Plain Vanilla Telehealth

Day-to-day uses of some telehealth assisters on the falls battlefield

First off, what does this falls battlefield look like? Though close to 2 million American seniors are involved in falls each year, there aren’t crowds or even many assisters nearby. Rather, most falls occur in individuals’ homes, often without ready help available for those who have fallen.

In fact, this common scenario of needy seniors requiring assistance was the impetus for the development of the Personal Emergency Responses Systems (PERS) [1] in the mid-1970s (the very well-known, “Help, I’ve fallen and can’t get up!” spot) and its extensive television advertising, beginning in the mid-1980s.

The remedy seems simple. PERS devices typically have a single button that the user presses to alert (through radiotransmitters) an off-site call center about a fall or need, and from which signaling, assistance will be sent. These small devices can be worn on the wrist or around the neck. There is no shortage of advantages about them:

• PERS devices are easy to use,
• They can provide the calming sense of “always there” care, when it is needed.
• Help is just a telephone call away.

However, this easy remedy for assisting with the widespread occurrence of falls by seniors has not resulted in routine issuing of these devices by home health agencies (HHAs) to their patients, nor is there widespread coverage of the PERS devices [2] by insurers, especially by Medicare, to address the falls problem among seniors. Out-of-pocket payment for the devices and services by seniors, who often lived on fixed and limited incomes, is the norm.

Needed: New, customized PERS devices

Thirty years later, after the implementation of PERS in homes first began, let’s re-inspect the falls battlefield. Are PERS working in addressing the falls situation? Yes. Telehealth can work in emergency situations. That is, the telehealth devices can assist with communications—but only as long as people wear them (which, unfortunately, is often NOT the case), as more than a few researchers have noted. [3]

Which leads us to the next battle arena—off the field and toward investigating elderly consumers’ personal sensibilities. Which products and services do they want and which one will they wear/use/and use correctly? Initial PERS development proceeded without even asking elders what mattered to them. Yes, seniors need a watchful eye for just-in-case matters, but no, they do not want to wear, as one telecare services industry commentator, Paul Gee, has often called it: “the badge of infirmity”—a PERS device/pendant, signaling that wearers are more helpless than most. As a result of this perceived stigma, large numbers of PERS devices reside in dresser drawers and are inaccessible when needed.

A Resolution?

Even though elders may be failing at home, there is still an independent streak that has to be accommodated in the creation of new assistive products for them. That much is becoming better understood. And so, many workarounds to the seemingly obtrusive PERS bracelet/pendant are in the works. For instance, trends shaping up in the last decade include embedding sensors and signaling devices in clothing or household walls and floors are taking one step toward making this accommodation—but slowly and with resistance (as will be discussed more in the Prevention 101).

A more low-tech but possibly seeming less invasive to elders is suggested by the “Electronic Concerned Neighbor” system [4] from Red Wing Technologies, Inc., a project funded by the National Institutes of Health (NIH). About the necessity for this research, it is stated in an overview of this project that while elders living alone could benefit from regular monitoring, members of this group “are likely to be intolerant of intrusive monitoring because there is no clear medical need for it and the cost of a ‘just-in-case’ monitoring system often outweighs the perceived benefit.” However, a concerned neighbor, who likely could note variations in a person’s routines (like, lights not being turned on or off at certain times of day), could be a first responder providing “actionable information on the welfare of a neighboring home’s occupant.”

PERS signaling devices and the Electronic Concerned Neighbor system can “work”—insofar as they can extend communications about detecting where and when a fall may have occurred. But interventions still must go further… Prevention 101—preventing falls altogether—indicates how far we need to go to get there.

Links:

1. Retrieved Feb. 10, 2010, from http://en.wikipedia.org/wiki/I’ve_fallen_and_I_can’t_get_up!
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2. In the U.S., most PERS purchased out of pocket range from $200-$500, with monthly fees of $10-$30. Some health insurers may pay for the devices, but require the patient’s to obtain a doctor’s recommendation. Medicare does not pay for PERS. Material retrieved from Feb. 1, 2010, Philips’ Web site: http://www.newscenter.philips.com/main/standard/about/news/press/article-15763.wpd
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3. See, for example, Levine, D.A., and R. Tideiksaar (1995). “Personal Emergency Response Systems: Factors Associated with Use Among Older Persons,” Mount Sinai J of Medicine 62 (4): 293-297.
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4. Retrieved Feb. 10, 2010, from http://www.agingtech.org/item.aspx?id=352&CA=2 titled: “Non-intrusive Monitoring of High Functioning Elderly Red Wind Technologies Inc (NIH), June 2009.”
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