As We Age, There’s No Place Like Home

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As my generations, the Boomers, continue to age our demographic bulge continues its disruptive ways. As our front edge downsizes their homes or moves into gated senior communities, the phrase, “I’ve fallen, and I can’t get up” may begin to take on a greater reality. From a health and healthcare perspective, there is a rising interest in “aging in place,” that is, growing old in your home and not in a nursing facility. The internet of things, the world of smart thermostats and lightbulbs, has arrived to make “aging at home” feasible, less expensive and safer. Welcome passive home monitoring.  

LifeCall’s Pendant Comes of Age

To make a home safe, you may need to install ramps over stairs and certainly handrails in tubs and shower. But as we get more “forgetful,” entering a period where our independence wanes and our family’s fears wax, can we find a way for to maintain my autonomy and reduce their calling, or more realistically, texting me throughout the day to “see how I’m doing?” Basically what we need to know is whether our loved one is getting out of bed, getting around the house, eating their meals, taking their meds and using the bathroom. Motion sensors, video cameras, and smart appliances can answer those questions without them being asked. 

Motion sensors can indicate how a person travels throughout the house and to some extent replace that LifeCall pendent noticing objects in the room for too long a time. Sensors can and do report on whether the toilet has been flushed or a cabinet has been opened. Smart refrigerators can report on their contents, and smart pill bottles can indicate that they have been opened. The information they provide can answer most of a family’s concerns, and we haven’t even considered the more intrusive but equally passive video camera quietly affixed to the wall. A startup in California, GreatCall, has brought all of these devices into an installation and app (what else); they are not new to the market, as the source of JitterBug a large format phone for the elderly who can see on those smartphone’s smaller screens.  

A Proof of Concept Study

A report in the Journal of the American Geriatrics Society, and yes featured and funded by GreatCall, demonstrates the system’s utility. It joins similar pilot studies researched by multiple sources. Both the intervention and control groups received personalized care plans from their primary physicians, but the intervention group had passive monitoring systems installed in their homes which provided additional information to their physicians, e.g., increase motion detection at night suggesting prostate issues or sleep difficulties, which they could in turn act upon. The participants were almost 80 years old and predominantly female.

The outcome of interest was to show a cost-saving benefit, the study was underpowered (not a large enough sample size to allow statistical discrimination) to answer that question, and the researchers demonstrate a trend, not a statistically significant benefit. They showed a roughly $600 savings for the remotely monitored individuals over those not being monitored and the third group of historical controls. But the monitored group had less hospital admission, visits to the emergency department and fewer admissions to short and long-term care. To be honest, the study was poorly designed, admittedly underpowered and even if they showed a cost-benefit, they did not include the cost of the system or the additional work of the primary care physician in responding to what the monitoring uncovered. But at the expense of about $8,000/month for long-term institutionalized care, the savings will be found for aging in place; and that doesn’t consider the peace of mind that comes from being able to stay at home  - for parent or child. Maybe because I am a Boomer, but that opportunity, to stay at home is priceless.

The Rise of the DME’s

DME refers to durable medical equipment, for the younger it means crutches and those soft-casts people are wearing; for the mobility impaired it means commodes or those scooters and canes we see on TV. DMEs include eyeglasses, hearing aids, and represent about 2% of our health care spending, and that will rise as the Boomer demographic ages and needs more of this technology. 

This area of healthcare has undergone consolidation and homogenization just like hospitals and doctors, but a new disruptor has appeared on the DME scene – BestBuy. The company announced that it was purchasing GreatCall and it’s 900,000 subscribers [1] and annual revenue of $300 million for $800 million. And call me old-fashioned, but $800 million is a significant investment to me. It is an extension of BestBuy’s Assured Living program, technology to assist in aging at home. It seems that the wellness trackers of the world are going to have to make room in their display area for passive monitoring. This is a smart move, especially if you can sell a system, not just components, and even more so if you can position it as a subscription service so that the cash flows for longer than one and done. This can be game-changing, a better quality of life that at-home aging can provide, peace of mind to patient and family, cost savings when measured against the cost of institutionalized care; the very definition of value. And oddly enough, a potentially significant healthcare savings did not come from the government, but from market forces, entrepreneurs and perhaps some academic guidance. 

 

[1] Most of these subscribers reflected their pendent sales, not remote monitoring systems.   

 

Source: Reduced Healthcare Use and Apparent Savings with Passive Home Monitoring Technology: A Pilot Study  Journal of American Geriatrics Society DOI: 10.1111/jgs.14892