Technology is currently critical to home health care. Future advances in home health care technologies have the potential not only to facilitate the role of home health care within the overall health care system but also to help foster community-based independence for individuals.
Today I have the pleasure of introducing another Guest Blogger, David Priseman, who is an accomplished Executive Director. David had a career in consultancy and banking, including spells abroad with two major European banks and has worked for several years in the field of private equity and alternative finance as well as an advisor to SMEs. He has considerable board experience and currently chairs a mid-sized care home group and is a non-executive director of a small but ambitious technology company. He has a particular interest in how technology can address the challenges of the care sector, which is often slow to adopt innovation.
David is going to discuss with us today the future of technology in home-care for the elderly.
Both councils and families strive to keep the elderly living in their own home for as long as possible. Councils see a simple cost advantage in doing so, whilst families also like the idea that mum (statistically, it is usually mum) can still live at home.
However the reality of a single elderly person living at home on her own can be far from the rosy ideal. There is an alternative image of a harassed care worker rushing into an elderly person’s home, quickly heating up a tin of baked beans then 15 minutes later rushing out of the door. Yet this might be the only contact the person has with anyone until the same or a different care worker rushes by the next day.
Domiciliary care, like residential care, is difficult to provide effectively and profitably. Companies are handing back council care contracts as they cannot operate at the fee levels on offer (1). Staff recruitment and retention is a permanent challenge.
Councils are reluctant or unable to pay more than £15/hour, which is not financially viable for home-care providers, who now have to pay employees a higher minimum wage as well as their travel costs. However it can be viable at £20/hour. With care home costs around the £1,000/week level, half this amount would buy 25 hours of home-care per week. As the number of residential care beds is in slight decline whilst the number of elderly people is projected to rise steeply, this implies that the number of elderly people living at home will also rise. With this could come a significant growth in the self-payer home-care market.
People living at home are exposed to the risk of physical vulnerability, slow and inappropriate care delivery and social isolation. However the recent development of new technologies may in combination significantly improve the social and care experience for such people.
The unpredictability of the number of hours worked together with the short term notice of rotas and sudden changes in rotas are a major cause of high home-care worker turnover (2) and a headache for domiciliary care providers. However a range of competing software and apps have now been developed to mitigate (though not remove) this challenge. This can improve the efficiency of staff scheduling from a provider’s view point, addressing one of the main sources of dissatisfaction of employees whilst also introducing flexibility for the elderly resident.
Many elderly people have traditionally had a regular, perhaps weekly, phone call with their children. Some now conduct this through Sype. In addition, some families have installed a videocam or webcam in their parent’s home, usually in the kitchen or lounge/dining room, so they can see mum. This helps to maintain social contact and give reassurances about mum’s safety and wellbeing.
The development of ‘wearable technology’ should become more widespread. Currently the dominant application is for fitness monitoring during exercise, however it will increasingly move over to healthcare monitoring. This can be a watch or a monitor which is worn as an arm panel or in the future may be embedded in clothing; in all cases it measures certain of the wearer’s vital signs.
At present, these are mostly used in hospitals to reduce the requirement of nurses, of whom there is a well-documented shortage, to conduct routine patient checks. Instead, the data are transmitted to a cloud-based server and if a vital sign reading crosses a warning threshold this immediately signals an alert. In time, these devices will migrate to the residential setting.
This will speed up the awareness and treatment of a wearer’s condition. Major medical devices companies such as Medtronics and GE are active in this area, which has also seen technology start ups enter the market, such as EarlySense and Snap40. (3)
The internet of things (IoT) is rapidly increasing the number of internet-connected devices in the home. This can be used in a number of ways to improve the safety of elderly people living at home. For example, many people get up, go to the toilet, have a cup of tea and open the curtains. Sensors can detect whether or not the toilet has been flushed, the kettle boiled and the curtains opened, and if any of these things has not happened by say 9am then an alert would be triggered. (4)
One of the main problems facing the elderly living alone is loneliness and the lack of contact with others. Here, a combination of technologies is emerging to provide at least a partial solution. Awareness has recently increased of Amazon’s Alexa voice-controlled system which can search the internet, answer questions and respond to simple commands. Apple’s Siri and Microsoft’s Cortana are similar and rival devices.
Owing to improvements in voice recognition and AI, it will increasingly be possible to have an interactive ‘conversation’ with such devices. At some point, it may be possible to combine this with the face of a person on a screen or even a hologram of a person in the room to create the impression that a human is having a conversation with and maybe even developing a relationship with an intelligent machine-based ‘person’.
This idea has been explored in television and film, for example the science-fiction drama Her when a man develops a romantic relationship with his computer’s feminised operating system (5). Soon, it may become reality and even commonplace.
Finally, more than one of these technologies may combine in a way that provides care monitoring, practical assistance and companionship. Developed countries all have aging populations so the need to find solutions is urgent and many companies and universities are conducting research into this area, such as robotics with AI (6). New market opportunities are emerging to integrate and package appropriate technology solutions.
The vulnerable elderly living on their own at home have often been poorly served to date. Yet the number of such people is poised to continue to rise steeply. However a number of technologies are now being developed in parallel to tackle the problems they face. The result may be an improved care environment for the elderly at home: safer, reliable, better supported and less isolated. Such a future could be with us sooner than we think.
You can contact David Priseman on LinkedIn or by email: davidpriseman @ btconnect.com (remove spaces).
References
1. http://www.bbc.co.uk/news/uk-39321579
2. http://timewise.co.uk/wp-content/uploads/2014/02/1957-Timewise-Caring-by-Design-report-Under-200MB.pdf
3. http://www.earlysense.com/ and http://www.snap40.com/
4. https://www.ibm.com/blogs/internet-of-things/internet-caring/ and https://www.ibm.com/blogs/internet-of-things/elderly-independent-smart-home/
5. http://www.herthemovie.com/#/about
6. http://www.bbc.co.uk/news/business-39255244
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