Using Technology to Enhance Family Caregiving

The increasing use and sophistication of new technical products and remote platforms for monitoring patients and family members was recently profiled in this great article from the New York Times by Katherine C. Pearson (Dickinson Law, Penn State). It offers many suggestions and solutions you may not have considered for monitoring your loved one’s care.

How technology can help families monitor the health and safety of older people kept from their families by the coronavirus.
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Norman Potter’s mother, Dorothy, who suffers from a chronic pulmonary illness, lives alone in the mountain town of Newland, N.C., two hours from his home in Winston-Salem. For a year, Mr. Potter has been looking for technology that would enable him to monitor his mother’s health from afar.

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Mrs. Potter, 90, refuses to move closer to her son or daughter. She and her seven siblings were born and raised in Newland. “She loves the house, her church and small group of friends,” her son explains, “she is fiercely independent.”

In mid-March, as the coronavirus was spreading, Mr. Potter installed a platform, made by GrandCare Systems, in his mother’s house that she enjoys using to video chat with her grandchildren — but of equal interest to her son are its motion sensor and two vital-sign devices.

Because of his mother’s respiratory issues, Mr. Potter said he and his sister were not comfortable visiting unless they were first tested for the coronavirus, although two people who live nearby check on her. “The monitoring allows me a sense of peace that she is up and starting her day,” he said.

With older people particularly vulnerable to Covid-19, sales of products and services aimed at protecting the health and safety of the homebound elderly are “skyrocketing,” says Laurie Orlov, founder of Aging and Health Technology Watch, which conducts market research.

Ms. Orlov said that families and senior living communities are buying devices to monitor older people whose loved ones are staying away for fear of transmitting the virus. The technology also enables health care providers to keep tabs on their patients.

“People are definitely not visiting the E.R. and going to the doctor because they are worried about leaving their home,” Ms. Orlov said.

Every morning, Mrs. Potter inserts a finger in a Bluetooth pulse oximeter, which gauges the oxygen in her blood. She steps on a Bluetooth bathroom scale, which measures her weight to detect possible fluid retention.

Mr. Potter can log into a portal to view the results, which are delivered via a wireless connection in his mother’s house. If either level is out of whack, Mr. Potter, who owns a home health agency, receives a text. When his mother’s oxygen levels dropped one day, Mr. Potter called to remind her to insert the nasal tube that connects to her oxygen supply device.

He also is notified if a motion sensor in the hallway that leads from her bedroom to the kitchen does not detect movement after 10 a.m., her usual waking time.

In choosing among the dizzying array of gadgets, apps and services, older people or their caregivers can narrow the options by focusing on “the problem you are solving, and what people are saying about the technology,” Ms. Orlov said.

For example, if an elderly parent’s primary issue is managing medications, a medication reminder may be the solution. That can be as simple as a smartphone app that sets off an alarm. Or for a parent who needs more oversight, an adult child can buy a dispenser that unlocks a pill compartment at the right time and signals the caregiver via a wireless connection in the older person’s home if the medication is not taken.

Once someone settles on the type of device, the consumer needs to “see how out-of-the-box ready” a product is to install and use, said David Lindeman, director of the Center for Technology and Aging at the University of California, Berkeley. He said most devices require a wireless connection.

“Make sure you can get the training and have support,” Dr. Lindeman said. That could come in the form of a nearby family member or a technology help service such as Candoo, which is geared to older people, experts say. Check that the company selling the product offers easy-to-use instructions and telephone support.

Monitoring for emergencies
A basic aging-in-place device is the medical alert, which in the past worked only in the home. But technological advances have “taken emergency response to a new age,” said David Inns, chief executive officer of GreatCall, which sells emergency response watches, pendants and cellphones.

The latest products typically use GPS tracking to pinpoint the location of someone having a problem while taking a walk, gardening or running errands. After pressing an emergency button, the user can speak with a call center or caregiver. An agent at GreatCall’s 5Star emergency center will decide whether to dispatch an ambulance.

“The family has an app to download to keep them informed if a senior calls 5Star,” Mr. Inns said.

GreatCall and some other medical alert products offer options, at extra cost, that are designed to detect a fall, even if the older person has not pressed the button, and signal a response center.

In July, the company VitalTech Affiliates plans to roll out a medical alert watch called VitalBand that will offer automatic fall detection as well as measure heart and respiration rates. The watch can alert a family member if, say, the user’s heart rate exceeds a certain level.

“The goal is to give seniors the confidence to exercise and do all their activities while providing for their safety and security,” said James Hamilton, the company’s chief executive.

Such telehealth technologies are becoming more important as the elderly stay at home and health care providers reduce office hours, experts say. The federal government has relaxed restrictions on Medicare payments to providers who monitor patients remotely.

Tablets with simplified designs can connect older people through video chat to their doctors and loved ones. And many adult children, like Mr. Potter, are using wireless devices that monitor and transmit vital signs — say, a diabetic parent’s blood glucose levels. Health care providers can view trends over time.

Vital-sign technology “can give clinicians the chance to see something before a crisis occurs,” Dr. Lindeman said. “It also gives older adults the ability to take greater responsibility for their own health.”

To keep tabs on frailer older people, motion sensors are an option. If a caregiver who logs into the system finds an unusual amount of activity from a bathroom sensor, for example, it could mean a parent is sick, said Laura Mitchell, GrandCare’s chief executive officer.

Ms. Mitchell recalled one client who determined that her mother seemed to be awake all night for many nights. At her mother’s next medical appointment, the daughter brought in the graph of her motion activity. After the doctor changed the mother’s blood pressure medication, the sleepless nights ended.
“Normally, you would not know that,” she said. The diagnosis “was based on the motion.”

Connected by voice
For many older adults living at home, digital voice assistants, such as Amazon Echo and Google Home, can reduce social isolation and encourage healthy behaviors, according to experts. By using their voices, older users can ask the device to call a friend, read an audiobook, set a reminder to drink water and seek first-aid advice or emergency help.

Such voice-activated tasks “are very small things but they are meaningful to people who may be living with certain challenges, whether they are mobility challenges or visual challenges or memory challenges,” said Davis Park, vice president of the Front Porch Center for Innovation and Wellbeing, the technology research arm of Front Porch, a nonprofit company that manages senior living and affordable housing communities.

Front Porch has installed the Echo with Alexa voice technology in 400 independent living units at six of its retirement communities. It plans to install 1,400 additional devices in response to the Covid-19 crisis. Many residents have installed smart home devices, which can help reduce falls by asking Alexa to turn on a light before a person enters a room or to adjust the thermostat from one’s chair.

A major benefit of voice-assisted technology is its potential to reduce loneliness, Mr. Park said. Residents who also have an Echo Show screen can direct Alexa to set up video chats with family members.

“Social isolation is probably one of the biggest killers of older adults, so while it’s critical that they shelter in place to stay safe, we need to provide tools to help them stay connected,” he said.

Before the pandemic, Esther McKee, 79, went to church, volunteered and visited with friends and two daughters who live nearby. Now, she said, she “would not have my sanity” without the video-chat feature on the GrandCare system she has had for eight years.

By pressing a name on the touch screen, Ms. McKee, who lives alone in a two-bedroom apartment in a 55-plus community in West Bend, Wis., can see any of her three daughters, six grandchildren and many nieces. Nearly every weekday at noon, she and a daughter who lives in Florida eat lunch together by their screens.

Ms. McKee’s aging-in-place technology also includes motion sensors that her daughters placed in her bedroom, bathroom and living room, and on the front door and refrigerator.

“I feel comforted knowing that they are watching over me,” she said.

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