The Big-Brother Model of Assisted Living

Good Samaritan isn't waiting for the study results to be finalized to roll out the LivingWell@Home service, in which the system has a financial stake, as an option in all its assisted living facilities. It's also putting parts of the technology into some skilled nursing facilities and even into seniors' own homes.

The organization's website tells the story of an elderly woman who agreed to have the sensors installed in the South Dakota farmhouse where she lived alone. Not long afterwards, the sensors detected a change in her toileting that prompted a call from a nurse. In response, the woman sought out her doctor, who discovered a bladder infection. "Maybe it was God talking to me," says 83-year-old Carol Tipton in a website video, seemingly near tears.

"We think the use of the technology can reduce the need for physical visits and will save expense and time," Nickell says. Still, the high-tech security blanket doesn't come cheap. The technology costs $500-$750 per month per person at home and about $175 a month for residents in Good Samaritan assisted living facilities that already have a personal emergency response button service. By comparison, notes Mary Cain, managing director of consulting firm HC3, conventional disease management costs well under $100 per month per patient.

"It's a very small percent of the population that's going to benefit from [the Good Samaritan] level of monitoring," Cain says. "How many will you monitor, and who is paying?"

A similar cautionary note comes from a spokeswoman for United Healthcare, the nation's largest health plan. United already covers devices such as those used to detect abnormal heart rhythms or measure blood sugar. But "health insurers typically rely on guidance from the clinical community in making coverage decisions," says the spokeswoman, and with sensors and similar technology "it's too early to do so at this time."

Privacy also remains a concern. Some critics may detect overtones of a 1983 song by The Police that warns, "Every breath you take, every move you make, we'll be watching you." As Christine Sublett, a health privacy and security consultant, put it: "Individuals should have the right to know exactly what information is being transmitted and that appropriate controls are in place." Good Samaritan says it takes appropriate precautions, but the research study may not provide a rigorous test of protection against hackers. Nor has Good Samaritan or its vendors yet encountered patients demanding their own datafeed, as has happened to makers of defibrillator monitors and similar technologies.

Still, other companies are jumping into this market. For instance, StealthHealth offers a radar beam to provide in-home monitoring of vital signs, activities of daily living, and falls. The company suggests its equipment be placed inconspicuously behind a picture frame. And GrandCare Systems offers to collect data from motion, temperature, door, chair, and bed sensors, in addition to pill box sensors for monitoring medication use and caller ID information to keep an eye out for telephone scams.

Choices are also proliferating for consumers willing to pay out of pocket for detailed quantification of their diet, exercise, and sleep patterns. In just one example, BodyMedia sells wearable sensors said to gather 5,000 data points a minute on skin temperature, heat flux, and galvanic skin response. The company says its aim is to provide users with a personalized assessment of health issues such as stress, fatigue, and depression.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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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