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PHOTO: ©iStockphoto/kupicoo

Last fall Harold Stephenson, 89 and with dementia, was found outside his rural home in Mount Pleasant, N.B., without a coat and confused. His family was constantly worried it might happen at night or in the cold, where every minute would make him harder to find. Even with THE help of a FULL-TIME home care worker, a niece who drops by every day and two sons who check in many times a week, there was still the constant worry Harold might fall or wander—and it could be hours before anyone knew.

But after installation of monitoring technology last fall, if Harold opens his door in the middle of the night, his son Lyndon is alerted and can go online to check whether his dad has just let the dog out, or has wandered away and a family member needs to go help. “It’s such a big relief,” says Lyndon, who lives a 20-minute drive away in Wicklow. This technology is stretching out the time Harold can stay in his familiar surroundings.

Baby boomers are expected to make such technology commonplace in Canadian homes, say aging-in-place experts. They will increasingly use it to help look after aging parents, and will rely on “smart home” technology themselves to remain in their own homes as long as possible, augmenting home care and helping stave off or avoid a move to a long-term care facility. Gadgets and gizmos to enhance safety, monitor health, prod memory, manage medical conditions at home and keep closer contact with family and friends are a worldwide trend.

Now on the market in Canada are monitoring systems that alert caregivers when a senior has fallen, missed medication, left the fridge door open—or hasn’t opened it all day. Caregivers can be alerted by phone, wireless device or e-mail anywhere they happen to be, even in a different province, where they can check the system’s sensor logs and use video cameras to check things out. Coming soon are automated systems that warn of rotting food in the fridge, that coach seniors with dementia, talking microwave ovens and scales to help those with failing vision. In development are companion robots that can help with household tasks and personal support.

Most of Canada’s early customers are families like the Stephensons, in the “sandwich generation”—raising their own children while caring for elderly relatives, often while juggling full-time jobs. Statistics Canada says 2.7 million Canadians over 45 provide unpaid care for seniors; a quarter of those caregivers are seniors and a growing number care for relatives with dementia.

Most Canadians want to remain in their own homes as they age, and for most of the time, most of us can do so independently. We can expect to live about 20 years beyond age 65—mostly in health. But the final years are marked by some degree of disability as chronic conditions like arthritis, high blood pressure, heart disease, vision loss and diabetes take their toll. One in five seniors aged 65 to 74 still living at home report a disability, but that rises to 28 per cent of 75 to 85-year-olds, and 45 per cent of those over 85, Health Canada reports.

Many are going to need some help at some point. But there are already tens of thousands of Canadians on waiting lists for long-term care facilities and the shortage is projected to continue as provinces struggle with increased demand coupled with stressed budgets. As well, there’s a shortage of employees to meet current demand for home support services.

“We need to find ways to be creative,” says Barb Burnett, executive director of the Atlantic Institute for Aging Care, which is conducting a pilot project that will help determine whether New Brunswick will add electronic monitoring to its menu of social services support. “When I saw this system I knew there was an opportunity to support individuals in their homes longer.” Technology can help fill the care gap created by a dwindling proportion of younger people as well as prevent caregiver burnout, she says. Canada’s army of caregivers, mostly family, provide unpaid services with an estimated value of up to $25 billion annually.

The longer seniors can remain in their homes, the fewer public long-term care facilities need to be built and staffed. Those facilities now cost about $15.5 billion annually, according to a Canadian Healthcare Association report. But there is also a financial incentive for families. Depending on the province, the senior’s income and services included, a resident pays between $540 and $2,800 a month for public long-term care facilities, more in private facilities. But some seniors—and their families—would be able to manage at home with some technological support, says Dr. Atiya Mahmood, assistant professor in the department of gerontology at Simon Fraser University (SFU) in Vancouver.

Alberta is investigating technology to aid aging in place. In a two-year $1.9 million project, seniors are trying out wander management systems, personal emergency response programs and medication management systems from CareLink Advantage, MedSignals and Priority Care Call. “These technologies are designed to provide seniors with more dignity and independence, while reducing stress on caregivers,” said Health and Wellness Minister Gene Zworzdesky. If it’s useful, the technology could be introduced throughout Alberta in the next two or three years.

Technology “doesn’t replace human contact,” says Burnett. “But we also know that seldom is someone able to be there 24 hours a day. This provides support when that human interaction is not there or not possible.”

The families in the New Brunswick pilot project, including the Stephensons, are charged $180 monthly rental for CareLink Advantage systems, which typically include a control panel with wireless Internet connection, bed sensors, several motion sensors, exit door sensors, medicine monitors and stationary and pan-tilt video cameras that can be set to capture video footage in the senior’s home.  Internet services are also needed in seniors’ and caregivers’ homes.

The system is designed to be unobtrusive to seniors and easy for caregivers to use, says CareLink Advantage President John Whitehead. “We wanted caregivers to be alerted to exceptions to normal behaviour, so they wouldn’t have to go looking for them,” he adds. “I couldn’t imagine stopping, two, three or four times a day, and logging in to see if there were issues.” As well, “the role of the senior had to be passive. It was important they just continue to live as they always have.”

The New Brunswick systems were individualized for each participating family. Wireless sensors placed throughout the home constantly transmit information to carelinkadvantage.com. The biggest worries dictate what is monitored—falling, taking the right medication at the right time, wandering. The system automatically alerts caregivers only when there is a problem—if a sensor indicates no movement when there should be, that medication was missed or taken in the wrong order, that an exterior door has been opened at night. Family and caregivers can log onto the website to look at sensor logs and operate video cameras to check on the senior at home. Also available are sensors for medication monitoring, personal emergency response alerts and fridge and pantry door sensors. Competing systems aimed at the luxury consumer market also provide two-way communication through the television, healthcare worker alerts and family websites.

In the personal emergency response system business, Whitehead was willing to explore technological help for his own frail parents. “Before we had this system installed, as you get up, you worry and as you go to bed, you worry,” he says. “You play the guilt game: maybe Mom’s lying on the floor, and maybe I should call.”

Such worry contributes to caregiver burnout, says Burnett. Aside from relieving worry, the system spreads the workload. “If an individual lives in Fredericton and has children here and a child in Edmonton, that child in Edmonton can play an active role,” she adds.

Critics worry about the potential for abuse and invasion of privacy. Law, policy and public discussion have not kept pace with this technology, says Charmaine Spencer of the Canadian Network for the Prevention of Elder Abuse and researcher at SFU’s Gerontology Research Centre. As a society we should be discussing where this technology is—and is not—appropriate.

Because the technolgy is so new, there’s a danger people won’t recognize when abuse occurs or know where to report it. And even in the few provinces with adult protection legislation, the primary remedy for neglected or abused seniors “ironically, is placement in a long-term care facility,” she says.

Systems should be designed to protect privacy, adds Dr. Alex Mihailidis of the University of Toronto and Toronto Rehabilitation Institute. Seniors should give informed consent before equipment is installed in their home, and it should also be up to the senior to decide who has access to the system and the information, and how it’s used says Michelle Chibba, director of policy for Ontario’s Information and Privacy Commissioner’s office.

Seniors are willing to give up some privacy to enhance independence and safety. “You have to understand that seniors lose privacy when paid caregivers come into their home,” say Burnett. Privacy is also greatly reduced in a residential facility. “With this system, the only individuals who have access to information are family members,” she adds. Lyndon Stephenson said Harold was involved in deciding on camera placement so as not to intrude on bedroom or bathroom privacy. And although they worried paid caregivers might object to the system, there have been no complaints. “It’s not a secret,” explains Whitehead.

Another worry is that a monitoring system will replace visits. But researchers have found no reduction in family visits. “We found a wonderful bonus we didn’t intend,” says Whitehead, who’s installed more than 100 systems in private homes and care centres across the country. He says prior to installation, family visits and calls were interrogations, with the senior queried about whether they had taken their pills, what time they got up, if they remembered an appointment, what they had for breakfast or lunch. “After the system is installed, family visits become social occasions again,” he says.

Caregivers can also track change in behaviour and investigate what is behind it. Lyndon Stephenson discovered his father was sharing meals with the dog. Now he calls to make sure the dog is put outside before his dad sits down to eat. Fridge and pantry door sensor data alerted Whitehead that his Alzheimer’s-stricken mother had been forgetting to eat lunch, so the family arranged for a member to stop by every day at lunchtime to share a meal. “You can spot changes in behaviour and address things before a problem develops,” he says.

United States Department of Veterans Affairs care co-ordinators are using remote monitoring systems to do just that. In response to an anticipated tripling of clients aged 85 and over, 17,025 veterans with chronic health conditions were monitored, resulting in a 20 per cent reduction in hospital admissions and a 25 per cent shortening in length of hospital stays. The annual cost of monitoring is $1,600 per patient compared to $13,121 for primary medical care service and $77,745 for nursing home care. The program is now being rolled out to more U.S. veterans. Veterans Affairs Canada considers support for home monitoring systems on a case-by-case basis based on need.

CareLink Advantage systems cost between $130 and $190 a month, depending on whether clients buy their own hardware (at a cost of about $1,000). Competitors serving the luxury consumer market are quoting $3,000 to $9,000 for equipment, plus monthly access fees, for systems with all the bells and whistles. But there are also small budget alternatives, says Mahmood. “Not everybody needs everything.”

Some families are independently buying and installing web cameras, adds Ursula Lebana of SPY TECH in Toronto. Such cameras cost between $500 and $1,000; the more expensive models offer e-mail or cell phone alerts and video recording.  Perimeter motion detectors, starting at $79.99, set off an alarm if a senior wanders away, and there are $300 to $400 GPS (global positioning system) locators worn on the belt to make finding wanderers easier, she says.

Not only will baby boomers be willing to use more gadgets and gizmos, but the devices will increasingly be smarter, cheaper and easier to use, says Dr. Rafik Goubran, dean of engineering and design at Carleton University in Ottawa. On the tip of his finger he displays a sensor smaller than a pencil eraser. These sensors can be placed anywhere—in a pad on the bed, a mat on the floor, the door of a fridge, where they can sense such things as differences in pressure or temperature or detect gases. A computer can analyze that data, and alert a caregiver about important changes, such as higher risk of falling indicated by changes in a senior’s strength in gripping a grab bar. The sensors can be connected to microphones and speakers to remind someone to close the fridge door or to alert residents that food has gone bad. Soon, sensors will be able to detect whether it’s the milk or the meat that’s gone bad. Sensors can also detect when someone gets out of bed in the night, and automatically light a path to the bathroom.

Consumers can buy automated Smart Home technology to control heating, lighting and entertainment systems, but the day is coming when Smart Homes will feature technology to support aging in place “without reliance on a family member, caregiver or health-care worker,” says Mihailidis. “Everything can be built into the environment so the resident does not have to wear anything or push a button or remember to turn on a system.”

Mihailidis has tested a computerized system which uses artificial intelligence to guide people with dementia through such everyday activities as tooth brushing. Web cameras monitor the senior, intervening to give instructions only if needed. “An electronic prompt can say it 80 times without losing patience,” says Mihailidis. Not only is the caretaker’s supervisory burden lightened, but the senior keeps up competence at the tasks of daily living.

Canadians have been slow to adopt aging-in-place technology, but Burnett predicts that will change. “We’re seeing very positive feedback from families” in the pilot test who report that the technological support has helped them cope and put off placement in a facility. “With our families smaller and much more spread out, the options to support someone in the community are more limited. This will provide another option.”

Burnett realizes, however, that not everyone is a fan of new technology. “It has taken a bit of time to identify the right population to embrace this. But those who like it are spreading the word.

30 Great Household Gadgets

For General Safety:

1    Stoves that automatically shut off when unattended
2   Overflow alarms for bathtubs and showers
3   Sensors that detect smoke, flooding or temperature changes and automatically summon help
4   Flooring that detects falls
5   Fridges that warn when the door has been left open
6   GPS (global positioning systems) that track wanderers
7   Personal emergency responders that detect falls and automatically summon help
8   Doors that automatically unlock and porch lights that blink to alert emergency responders and neighbours when help has been summoned
9   Bed sensors that automatically trigger lights that lead to the bathroom
10 Toilets that assist with personal cleaning
11  Taps that turn themselves off

Health Monitoring:

12    Sensors that track whether the right medication is taken at the right time
13    Sensors in grab bars that measure grip strength
14    Sensors that track pulse, respiration, temperature, blood pressure and blood sugar level
15    Sensors that track motion, meal intake, sleep patterns and alert caregivers to changes that may signal a problem
16    Automated reminders for people with memory deficit
17    Locators for lost glasses, keys and remote controls
18    Games that track mental acuity

Promoting Better Health:

19    Brain and physical fitness activities
20    Two-way communication through a computer or television to facilitate rehabilitation exercises
21    Intelligent fitness systems that prompt and guide exercise
22    Remote monitoring systems that keep track of vital signs and alert a health-care worker or doctor
23    Automatic prompts to help people remember daily tasks and how to do them

At Your Convenience:

24    Trash containers that open automatically
25    Robotic vacuum cleaners, lawn mowers
26    Combined washer/dryer to eliminate moving loads between machines
27    Talking microwave ovens for those with vision problems
28    Robotically controlled systems for lighting, draperies, entertainment systems

Social Interaction:

29    Two-way audiovisual communication with friends and family through the television
30    Social groups, like book clubs, that have virtual meetings through the computer or television

Aldebaran Robotics NAO.

PHOTO: ALDEBARAN ROBOTICS

Personal Helpers

For baby boomers raised on sci-fi movies and books featuring robots with human-like characters, a companion robot may be the ultimate gizmo for aging in place.

Right now they’re pricey pals, ranging up to half a million dollars for an interactive robot that can express and understand human emotion, take out the garbage, remember where you put your glasses and remind you when to take your medicine. But prices are coming down. Toyota expects to be selling more robots than cars by 2030.

In the real world, developers have struggled to produce “just-right” robots strong and dextrous enough to do household chores, that recognize people and their emotions, behave ethically, understand and follow orders and look enough like a human to be endearing, but not so realistic they creep people out. Robots are even being programmed for ethical behaviour—for there is a fine line between reminding and nagging (not to mention snitching that you’ve indulged in a second helping of dessert).

Here are a few of the faux friends now in development:

The French firm Aldebaran Robotics has produced the pint-sized Nao and larger Romeo companion robots. The agile Nao, priced from $2,500 to $15,000, has been transformed from a dancing, soccer-playing toy into a therapeutic tool by programming developed by an eight-country university consortium funded by the European Union. The two-foot-tall robot learns, expresses emotions, recognizes faces and carries on conversations. In pilot projects it has been used to teach emotional skills to autistic children and to help people with cardiopulmonary obstructive disease manage their condition at home. Trend spotters predict the little guy has a future as a family companion, too. Romeo, at 41/2-feet and 88 pounds, will be able to help with household tasks like taking out the trash and fetching things. It can help people get up if they fall and it keeps track of oft-misplaced items like eyeglasses or remote controls. It can remind people to take medicine, start dinner or prepare for appointments.

In the U.S., Pearl the NurseBot, developed at Carnegie Mellon University’s Robotics Institute, reminds people to take medications, help them open jars and escorts them to the dining room or to appointments.  It can collect health data, like a diabetic’s blood glucose levels, and give medical instructions, such as how to care for a wound. While Pearl has been tested in nursing homes, GeckoSystems’ CareBot is designed for elder care in private homes. With customized voice, personality and phrases, it’s designed to keep an eye on its companion and deliver reminders. It has a video link to caregivers, whom it notifies if something goes wrong.

In Japan, Twendy One is just one of dozens of robots designed to support aging in place. It can assist someone out of bed and into a wheelchair, fetch things from the fridge and fix breakfast. Paro, a baby harp seal replica, has been designed as a companion for older adults and for pet therapy. It remembers individuals and how to behave to get them to interact.

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