The Big-Brother Model of Assisted Living

Sensors installed in nursing homes and even individual residences are helping nurses monitor seniors' health, but questions remain about cost, and privacy.

Cathal McNaughton/Reuters

In an inconspicuous control room at the Sioux Falls, S.D., headquarters of the Evangelical Lutheran Good Samaritan Society, nurses keep round-the-clock watch on motion and humidity sensors in the living rooms, bedrooms and bathrooms of elderly men and women in five different states.

The seniors -- a handful in their own homes and the rest in assisted living facilities owned by Good Samaritan -- are part of one of the most comprehensive remote health monitoring efforts anywhere. Using sophisticated sensors, computerized pattern recognition and human responders, Good Samaritan hopes to show it can detect and head off health threats to the elderly and thereby accomplish two important goals. The first is saving money on medical costs. The second is helping seniors feel secure enough to "age in place" at home or avoid moving from assisted living to a skilled nursing facility.

Whether this costly technology will ultimately prove clinically or economically effective remains uncertain. So, too, is whether a benign health care purpose can help overcome the unsettling "Big Brother" overtones for some potential users. What is clear, however, is that health care is joining a national trend toward greater surveillance of everyday life.

For example, more than 70 U.S. cities now use ShotSpotter sensors to pick up the sound of gunfire and alert authorities even before 9-1-1 is dialed. Auto insurers are hooking up sensors to a car's computer system to monitor driving habits and, with the driver's permission, calculate premiums accordingly. Even some farmers are equipping cow collars with monitors allowing automated milking systems to track the cow's milk production, amount of feed eaten and even how long it chews its cud. If the system detects a problem, it can call the farmer on his phone.

What benefits bovines might also help humans, albeit with appropriate modifications. Good Samaritan is the nation's largest nonprofit provider of senior services, operating more than 240 facilities in 24 states. Working with the University of Minnesota, the system recruited 1,600 seniors in North Dakota, South Dakota, Minnesota, Nebraska and Iowa to test the impact on cost, quality of care and senior independence of a comprehensive set of monitoring tools. With an $8.1 million grant from the Leona M. and Harry B. Helmsley Charitable Trust, the LivingWell@Home study began collecting data at 40 of its assisted living facilities in January 2011, and will stop at the end of June 2013.

LivingWell@Home is comprised of three technologies. First, sensors from WellAware Systems are distributed throughout the living space. (The company stresses that no cameras or microphones are involved.) When a senior is sleeping a motion sensor records how often he or she moves in bed. Showering, toileting, and other activities of daily living are also analyzed by WellAware algorithms and scrutinized by nurses for changes that might signal health problems.

The second piece is a medical alert button from Philips Lifeline that includes an auto-alert function designed to detect a fall and call for help even if the user is incapacitated. Lastly, remote monitoring is provided by the telehealth unit of Honeywell through a clock radio-sized console in each apartment. It turns on each morning and prompts seniors to strap on a special blood pressure cuff, step on a special scale, and transmit that and other information back to the monitors in Sioux Falls.

Jacci Nickell, who is Good Samaritan's vice president of development and operation delivery systems, emphasizes that the technology is just a tool. "Unless you gather, integrate, and interpret that data in a meaningful way to the client and to their formal and informal caregivers, a sensor hanging on a wall isn't going to help anyone," she says. "It's what you do with that data, and how you optimize well-being."

Presented by

Michael L. Millenson is a visiting scholar at the Northwestern Kellogg School of Management and the author of Demanding Medical Excellence: Doctors and Accountability in the Information Age

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