Thursday, July 29, 2010

Pricey Elder Care Monitoring Systems Overlook Logic

As an aging baby boomer myself with medical issues that invariably accompany the aging process, I have found myself frequently annoyed at my own loss of short-term memory and its impact on trying to manage my own health care and the even more challenging task of overseeing the care of my husband, a disabled Vietnam veteran.  So I was instantly drawn to the article, "Technologies Help Adult Children Monitor Aging Parents", in the New York Times this morning.  But as I read the article and checked some of the related links, I couldn't help but be dismayed that so many companies are developing systems that are based around a pricey monthly subscription plan and the more complex systems rely on an expensive system of sensors throughout the elder person's home.

Although such systems are touted as far less expensive than a nursing home, they ignore the fact that most of the activities they monitor could be keyed to the daily activities that surround medication management for a lot less money.  

For example, the article talks about using motion sensors to tell if a person has gotten out of bed.  If the person's daily routine includes taking medications in the morning and the medications are in the bathroom or the kitchen, then the person has obviously gotten out of bed if they have taken their morning medications. 

One of the more elaborate systems costing in excess of $8,000 uses sensors on the refrigerator to track when the door is open or closed and for how long.  The apparent assumption is that if the door is open for more than a few seconds, the person has gotten enough food out of it to indicate they have prepared a meal.  A much more reliable indicator would be to use blood glucose levels, whether a person is diabetic or not, and weight.  Both of these activities could be incorporated into the morning medication routine.


As for using motion sensors to track whether the person is moving around the house, how do those systems distinguish between the resident and their pet(s)?  The article mentioned the case of a man becoming panicked because his mother's motion sensors showed a flurry of activity in the sun room.  She had decided to paint the room and was happily redecorating when he called her.  When I examine my own activities during the day as a retired person, I find that, although I have somewhat of a daily routine, my activity levels often vary based on the weather, the time of year, unscheduled visits of friends and family or weekly or seasonal errands.  This morning, for example, I went outside to do yard work early in the morning because it is supposed to be pretty warm later in the day.  In the winter, however, I may sleep in a little longer.  If I've worked hard out in the yard I may decide to take an extended nap after lunch and motion sensors would not track much movement at all although I am perfectly fine.  So I think minute by minute tracking of a person's daily movements is overkill in my opinion.  


Of course such precise monitoring and reporting via email, text message or phone call is the justification these companies are using to charge their monthly monitoring fee.  But we all know that we don't really want to know all the times things are within normal parameters.  We only really want to know when something is wrong.  


The really promising device mentioned in the article was the computerized Med Minder, lovingly called "Maya", produced by Med Minder Systems, Inc..  It resembles a large weekly medication dispenser with a power cord that has a computerized monitoring system incorporated into it. The device is wireless like a cell phone and can transmit a host of reminders to family or caregivers via phone, email or text message:

  • Medication was not taken on schedule
  • Medication cup was taken out at the wrong time
  • Medication cup was not returned to the compartment
  • Scheduled refill has started
  • Refill was started, but not finished
  • Unscheduled refill occurred
  • MedMinder tray was not replaced during the refill
  • Reminder to take medication
  • Reminder to refill the box
  • Scheduled refill was missed
  • Pillbox registration failed
  • Pillbox was deregistered
  • Loss of wireless connection
  • Wireless connection reestablished
  • Pillbox turned on
  • Pillbox lost power and is running on battery
  • Pillbox power restored
  • Pillbox shut down
As many older people have problems with vision or hearing loss, Maya's alerts include both visual and auditory signals.


"Maya provides alerts that are both visual and auditory. The beeps can be easily heard and the lights flash on & off to get your attention. The system also provides automatic phone calls as reminders, in case the lights and beeps do not prompt taking the scheduled medication. You can also choose to receive just some of the reminders and disable the others. If you are visually impaired, the unit opens easily and the cups and compartments are large enough to feel and easy to remove and replace." - Med Minder website


For the technology the device uses, it's hardware price of $147 is actually pretty reasonable.  However, it also requires a $19 per month subscription fee.  This fee is not exorbitant but for elderly patients with a computer system and a DSL wireless router, I think the device should be configurable to use an existing wireless network instead to eliminate the monthly subscription fee.  


If the device were combined with a wireless enabled digital scale, a wireless blood glucose monitor, a wireless blood pressure cuff, and software that can be configured for individual normal parameters and only emails family and caregivers if daily readings vary by a specified degree, I think many seniors would welcome it without concerns about control and privacy.  Such a system could probably be produced for less than $500 and still give the manufacturer a decent profit.   It could also be expandable to include add-ons like a wireless CPAP machine interface, wireless exercise bike or treadmill, an interface to a Wii or a smart card interface. 

Many grocery stores have incorporated buyer "preferred" cards that they scan along with your debit card when you buy groceries so they can offer you more targeted coupons (and probably sell your preferences to corporate marketers).  Just think of the nutritional information that is available by simply having software analyze the weekly grocery purchases.  In fact, a good nutritional analysis program could also make recommendations for more nutritious alternatives which I'm sure many seniors, including me, would welcome.


Elder Care Made Easier: Doctor Marion's 10 Steps to Help You Care for an Aging Loved One
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