1	Smart Home Technology for Aging in Place Longer and Better Robert E. Roush, Ed.D., M.P.H. 21^st Annual Summer Series on Aging Sanders-Brown Center on Aging University of Kentucky June 16, 2004
2	Summary of Presentation Challenges to aging in place Gerontechnology can be used to assess well-being From expensive “smart homes” to inexpensive devices e-Activities of Daily Living Reporting Systems Gather data on selected elders’ routine home activities Wireless motion and light sensors upload data Establishes baseline, looks for marked changes Clients sent reports via website, e-mail or phone Possible problems checked out sooner Your role in assessing indications and efficacy
3	The Aging Process
4	Global Aging
5	Principles of Aging
6	Cartoon
7	Cartoon
8	Only Four Types of People Those who have been caregivers Those who are currently caregivers Those who will be caregivers Those who will need caregivers -- Rosalynn Carter
9	Challenges to Aging in Place There are over 36 million seniors over the age of 65 Over 10 million live alone Fastest growing demographic group in the U.S. The vast majority ( 95% ) of seniors want to “age in place” -- live in their own homes The burden on family caregivers is severe 25% of families care for someone outside the home 30% of elderly admissions to a nursing home or assisted living facility occur not because of deterioration in the senior’s condition but because of caregiver burnout Homecare costs borne by family, institutions, and government are soaring. Both the delivery of assistance with ADL’s and safety monitoring are being provided by $12/hour home care aides Federal Medicaid spending for home and community-based care was $24.7 billion in 2002
10	When it’s Your Turn Fast forward 30-50 years from now and see yourself on a beautiful Sunday afternoon… What do you want to be doing, where, and with whom? How will you get from here to there? “Aging is like anything else: to be good at it, you must start early.” -- Theodore Roosevelt
11	Smart Homes Today’s “smart homes”… Tomorrow’s “smart homes”… Where to find out about them – www.agingtech.com… Guidelines to determine if they are indicated for your patients/clients – i.e, medical, social, & ethical issues, costs, benefits…
12	Smart Homes
13	FROM CARING HOME TO SMART HOUSE
14	TELECARE STRATEGIES
15	CARE TECHNOLOGIES & OPERATIONS
16	The Assisted Cognition Project University of Washington Computer Science & Engineering UW Medical Center Alzheimer’s Disease Research Center (ADRC) UW Institution on Aging Outside Collaborators: Intel Research – Seattle and Jones Farm OGI/OHSU Elite Care
17	Assisted Cognition Henry Kautz Don Patterson, Nan LI Oren Etzioni, Dieter Fox University of Washington Department of Computer Science & Engineering
18	The $80 Billion Question Can we build computer systems that (like a caregiver) actively assist a person with Alzheimer’s perform the tasks of day-to-day living? Enhance quality of life Prolong aging in place Lessen burden on other caretakers Depression affects 20% of Alzheimer’s patients, but 50% of Alzheimer’s caregivers Crisis in demographics – shortage of caretakers
19	Vision Understanding human behavior from low-level sensory data Using commonsense knowledge Learning individual user models Actively offering prompts and other forms of help as needed Alerting human caregivers when necessary
20	ADL Prompter General approach: build a probabilistic model of Common user goals “Plans” (complex behaviors) that achieve those goals Including failure modes How simple behaviors are sensed Run model “backwards” to interpret sensed data
21	Night bathroom run
22	Night snack run
23	Night pattern
24	Timing Constraints
25	Summary: ADL Prompter Commonsense knowledge base of “significant” behaviors Hierarchically organized Probabilistic at all levels Several parallel ongoing activities possible Absolute and relative timing constraints Probabilities “tuned” by machine learning techniques for individual users Failure modes – points of possible intervention
26	Key Issue How to go from noisy and incomplete sensor measurements to A meaningful description of what a person is doing “Trying to brush teeth” “Trying to get home” A decision by the system about whether or not to intervene … in a principled and scalable manner!
27	Conclusions Growing research area combining AI, ubiquitous computing, and assistive technology NIST, AAAI, Ubicomp Workshops RESNA Gerontechnology Key idea: Patient and computer as a problem-solving team
28	Technology
29	Site
30	The Social and Psychological Aspects of SHT Within the Care Sector Guy Dewsbury SEARCH (Scottish Centre for Environmental Design Research) Robert Gordon University Aberdeen
31	Efficacy and Consequences of SHT AT in the Care Setting Technologisation of Needs Smart Homes and Social Care Technological Cost and the Benefits The Future Tentative Guidelines
32	The Guidelines 1. A proactive view of people’s conditions is required at the point of assessment. 2. Assessments must consider how a person interacts with the technology. 3. What can technology do for all stakeholders?
33	The Guidelines 4. Technology should be seen and designed as enabling and empowering. 5. Specification of device interaction is crucial. 6. Maintenance of system.
34	The Guidelines 7. Material cost/benefit is not a good way to view SHT. 8. Technology is not a panacea. 9. Devices should be used correctly to enable a person. 10. User needs should involve all stakeholders.
35	The Guidelines 11. User needs assessment central to design. 12. Training is essential for everyone.
36	e-ADLARS Commercial Example
37	Site
38	QuietCare Serves Seniors and their adult children Adult children are the usual purchasers of services There are 22 million adult children who serve as full- or part-time caregivers to seniors living outside their home The majority are women, with an average age of 49 Most work full or part-time On average, they devote 15 hours per week to this part-time care Institutions who deliver and/or pay for home and community-based services for the elderly State Medicaid programs Private insurance programs Healthcare providers operating under capitated rate and shared risk programs (such as CCRC’s)
39	How It Works
40	Monitoring ADL’s Passively & Alerting Caregivers to Emerging Problems Functions as an “early detection, early warning system” that lets caregivers and family know that a loved one is safe; and recognizes emerging problems before they become catastrophic Has Mom gotten out of bed? Has she navigated the bathroom safely? Did she eat? Has she taken her medicine? What is her overall activity level? Is she sleeping well? Are her bathroom habits changing? Room temperature alerts for heat and cold Partnered with Personal emergency Response Providers (PERS) to provide both 24/7 monitoring/ response and a full pro-active/reactive “circle of safety.”
41	What the Institutional Monitor Sees
42	What the Caregiver/Family Sees
43	e-ADLRS Tracking Data (courtesy of Living Independently) 5 subjects, independent living apartments 4 motion sensors plus medication monitor Base station in bedroom 30 days Data Analysis Preview 5 behaviors: waking, meals, medications, overnight bathroom visits and bathroom falls Behavioral trends: normality, changes and consistency
44	Site 1
45	Site 2
46	Site 3
47	Site 4
48	Site 5
49	Site 6
50	Site 7
51	Site 8
52	Overnight Bathroom Visits
53	Chart 1
54	Chart 2
55	Chart 3
56	Chart 4
57	Chart 5
58	Five Individuals, Five Baselines, Two Shifts in Pattern…
59	Five Individuals, Five Baselines, Two Shifts in Pattern
60	Subject 5: Trend Analysis and Alarm Thresholds
61	Why the changes in Subject 5?
62	Chart A
63	Chart B
64	Summary of Preliminary Findings Social work supervisor views data daily, sometimes twice Subjects of field test enthusiastic Changes in behavior perceived within a week by supervisor who queries individuals Trends and changes quantitatively identifiable Hardware and software reliably track ADLs e-ADLRS is a tool for caregivers to better serve the elder
65	Responding to Emerging Issues Improving Medication Monitoring of a Goddard Resident
66	Responding to Emerging Issues Continual Product Innovation
67	An Affordable Way to Monitor Sleep Disturbance
68	Benefits of e-ADLRS Helps seniors Live more safely and independently in their own homes By alerting caregivers to emerging problems, thereby reducing risks and likelihood of hospitalization Through full “circle of safety” via integration of full Personal Emergency Response Service (PERS) pendant and monitoring 24/7 By reducing anxiety of and burden on family caregivers Helps eldercare agencies “Fill in the gaps” in care coverage Direct care where most needed Recognize & better understand patient condition
69	How QuietCare Might Prevent Institutionalization QuietCare might dramatically reduce the likelihood of hospitalization and enables timely intervention One-third of all hospitalizations of people 65+ occur because the senior is not taking their medication properly QuietCare monitors medication interaction Fully 30% of people 65+ experience a fall every year QuietCare automatically alerts a caregiver if a person does not come out of the bathroom in 60 minutes On average, seniors receive 10 hours of home care weekly. Even tripling the amount of homecare -- the average in NYC -- leaves seniors “uncovered” 138 hours per week. QuietCare “fills in the gaps.” 30% of all admissions to nursing homes & assisted living facilities occur not because of deterioration of the senior’s condition, but because of caregiver burnout One-quarter of all households are providing part-time care -- averaging 15 hours per week -- to an elderly friend or relative not living with them QuietCare reduces caregiver anxiety by providing 24/7 early detection/ early warning of emerging problems before they become emergencies
70	How QuietCare Serves its Users -- Enhancing Productivity According to a Met Life/AARP study, more time is lost in the workplace to eldercare than to childcare QuietCare provides both timely information and insight into the elderly’s ADL’s Identifying emerging problems before they become emergencies means More lead-time to plan for and deal with problems; and more “free” time for the careiver Enhanced peace of mind Social service agencies with limited resources use QuietCare to direct help where it is needed first QuietCare provides high tech tools that complement the “high touch” services home health/care workers
71	Competitive Cost Comparison Hospitalization Cost per day: $1,200 Average stay: 8 days Total: $9,600 Nursing Home Cost per day: $400 One week of rehab: $2,415 Assisted Living Facility Cost per month: $3,500 Cost per year: $42,000 Home health aide Cost per hour: $15 Average hours/week (NYC): 30 Annual cost: $23,400
72	Estimating the Benefits For every $1 spent on QuietCare, $10-$12 might be saved in direct health care expenses Prevented hospitalizations, due to prevented falls, improper medication compliance Shorter hospitalization due to quicker intervention Reduced rehabilitation costs Fewer admissions to nursing homes due to caregiver burnout A full year of the QuietCare service costs less than 15 minutes a day of homecare QuietCare costs between $2 and $3/day Homecare costs average $12/hour U.S. employers lose approximately $200 billion annually in lost wage productivity due to informal eldercare assistance Reducing the uncertainty and unpredictability family caregivers face reduces absenteeism and anxiety, enhancing productivity
73	Client Perceptions of The System Consistently and unanimous enthusiastic Finds system makes them feel safer and more secure Wants monitoring extended from 8 hours per day (9:00am to 5:00pm) five days per week to 24/7 Some want family caregivers to begin accessing information Requesting utilization of emergency response capacity Urging system be place in all apartments in the complex
74	Responses of Institutions and Care Managers Health insurance companies, hospitals, home care agencies, and housing for the elderly, see systems as a means of preventing illness and maintaining wellness Capitated rate/shared risk programs benefit A needed service to attract new members/patients/clients/tenants A means of developing new models of service delivery Responses of care coordinators at the above range from Concern about additional work, responsibilities, and liability Concern about their own responses being monitored A way to better understand the needs of their clients A way to focus interventions and better use scarce resources
75	Value to Patients and Providers Consumer Value Proposition: Early Detection + Early Warning = Can prevent unnecessary hospitalizations and provides peace of mind Institutional Value Proposition: Early detection + Early Warning = Better allocation of resources = Better Care
76	Indications for Smart Home Technology What are the leading medical indications? What are the main social indications? What criteria should be used in writing an Rx for SMT like e-ADLARS? What are the geroethical issues that need to be considered?
77	Why We Do What We Do Not just for today’s older people But for tomorrow’s, too As most of the little children of the world will live most of the 21^st century Like my granddaughter, Carmella, born June 23, 2001, and her mother, Stephanie
78	Picture
79	Bob’s Top 10 List for Living Long and Well
80	Aún aprendo by an old master
81	View of aging by a new sage The wisdom of the venerable George Carlin The only time in our lives when we like to get old is when we’re kids! Ask someone under 10 years old “How old are you?” They think in fractions: “I’m four and a half.” You become 21, turn 30, pushing 40, reach 50, make it to 60, hit 70… If you get to 100, you become a little kid again: “I’m 100 and a half!”
82	Contacts Dr. Bob Roush, Huffington Center on Aging, Baylor College of Medicine, Houston, Texas – rroush@bcm.tmc.edu Dr. Dave Kutzik -- Drexel University, Philadelphia, PA kutzik@drexel.edu Dr. Anthony Glascock, Drexel University –glascock@drexel.edu David Stern, M.S.W., Chief Professional Officer, Living Independently, NYC, NY -- dstern@livingindependently.com