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Getting wise to the smart home
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 Posted: Tuesday Dec 13th, 2011 01:16 am
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http://www.agedcareinsite.com.au/pages/section/article.php?s=Technology&idArticle=22842

Many studies have demonstrated the economic and health benefits of telehealth in aged care, yet the take-up remains patchy. Darragh O Keeffe and Natasha Egan report on the reasons why, and what’s needed to change it.
At this stage they are like old friends. We are all intimately familiar with the gadgets and gismos promising us independence in our old age; a dazzling array of sensors, monitors, alerts and alarms.
And yet despite the promise, and the body of research that confirms their usefulness and cost effectiveness, these assistive technologies remain largely underutilised in the aged care system.
Those working in the field say it is now possible to build a home that virtually supports older people to live independently, but, as with any innovation, it is not yet cost effective for the majority.
“I would think in the next five to 10 years that capability will be an accepted part of the installation in any elder person’s home who wishes to remain at home safely,” says Deborah McKern, business development director with Seasons Aged Care.
Seasons has five high-tech retirement villages in Queensland, a sixth under construction and another four in planning.
The target market is frail elderly people who can no longer live safely in their existing residence but still want “a home”. The purpose built villages are constructed with cabling that support any level of monitoring currently available. “They move into our apartments ... and they remain as independent as possible, for as long as possible,” says McKern.
Unit monitoring can include sensors to detect water, falls and movement. Kitchen elements can be disengaged to ensure safety but allow residents to continue to feel like they are at home. Electronically wired front doors can send a message to care workers when opened, while invisible perimeter alarms, applied at an individual level, can notify staff when wandering residents have crossed a prescribed boundary.
The next stage is to give smaller providers and the wider community access to the high-tech services; a field Silver Chain in Western Australia is already working in, McKern notes (see panel).
Seasons, through its care business, Envigor, is putting together packaged IT support services that will extend people’s capacity to stay in their own home, she says.
McKern describes a 24-hour monitoring hub, that could be anywhere in Australia, that would respond to alerts, then engage a local team to provide on-the-ground support where required. It would be a cost effective approach for families and operate much like a back-to-base alarm system. “It doesn’t rely on the person initiating the call but the actual technology initiating the call.”
The next generation of smart homes will be programmed to respond to activity such as time and weather, McKern says. They will cause lights to go on and off, blinds to go up and down, temperature to adjust appropriately, meals to be heated and “pop open” when they’re ready to eat. “We will see this becoming available in the next decade as people continue to age.”
Medication management services that prompt people to take their pills and telehealth initiatives for monitoring, diagnosing and reviewing in remote areas are other examples of technology already in use.
McKern doesn’t see anything specific stopping the ideal smart homes from becoming a reality. She says she’s confident because the research, documentation and most importantly, the demand of an ageing population is there. “Because the focus is on people maintaining their independence for as long as possible, we’re already seeing that starting to be taken up.”
According to an Australian expert in this area, Associate Professor Jeffrey Soar, the challenge for telehealth is translating the research into practice; moving from pilot phase to large-scale implementation.
Numerous research projects here and overseas have clearly demonstrated the benefits of telehealth to seniors, and yet there hasn’t been large scale roll out of the technologies, says Soar, who is convenor of the Queensland Smart Home initiative and associate professor in information systems at the University of Southern Queensland.
When INsite last profiled Soar (Oct/Nov 2007) we remarked there was a sense of deja vu about the Queensland Smart Home.
“The unit was equipped with state of the art technology for independent living and home care. It had the type of assistive technologies that are designed for safety and security, like flood detectors and gas monitors. There were also bed and chair sensors to monitor vital signs.
“That feeling of deja vu was because, quite simply, this was nothing new,” that article said.
What was new about the Smart Home, however, was that its second phase was about to start investigating the barriers that prevent older people from using the technologies. “To put it simply there isn’t much point developing assistive technologies if the intended user won’t use them,” the article said.
Four years on and Soar is still focused on assistive technologies and their role in supporting a growing ageing population. He has just returned from China, where he, and a handful of international researchers, are advising the Chinese government on how it can use telehealth to support its elderly.
He says that, based on conversations with international colleagues, the feeling overseas is that assistive technology now needs to move beyond the pilot phase. He says that sentiment prevails here too.
“I mean these pilots have been evaluated in a rigorous way in Australia, the US and Europe, and have shown there are savings from using this technology. We know there’s a 20 per cent reduction in hospitalisation, a similar reduction in the length of stay in hospital, and a reduction in the need for nursing home care, in the range of 60 to 80 per cent.”
The question then becomes, why isn’t the technology being rolled out large scale?
The frustration among providers, particularly those who have gone it alone and pioneered their own pilots using the technology, has been previously reported in INsite.
In the Aug/Sept issue, Feros Care, a not-for-profit provider of community, residential and respite care, reported on its pilot telecare and telehealthcare projects.
Its telecare project involved installation of multi sensors in 30 client homes, including movement sensors, fall detectors, door sensors, medication reminders, smoke and other environmental sensors, and emergency pendants, which had since extended to more than 180 client homes.
The telehealth trial customised home monitoring technologies, including blood pressure, pulse and oxygen saturation monitors, weight scales and glucometers in the homes of 15 clients with chronic health conditions.
In the article Feros Care CEO Jennene Buckley said she was keen to build up interest and momentum for assistive technology in the aged care sector. "I'm on a political path now because I've got a good story, it's happening on the ground, and its benefits need to be shared, and rolled out within our sector," she said at the time.
In another INsite report (June/July 2010), Megan Stoyles reported it was “internet capacity, not patient reluctance” that was the main barrier to assistive technology in home care for the aged.
“The roll out of the national broadband network can’t come fast enough for organisations providing in-home monitoring and care to older people. It holds the key to keeping them safe and maybe avoid nursing home care or hospital treatment,” Stoyles wrote.
As well as citing Feros Care, that article mentioned Hunter Nursing, which was also trialling home monitoring services. Both organisations said the major challenge of the otherwise “absolutely fantastic” technologies was unreliable connectivity at current internet service levels.
Asked if the broadband network would therefore facilitate the large scale roll out of telehealth and assistive technologies, Soar said it would be a “huge help”.
“There are some programs and safety devices that can operate on phone systems. But with telehealth, particularly where video is needed – for a clinician to see a skin lesion, or for face to face consults – broadband is required.”
However, Soar is most excited by the international collaborations, primarily the work he is doing with his new Chinese partners. He said the project would have a global impact, assisting all countries with an ageing population, such as Australia.
“The results will impact not only China but across all countries that face challenges of an ageing society. The journal papers from this project will be of interest to policy makers internationally.”
He said the National Population and Family Planning Commission of China has been given broad responsibility for whole of life care and health. It has a keen focus on ageing and is interested in delivering care to people in their homes; as well as broader issues of community and housing design and building.
Soar is leading four projects for the Chinese, one is establishing demonstration smart homes in Hangzhou and Changzhou, modelled on his Queensland version. Another is a worldwide review of the research and a scan of the systems. He is also building the new model of care and business for deployment in China; and establishing initial examples in the two cities to refine the models before large-scale deployment, then delivering them to Shanghai and Beijing.
Given the current state of play with telehealth in Australia, it’s not surprising that Soar is encouraged by the Chinese collaboration. As he points out, it has the world’s largest group of older people and is facing a rapidly ageing population, exacerbated by the one-child policy. Who better than the Chinese to develop the business model for large scale use of these technologies?
“I think the fact the National Population and Family Planning Commission is taking ageing as a key issue is very exciting,” Soar said.
Elsewhere, as INsite went to press, Veterans Affairs Minister Warren Snowdon announced the Australian government would launch an $8 million trial of the use of technology to monitor the health of critically ill veterans at home.
Snowdon said the trial would involve about 300 veterans in areas with a significant veteran population and where the broadband network was now available, including Toowoomba in Queensland, Coffs Harbour and Armidale in NSW, Mandurah and Geraldton in WA and Kingston Beach in Tasmania.



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