for congestive heart failure patients down from $8 billion a year to $4.2 billion, including costs of providing remote monitoring.

New Book: The Parent Care Conversation

Dan Taylor has written a book titled The Parent Care Conversation. Here's an interview where he talks about the steps in the conversation process. And this is from his highly informative website:

The Family Relationship Time Bomb

It's awkward and uncomfortable but it's critical to talk about providing for the care of your aging parents now. Most ignore the problem, some think they'll get by, but a catastrophic event or prolonged illness can quickly deplete a lifetime of saving.

Worse than the financial crisis is the relationship crisis that often occurs as families struggle to deal with this issue after the fact. It's a family relationship time bomb.

The Parent Care Conversation is a good read, and we've added it to our "Virtual Book Shelf" that you can see on the bottom right of our blog. And note that Dan has his own blog (URL: http://www.parentcaresolution.com/blog.asp).

This eWeek article from last year about remote monitoring hardware and software, titled: Report: Digital Health Coming to Grandma's House, has a key sentence:

The Parks Associate report predicts such equipment will become more common, particularly as a nursing shortage restricts home-care visits.

The fact is, just as an increasingly connected world (email, web, PDAs, cell phone text messaging) means home monitoring from near and far (remote) is now efficient and high fidelity, by public and private caregivers, there is a stimulus unrelated to technology: A deficit of accredited home health workers.

Further, new services such as from www.simplyhome-cmi.com flip the paradigm-- instead of the need for a consistent visit from a caregiver, whether that caregiver is a nurse, friend or family member, a "canary can be placed in the coal mine" such that WHEN there's trouble, or the appearance thereof, alerts are instantly fed electronically to one or more folks who can then react as needed.

The idea is continuous monitoring and reactions/visits as needed, versus hoping to catch trouble on a daily or bi-weekly on-site visit on a schedule. After all, trouble fits no set schedule.

According to this 1/31/2007 eWeek article, one of the world's biggest companies is joining the effort to help the elderly live independently:

Intel and the Industrial Development Agency of Ireland are teaming up to create technologies that help seniors live at home. The three-year, $30 million collaboration establishes the TRIL (Technology Research for Independent Living) Centre, where researchers from Intel and Irish universities will create devices that can keep elderly people engaged in their communities, detect and prevent falls, and help those with failing memory to maintain their independence.

The article continues:

Last week, Intel announced a $1 million collaboration with the Oregon Health & Science University to develop technologies that detect "behavioral markers" that can sense when an elderly person needs help. Such technologies could help the elderly live independently longer. The term "behvaioral markers" is similar to the term "biomarkers," which people in the preventive-disease community use to describe physiological signals that can serve as early warnings of disease.

Intel sees an aging society: But Intel is betting that the numbers are on its side. "There were 600 million seniors in 2000; there will be 1.2 billion seniors by 2025 and more than 2 billion by 2050," said Eric Dishman, manager of Intel's Health Research & Innovation Group, as he introduced the new center. According to a market report released last year, the market for digital home health services could exceed $2 billion by 2010. That's up from a mere $450 million in 2005. Still, the number pales in comparison with sales of blockbuster drugs, which can top $20 billion a year.

This USA Weekend article had a sentence that points to why we're seeing a plethora of "helping the disabled and elderly live independently" products and services, including many that electronically link family caregivers to their charge, like our own SimplyHome offering:

According to a 2004 study conducted by MetLife and the National Alliance for Caregiving, more than 34 million Americans provide support to an aging family member -- and about 5 million of them do so from a distance.

The article goes on to say:

When it comes to looking after your parents, you always have to be on the ball.

The SimplyHome offering helps you stay in constant touch with those you're helping, via email, cell phone text messaging and the web/PDAs. It makes distances far less relevant, because sensors in the residence report to you and your fellow caregivers with immediacy, and based on rules you set that are broken-- like a door open at night, or the absence of activity in the morning when the resident should be "up and about." SimplyHome helps you be on the ball.

Virtual Meals

This article on the AP wire from December 2006 shows another use for web technology:

Now, the technology consulting company Accenture is developing a system called "The Virtual Family Dinner" that would allow families to get together -- virtually -- as often as they'd like.

The concept is simple. An elderly woman in, say, California, makes herself dinner. When she gets ready to sit down and eat, the system detects it and alerts her son in Chicago. The son then goes to his kitchen, where a small camera and microphone capture what he is doing. Speakers and a screen -- as big as a television or as small as a picture frame -- allow him to hear and see his mother, who has a similar setup.

It seems that the long-talked about "picture phone" rears its head in this broadband-rich world with increasing frequency.

The article continues--

"I feel very limited by only being able to talk on the phone most of the time," said Cai Glushak, one of an estimated 34 million Americans caring for a person age 50 or older.

The array of technology tools and packaged services aimed at the "Sandwich Generation"-- people like Cai Glushak-- is broader and deeper by the month, and will radically improve care of the elderly and disabled.

Case Study: Helping Social Workers Better Monitor People with Disabilities (Part 3 of 3)

[Part 3 of 3. Part 1 and Part 2 are posted in this blog on 1/29/2007 and 1/20/2007, respectively]

In summary, caregivers felt that the Alarm.com system as implemented by Innovative Services, Inc. gave substantial improvements in cost effective support and oversight in a minimally invasive manner to residents, using the absolute minimum amount of time in their over-crowded schedules, but allowing for high fidelity electronic alerts anytime, 24/7, for real problems which required a rapid, certain response.

If you are interested in hearing more... call Allen Ray of CMI at 828-684-8441.

Who was Helped, and How?

Adolf J is in his early sixties, and for the past quarter of a century—-since his parents were no longer able to have him live in their home-- he has lived in an institution, along with thirty-one other disabled men. At the institution, his daily routine was dictated down to the hour. Everything was scheduled given the large number of residents in a relatively small space, from meals to showers to going outside for a walk. Adolf yearned for some independence, in regards to his mundane, daily routine-- tasks that those who have no disabilities take for granted everyday.

Now, with an all-wireless Alarm.com system quietly working in his apartment at the Valley Green complex in Green Bay, Wisconsin, Adolf lives by himself. Moderately cognitively disabled and not able to drive, Adolf has a full-time job in light assembly to which he can walk every Monday through Friday. Given the Alarm.com web dashboard, and its real-time email and cell phone notification capability, social workers know that he is up and about in the morning, and when he returns at the end of the day. Adolf also has a panic pendant which is connected to his support team, which gives him an added sense of security.

Adolf’s parents are no longer around to provide support—- but the parents of Becky H are still in Green Bay, and with great hope and excitement had helped Becky move into her own apartment a few years ago. Becky has a mental illness, and is legally blind.

Becky had been doing well in the same apartment complex as Adolf-- Valley Green-— until early last year. It was then that her parents began to suspect Becky was going in and out at odd hours, and perhaps also having “friends”-— potentially some of whom did not have her best interests at heart—- into her residence very late at night. Thus, her parents endeavored to move Becky back to an institutional setting, with great disappointment all around. However, with the installation of an Alarm.com system, Becky instead was able to remain in her apartment, and keep her nearby job in the packaging industry, which is the key source of her socialization.

Becky’s caregivers are using Alarm.com’s “Custom Threat Alerting” feature to set rules such as this one: If her front door opens after 9 pm, or before 6 am, they get an email and a cell phone message. Further, Becky lives in a basement apartment where flooding is potentially an issue, so one of the up to twenty-three wireless sensors with the Alarm.com system is a Flood Sensor, that can alert the team via email/cell phone messages.

Parents and social workers alike in Green Bay are using Alarm.com to help protect people like Adolf and Becky, who have a far higher quality of life living independently than if they were in an institutional setting. Further, the total costs of living independently are far less than those associated with an institutional setting.

With Alarm.com, the power is in the real-time messaging—- the system gives parents and other caregivers “exception data” that they can react to—-like a door open when it shouldn’t be, a stove left on too long, etc. Safety, peace of mind, and the accurate data to determine exactly what should be done when for the resident—- the Alarm.com system as implemented by Innovative Services has proved to be a powerful assistive home technology that provides all this and more, where the “home” is not an institution, but the resident’s very own apartment.