Advancements in artificial intelligence, mobile apps and even robots are becoming the new normal for improving seniors’ health.
By Eric Taub
A plaintive call from an elderly family member several years ago illustrated society’s digital divide.
“The TV commercial said I should go on a website for more information,” she complained. “But I don’t know how to get on the internet.”
That generation of individuals alienated by technology is now dwindling in number, gradually being replaced by aging baby boomers who, while not growing up with computers and smartphones, are not that intimidated by them.
The upshot is that senior living operators can no longer view the installation of ubiquitous Wi-Fi access throughout a community as a luxury add-on, something desired by only a few tech-savvy residents.
Much like a century ago, when electric light began to expand living spaces and phone service started to shrink the world, today’s Wi-Fi serves as the conduit through which other technological advancements become possible.
Artificial intelligence proliferates
New underlying digital technologies are beginning to change the face of senior living, creating efficiencies, cutting costs and improving resident satisfaction and health. Most important among them is artificial intelligence (AI), the ability to use data to accurately predict and evaluate behaviors, and even advise correct courses of treatment.
Increasingly, AI is being incorporated into sensors, robotics and cameras that can evaluate falls, analyze eating habits and even improve hearing.
That’s why Raymond Marneris, chief financial officer of Smith Crossing and Smith Village, senior residences based in Orland Park and Chicago, Illinois, decided in 2015 to make Wi-Fi available in every nook and cranny of the two facilities that collectively serve 600 residents.
“Ten years ago, residents came to Smith with one or two devices, and about 55 people needed them on a network. Today, everyone comes to Smith with 10 to 12 digital devices, and they want them all connected to each other,” says Marneris.
Examples include one or more smart phones, plus a tablet, computer, printer, a smart TV, Wi-Fi speakers, an Alexa device, a TV streaming device and digital picture frames. And on rare occasions, it even includes security cameras, says Marneris.
To serve today’s new aging population, “Wi-Fi should be thought of as a utility,” no different than running water or electricity, says Majd Alwan, senior vice president of technology and business strategy for LeadingAge, an association of nonprofit providers of aging services.
AI-enabled products and services can address staffing shortages through the increased efficiencies possible with automation. For example, instead of manually sifting through data, AI can automatically evaluate restlessness such as excess nighttime activity, consider whether an individual may be experiencing a urinary tract infection, and suggest appropriate treatments or a physician referral.
AI is also being used experimentally to check changes in one’s tone of voice as a way to detect early signs of Parkinson’s disease and dementia, notes Alwan.
While that service has not yet been commercialized, AI is helping voice control systems such as Amazon’s Alexa more accurately understand seniors’ requests, reducing the number of times a frustrated user will hear “hmmm, I don’t understand.”
As communities struggle with inflation and reduced availability of staff due to COVID as well as traditionally high employee turnover, automated systems can help cut costs while keeping resident engagement and satisfaction high.
AI fuels advancements in fall detection
Falls by senior residents is an ever-present danger, often precipitating other more serious health issues. To improve rapid intervention when a fall occurs, Kami Vision now offers KamiCare, a camera system that utilizes AI to more accurately detect falls and quickly alert staff when they occur.
The system, which became commercially available this year, improves upon fall detection technology found in wearable devices, says Ajay Gulati, the company’s chief technology officer. That’s because KamiCare doesn’t require staff to constantly recharge batteries, and the system avoids false positives that can happen if a wearable device is thrown on a bed.
In addition, a dementia patient wearing a fall detection device may not always be able to respond to a false positive, forcing overworked staff to attend to what might not be a fall event.
Using off-the-shelf camera systems equipped with Kami Vision’s AI technology, when a fall is detected an alert and video clip are sent to the cloud and verified by a human observer before notifying one or more caregivers. Exclusion zones can be set up in a room so that a rapid flop onto a bed will not trigger a response.
The system, which costs between $75 and $80 per month per resident, has already prevented a more serious injury to a resident at Village at Valley View, a 48-unit memory care community in Ashland, Oregon.
“Normally we don’t know how a resident fell, so it’s hard to do an intervention,” says Marilyn Lawson, the community’s executive director. But with KamiCare installed in residents’ apartments, the community was able to quickly detect one resident’s fall, notice that he had a skin tear, and then remove the hazard that caused the fall — an exposed electrical cord.
“We’re very satisfied with KamiCare,” adds Lawson. “In the future, we’d like to install their cameras everywhere in our community.”
For those operators who worry about privacy issues that could occur by placing cameras in residents’ apartments, Cognitive Systems has developed Caregiver Aware, software embedded in Wi-Fi routers that enables motion to be detected based on the distortion of the Wi-Fi signal as individuals move throughout a room.
Any Wi-Fi device, whether a router or a connected thermostat, becomes a motion detector. Using AI, the collected data can be analyzed to indicate when a resident goes to sleep or wakes up, as well as changes in historical movement patterns.
The software is sophisticated enough to filter out movements of pets. It can also distinguish between normal resident bed movements compared with sleep disturbances that could indicate a medical issue, says Taj Manku, CEO and founder of Cognitive Systems.
The software product will launch commercially next year and be available through internet service providers. And later this decade, a new Wi-Fi standard will incorporate motion detection in all new devices. Known as Wi-Fi 7, or 802.11bf, it’s expected to supersede the current Wi-Fi 6 standard sometime after 2024.
Artificial intelligence is also being used in a new, HIPAA-compliant cloud-based mobile tool designed to de-escalate fraught situations among those with dementia and mental illness.
TapRoot has collected data on the 27 most common reactions among dementia patients, including refusal to change clothes, medication resistance, elopement and fall risks, among others. Ella, from TapRoot, suggests non-drug interventions customized for each individual that can effectively calm an agitated resident.
Ella integrates into any electronic health record, including PointClickCare, Caremerge, MatrixCare, and others, giving access to a resident’s vitals and medications. The app will, for example, suggest a caregiver offer a patient his or her favorite snack, if that action has been shown in the past to help de-escalate a situation.
Or in another situation, Ella may suggest distracting a verbally aggressive patient by reminding that person of his or her likes or favorite memories, if such actions have been shown previously to be effective.
Immanuel Campus of Care in Peoria, Arizona, has employed Ella for the past year to further its non-pharmaceutical, person-
centered, psycho-social approach to patient care, says Aliece Anderson, director of outpatient services.
Employed among its 240 skilled nursing and memory care patients, “Ella helps us manage and de-escalate situations better and faster,” says Anderson.
While many of Immanuel’s caregivers initially balked at using it, believing that inputting data into Ella would increase their workload, “as soon as they use it it’s like a light switch,” says Anderson. “Ella is especially good with new med techs and nurses unfamiliar with the residents and their high level of acuity. This way they can check Ella ahead of time to understand the patients’ needs.”
According to research conducted by TapRoot, Ella has a 98 percent accuracy in both predicting that a resident will be resistant to showering as well as suggesting an effective way to de-escalate that reaction. By using Ella’s suggested interventions, the app has also been shown to be able to reduce the use of calming medications by 13 percent, says Linda Buscemi, TapRoot co-founder and chief clinical officer.
The downside of the slew of new AI-centric apps and digital services available to senior living residents is that accessing them all can be confusing and laborious. While the boomer generation may be familiar with technology, using one app to see the night’s menu, another to complain about a broken toilet, and a third to make a video conference call can become overwhelming as people age.
Juggling multiple apps
K4Connect believes that it has a better idea: Its mobile app and Fusion OS operating systems act as a control center for a number of service providers, allowing easy common access to apps that offer menus and food delivery, video chat, games, blood pressure monitors, and connected home devices, among others.
“The average assisted living resident is 84. Are they going to use multiple different apps while not giving the community access to all that siloed data?” asks Scott Moody, K4Connect CEO.
With the K4Connect app, a resident will be able to control his or her apartment’s lights from a single interface; which company actually provides that service will be irrelevant.
And the data collected from those various apps can be used to analyze resident behavior and provide an automatic check-in whenever a device is activated through the service.
K4Connect has partnered with a wide range of service offerings. It’s the largest provider of Amazon Alexa voice devices in the senior living space, giving residents a voice-controlled way to complete their daily check-in with staff. And it also aggregates services from Coro Health, GE, Google Meet, Grove Menus, Johnson Controls, Microsoft Teams, YouTube and Zoom, among others.
As data is integrated between providers and among residences, residents can ask Alexa to read the daily menu.
The menu can also be automatically available to every campus of a multi-building operation. The menu can also be integrated into the dining room’s point-of-sale system, enabling residents to learn about the nutritional value of their meals.
If the system notices that a resident who has high blood pressure continues to eat salty foods, it can suggest articles about proper nutrition to the recipient.
Now available to 40,000 senior living residents, the average price per person per month is $20.
“K4Connect is working out great,” says Marneris of Smith Crossing and Smith Village. “The residents love it and love that they can use any device in any place.”
Cypress Cove, a 650-resident senior living community in Fort Myers, Florida, recently added K4Connect, testing it with 20 residents for the past six weeks. The community expects to offer the product to all its residents within the next six to 12 months, says Joe Velderman, vice president of innovation for Cypress Living.
“We want to aggregate data such as room temperature, smart light activation and bathroom trips. Any activity becomes an automatic resident check-in. Now the resident no longer needs to push a check-in button every day,” explains Velderman.
Robots fill the staffing gap
To keep its staff safe from infection during the pandemic, Cypress Cove purchased two Ohmni Telepresence robots from OhmniLabs to automatically do remote check-ins with its memory care and skilled nursing residents. With several dozen telemedicine visits each day, “the robots have become incredibly efficient for us,” says Velderman.
Faced with staffing shortages, the community next purchased several culinary-designed robots from Bear Robotics.
Once entering a resident’s order on a point-of-sale tablet, the robot delivers the food to the server, eliminating the need for the server to go to the kitchen. With the addition of three more units, the robots “taxicab” in the kitchen.
After they deliver food, robots automatically get back in line to wait for the next orders to bring out to the dining room.
Employing the robots allowed Cypress Cove servers to handle at least six tables rather than the traditional four.
The community enjoyed a 35 percent reduction in required labor hours, allowing it to raise servers’ salaries from $12.50 per hour to above minimum wage, according to Velderman.
“Now we can be competitive with Chili’s and Texas Roadhouse in salary.”