5,000,000 Alzheimer's Patients in the US Today

This NY Times article is rich with information:

Five million people in the United States have Alzheimer’s disease, according to a study last week by the Alzheimer’s Association. About half, 2.5 million, are at the early stages of the disease, other studies have found, struggling to pass for normal.

There's been a significant increase in better treatment methods for Alzheimer's. Probably one of the biggest areas of research and productization is relating to small devices that the patient can wear such that he/she can be tracked at all times-- including an alert being sent to caregivers if the patient moves out of a "geo-fence" (a "virtual" circle on a map).

Retirement Living TV

The Baltimore Business Journal recently wrote about a bold new TV effort:

Through its educational programming -- shows about everything from Medicare to fitness to money -- RLTV aims to change the way Americans perceive, and live, their retirement years.

Just about a year after its launch, Retirement Living can now be seen in about 26 million homes nationwide, filling blocks of time for two Comcast networks -- CN8 and CET5 -- and also being distributed through DirecTV.

The network is developing about 15 original shows, has 300 hours of programming in the can and recently signed a deal with the American Federation of Television and Radio Artists (AFTRA) that will allow RLTV to bring in proven talent to host those programs.

Check out their web site at www.rl.tv. We think a channel like this is much needed and we hope it's successful.

AT Network

California based AT Network has a website filled with information on Assistive Technology (AT).

Here's their mission statement:

California’s AT Network is dedicated to expanding the accessibility of tools, resources and technology that will help increase independence, improve personal productivity and enhance the quality of life for all Californians.

AT Network is affiliated with The Alliance for Technology Access, which projects this mission statement:

The Alliance for Technology Access (ATA) is the national network of community-based Resource Centers, Developers, Vendors, and Associates dedicated to providing information and support services to children and adults with disabilities, and increasing their use of standard, assistive, and information technologies.

Both websites have helpful information for public and private caregivers.

Folding@Home

In the DigitalMediaWire yesterday was a report about "Folding@Home"--

More than 42,000 PlayStation 3 owners have signed up so far for Folding@Home, a distributed computing project from Stanford University that will use the consoles' Cell processors to crunch research data on diseases like Parkinson's, Alzheimer's and cancer.

This community program processing was famously done once before, with SETI at the University of California:

SETI@home is a scientific experiment that uses Internet-connected computers in the Search for Extraterrestrial Intelligence (SETI). You can participate by running a free program that downloads and analyzes radio telescope data.

So now not only are microprocessor-based systems like SimplyHome going into residences to help folks live independently, but excess computing power in aggregate from other microprocessors-- namely game consoles-- are being harnessed to help solve the very health problems that cause folks to LOSE the ability to live independently.

Planning for Caregiving

This Washington Post article yesterday has this lead sentence:

When Anne and Robert Tucillo think about retirement, their thoughts immediately turn to their oldest son, 14-year-old Bryan. What will he need, and how will they provide?

There appears to be a substantial, nationwide movement afoot among those who may care-- or already care-- for the disabled or elderly to proactively plan methods whereby their loved ones can live as independently as possible, for as long as possible, and as safely and cost-effectively as possible.

Embracing Technology... (Part 4 of 4)

Embracing Technology...

It's Not Your Parent's "Big Brother"

by Allen Ray, CEO of CMI

[fourth of four parts]

What monitoring technology is available?

o Personal Emergency Response Systems (PERS): Personal Emergency Response Systems (PERS) devices are stand alone systems. Often, these are very limited in their scope, and may require an expensive long-term contract. The responders are usually police, fire departments and/or EMS. There are charges for fire department and EMS responses as well as for false alarms.

o Central station monitoring: Monitoring is provided by a licensed security company. Central station monitoring limits the types of events monitored and the reports and data made available to consumers or care providers. The role of the central station should be to supplement but not replace that of local care providers--especially friends and family--who have the advantage of a relationship with the resident and knowledge about their particular situation and history. The consumer and care team should know exactly what to expect from a central station system. How does the central station system insure they have current data on which to base a response? Will this system provide notifications to the caregiver support team?

o Pre-packaged systems: These systems are available through retail outlets and infomercials. They usually have limited reporting features and expandability.

o Personalized activity monitoring systems: I recommend considering a system that is expandable and encourages creation of an individual plan of support with flexible notification options but does not require a long-term contract. Systems that can accommodate unique devices like stove sensors, pressure sensors, medical monitors, etc. for maximum flexibility allow many consumers to live at home longer, possibly with assistance but without the need for full-time institutional care.


What are the costs?

o Hardware costs typically range from $200 for a PERS (Personal Emergency Response System) system to $500-950 for a basic, but individualized, monitoring system. Specialized systems cost more.

o Monthly costs generally begin at $40 but can go much higher depending on the level of oversight, and whether the service plan includes central monitoring. Central station monitoring services may require an extended contract of 1-3 years.

What are the savings?

o There is no bricks and mortar component. In a time of reduced funding, all necessary support, when appropriate, should go to services.

o The costs of these systems are often offset by the savings they create. Care providers can eliminate or reduce the number of full time employees on call at a given time for “what if” scenarios.

I get my own mail now!

The greatest value of using personalized monitoring technology is in enhancing the quality of life we often take for granted. Recently, our company moved several individuals from institutional ICF/MR facilities to apartments and other supported home settings. We had run all the numbers and expected significant savings. We trained staff for their new roles, expected some improvements in behavior rates and anticipated some challenges with community placements. What we could not predict were the consumers’ responses to moving from institutional care to their own home. We did not consider how readily these consumers would claim ownership of their daily schedules; how quickly they participated in meal planning, shopping and preparation; how definite their tastes were in decorating their own space; how proud they were to do laundry, to develop housekeeping and lawn maintenance skills; and the absolute joy in going to their own mailbox. While the savings and other business aspects of the moves are certainly quantifiable, the improvements to quality of life are immeasurable!

In summary, there is no one perfect answer to aging in place or living successfully with a physical or developmental disability. There is, however, a new technological arrow for your quiver. Embrace it! Imagine what we can accomplish by supporting and sustaining people in their homes for as long as possible. Truly, there is nothing better.



Author Bio
Allen Ray is President/CEO of Community Management Initiative (CMI), Inc., a company that delivers programs, supports, tools and services designed for caregivers of the elderly and disabled. Blending Alarm.com’s wireless and Web-enabled monitoring technology into CMI’s “SimplyHome” offering, Ray has helped develop a cost-effective solution for public and private caregivers that allows care recipients to lead more independent lives. Through an affiliation with CMI and other companies, Ray has been involved in owning, procuring funding for and providing services to seniors and developmentally disabled adults since 1989. If you have questions or would like more information please contact him at allen.ray@simplyhome-cmi.com or toll free at 1-888-684-3581.

[This is a four-part series. To read the first three parts, see the blog entries from March 20-22]

Embracing Technology... (Part 3 of 4)

Embracing Technology...

It's Not Your Parent's "Big Brother"

by Allen Ray, CEO of CMI

[third of four parts]

What prevents technology from being embraced as a form of service and support?

o Funding Obstacles: Much of today’s funding utilizes Medicaid and Medicare systems designed in the 1960’s, when little affordable technology was available. New systems of support make better use of limited resources. Most states already have or are in the process of implementing proper funding mechanisms to include electronic supports; thereby stretching the available dollars while increasing consumer options.

o Fear of what we don’t know: By embracing this concept, many seniors, caregivers and service providers will be exposed to new equipment and to a new service delivery system. Seniors may fear they are being “spied” upon or are losing their opportunities to “touch base” with their family member/caregiver. The caregiver may believe they are “being replaced” or forced to become a computer “geek”. Using technology for monitoring supports and data collections will require providers to learn and to use a new skill set. It is human nature to avoid something we perceive as challenging or difficult.

o Fear of losing control over what we know: Healthcare providers have always had to rely on what people tell them. Not all consumers recognize trends in their own behavior, are aware, forthcoming or totally truthful about their problems. Just what will a sensor sense?

o Fear that technology will replace the “care” component: Contact with family, friends and the community are vital components of everyday life. Will being able to “log-in” or receive a text message replace direct interactions?

To implement technology as a valid platform of service provision, healthcare providers, caregivers and family members must integrate these tools into the continuum of care. “Caring” for people requires being with them. Technology should enable and inform caregivers… not replace them.

[Part 4 is tomorrow; Part 2 was yesterday]

Embracing Technology... (Part 2 of 4)

Embracing Technology...

It's Not Your Parent's "Big Brother"

by Allen Ray, CEO of CMI

[second of four parts]

The solution to many of these problems can be found by embracing technology as an optional form of service for all caregivers. While it’s not for everyone, it should be considered as an option to allow consumers to stay in the most independent setting possible. Here are a few samples of how technology can be used to allow increased opportunities for independent living:

1. Family and Friends can access the web any time and from anywhere to trend activities like sleep patterns, meal preparation or the timeliness of medication dispensing. Caregivers can design customized parameters to be notified of exceptions to normal everyday patterns, such as: prolonged inactivity during certain hours when the individual would typically be moving about the home; a door or window being opened at unexpected hours; or an electric stove being on for longer than normal. Automated phone, text message, and email alerts let friends and family find out immediately if there’s a potential problem at the home of a loved one.
   
   
2. Case Managers can access individualized reports containing valuable information about a care recipient’s day-to-day activities. Using this information, they can create a more accurate and useful Individualized Support Plan. Additionally, they can verify visits by professionals (Nursing, PT, OT, etc.) through the use of an entry and exit access code.
   
   
3. Community and Home Health Agencies can use medical and disease management devices to analyze data trends as well as receive notifications for specified data anomalies. Data is stored in a password-protected web site. There is also a benefit in tracking employees through access codes to ensure accurate billing.
   
   
4. Long-term Care Providers can be part of the paradigm of community services by becoming a part of the response team of caregivers. If a resident chooses, the local care provider can receive alerts and notifications for certain types of non-alarm events for which central station response might not be appropriate or effective. This direct monitoring connection between consumer and local care provider allows for a more tailored response in the event of a potential issue at the residence. It also lets care providers establish a link early on with consumers who live independently but may need additional long-term care supports in the future. By using electronic monitoring, campus providers can offer their consumers additional supports to “age in place.”
   
   
   [Part 3 is tomorrow; Part 1 was yesterday]

Embracing Technology...It's Not Your Parent's "Big Brother" (Part 1 of 4)

Embracing Technology...

It's Not Your Parent's "Big Brother"

by Allen Ray, CEO of CMI

[first of four parts]

No longer evoking fears of Big Brother, personalized monitoring technology has gained popularity over the past several years as consumers have begun to understand and welcome the advantages it offers. Many individuals, who historically would have been dependent on institutional supports can now use non-invasive assistive technology to live at home. Why is staying at home important? Why are we connected to a place? Home is the place that gives quality to our lives. It is where we shape our behavior and weave the fabric of who we are.

Caregiver Crisis… Who will be the caregivers?

In a time of increasing demands and diminishing resources, who will we depend on and where will we live?

v Family and Friends: Historically, family and friends have been the safety net.

o Problem: Family and friends strive to balance parenting and work with the challenges of providing appropriate care--often long distance--for loved ones.

v Case Managers: Case managers have always been the backbone of identifying proper supports.

o Problem: Decreased funding and increased case loads have limited this option to crisis management.

v Community Agencies and Providers: This provision of care has always emphasized home supports.

o Problem: The number of support requests continues to grow, while agencies and providers struggle to attract and retain qualified caregivers.

v Long-term Care Providers: Historically these have been the nursing homes, intermediate care facilities, assisted living centers and retirement campuses.

o Problem: Reimbursement pressures, staffing shortages, and consumers’ increasing resistance to long-term institutional options have decreased the use of this form of care.

[to be continued tomorrow...]

Online Oxygen

TRENDWATCHING.com wrote about what they call "Online Oxygen" here, and it will resonate with all of those who crave ubiquitous online access:

Just consider the fact that these days, consumers don't want online access anywhere/anytime, they absolutely CRAVE it! From airports to living rooms to roof gardens to classrooms to city parks, people go to great lengths to get a dose of what TRENDWATCHING.COM has dubbed ONLINE OXYGEN. Seven years after the first web sites started popping up, and email made its way from science labs to office desks and living rooms, 600 million consumers worldwide are beginning to see online access as an absolute necessity, and there are no signs that the pace of integrating online access into daily life is slowing down.

Assistive Technology (AT) like that offered by SimplyHome levers this trend-- our system sends real-time alerts & notifications to caregivers via what we call "the electronic tether." The alerts & notifications are emails, cell phone text messages and/or automated voice calls, and we rely on an increasingly connected world.

The Greenhouse Project

The Greenhouse Project states their mission with crystal-clear clarity on their website:

The Issue: Seniors And Persons with Disabilities Need Alternatives to Costly Institutional Settings

Hundreds of thousands of Americans are forced out of their homes each year due to an inadequate supply of high quality, affordable housing with services. Those who choose not to leave forgo needed services or rely on family members who struggle to meet their needs. Many are even placed in a nursing home unnecessarily. As America’s senior and disabled populations continue to rapidly increase, it is crucial to create more affordable, less restrictive alternatives to nursing home care.

It's worth reading more at their website, especially about the company behind it, NCB Capital Impact:

NCB Capital Impact serves as a bridge between those programs, offering states, federal agencies and providers assistance with:

• Medicaid policy and programs
• Real estate development
• Regulations and licensing
• Project financing
• Housing finance policy
• Policy research.

Funding, Funding, Funding

This article in USA Today talks about the complexities of reimbursement, telling the story of a family with three adults on disability:

Now, the Zolotorows are among the approximately 50 million people who qualify for assistance through Medicaid, a $313 billion-a-year federal-state program that provides health care coverage for low-income pregnant women, children, the disabled, some adults and many of the nation's nursing home residents.

Despite its wide reach, the program is not an all-encompassing safety net.

There are 300 million Americans-- Medicaid serves almost 20% of us. Funding issues only become more complicated by the year across the board, of course, but on the plus side an array of Assistive Home Technologies for the elderly and the disabled are hitting-- or have hit-- the market-- which should have a profound effect on the quality and cost of care.

SugarStats.com

Nearly 21 million Americans are believed to be diabetic, according to the Centers for Disease Control. Further, 41 million more are prediabetic -- their blood sugar is high and could reach the diabetic level if they do not alter their living habits.

Nationwide, the disease's cost -- from medical bills to disability payments and lost workdays -- was conservatively estimated by the American Diabetes Association at $132 billion a year. All cancers, taken together, cost the country about $171 billion a year.

Thus we keep a close eye on the treatments, technologies and new services in this space, and we've been watching a new firm called SugarStats (www.sugarstats.com). Here's what they say on their website; we think they may add value in a new way using what is called "Web 2.0."

Built by diabetics for diabetics, SugarStats is not meant for tracking every minuscule detail but to provide a simple, clean interface to access the most essential and decisive info which empowers you to spot dangerous trends and better manage your diabetic lifestyle.

You can input and access this information from any modern web browser and soon via many cell phones, PDA's and mobile devices. So no matter where you are, you have easy access.

How the SimplyHome system works

This March 12, 2007 article in the Sun-Sentinel in South Florida has a lead paragraph as follows:

A host of new technology products and services may help reduce medical costs for individuals, employers and health insurance companies by making it easier for people to remain independent in their homes longer, reducing the need for hospital care.

Note that there are some key differences between the system mentioned in the article, and our own SimplyHome system:

1. Our system tethers residents to their friends and family-- those who know them best, and some of whom are likely right nearby.
   
   
2. All the sensors in the world don't matter if data isn't transmitted in real-time. We allow a phone line-- and/or our nationwide two-way radio network. Some folks don't have traditional phone lines these days because they've gone to VoIP.
   
   
3. Our system is highly focused on Exception Data. You set rules looking for activity that occurs that should not ("back door open at midnight") or the absence of activity when there should be some (our "Up & About" feature). When rules that you set with our initial coaching are broken, you and others on the contact list get phone calls (automated voice), emails and/or cell phone text messages, depending on how you set it up.

Finally, it's especially important to select a system that is easy to install-- too many solutions get purchased but not correctly implemented, activated and set-up. Our system can easily be installed by you-- and then we get on the phone and work you through the set-up process, via the web.

"Minding our Elders" blog

Here's a well-written blog called "Minding our Elders" with the subheading "Why You Can't Parent Your Parents."

It's written by Carol Bradley Bursack, and here's her bio:

Columnist, author, speaker and blogger Carol Bradley Bursack, author of Minding Our Elders: Caregivers Share Their Personal Stories (published by McCleery and Sons Publishing, 2005; ISBN 1-931916-41-1), has been interviewed on national radio shows, and by journalists interested in elder care.She has also written articles on elder care and speaks frequently at conferences and workshops. Minding Our Elders has been chosen as a text for college gerontology classes as a vehicle to humanize the caregiving experience to students.

Bursack is an elder care columnist with a weekly column in the Sunday edition of The Forum, flagship newspaper of Forum Communications Company. Her radio interviews include The Bev Smith Show, Radio Health Journal, The Tom Pope Show, Coping with Caregiving (clip here), The ElderLaw Forum, and The Lee Michaels Show and The Sherrie McCutcheon Show.

For over twenty years Bursack cared for a neighbor and six elderly family members. Through the years of caregiving and deaths, she came to know professionals in the field as well as many family caregivers Bursack became an avid student of the subject as she discovered she was just one of the 44 million people taking care of another adult (according to AARP). It was the caregivers themselves who inspired and encouraged Bursack to write Minding Our Elders: Caregivers Share Their Personal Stories.

Bursack is a member of AARP, CAPS (Children of Aging Parents), the National Caregivers Advisory Panel, the National Family Caregivers Association and is on the advisory board of RSVP (The Retired Senior Volunteer Program). She is a charter member of WWNO (World Wild Networking On-line for Health and Elder Care Professionals). She has a degree in English Literature and has worked in libraries in the United States and Europe. She has written humor and interview columns and developed and written newsletters for businesses in the elder care field.

Bursack is a native North Dakotan and the mother of two grown children. After pursuing adventures elsewhere, she returned to Fargo, ND to enjoy family and friends in a quality atmosphere. She feels fortunate to have lived her caregiving years in an area that continually upgrades services to its elderly and those who care for them.

There are few good blogs in the space of "Independent Living," but they're coming. This is one of the best, today.

What is Assistive Technology (AT)?

The Voice of America explains it in a radio broadcast here, where there's also a text transcript.

Here's how it begins:

Technology offers many different ways to help people with disabilities lead more normal lives. Devices that help them perform an activity are called assistive technology. Assistive technology can help people reach their personal and professional goals.

It's worth a listen.

NCOA

The DC-based National Council on Aging has important resources for "Staying Independent," click here for the key web page.

The NCOA's mission is this: To improve the lives of older Americans.

Founded in 1950, the NCOA is a charitable organization with a national network of more than 14,000 organizations and leaders. Members include senior centers, area agencies on aging, adult day service centers, faith-based service organizations, senior housing facilities, employment services, consumer groups, and leaders from academia, business, and labor.

New Take on Nursing Homes, and a New Book

Check out this NPR piece (two-parter). It has a fascinating first paragraph that addresses the issue of "Aging Well" from a different perspective, that of fixing nursing homes:

Many people think of nursing homes as grim places where residents often seem bored, lonely and sad. But now some reformers are experimenting with a new kind of nursing home. Instead of an institutional setting, they want to provide a homelike atmosphere for residents.



Also, check out this new book we added to our book shelf on the bottom right; it's a good read.

Video: Too Invasive?

Our view is that folks seeking to live independently with the help of caregivers-- whether those caregivers be public or private (family/friends)-- don't want to feel "spied on."

So when we see clever solutions like this from a firm in France, we tend to think it goes in the wrong direction:

EMITALL Elderly Monitoring
The system performs non-intrusive video monitoring thanks to a scrambling functionality (only the outline of the person is visible) with automatic slip and fall detection and non-moving person detection. In case of a fall or immobility, an alarm (SMS, MMS, e-mail...) on client devices (cell phones, smart phones, PDA's...) . Neutral areas can be defined where change detection is not activated to avoid false alarms (bed, sofa,…).

Clearly it's time to take advantage of real-time electronic, two-way communication. The question is where does this helping behavior cross the line to feel, to the resident, like surveillance?

Elder Care Benefits

This Washington Post Life at Work column entitled "Caring for Dear Old Dad Gets a Little Easier (More Companies Are Offering Benefits)" said the following:

About 27 percent of companies offer some elder-care benefits, according to the Society for Human Resource Management, a percentage that has been steadily increasing in the past few years. They realize that just as parents in the workforce could be more productive with assistance like backup child care, support groups and free advice, those same people could also use help caring for their parents or grandparents.

Perhaps-- hopefully-- you're seeing this trend at your company:

Elder-care benefits are following the same path as child-care benefits, which increased as the number of women in the workforce grew. The popularity of the benefits has risen as statistics show that employers benefit as well: Fifty-four percent of employers say child-care services reduced the number of missed workdays by as much as 20 to 30 percent, according to a Cornell University report.

15 Years Ago, a Vision of Digital Health

Way back in 1992, Glen Williamson wrote this prescient article. Here's the abstract, and the whole document is here:

A computer (PC) based, nonrestrictive activity monitoring and emergency detection system for the elderly or infirm is proposed. The intent of this system is to allow a population of people, meeting certain criteria of mobility, to continue to live in their own homes beyond a time when they might move into a retirement or nursing home. The effect of such a system would be the reduction of the direct-care nursing home population, having the obvious benefits both economic and psychological. The system is meant as an adjunct to - not a replacement of - social services such as person to person call-in programs, "Meals on Wheels," visits by social workers, care givers, etc. This paper discusses the need for research aimed at making such a system totally non-intrusive to the user, providing security and, at the same time, preserving a feeling of autonomy. The costs of this system, when compared with a live-in companion, for example, would be significantly less.

Continua Alliance

We've been keeping an eye on San Francisco-based Continua. Their overview page speaks to their mission:

Busy lifestyles that leave little time or motivation for fitness and weight management; a rise in chronic diseases; an aging population that requires escalating levels of supervision and medical intervention – these are the lifestyle, health and demographic trends that are directly contributing to skyrocketing health care costs.

• More than 1 billion people in the world are overweight, and at least 300 million of those are clinically obese. Without action, more than 1.5 billion people are expected to be overweight by 2015.
• Over 600 million people worldwide have chronic diseases, and the spending on chronic diseases is expected to increase. For example, in the US alone, spending is expected to increase from $500 billion a year to $685 billion by 2020³.
• Globally, the number of persons 60 and older was 600 million in 2000. It is expected to double to 1.2 billion by 2025 ^[4].

The personal telehealth opportunity

In a system well-designed for improving health, people with heart disease or diabetes can transmit their vital signs – blood pressure, heart rate, glucose levels, temperature, weight, respiration – seamlessly from home to their health professional, and get real-time feedback on their condition. A busy professional is able to receive a daily electronic check-up on the health status his aging parent who lives alone, suffers from a series of chronic conditions and is on multiple medications. A traveling businessperson can have a real-time discussion about the workout she just completed with a trainer who is hundreds of miles away.

Today, technologies like these that can enable more proactive personal health exist and are being applied – but not nearly as commonly as needed to radically improve health and quality of life and eliminate unnecessary costs from the healthcare system. To become a central component of the way we manage health, personal health and medical devices must be fully interoperable with each other and with other information sources. Because broad interoperability has yet to be achieved, it is an emerging priority for health systems and for the medical and information technology industries. Creating a rich eco-system of interoperable health and fitness devices will:

• Empower individuals and patients to better manage their health by providing them with information regarding their fitness and health through personal medical devices and services.
• Allow loved ones and professional care givers to more accurately monitor and coach chronic disease patients and elderly individuals living independently.
• Enable medical and fitness device manufacturers to rapidly develop interoperable devices and services using industry developed connectivity standards.
• Enable health care providers to offer better quality care through personalized health solutions assembled from a rich marketplace of interoperable health care devices and services.