Tracking Life's Tempo: New Technology for Aging at Home
Richard D. Brennan, Jr.
Keeping track of an aging parent’s health can be wearing when there are other demands on your time. It’s the challenge faced by 10 million members of the sandwich generation who hold jobs, take care of their parents, and raise families of their own. Fortunately, wearables can help care for seniors when their kids are not around. There’s now a wide range of devices, and more on the way, to do for the aged what wearables like those from Jawbone and Fitbit do for younger, healthier adults. One difference, of course, is that the seniors’ health concerns have much higher stakes. So family caregivers are now turning to wearable technology to watch over aging parents who wish to remain in their own homes.
The devices are designed to bring loved ones home though they live some distance away. They include fall detectors that fallers wear as pendants or bracelets. When a fall occurs, the senior presses an alarm button that wirelessly connects to an alert unit installed in their home, which notifies a remote monitoring center (such as Phillips Life Line or Medical Alarm.com) via telephone or broadband connection. The device is well known because of TV commercials in which a senior plaintively says, “I’ve fallen and I can’t get up.” Less familiar is PAL (Protect and Locate), a new piece of technology from Lifesaver that can locator a senior who is missing. The tracker is worn on the wrist, carries an individualized signal, and notifies the caregiver if the senior wanders off. Meanwhile, researchers at the University of Virginia are using conductive fabric that powers gyroscopes and compasses attached to bits of clothing to track elderly patients. The technology isn’t perfect yet, but the idea behind it is for a caregiver to be able to monitor an elderly patient’s movements.
Satish Movva wanted to do just that in between weekly visits to his 76-year-old mother and 86-year- old dad, so he launched CarePredict Tempo. His new device is worn on the wrist and monitors the activity of older adults for early signs of serious health concerns. He had the idea for the device when he began noticing subtle declines in his parents’ health from visit to visit. “If I had been aware of these changes during the week,” he says, “I could have intervened and gotten the problem taken care of. For example, I go there this Saturday and my father is shuffling instead of taking steps because he’s retaining fluid in his ankle. If I had known about it, I could have made a doctor’s appointment or had a home care nurse visit scheduled. Somebody clinical could have taken a look at him or at least talked to him on the phone.”
That didn’t happen because Movva’s parents are reluctant to call him when problems arise. They don’t want to bother him because they know how busy he is with his work and three young children. “I am a classic member of the sandwich generation,” he explains, “because I have a five-year-old daughter, two new-born twins, and two older parents. Like many members of the sandwich generation, I find it very hard to juggle it all together: work, life, and your own children. If something out of the blue happens with your parents, you have to make alternate arrangements for somebody to take the kids to school and pick them up or do whatever while you’re caring for your parents in the ER.”
The thought of all the disruption this would cause led Movva to envision a better way, and he had the know-how to put his ideas in action. Before launching CarePredict, Movva served as vice president and CIO of Interim Healthcare, where he invented the world’s largest SaaS home care and hospice platform. “I built the software,” he recalls, “spun it out into a separate company called ContinuLink, and was successful with it. In 2011, I met Warren Brown, president of Procura, and thought ContinuLink would be a good fit for his company, so I made that marriage happen.” Afterward it became clear to him that Procura needed to do what it wanted with the product so it was time for him to exit. But the entrepreneurial blood still ran through his veins. “Once you’ve done a startup, you’re always looking for new things to find solutions for,” he explains. And he found inspiration close to home as he noticed gradual changes in his parents’ behavior, some of them so subtle that his parents didn’t notice. But these changes would be clear to the sophisticated software in CarePredict, which tracks change in behavior as they occur.
The system consists of a wrist-worn sensor able to detect arm movements, posture, and walking speed, along with four peel-and-stick sensors attached to the walls of the home. Once installed in the home, the system tracks the user’s movements and body orientation for seven days to learn the usual pattern of activity and set a baseline. After the initial set-up is complete, CarePredict is able to detect changes in the patterns that could signal a decline in health. Changes in patterns are sent by text, email, or push notification to a designated contact.
The changes don’t need to be major inflections in health, Movva explains. “Our system can detect when someone’s taking longer and longer to do the same things. Say my mom is taking longer and longer to walk from the bathroom to the kitchen, that’s a reason for concern. Or say she wakes up in the morning and instead of doing all the normal things she lies on the bed again. If she’s not feeling well, I can give her a call and find out how she’s doing. That’s the genesis of this idea. It was a very personal thing for me, and it was very much rooted in my own life and what I was facing. Now it’s not like my parents have major clinical issues and require telemonitoring that measures their heart rate and blood pressure and so on. They needed something that was much more geared toward tracking activity and behavior.”
As he searched for an answer to their needs, Movva did his research and talked with colleagues in the field. “I was acutely aware of the state of the industry,” he says, “and I knew about all the telehealth and telemonitoring programs on the clinical side. Remote patient monitoring is a mature field, and everything you see in it is what you call ambient monitoring where you use cameras, motion sensors, and switches to figure out if there is activity in the house. Depending on a switch’s location, you can say what is happening. So, for example, if you see the toilet seat go up and down five times, you know somebody used the toilet five times. But the problem with all the ambient monitoring systems is they require a lot of infrastructure, and somebody has put the switches on the refrigerators and toilet seats.” The existing systems were so complex that he knew his parents wouldn’t be able to deal with them if he wasn’t around.
And there’s an added issue with ambient monitoring systems since they monitor the space instead of the person. “The model falls apart as soon as soon as there’s more than one person in the house,” Movva says. “In my case, I had my mom and dad in the house, and the system could not detect who was having a problem. And that’s a major problem because you could have scenarios where one person has dementia and the other does not. One person might be comatose in a corner of the room while the other person is moving around. So the system might think everything is OK because it’s detecting activity.”
Movva decided to overcome this hurdle by turning to wearable technology, and once he had a plan he discussed it with his parents. Despite her lack of technical know-how, his mother had firm opinions about style. “She declared, ‘I’m not wearing anything that looks like a radar collar,’” he recalls. “She wanted something very unobtrusive, so I came up with the idea of something that people don’t mind wearing and that can be housed by the person in different settings. They can snap it out and put it into a bracelet or a watch band, or whatever their personal taste. The only stricture is the device has to be worn on the wrist. We are tracking arm and joint movement, so we can actually tell when someone is eating or brushing their teeth. We were particularly interested in helping seniors age at home, and we didn’t really need to know what they were doing outside. Besides, my mom said, ‘There’s no way I’m going to go around with a GPS tracker on me so you see a little arrow on a map.’ So I asked, ‘How about if I know what room of the house you’re in at any given time?’ She said, ‘Fine, we stay in our home most of the time because we are tired out early.’”
But Movva’s device never gets tired or takes a break. Whether seniors are resting, bathing, or cooking meals, CarePredict is busy collecting data on what they’re doing and where they’re doing it. “The data goes into the cloud,” Movva says, “where we have sources that are running sophisticated, predictive analysis and determining whether the person’s activities are outside their normal threshold. The device gets to know what your life’s tempo is and looks for the discordant note that says something might be off.” Then it sends an alarm to the caregiver, but fortunately it doesn’t set off any alarms in the FDA. Movva did not want to measure clinical signs, a highly regulated market for valid reasons that he supports.
Besides it could have been a hassle getting FDA approval for the device since the mHealth regulatory framework is nowhere near settled. Movva avoided this roadblock by working on the consumer side instead of the clinical side, so the device doesn’t require FDA approval. “Everyone monitors vital signs but no one monitors behaviors,” he explains. “I thought that if I monitor clinical indicators like heart rate that immediately puts this device into the clinical category, which means a lot of oversight — a good thing but it doesn’t add much to what I was hoping to do. So I went a little further and started speaking to a lot of my friends in the health care industry, many of them physicians. They said, ‘Don’t even think of doing this from the health care angle. Do it from the consumer non-medical angle because the sandwich generation and the adult children of seniors are a forgotten demographic in this country.’”
The consumer route appealed to Movva’s physician friends because many of them belong to the sandwich generation. This is an untapped market that lacks affordable aging solutions, so going the consumer route made good business sense. That doesn’t mean the device can’t work on the health care side, as Movva points out. “Our device can provide a lot of information and tell us, for example, that someone is taking longer and longer to walk from the bathroom to the kitchen. That information suggests to the caregiver that someone is slowing down because they’re retaining water. They, in turn, can alert the home care agency and say there’s something going on with my dad. Perhaps, it’s worthwhile for a home care nurse or aide to visit so they can move it up the clinical path and see what intervention is needed. Now that intervention can come on the social model from family and friends or it can come on the clinical model from the home care agency. In either case, the system can work for both models.”
It promises to play an important role in the aging boom that’s already on the horizon. We don’t have enough resources to care for all the aging boomers, so there’s a need for systems that know a person’s normal baseline and can trigger notifications when they deviate from it. “This will conserve our strained health care resources,” Movva says, “because we won’t need to have people spending so much time checking and seeing if someone is OK. The system will tell us if the person is OK. The only time we need to take action is if the system sends an alert.” The result is to improve seniors’ quality of life while saving valuable funds.
Movva’s product promises to cut costs even more by preventing hospital admissions and readmissions. “You need clinical readings for clinical monitoring,” he says, “but we can come around to that same result in a different way: by looking and seeing that activity has changed. If seniors are eating or sleeping more or less, or if they are not walking at the same pace, we know something is different and we can then raise the intervention to a home care nurse or a loved one. They, in turn, can say we need to call the home care agency. So while we do not directly prevent admissions or readmissions, I think we arrive at the same result.” And Movva plans to move his results to a higher plane in a future version of the product. “We hope to have a nurse call center, so when the information comes in, the care coordinator will get an alert or the nurse will get an alert. They will then call the caregiver or patient or get some clinical intervention. Anything you can do to prevent a person winding up in the hospital is going to be cost-effective. Even if you have to get home care, that’s a lot cheaper than spending $3,000 on a hospital admission.”
But you can’t put a price on the peace of mind that Movva’s product promises to bring. Many members of the sandwich generation live too far away from their parents to be in their homes on a regular basis. With CarePredict, they’re able to have a technology that sends them reminders to check on Mom or Dad. “To a large extent, this also helps to reduce the isolation of aging. Loneliness is the number-one unspoken issue with aging,” Movva says. “Without the senior having to make a decision to bother someone, the system discreetly tells adult children that Mom or Dad needs attention now. Then seniors get care without the guilt that they’re bothering their children and clamoring for attention. The minute something is different, the system is raising an alert and bringing in the social circle that surrounds us all.” For seniors, a device worn on the wrist can mean that a helping hand is always near.
About the Author: Richard D. Brennan, Jr., M.A. serves as Vice President of Technology Policy in the Government Affairs Department of the National Association for Home Care & Hospice (NAHC) and Executive Director of its affiliated Home Care Technology Association of America (HCTAA). Brennan’s areas of expertise include legislative and regulatory policy issues pertaining to electronic health records (EHRs), telehealth, point-of-care technologies, remote monitoring technologies, and disruptive technologies use in home health and hospice. He is also actively involved in the development of standards to support the exchange of health information with post-acute care providers. You can reach him at email@example.com.