How Technology Will Revolutionize Long-Term Care
Jun 30, 2015
MARC AGRONIN: Henry went viral. Over 1.7 million viewers and counting have witnessed this wheelchair-bound nursing-home resident being provided with his favorite music piped into headphones from an iPod. This clip, from Alive Inside, a movie about the Memory and Music project that brings donated iPods to individuals in nursing homes, is one illustration of how technology is driving innovation in the long-term-care sector of health care.
The average long-term care resident, whether in a nursing home or assisted-living facility, is in his or her 80s or 90s and suffering from one or more serious physical or cognitive limitations. Aside from a few computer-savvy people, most of these individuals need help getting wired. In addition to the Music and Memory program, several other initiatives have begun using iPods, iPads and other tablets to bring sensory and cognitive stimulation to residents who are otherwise bored, restless or in search of some purpose in the moment. For example, a pilot study at the University of California, San Diego found that iPads were safe and effective in reducing agitation in patients with dementia. These same tablets are increasingly being used by family members to connect grandma or grandpa with distant family and friends via networks like Skype. Telemedicine and telepsychiatry make use of similar but more souped-up technology to bring specialists such as geriatric psychiatrists to the bedside of nursing-home residents in underserved areas.
Wearable technology in the form of bracelets, shoe and ankle attachments or lanyards are widely used to enhance safety in various facilities, whether through remote alarms activated at the push of a button or passive systems that either denote location or prevent egress from the facility by inactivating doors or elevators. This wearable technology is certainly on the verge of an explosion in which a host of physiological indexes such as daily motor activity, sleep and vital signs can be monitored in real time. For example, a 2013 study by Mayo researchers fitted post-surgical patients with Fitbits to track daily activity and correlate it with recovery time. Other researchers have begun using a combination of wearables, environmental sensors and Kinect cameras to track activity in long-term-care settings, and then apply this to a whole range of tasks such as detecting depression, sleep disorders and other present or impending illnesses.
There are two barriers to wider introduction of these technologies into long-term care: costs and privacy issues. Even donated iPods require maintenance, troubleshooting and safeguarding, all of which incur staff time that is costly and not reimbursable.
High-end products like the Fitbit and Apple Watch may not be affordable—or necessarily practical—in most nursing homes, but one can imagine simpler and less expensive versions eventually being worn by every resident to facilitate resident to staff communication and centralize a host of data collection that feeds right into the important metrics and quality indicators required by federal regulations.
This data collection by wearables, video links or other sources must conform to privacy rules, however, dictated in part by the Health Insurance Portability and Accountability Act, or HIPAA. Such compliance is critical to preserving the dignity and confidentiality of residents and managing potential liability (hence the concerns about having Web-based cameras placed throughout nursing homes). In addition, compliance does come with significant costs of development and ongoing monitoring by individuals well versed in a complex array of regulations, all of which are out of the reach of most long-term-care facilities, particularly those reliant on Medicaid as a prime funder for its residents.
Ultimately, the growth of technology in long-term care will be driven by the residents themselves. Our viral hero Henry was provided with his iPod by a generous donor, but more long-term-care residents will be bringing their own technology into facilities and expecting to be wired in.
Marc Agronin (@MarcAgronin), is a geriatric psychiatrist and the author of “How We Age: A Doctor’s Journey into the Heart of Growing Old.” He is the medical director for mental health and clinical research at Miami Jewish Health Systems and an affiliate associate professor of psychiatry and neurology at the University of Miami Miller School of Medicine.