Guest-blog: David Priseman – The future of technology in home-care for the elderly

David Priseman

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

Why H2H and a sense of purpose is still what real people (not machines) focus upon!

By now you’ve probably heard a lot about wearables, living services, the Internet of Things, and smart materials. As designers working in these realms, we’ve begun to think about even weirder and wilder things, envisioning a future where evolved technology is embedded inside our digestive tracts, sense organs, blood vessels, and even our cells.

Let’s talk about a scourge of modern times. There is so much stuff to watch, read, listen to, buy, eat or learn about. The world is available at our fingertips at any moment. It feels glorious but also horribly, paralyzingly overwhelming.

Should I wade into Spotify’s sea of every song ever recorded or give up and listen to my downloaded copy of Beyonce’s “Crazy for Love” for the 47,000th time? Psychologist Barry Schwartz called this the “Paradox of choice” in his 2004 book of the same name. Like many ideas that come out of TED Talks, it is too simplistic to say more choices are counterproductive, but I think we’ve all experienced the feeling.

Naturally, technology companies have some ideas about how to help people discover things and select among the flood of options — and make money in the process. And even they are recognising the limits of technology in helping people stay informed and entertained.

To see the future, first we must understand the past. Humans have been interfacing with machines for thousands of years. We seem to be intrinsically built to desire this communion with the made world. This blending of the mechanical and biological has often been described as a “natural” evolutionary process by such great thinkers as Marshall McLuhan in the ’50s and more recently Kevin Kelly in his seminal book What Technology Wants. So by looking at the long timeline of computer design we can see waves of change and future ripples.

The effects of technological change on the global economic structure are creating immense transformations in the way companies and nations organise production, trade goods, invest capital, and develop new products and processes. Sophisticated information technologies permit instantaneous communication among the far-flung operations of global enterprises. New materials are revolutionising sectors as diverse as construction and communications. Advanced manufacturing technologies have altered long-standing patterns of productivity and employment. Improved air and sea transportation has greatly accelerated the worldwide flow of people and goods.

All this has both created and mandated greater interdependence among firms and nations. The rapid rate of innovation and the dynamics of technology flows mean that comparative advantage is short-lived. To maximise returns, arrangements such as transnational mergers and shared production agreements are sought to bring together partners with complementary interests and strengths. This permits both developed and developing countries to harness technology more efficiently, with the expectation of creating higher standards of living for all involved.

Rapid technological innovation and the proliferation of transnational organisations are driving the formation of a global economy that sometimes conflicts with nationalistic concerns about maintaining comparative advantage and competitiveness. It is indeed a time of transition for firms and governments alike.

In the markets of the United Kingdom and the United States, we are constantly seeing ‘flexibility’ and ‘change’ to our economies; this evidence is continuing with the ‘Gig Economy,’ the millennials and a new operating business economy. There are huge advantages to inflexibility and predictability, as continental Europeans appreciate. The evidence shows that continuous re-optimisation is not always the best route to building solid, sustainable foundations for business and relationships.

People also want to be trusted and respected themselves. This requires that they have some responsibility and autonomy. Most of us like to feel we are working well or helping others, because we could not expect to be respected otherwise. That is a key element in the motivation to work, the satisfaction of the professional norm. Yet in recent years employers have used more and more financial incentives to motivate people: Performance-related pay has been creeping in everywhere, including the public service.

With all of these considerations, are mainstream economists right or wrong in how they approach our social and economic problems? Partly right, partly wrong. Here is the good part: Each individual knows more about himself or herself than anyone else does. So, there are huge gains all round if we can freely exchange

goods and services with each other, including our labour. This is especially so where markets are large and well-informed and no one affects anyone else except through the process of voluntary exchange. Indeed, economists have correctly shown that if these conditions exist and contracts can be enforced and people can start sharing within a ‘shared economy,’ the outcome will be fully ‘efficient.’ In other words, everyone will be happy as is possible without someone else being less happy. This important claim helps to explain the extraordinary success of post-war capitalism in producing material advance.

Yet, why did this advance not guarantee a rise in personal happiness? The reason is that many of the most important things that touch us do not reach us through voluntary exchange. Nor have our tastes, expectations and norms remained unchanged, and these too affect our happiness.

Values in people can also change. In the last 50 years we have become increasingly independent and individualistic. We are ever more influenced by the Internet and versions of the ‘survival of the fittest;’ Charles Darwin said, ‘It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.’ Describing ‘the invisible hand,’ Adam Smith said: ‘The great source of both the misery and disorders of human life, seems to arise from over-rating the difference between one permanent situation and another. Avarice over-rates the difference between poverty and riches: ambition, that between a private and a public station: vain-glory, that between obscurity and extensive reputation.

The person under the influence of any of those extravagant passions, is not only miserable in his actual situation, but is often disposed to disturb the peace of society, in order to arrive at that which he so foolishly admires. The slightest observation, however, might satisfy him, that, in all the ordinary situations of human life, a well-disposed mind may be equally calm, equally cheerful, and equally contented. Some of those situations may, no doubt, deserve to be preferred to others: but none of them can deserve to be pursued with that passionate ardour which drives us to violate the rules either of prudence or of justice; or to corrupt the future tranquillity of our minds, either by shame from the remembrance of our own folly, or by remorse from the horror of our own injustice.’

My final thought in the matter is that the answer to technological overload is not less technology but more humanity.

Digital transformation, solving problems with technology, exponential growth through technology, the integration of humans/machines, Artificial Intelligence, Internet of Things etc. Like it or not, there is no way out, technology has taken over already: I lived without a Smartphone for a few weeks to find out that you soon get excluded from communities, groups, discussions and business.

The problem is not development of new technology, this is nothing new for humanity. The problem is the speed and the major impact it creates for us. It is paradoxical, but humans have the capacity to create innovation and technology with which, at the same time, they have problems keeping up with, technically, emotionally and as a society. We are used to slow, incremental change. Only few people can keep up with the speed and nature of change, most of us get anxious and try to row backwards.

The most important things for our survival are not digital: air, water, food, clothes, emotions, the warmth of a human body next to us. Spending time with people living in a strong connection with and in and from nature was eye opening: we do not live in and with the nature, we are a part of nature, fully integrated with it.

We should ask: “If technology was supposed to make our lives easier and better, why is everybody so exhausted?”. “How can we stay present and awake in a world of distraction and consumption?”

My belief is that a society cannot flourish without some sense of shared purpose. The current pursuit of self-realisation will not work. If your sole duty is to achieve the best for yourself, life becomes just too stressful and too isolated and lonely, and you will be set up to fail. Instead, you need to feel you exist for something larger, and that very thought takes off some of the pressure.

We desperately need a concept of a common purpose, a common vision and a sense of working together to achieve the one overall goal. Human happiness comes from the outside and from within. The two are not in contradiction. The secret is compassion towards oneself and others, and the principle of the greatest happiness is essentially the expression that can all share connections. Perhaps these are the cornerstones of our future culture.

I believe now is the moment to define our terms. Technology is fast, and fast is getting faster, fast is busy, controlling, aggressive, hurried, analytical, stressed, superficial, impatient, active, quantity-over-quality. Slow is the opposite: calm, careful, receptive, still, intuitive, unhurried, patient, reflective, quality-over-quantity. It is about making real and meaningful connections – with people not machines, culture, work, food, everything.

A great quote by Gwyneth Paltrow, she once said:

‘My life is good because I am not passive about it. I invest in what is real. Like real people, to do real things, for the real me.’

Social Media, H2H relationships and the smartphone

I recently had a very intriguing conversation with my social media and blog agency – we have those conversations normally at 11pm London time, every Sunday night. Jacques will ask me: “How are you my friend? Your blog for Monday is all set.” I will respond with: “I am Social Media worked out, so tired”, to which Jacques responds: “So just come off Social Media and concentrate on your writing, I still want to see your next book!”
At this point I laugh loudly, but the facts are, when Jacques said this to me it was a precious moment of introspection and reflection – some people call this a light bulb moment, the result is he is so right, and this is a subject I have written extensively about: ‘Is Human 2 Human Communication Dying’, ‘In the praise of speed or not, as the case may be’, ‘Has technology killed love and romance’, ‘Why are our H2H relationships so disconnected from life?’ – just to name a few.

One month after truly quitting Twitter (we even removed the Twitter-share buttons from the site), I feel much better: no incessant alerts anymore, no more sending only (without feedback). And, I actually found a true quality-alternative: interaction, feedback and participation – you can find me here: Geoff on beBee.

If you are emotionally attached to your smartphone and rely on it every waking minute, it may be harming your relationships – I find most accidents happen with people texting when they walk, not to mention what happens when you are in their line of the street. The new education for humans is how to avoid being knocked over by the person texting on their smartphone.

So how does social media affect interaction in our society? Will face-to-face communication ultimately diminish because of these new social technologies? These questions are ones that many researchers have found extremely intriguing since the advent and popularisation of social media in the last decade. Within this topic, social competency is an important ideal that most people strive towards, but there is evidence to support the claims that social media is actually harming people’s ability to interact competently in an offline setting.

Psychologists claim that increasing numbers of people in long-term partnerships are having to compete with their partner’s smartphone for attention, making it the ‘third wheel’ in their relationship.

A survey found that almost three quarters of women in committed relationships feel that smartphones are interfering with their love life and are reducing the amount of time they spend with their partner.

Scientists found that what they describe as this ‘technoference’ – even if infrequent – sets off a chain of negative events: more conflict about technology, lower relationship quality, lower life satisfaction and higher risk of depression.
• 62 per cent of women in long-term relationships who were surveyed said technology interferes with their free time together
• 35 per cent claim their partner will pull out his phone mid-conversation if they receive a notification
• 25 per cent said their partner actively texts other people during the couple’s face-to-face conversations
• 75 per cent said their smartphone is affecting their relationship.
The poll, which was conducted by Brandon McDaniel of The Pennsylvania State University and Sarah Coyne of Brigman Young University in Utah, surveyed 143 women.

Further studies on the social competency of youths who spend much of their time on social media networks are sometimes very conflicting. For example, a study executed by the National Institute of Health found that youths with strong, positive face-to-face relationships may be those most frequently using social media as an additional venue to interact with their peers. As a pretty outgoing person myself, I find myself using social media as an extra outlet to obtain real-time news feeds, research and interact with people who are interested in my book. Although I personally agree with this study’s findings, I also believe that social media can be an excellent avenue for introverted people to find a comfortable setting to interact and from the opposite it can drive a highly-motivated individual to isolation, loneliness and to mental health disorder.

I definitely believe that face-to-face interaction must continue to be our main source of communication. According to Forbes magazine, only 7% of communication is based on the verbal word. That means that over 90% of communication is based on nonverbal cues such as body language, eye contact, and tone of voice.

Scientists at the Chinese Academy of Sciences found that the brain chemicals of people who habitually used the Internet and were perhaps addicted to it had abnormal connections between the nerve fibers in their brain. These changes are similar to other sorts of addicts, including alcoholics.

Take “ghosting,” which has been discussed regularly in the media lately. The name refers to someone simply vanishing from another person’s life, usually after the two have gone on several dates. It’s a frustrating, confusing and, certainly, impolite way to end a relationship, but it’s not new.

The connected world’s larger behavioral impact is more on how we interact with each other on a daily basis. A 2014 study: “The iPhone Effect: The Quality of In-Person Social Interactions in the Presence of Mobile Devices” looked at the effects that phones have when people talk face-to-face. Observing 100 friendly couples having a 10-minute conversation while their phone was present, researchers noticed that the individuals still continued to fiddle with their phones. When those same couples conversed without a phone present, their conversations resulted in greater empathy.

A very interesting white paper named “Information in the Study of Human Interaction” by Keith Devlin and Duska Rosenberg states that in today’s world, most of us think of information as a commodity that is largely independent of how it is embodied. It can be bought, sold, stolen, exchanged, shared, stored, sent along wires and through the ether, and so forth. It can also be processed, using information technologies, both concepts that would have sounded alien (and probably nonsensical) to anyone living in the nineteenth century, and even the first half of the twentieth.

Little by little, Internet and mobile technology seems to be subtly destroying the meaningfulness of interactions we have with others, disconnecting us from the world around us, and leading to an imminent sense of isolation in today’s society. Instead of spending time in person with friends, we just call, text or instant message them. It may seem simpler and easier, but we ultimately end up seeing our friends face to face a lot less. Ten texts can’t even begin to equal an hour spent chatting with a friend over coffee, lunch or dinner. And a smiley-face emoticon is cute, but it could never replace the ear-splitting grin and smiling eyes of one of your best friends. Face time is important, people. We need to see each other.

This doesn’t just apply to our friends; it applies to the world around us. It should come as no surprise that face-to-face interaction is proven by studies to comfort us and provide us with some important sense of well-being.

There’s something intangibly real and valuable about talking with someone face to face. This is significant for friends, partners, potential employers, and other recurring people that make up your everyday world. That person becomes an important existing human connection, not just someone whose disembodied text voice pops up on your cell phone, iPad or computer screen.

While technology has allowed us some means of social connection that would have never been possible before, and has allowed us to maintain long-distance friendships that would have otherwise probably fallen by the wayside, the fact remains that it is causing us to spread ourselves too thin, as well as slowly ruining the quality of social interaction that we all need as human beings.

As Anthony Carmona once said:

“Social media websites are no longer performing an envisaged function of creating a positive communication link among friends, family and professionals. It is a veritable battleground, where insults fly from the human quiver, damaging lives, destroying self-esteem and a person’s sense of self-worth.”