I would love to share with you the future impact of IoT on senior care.   I hope to educate owners, operators, and workers in independent living, assisted living, memory care, and continuing care communities on the value of IoT, what it can do for senior care communities in the next 10 years, and how it will lower costs and attract and retain customers and employees.

We believe there have been great strides in the quality of care in senior care communities over the last 10 years with improvements in communication systems, nurse call systems, security systems, vendor management systems, compliance systems, staff scheduling and management and reporting systems.  In fact, the senior care community is doing a better job than at any time in history.

I believe that IoT, machine learning, crowdsourcing, and a relentless commitment to innovation in senior care will bring about an even greater revolution in senior living in the next 10 years creating SMART Communities:

1. Safety (wearable and environmental sensors — fall prediction and mitigation, wandering, refrigerator, windows, home automation – lights/thermostats, air quality)
2. Mental and physical health (sense of independence, reduced anxiety, heart rate, blood pressure)
3. Activity (exercise)
4. Rest (monitors sleep, promotes rest with automated lights, etc.)
5. Togetherness (connects them with caregivers, other residents and their families, improving happiness)

In writing this article I was looking for examples of competitive industries leveraging technology and stumbled upon this article about the reasons that Norwegian countries are so productive.  They sport the highest productivity per individual and some of the most globally competitive companies in the world.  Their secrets to success are:

• A commitment to relentless innovation
• A balance of passion for the new with an ability to take the long view
• A consensus-based approach to management
• A passion for replacing labor with machines

IoT, the internet of things, is the connection of devices to; each other, people, and things.  IoT collects and ships data and events from devices either in, on, or around people and their environment.  When married to analytics and machine learning IoT becomes the most powerful tool we have for responding effectively, just in time, and predicting effectively when an event might occur before it happens (knowing a resident is going to fall in the next hour).  IoT has been around for a long time in many industries.

IIoT (Industrial Internet of Things) runs all modern manufacturing plants

IoT controls product flow of gas, oil, and electricity worldwide

IoT identifies and notifies most major cities of gunshots and their location

IoT controls a vast array of lights and intersections in our cities

IoT is what allows self-driving cars to drive themselves

IoT is transforming the way we care for seniors, lowering costs, improving senior care performance, improving the quality of life for residents, and creating and connecting residents to their family and community.  It will have the single largest impact on your bottom line in the next ten years because it will help you do more with less. Let’s see what you get with a SMART Community.  The first two things we need to understand are what are sensors and how is their data analyzed.

Sensors are measuring devices.  This is true of microphones and video also.  Microphones measure the sound and video measures light.  The variety of sensors and what they can measure has been growing rapidly as the cost declines over the last few years.  Here is a shortlist from Wikipedia:

1. ACOUSTIC, SOUND, VIBRATION
2. AUTomOTIVE, TRANSPORTATION
3. CHEMICAL
4. ELECTRIC CURRENT, ELECTRIC POTENTIAL, MAGNETIC, RADIO
5. ENVIRONMENT, WEATHER, MOISTURE, HUMIDITY
6. FLOW, FLUID VELOCITY
7. IONIZING RADIATION, SUBATomIC PARTICLES
8. NAVIGATION INSTRUMENTS
9. POSITION, ANGLE, DISPLACEMENT, DISTANCE, SPEED, ACCELERATION
10. OPTICAL, LIGHT, IMAGING, PHOTON
11. PRESSURE
12. FORCE, DENSITY, LEVEL
13. THERMAL, HEAT, TEMPERATURE
14. PROXIMITY, PRESENCE
15. SENSOR TECHNOLOGY
16. OTHER SENSORS AND SENSOR RELATED PROPERTIES AND CONCEPTS

New technology combines sensors, memory, computing devices, and communication devices either as a single chip or on very small boards.  The result of this is the ability to collect, analyze, and send both data and events from those devices.

As the cost of sensors drops almost every market vertical is adopting sensors to measure effectiveness, improve material and process flow, and provide just in time delivery of services. Senior care is no exception.  Wearable and environmental sensors are poised to revolutionize the industry by predicting future failure, improving response times, improving the delivery of service, and improving the quality of life for your community.

what is analysis and how is it done?

Sensor data is not clean and can change dramatically between environments and people.  The challenge in the analysis is to collect good data, have that data be adjusted for the environment or person it is in reference to, understand what aspects of the person or environment the data is, directly and indirectly, measuring and adjust the thresholds and pattern matching for the creation of events that people, machines, and the environment respond to.  This is done through complex mathematics, AI, and event analysis at various locations from the sensor itself to the cloud.

Although the analysis does take place on the sensors themselves; most sensors lack the computing power.  There is a lot to be gained by combining the information and events from multiple sensors to determine how we should react to our environment.  Imagine that we have a motion sensor connected to the bed and a microphone that listens for respiration. Increased motion in bed while asleep might be a perfectly normal event but when coupled with increased respiration may indicate a heart attack or a serious condition.  To accomplish this type of analysis, multiple sensor data is collected on gateways and analyzed there. Gateways are devices connected to many sensors that analyze and transport the data over relatively long distances.

 

Effective wireless systems relay alarms and events to mobile client applications and dashboards that inform either centralized or distributed help centers and individuals that a fall has occurred.  Staff in facilities are immediately notified of falls on their cell phones. Staff commitments to respond, their arrival time, an assessment, and resolution time are all stored at the time the event took place.

Dashboards show the health of communities at a glance and areas requiring improvement with respect to fall remediation.

Now that we have an idea of what sensors are, how analysis works, and how notifications are resolved it’s time to think about a SMART Community; Safety, Mental & Physical Health, Activity, Rest, and Togetherness.

safety

The health, happiness, and safety of community members is the primary focus of senior communities.  We like to think of safety as all those things that optimize the security of the environment. Safety for us includes the mental and physical health of our community members now and into the future.  

Wearables and environmental sensors in conjunction with AI can make a senior’s environment safe by:

1. predicting falls
2. Indicating physical problems before we are aware of them
3. significantly lowering response times in fall situations
4. notifying us of soiling events
5. constraining residents to physical areas
6. warning us if refrigerator doors have been left open
7. telling us if the resident is too cold
8. notifying us of air quality issues
9. controlling thermostats
10. turning lights and appliances on and off 
11. acting as call buttons

fall prediction, prevention, and detection

Falls are one of the most frequent and serious problems facing the elderly and the guardians of senior communities.  Residents often refuse to wear or use safety pendants or call buttons. Responsive flooring, lighting, environmental enhancements, and assessments reduce the impact of falls but have not staunched the bleeding with 220,000 residents falling in assisted living facilities in the United States per year.  The two most critical factors impacting the risk and cost of falls are:

1. Immediate knowledge and appropriate mitigation of a fall
2. Prediction of an impending fall

SMART Communities are turning to IoT to solve these problems by using:

• sensors built into fashionable clothing, wristwatches, and belt clips with sophisticated event analysis
• video analyzed with AI that recognizes fallen residents

wearable sensors

Both of the above solutions do not require the senior to make a decision to wear something they feel is unattractive or label them as a senior.  The new paradigm for sensor based fall mitigation is to provide an array of sensors built into fashionable clothing that seniors choose to wear naturally with no stigma attached. The advantage to this approach is that the sensors continuously collect data on the movement and behavior of the resident such as getting up from a chair, sitting down, walking, distance moved, and acceleration in their steps.  All of this data is analyzed for trends over time and is a very good predictive indicator of future falls and need for intervention.

video analysis

Identification algorithms have become sophisticated enough for video cameras to now identify a fallen person in a room and recognize them by facial features. Although these systems are not yet on the market they will be soon allowing senior care communities to install cameras throughout their facilities to immediately identify fallen residents.

helping with cognitive impairment and wandering

Cognitive impairment is a serious issue for senior communities. It is extremely difficult to analyze for eventual impairment during the admission process. Communities often end up with a growing population of cognitively impaired residents and must think of ways to accommodate them. Their challenging tasks include:

1. Keeping cognitively impaired residents safe by not letting them wander far 
2. Lowering their anxiety brought on by the unfamiliar or sensory bombardment
3. Minimizing repetitive behaviors
4. Dissuading impulsive behaviors
5. Helping them get better sleep
6. Providing adequate supervised exercise
7. Providing adequate response time to a call for help

IoT promises to deliver ingenious wandering solutions based on passive geofencing. Location solutions outside of buildings using GPS have existed for years. New indoor positioning systems (IPS) coupled with GPS allow IoT systems to determine resident locations inside and outside of buildings. New ergonomic earbuds not only cancel the cacophony of sounds bombarding cognitively impaired seniors they also are controllable over BLE through gateways. Soothing sounds can be played when:

• There are increased heart rates
• When they are headed in the right direction
• When they are anxious

mental and physical health

For those of us over 50 who remember 2001: A Space Odyssey and the HAL 9000 there is a spooky quality to being reminded by a computer to do something. Regardless of our trepidation music, familiar voices and audio suggestions measured with heart rate monitors are an effective way of controlling anxiety, reinforcing exercise, and helping with sleep cycles.

Recent research has significantly improved our understanding of neuroplasticity; the ability of the brain to build more connections throughout our lives. A longitudinal study dubbed The Nun Study has shown that even with all the physical characteristics of amyloid buildup in our brains, an indicator of Alzheimer’s disease, some nuns scored high on cognitive studies until they died. The significance of this is that our brains can be trained to build circuits around impaired areas of our brain through exercise and mental activity. The use of smart speakers and earbuds automatically playing music based on anxiety, lack of exercise, or a need for mental activity will help keep seniors physically and mentally active longer.

Providing audio feedback telling a senior that someone is on the way after they have fallen significantly reduces their stress and fear response to a negative fall situation. Turning lights on when they get out of bed and helping them negotiate an environment or find their way back to their room remove the stress associated with memory loss and aging.

Providing an audio review of a seniors activity during the day keeps them active.

john, you walked 2,000 steps today, 300 more than yesterday. your average heart rate was 61 beats per minute, 4 beats per minute better than the average for your age. your blood pressure was 130 over 80 which is great with 02 at 98%. you answered every one of your 5 quiz questions correctly today. congratulations.

We are creating a future for seniors where their anxiety and fear are significantly reduced improving their sleep, and keeping them healthier and happier longer.

activity

Our goal for the future is to get to keep seniors active and safe. We can do that by measuring their activity levels, oxygen levels, heart rate, and blood pressure, body density. All of these sensors are either on the market or soon will be at reasonable prices.

Activity monitors are everywhere but senior activity monitors require more targeted functionality. We care about changes in pace, changes in the gate, how fast a senior sits down and gets up, how many steps they take in a day, what was their heart rate at what pace, what was their blood pressure, and did they stay close to the point of origin.

IoT empowers seniors because it calculates trends from continual measurements. With speakers, earbuds, and smartphones seniors can be encouraged to perform specific exercises or to pause in their current exercise. With new IoT implementations, they can be informed to give their knees a rest and drink some water for hydration.

The most important aspect of IoT and activity is the integration of a seniors’ activity with their neighbors. This is covered in togetherness, the real lever for improving our senior care system and leveraging the vast wisdom of our seniors.

rest

Sleep Safety using Bedpost Fixed Sensors

Accelerometers can be affixed to the legs or backboard of beds with batteries lasting up to one year are designed to recognize when a resident has gotten out of bed, rolled out of bed or left the bed at night and not gotten back in bed. These take the place of the environmentally frustrating bed exit alarms using speakers. With fixed bedpost accelerometers, the staff is notified of bed exit events on their phones without scaring the resident.

Bedpost accelerometers are an excellent alternative to wrist-worn sleep monitoring systems allowing for analysis of resident sleep habits by bed entry, bed exit, and motion at night without the annoyance of wearing something that irritates a senior’s skin at night.

Sleep, Heart Rate, and O2 Sensors

New O2 and heart rate monitors wirelessly monitor oxygen and heart rates. Soothing music can be turned on to change breathing behaviors at night when the O2 monitor is connected to IFTTT (If This Then That) and an Amazon Echo. Any event that requires investigation like a rise in the heart rate at the same time O2 is decreasing can be set up to notify stakeholders in the senior’s life such as staff, physicians, and family members.

togetherness

Togetherness is the core principle of an improved senior care society. IoT, measurement and communication, is a tremendous lever to improve all aspects of senior care. Just as Uber is a logistics company for people and things IoT for senior care connects seniors to each other, their family, and their society through apps. Transparent awareness of your friends or loved one’s movement, anxiety, and activity status allows groups of seniors to walk together when they realize their friend needs exercise and brings caring staff to an immediate need.

conclusion

We have had tremendous advances in our level of care for seniors. The next generation of senior managed SMART Communities will provide unprecedented levels of care at much lower costs utilizing IoT and AI. The best part about the future of senior living is the reintegration of seniors into our lives. Not only will IoT bring families and communities together again it will improve on communication through instant video conferencing and lower the burden for caregivers.

Embracing IoT is a market differentiator with measurable results. Adopters save money, retain loyal customers and staff and provide better service.