Home monitoring industry - and privacy

As more and more people need to monitor elderly parents , Information Technology is providing ways to do that remotely. Would parents want the same setup to track their children away at college?

This is beginning to look a lot like strategic IT, use of "technology mediated collaboration" to cut health care costs and dramatically transform the way hospitals think of themselves and provide quality control over extensive services.

Or, would anyone want something similar to keep track of a friend or family member who was an inpatient in a hospital. There's an interesting question. Would hospitals encourage this constant vigilance from outsiders or discourage it? Given the shortage in nursing care in many places, maybe this is destined to become a new feature of in-patient hospital care.

For that matter, maybe no one should even go for an out-patient visit without being wired up and having a remote group of friends and family virtually along for the ride, aware of everything being done or not done. I can recall personally going to a large chain hospital emergency room for chest pains, being looked at briefly and put into a solitary closed room, and not seeing another human being for the next 80 minutes. I would have really preferred that someone at least would know if I fell over. The reason it's called "observation unit" is because someone is supposed to be "observing" the patient and would know if they collapsed.

Again, we have technological capacity (a remote TV video monitor) versus privacy concerns competing for more visibility versus less visiblity. These issues need to be addressed.

It raises the question as well as to whether some "observation unit" patients couldn't be released early, if heavily remotely monitored, or if some observation patients taking up Emergency Department beds couldn't be physically sent home, or to the cafeteria, or anywhere except taking up a bed, while they were still in "electronic tether" range and being monitored remotely. That could free up beds for people who really need them.

Today's New York Times has an article
In Elder Care, Signing On Becomes a Way to Drop By
Christine Larson
Feb 4, 2007

CONNIE ARAPS, 57, of Delray Beach, Fla., thought that her father, Tom Araps, 87, was managing just fine on his own. But when he came to stay with her for a few months in 2005, she found that he was skipping meals, sleeping all morning and not taking daily walks.

To satisfy her father’s desire to live alone, but to ease her mind about his safety, Ms. Araps found an apartment for him less than a mile from her home and had it equipped with QuietCare, a home health alarm system provided by ADT Security Services.

She drops by his apartment often, and logs into a Web site several times a day to check on him. Motion sensors track how often Mr. Araps opens the refrigerator, when he gets out of bed and how long he stays in the bathroom. If his normal patterns vary, the alarm company alerts her.

One day, the company called her to say that no one had entered or left the apartment all day. It turned out that a home health aide had failed to show up, and her father had not received his diabetes medication. Ms. Araps rushed over and made sure that her father took his pills.

“We are so pleased with all the technology,” she said. “I don’t think we would have let him live alone without it.” On the market since August, the QuietCare system costs $199 to install, and monitoring starts at $79.95 a month. In addition to the QuietCare system, Ms. Araps had the alarm company install video cameras showing the floors and the foot of her father’s bed, so she could see if he had fallen.

Other items:
* 19 million americans care for someone over age 75, according to National Alliance for Caregiving.
* QuietCare - alrm technology
* Nursing homes have been using this technology for years (peek ahead), and a few allow family members to view the data remotely. More are moving into home versions.
* Not all systems are emergency alarms, according to the Times:

A system called iCare Health Monitoring uses a very different model. It is not meant to serve as an emergency alarm system. Instead, it tries to prevent emergencies by allowing care providers, family members and older people themselves keep track of specific health data, like blood pressure, weight or medications use. Nurses monitor the system, but not around the clock.

Using a small electronic device with a text screen and four input buttons, the system asks a series of daily multiple-choice questions about an older person’s health. Family members or other care providers can view the answers online and look for any telltale changes in health. Available through www.cvs.com and some CVS pharmacy stores since July, the system costs $99 to install and $49.95 a month for monitoring.

Alberta Jackson, 78, of Aurora, Colo., who has chronic obstructive pulmonary disease, uses iCare to track her lung function every day. She spends about eight minutes a day answering questions. Once when she responded that she was not feeling well, a nurse called within minutes to check on her.

A final warning:

While geriatric care managers can offer invaluable help to families, the industry is largely unregulated.

“There are fabulous care managers out there who really know the whole system and are well trained,” Ms. Stone said. “But, buyer, beware: there is no required accreditation.” Only a few states require care managers to be licensed, although care managers who are also nurses or social workers may have state licenses.

Starting in 2010, the National Association of Professional Geriatric Care Managers will require all its members to hold one of four specific certifications in care management or social work.

Geriatric care managers usually charge $80 to $200 an hour, depending on the services provided. The managers can have vastly differing backgrounds, typically in nursing or social work. “If your mother has complex medical problems, you probably want a nurse,” said Andrew Carle, assistant professor and director of the program in assisted living/senior housing administration at George Mason University in Fairfax, Va. “If she’s lonely or has social issues, a social worker might be a better fit.”

*But, not everyone wants big brother looking over their shoulder. Interestingly enough,
there was another article in the Times today on the far end of the Privacy spectrum:
States Oppose National Driver's Licence

WASHINGTON (AP) -- A revolt against a national driver's license, begun in Maine last month, is quickly spreading to other states.

The Maine Legislature on Jan. 26 overwhelmingly passed a resolution objecting to the Real ID Act of 2005. The federal law sets a national standard for driver's licenses and requires states to link their record-keeping systems to national databases.

Within a week of Maine's action, lawmakers in Georgia, Wyoming, Montana, New Mexico, Vermont and Washington state also balked at Real ID. They are expected soon to pass laws or adopt resolutions declining to participate in the federal identification network.

''It's the whole privacy thing,'' said Matt Sundeen, a transportation analyst for the National Conference of State Legislatures. ''A lot of legislators are concerned about privacy issues and the cost. It's an estimated $11 billion implementation cost.''

The law's supporters say it is needed to prevent terrorists and illegal immigrants from getting fake identification cards.

States will have to comply by May 2008. If they do not, driver's licenses that fall short of Real ID's standards cannot be used to board an airplane or enter a federal building or open some bank accounts.

About a dozen states have active legislation against Real ID, including Arizona, Georgia, Hawaii, Massachusetts, Missouri, New Hampshire, Oklahoma, Utah and Wyoming.

With reimbursement and regulatory requirements pushing patients out of hospitals sooner,
this becomes more and more of an issue on tracking patients for the first few days after they have left the hospital setting and are transitioning to home care or new medications.

From personal experience again, I know that when a child of mine is released with instructions to me to "keep an eye on her and let us know if anything changes", it exhausts me trying to figure out what level of change constitutes a problem sufficient to drop everything and drive over to the hospital. This is probably a very wide-spread problem.