How Intel fosters senior independence

He is as ubiquitous at long-term care (LTC) conferences as anyone, and yet he is not a provider or management consultant. He is not a “techie,” but works for one of the elite technology companies of the world and is spearheading developments that promise to transform long-term care. He is a caregiver, and his personal stories enrich the message he delivers—a message that, if all goes according to plan, might minimize the caregiving and maximize senior independence. Eric Dishman has been investigating the impact of modern technologies on “average” people for nearly 17 years, and has spent the past nine years focusing on technology’s possible impact on geriatric quality of life. A founder and national chair of AAHSA’s Center for Aging Services Technologies (CAST), Dishman is pursing deeper investigations into livable senior living, both at a pioneering continuing care retirement community (CCRC) in Portland, Oregon, and at an Ireland-based technology think tank called the Technology Research for Independent Living (TRIL) Centre. His frustration is deep with the pace of development and incorporation of these promising technologies into long-term care facility operations. Recently, he discussed with Long-Term Living Editor-in-Chief Richard L. Peck his current perspective on state-of-the-art resident care technology.

Peck: For starters, how did Intel, known for being the world’s microprocessor pioneer, get involved in senior care issues?

Dishman: I was hired in 1999 as a social scientist by training to conduct a study of new digital entertainment technologies and how they would impact people’s lives. It was called the “Future of Fun” study—it looked at early prototypes back then of what today have become iPods, MP3 players, TIVO, and other recording devices for sharing music, movies, television, and personal content. We worked with 100 households in the United States and Europe. As it turned out, a lot of those families said they really didn’t need another way to watch TV, but they did need a way to take care of mom and dad. I took this idea and ran with it—I laughingly said at the time that I started with digital entertainment and ended up with dementia, but it was no laughing matter. I worked to convince Intel about the viability of this with video clips of these families, and we started a small lab in 2002 focusing on technologies to help families cope with cognitive decline, cancer, and cardiovascular disease. We studied households and CCRCs and home care nurses, knowing that the technology had to model how good quality care was done and how it might effectively extend caregivers’ capabilities. That early fieldwork and prototyping led to the founding of Intel’s Digital Health Group in 2005, which reports directly to the CEO.

Peck: Would you talk a bit more about some of your early attempts at developing these technologies?

Dishman: Our first prototype was a monitoring system to make sure that a person was getting adequate hydration and nutrition and to serve up reminders when necessary on their TVs. It was really more Star Trek than reality but it kind of worked and raised the challenge of making it work better. We also began to focus on social networking possibilities because, in our studies that have now grown to 1,000 households in 20 countries, we saw countless instances of seniors’ social isolation only exacerbating their healthcare concerns. This was particularly true for seniors dealing with memory loss. So, our very first real-home technology pilot was to help people with Alzheimer’s to remember the names and faces of their loved ones via the phone, PC, or in person. Another of our efforts in this area that we call “social health,” using the TRIL Centre in Ireland, was to mount global positioning systems (GPSs) on elders’ cars and ask them to share their trips with elderly who were homebound. This actually developed a sense of social engagement and purpose on both sides.

Peck: Are you starting to see LTC facilities adopt this sort of thing?

Dishman: There are bits and pieces of a solution emerging in a few facilities. For example, CAST has seen great results from facilities trying out the Dakim BrainFitness technology. But no one as yet has integrated everything (disease management, meds assistance, PERS [personal emergency response services], brain fitness, fall prevention, social support, wandering detection, ADL support, etc.) into an interoperable platform that helps them extend their services deeper into the community, which is the Holy Grail. The technology just isn’t robust enough or interoperable enough as yet, and LTC providers are forced to be systems integrators, such as the great work that Keith Perry is doing at the Sears Methodist Retirement System in Abilene, Texas [see “Broadening the Business,” May 2007 Nursing Homes/Long Term Care Management, p. 26]. We should let providers be providers, and push technology companies to be more interoperable. Intel, which has recently announced a branded product for chronic disease management at home and, later, support for assisted and independent living, was a founding leader of the Continua Health Alliance. Continua is a nonprofit, open industry alliance of the finest healthcare, consumer electronic, and technology companies in the world joining together in collaboration to drive interoperability and standards for home health technologies. In early 2009, the first products like blood pressure cuffs, digital weight scales, and glucometers will appear on the market with a Continua logo—think of this as “plug and play” for home health devices.

Peck: I was interested to see that you are on the board of Mirabella at South Waterfront in Portland, Oregon, [profiled in the May 2008 Long-Term Living, p. 30], a New Urbanist and environmentally green senior high-rise. What sort of technology research are you doing there?

Dishman: I’ve known (Pacific Retirement Services CEO) Tom Becker for years and have done studies in many of his facilities in my home state of Oregon. They have helped me understand the lives of staff and residents in a CCRC. Partnering with Oregon Health and Science University, we have designed the infrastructure on one of the floors at Mirabella to test cognitive enhancement games, activity support systems, and other technologies on a limited number of residents who volunteer. Across the street from where Mirabella Portland is being built is the Oregon Center for Aging and Technology (ORCATECH), where we’re recruiting 36 independent living households to be pilot participants for technologies we’re testing for memory assistance, medication management, and other sensor networks—sort of “kicking the tires” on the new technologies. From there, the more promising concepts can go on to a 300-household cohort in ORACTECH where, for example, we can study early detection of Alzheimer’s disease with the hope that some of this in-home data will provide an “early warning system.” Working with Pacific Retirement and many other facilities in Oregon, we hope to develop a 10,000 household “living lab” that will involve large-scale testing of physical activity monitoring, walking speed, restlessness at night, social interaction, and medication compliance, among other things. If we want a marketplace to exist, we first have to prove that these technologies are useful, helpful, and affordable to providers and residents.

Peck: It’s been said that elders are often reluctant to accept monitoring technologies of this sort because of privacy concerns. Are you finding that to be the case?

Dishman: On the contrary, we’re finding far more people wanting to be part of these studies than we can accommodate. What helps is that we provide them with feedback of the results and empower them to do better by themselves and for themselves in their own homes, rather than treating them as “lab rats.” The seniors are monitoring and caring for themselves, instead of necessarily having someone else monitor them, which makes a big difference. We do take privacy concerns very seriously, but we’re finding that seniors want to decide for themselves what their privacy needs are, which are very different from household to household and country to country. My point is that we have to listen to the seniors themselves and not treat them as if they are helpless or ignorant. Families, sometimes, will start out by saying “There’s no way mom or dad can learn this,” but then their parents end up not wanting us to take the equipment away and often offer to buy these crude prototypes from us. This is why I’m frustrated that we can’t make this marketplace happen faster—there’s an enormous pent-up need and demand. Even with our recent CAST video describing these possibilities delivered to everyone in Congress and with a conference nearly every week on this topic, there’s not been much progress in developing a wide variety of affordable technologies for real-world use.

Peck: What seems to be the largest obstacle?

Dishman: Imagination and advocacy for long-term care are our two big challenges. People still cannot imagine a different model of LTC and are stuck in an antiquated notion of “nursing home” paranoia that just isn’t accurate to describe the great quality and diversity of care being done by providers today. And on the advocacy front, getting LTC a seat at the table for healthcare innovation is a big challenge. Most investment these days goes to hospitals and physicians in connection with electronic health records and big, expensive diagnostic equipment, but that’s not what our research is all about. We have to figure out how to care for people before they are sick and before they go to the hospital. Long-term care has unique needs and expertise that have to be more widely recognized and understood—and LTC has to be a co-inventor of these home-oriented, holistic care paradigms that will ultimately be important to people of all ages.

For further information, visit https://www.intel.com/healthcare. You can learn more about ORCATECH at https://www.orcatech.org or TRIL at https://www.trilcentre.org. Continua is at https://www.continuaalliance.org. To send your comments to the editors, e-mail 3peck0209@iadvanceseniorcare.com.

Long-Term Living 2009 February;58(2):26-29

I Advance Senior Care

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