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.

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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."

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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