Using Tech Sensors in Homes of Seniors: A National Study

A seven million dollar, four-year study funded by the Department of Veterans and the National Institutes of Health is being executed to accumulate information about senior living behaviors at home. The goal of the study is to monitor and detect health changes in older adults allowing them to live safer and longer in their own homes. The meta-data gathered from the sensors is then distilled using algorithms and artificial intelligence to look for patterns and draw conclusions. This data analysis will enable researchers to observe the inter-relations of various activity patterns and predict the onset of new medical problems.

The study, known as Collaborative Aging Research Using Technology (CART), was developed by a team of gerontologists, clinicians, engineers, computer and data scientists, as well as end-users. Sensors are alert to the presence of the at-home senior, collect real-time data, are unobtrusive, and do not hinder daily life. The platform is open-ended, accommodating new data systems or devices that may be developed in the future. All study participants consent to the use of the data collected. The data is ultimately de-identified and stored on participating universities’ advanced computer centers and are available to the research community.

Sensors track mobility, such as movement between rooms and walking speed. Engagement in social behaviors like phone calls, emails, social media, and outings are monitored. Sleeping patterns and physiologic functions like BMI and pulse are also monitored, as are sleeping patterns. Changes in a senior’s activity norms, like computer use or driving habits, can be early signs of cognitive decline. Changes in their gait and movement may identify frailty issues. Real-time information provides a more objective measure of ongoing health than patient-based recall in a doctor’s office, trying to describe something that happened weeks ago. Lead researcher Dr. Jeffrey Kaye states, “The technologies that we install are designed to detect changes that are basic to people’s daily function and their ability to stay independent.” Dr. Kaye further comments, “With this more objective and much more frequent data, you can determine the true trajectory of change over a short amount of time with fewer people.”

Specifically, CART uses wall and ceiling sensors that can track the amount of time someone spends in a room as well as movement between those rooms and walking speed. Outside door sensors monitor the number of times a study participant leaves their home by tracking the doors openings and closings. A digital scale not only measures weight but body composition and heart rate. A digital pillbox measures adherence to medication regimes through tracking the opening and closing of the pillbox lid. Many participants are excited to get an upgrade to their old watch in the form of a digital wristband that measures daily activities, steps taken, and sleep patterns. Driving sensors installed in participants’ vehicles track how often and for how long the senior is driving. A sleep sensor is fitted underneath the participant’s mattress and can monitor when someone falls asleep as well as moments of restlessness, and time spent in light, deep and REM cycles of sleep. Computer use is audited via an installed software program following a participant’s logins, app usage, and time spent on the device. All of these sensors create an array of information to be studied by CART researchers without using overly intrusive cameras or keylogging.

The Wall Street Journal (WSJ) reports the technology for CART participant homes currently number 50, with a projected 250 homes to be outfitted. Participants include a group of low-income seniors near Portland, the second group in rural Oregon and Washington comprised of veterans, a mostly African-American Chicago based group, and finally a group in Miami who primarily speak Spanish. This study is being closely watched by a group known as Aging in Place Technology Watch. Founder and principal analyst Laurie Orlov feels a system like CART can present a better opportunity to manage patients sent home from the hospital but still require some form of medical and daily living monitoring. Because CART looks for behavioral change that is predictive of an adverse event, it is superior to other monitoring systems that reactively alert observers that someone has fallen.

CART’s mission is the creation of a national research infrastructure using new and evolving technologies as well as meta-data to study aging in place. Detecting subtle, but meaningful, changes in a diverse group of older adults’ shifts in daily living habits provides information to assess and aid healthy, independent aging. The cost of care projections for the growing US aging population is more than 1 trillion dollars by 2050. Medicare and Medicaid programs are the primary payers of health care for those Americans aged 65 or more. Creating safe and successful living scenarios for the elderly in non-institutional settings is one of the few ways to reduce spending while expanding services to a broader population through technology. A system like CART can potentially detect the onset of medical issues that require intervention by a medical professional or caregiver for those seniors opting to age at home.

We help seniors and their families create legal plans that cover long term care and how to pay for it. If you would like to talk about your particular situation, please don’t hesitate to reach out. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help.

Problems, Policies, and Proposals for Long-Term Care

The long-term care (LTC) crisis is on the rise for aging Americans. Industry driven, massively underpriced policies are playing fiscal catch up with hefty premium rate increases. This price increase is forcing some aging Americans to abandon their policy while others struggle to reduce their amount of LTC coverage to keep their rates affordable or reduce their future lifestyle by dipping into their retirement savings. Abandoning LTC policies turns out to be the last resort for many policyholders as they understand how valuable they are and that a policy lapse would cause them to lose all of their monies paid to the insurer.

Throughout the insurance industry, the metrics applied to the long-term care business model underestimated how long policyholders would live and the number of claims they would submit. Policyholders are living years longer than the actuaries had projected. Compounding the crisis of this flawed business model is years of very low-interest rates. On an inflation-adjusted basis, return on investment has fallen vastly short of needs for all long term investors, including pension funds, life insurers, and the average American saving for retirement. The financial fallout is that fewer people are seeking long-term care insurance policies and those that are, typically pay more and receive less coverage.

Further compounding long-term care problems is the escalation of Alzheimer’s diagnoses and other dementia diseases, which invariably increases an individual’s need for long-term care. Medicare does not make provisions for coverage in long-term care facilities. Even if you position yourself financially to qualify for Medicaid, which does provide for LTC, there is often a long waiting list and reportedly not a high standard of care when you become a resident.

Senator Patrick Toomey (R-PA) is preparing legislation that includes a clause to allow people to pay for long term care insurance via a tax-free withdrawal from their 401(k) retirement plan. The withdrawal, up to 2000 dollars a year, would not be subject to income tax, and the limit would be indexed for inflation over the years.

The Internal Revenue Service is also trying to offset tax liabilities for Americans that cover long term care insurance premiums in 2020. There is a range of tax-deferred dollar amounts depending on your age, and this information is posted on the American Association for Long-Term Care Insurance website.

Relying on the federal government to fix the long term care crisis is a cautionary tale. McKnight’s Senior Living reports that the LTC sector typically gets very little play in Washington, DC. Hospitals, doctors, insurance companies, and drug companies with big lobby monies are far more likely to receive legislative attention, often to the demise of long-term care operators and the vulnerable American population they support. Beyond the untenable high costs of LTC premiums, excessive administrative costs burden the US health care system. Washington DC, notorious for its complex, plodding policy progress, will not likely address the situation beyond creating tax-deferred access to retirement accounts and other tax incentives. Instead, the government is okay to allow the paying public to absorb the high costs of long-term care as the industry sector tries to salvage itself.

One of the worst outcomes of these scenarios is that long-term care has become such an expensive problem that Americans are shying away from proactive planning to address the very likely need they will require long-term care insurance in their future. The US Department of Health and Human Services has a website that addresses long-term care basics and provides resources, tools, and links to guide your LTC planning.

Other solutions can provide the essentials for long-term care packaged in different insurance programs. Short-term care insurance, or convalescent insurance, provides a long-term care type of coverage for 180 to 360 days. Because there is no long- term commitment to the insurance companies, premiums usually are less than traditional LTC. Critical-care or critical-illness insurance are two similar types of insurance coverage offering lump-sum cash payments to those who are diagnosed with a stroke, heart attack, and other serious illnesses. The benefits range can be six months up to two years, depending on the company and policy chosen. The drawback to these insurance policies is they do not cover pre-existing conditions. Deferred annuities for after retirement and annuities with long-term care riders can also be alternative solutions to traditional LTC insurance.

The time to get proactive and creative about long-term care insurance is now. Current statistics may give a false sense of security regarding the likelihood you will need long-term care. Projections are indicating between 65 to 75 percent of Americans will require some level of long-term care after retirement. The unspoken truth that many within the LTC industry and government do not address publically is that if the problem is not resolved, it will still ultimately go away because the person who receives sub-standard or no care will die. The idea that aging Americans would be allowed to languish without proper care when they are at their most vulnerable is unthinkable from a human standpoint. Pro-active planning to find a long term care solution is essential to your future health and financial well-being.

We can help you put a plan in place that includes accessing and paying for appropriate long term care. We can review potential programs to help offset some of the costs while creating a legal plan to protect your assets from the high costs of care. Contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help you with your long-term plan needs.

Understanding Veterans, Home Health Care, and Technology

In the quest to provide cost-effective, quality in-home care for veterans, the Department of Veterans Affairs (VA) has been surprising trailblazers. Although the agency has long been mired in controversies surrounding its programs, particularly arbitrary caregiver dismissals, the home health services sector of the VA has long been touted as an overall success story. As Thomas Edes, director of comprehensive geriatrics and palliative care programs for the VA puts it “We’re working in this environment of challenging budget constraints, and at the same time, we’re a very mission-driven organization. Put those together and what happens? That really pushes us to innovate.”

The VA Innovations

This innovation has seen home-based primary care for veterans quadruple since 2000, and all VA medical centers throughout the US now have a palliative care program as well. The VA Medical Foster Home program care has expanded from a pilot to a national program, recognized in at least 45 states and providing veterans housing as well as in-home care. These success stories are great news for veterans and a must for the Veterans Administration in part because the median age of a veteran is now 64 and the US aging veteran population is growing even faster than the senior civilian population.

It is not just the “new-comer” seniors straining the VA health care system. Nationwide the 85 plus population is on track to increase 70% from 2000 to 2020 according to the US Department of Health and Human Services. The overall unsustainability of the US health care system has forced the hand of the VA, and there is no more cost-effective way than through subsidized, at home family and community-centered health care and technology to meet veterans’ care needs.

The Official Blog of the U.S. Department of Veterans Affairs reports that Telehealth is revolutionizing veteran care and providing high-quality treatment for them. The VA Video on Demand is delivering convenient, accessible health care particularly to those 24 plus percent of veterans who live in rural and remote access locations. Telehealth is also important for those veterans who are disabled. Although a veteran might live in a city they might be unable to get themselves to a medical center for an appointment

Technology Trends for Veterans

Assisted living technologies for veterans include assistive mobility equipment – an ever-expanding category including wheelchairs, all-terrain vehicles, exoskeletons, and in-home ceiling track mobility systems. Each of these continue to be refined and specialized to meet the individual veteran’s needs. The Veterans Administration awards grants to develop technology to assist veterans and service members in modifying their homes. Adapted computer access and electronic aids to daily living and environment control units (personal assistants) provide customized interactive abilities for veterans.

Electronic cognitive devices help veterans who struggle with activities of daily living (ADL). These devices include personal digital assistants (PDAs), smartphones, pocket personal computers (pocket PCs) and other handheld devices, global positioning systems (GPS), reminder watches, pagers with reminder features, and digital voice recorders. The use of these devices helps a veteran stay on schedule with medications as well as stay connected with family, friends, and their medical monitoring community. Those veterans with Post Traumatic Stress Disorder (PTSD) are further helped with their ADLs when robots with artificial intelligence (AI) are introduced into their environment. These AI “tech bots” are capable of reading human facial expressions and can identify when a veteran is feeling particularly stressed, isolated, angry, or depressed. The robot can upload the information to the veteran’s caregivers thus alerting them to the need for human intervention. Wearable sensors can also alert a caregiver or medical professional when vital signs are outside of a normal, healthy range.

Disabled Veteran Opportunities

The VA will provide a payment to disabled veterans toward the purchase of a car or other transportation and additionally will pay for adaptive equipment, repair, reinstallation or replacement of necessary equipment due to disability. If a veteran has lost the use of at least one foot, hand, or has a permanent impairment to their vision or severe burn injuries or immobile joints that their limit mobility, the VA will help to fund the adaptation of the vehicle to make it fully operational to the veteran.

While the latest technology brings benefits to all seniors opting to age in place, the veteran community is especially helped. Many veterans would like the luxury of aging without combat or noncombat injury so inherent to military service. Some of the aging in place obstacles they must overcome are extreme, commensurate with the injuries (psychological and physical) they have endured. Navigating the benefits that are available to a senior veteran is complicated if you are not well versed in the process. Getting enrolled in the correct program and receiving benefits can also be a lengthy process, so it is best to seek help before wasting valuable time.

If you have questions or would like to discuss your particular situation, please don’t hesitate to contact our office by calling us at (318) 255-1760 and schedule an appointment.