Healthcare providers — even senior care providers, which often may be slow to adopt new technology — increasingly may be buying into the use of remote patient monitoring tools.

And the premise is a good one: Combined with artificial intelligence, wearables or passive sensors can collect health vitals, build a behavior pattern and then flag a concern before an older adult has a falling emergency or suffers a heart attack. 

Although the concept of RPM is gaining traction rapidly, the next step for healthcare organizations is to address more granular questions such as how long should individuals be continuously monitored and who gets to see the data.

Experts addressed “what happens next” for RPM in a new report from the Bipartisan Policy Center, “The Future of Remote Monitoring,” that was released this month.

“Underuse [of RPM] could limit access to beneficial care,” the report’s authors noted, “while overuse could unnecessarily increase spending in federal health care programs. Additionally, providers cite the need for tools — such as (AI) — to manage streams of data, otherwise the volume of patient-generated information can become overwhelming and unmanageable.”

Many providers are aware of the need to synthesize the data in something meaningful for both clinicians and patients; some RPM companies are creating “actionable information” in the form of weekly or even daily health reports, and are helping senior living and care staff members prioritize high-risk residents and patients, an executive with EchoCare recently told the McKnight’s Tech Daily.

As RPM becomes more extensive and is used to monitor a wider range of conditions, federal agencies and healthcare providers may need to update their coverage policies, the BPC report observed. In addition, the report recommends reviewing existing privacy protection laws to make sure they apply to RPM tools. 

One of the four case studies the report analyzed was on heart failure, a major concern among older adults; the researchers worked with the Department of Veteran Affairs and found monitoring symptoms via a wearable prevented emergency department visits and reduced costs. 

Older adults with heart failure, as a group, have been singled out as not using new monitoring devices as often as they could, according to one recent study.

Unfortunately, if a tree falls in the forest thanks to an extreme weather event, and nobody nearby is able to hear it, then the possibility of an emergency still exists. 

A new emergency alert system targets older adults who are hard of hearing, combining a text-based alert with bright flashing lights and louder-than-normal alarms to make sure the message is received. 

The new alert tool, from phone provider ClearCaptions, is mainly meant to inform users of extreme weather events. That may be slightly more salient for older adults living independently, since many probably don’t have an external caregiver or community system to give updates. But it still is something notable for senior living providers to consider, particularly in areas such as the Southwest, which are expected to experience more extreme heat events. 

In those cases, older adults and their caregivers need to know when it is important to stay inside or adjust environmental conditions. Other weather extremes also need guarding against.

In addition, many nursing homes lack adequate emergency alert systems, according to a recent audit of the industry by the US Department of Health and Human Services Office of Inspector General.

“Hard-of-hearing individuals, especially those who are seniors, have less access to something we all take for granted — the ability to receive and understand emergency alerts,” ClearCaptions CEO Robert Rae said in a statement. “We are filling a long-overdue need for people with varying degrees of hearing loss. We firmly believe this should become an industry standard.”

ClearCaptions currently serves more than 100,000 older adults who are hard of hearing, the company said.

A majority of seniors have some form of hearing impairment, and an unfortunately high number of them do not take steps to address it: Only 29% with hearing loss use hearing aids, one recent study found. 

The increased availability of over-the-counter hearing aids may help close the gap, the McKnight’s Clinical Daily reported last week. Additionally, consistent hearing aid use has been shown to slow or reduce the risk of dementia. 

New tools such as passive sensors and artificial intelligence are growing rapidly within senior living and care. 

Although various studies show mixed responses from older adults toward accepting those technologies, at least one company is offering training and question-and-answer sessions to help ease residents’ concerns. 

“Seniors have a lot of questions [about our technology],” said David Ly, CEO of Iveda, whose AI-enabled monitoring system, IvedaCare, helps prevent falls. “They ask: What is it going to do? Is it going to be listening to me? Watching me? We have to show them: Traditional alarm systems in our house are similar.” 

Ly, who has visited some assisted living communities personally to discuss Iveda’s technology, said it was important to explain to residents what AI is and what information it is sharing.

Iveda is one of several emerging companies now trying to carve out a niche within both independent living and assisted living living; although most AI-enabled sensors work on similar principles, experts have told the McKnight’s Tech Daily that much room to grow remains within the industry. 

Iveda hopes its educational outreach increases buy-in to its tech; the company also has made inroads with care for older veterans. Iveda was awarded a contract to add its fall detection and telehealth software in VA facilities, the company announced last summer.

Although Ly, like many others, characterized AI as a powerful data collection tool rather than some mysterious entity, he acknowledged that popular perceptions have been shaped negatively by film and TV portrayals of robots or AI gone rogue.

“We use all kinds of analogies for AI,” Ly told the McKnight’s Tech Daily on Wednesday. “At the end of the day it’s just one tool to help us achieve [health outcomes]. Hopefully, it will only become more accurate, and more compassionate.”

The remote patient monitoring industry has become highly competitive as tech developers continue to build out their sensors’ capabilities. 

Although many of the innovations and data-gathering abilities — such as using artificial intelligence to build large data sets — may appear similar, much territory exists for RPM companies to expand to within long-term care, one business strategy leader suggested.

“It’s a conservative industry that has to be taken kicking and screaming into the future,” quipped Dov Sugarman, vice president of business and development with EchoCare, during an interview with the McKnight’s Tech Daily. “Hopefully ahead of us is a big market.”

Like many new sensors, EchoCare’s tool provides multiple functions beyond the immediate detection of an emergency. When a person falls, for instance, the tool can collect respiratory data that later can help detect when he or she has a condition such as preclinical pneumonia. 

Although many big innovations in monitoring tech may be done, AI and data science are allowing RPM developers to take a more granular approach to use cases and patient health, Sugarman said.

He also suggested that companies like EchoCare may be able to get ahead by generating “actionable information” for long-term care partners, collecting data points such as heart rate or sleep quality. 

For senior living and care operators, these kind of data can go beyond wellness reports and can help flag early conditions such as pneumonia and forestall a resident’s trip to the hospital or rehab center.

“We don’t want to throw a bunch of data at the caregivers,” Sugarman said. “We really want to look into predictions, to give meaningful insights as opposed to ‘maybes.’” 

Other fine-tuning of sensors will allow them to operate effectively amid environmental changes, such as lighting or humidity, or allow them to detect motion through walls or barriers.

Already, several RPM sensor systems are able to flag high-risk residents and patients for caregivers and help prioritize who they should attend to next.

EchoCare uses a wideband radar system, Sugarman explained, whereas different tech companies employ audio detection or even capture video that only AI can “see,” protecting people’s privacy.

Overall, an increasing number of healthcare providers and organizations have listed RPM adoption as their highest priority moving forward, according to a high-level report released in November.

For older adults living in long-term care settings, tending to certain health concerns sometimes can become a challenge when doing so clashes with a desire to maintain a sense of privacy and dignity. 

This challenge has remained an issue for those older adults who have incontinence, which could be between 50% and 90% of residents at one time or another during their stays. Overall, 43% of assisted living residents need help with toileting, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics, with a range of 40% to 57% depending on the size of community.

Unfortunately, incontinence is not merely a matter of staying dry and comfortable. Many older adults who struggle with restroom-related issues are susceptible to falling and the subsequent cascade of health emergencies that follow.

But new technology solutions aim to make the process of monitoring incontinence both more effective, and more dignified, for both residents and their caregivers. 

The Village at Gainesville, a SantaFe Senior Living independent living, assisted living and memory care community in central Florida, recently began a pilot study in its memory care residences to integrate one new incontinence monitoring tool into its overall digital health systems. 

The community is using etectRx’s eBrief sensor system, which will offer remote, real-time monitoring via a disposable sensor that can go into incontinence products, the company announced recently.

“We are excited to collaborate with The Village at Gainesville,” Eric Buffkin, CEO of etectRx, said in a statement. “Our mutual goals for the project are to reduce residents’ incontinence-related health risks and demonstrate increased job satisfaction and productivity for the staff who care for residents day in and day out.”

Other conditions that can result from incontinence include wounds, infections and pressure ulcers, etectRx noted.

Although the senior living pilot study is a novel approach, several technology tools already are on the market that track incontinence in various ways, including products by Advosense and Smardii. 

In addition to sensors that can be applied or placed in clothing, tech developers also are marketing “smart” toilets to senior living operators. Those devises offer an external validator for such issues, another way of relieving care anxieties among senior living staff members.

As healthcare organizations, including senior care providers, must weigh an increasing number of tech innovations to adopt, one new high-level survey aims to “sift through the noise” by capturing what tools may be most beneficial. 

Although cybersecurity and telemedicine currently are the most widely adopted tech tools among those pooled, adding more remote monitoring appeared to be the highest future priority for healthcare companies, according to a newly released report from digital marketplace Panda Health.

Eighty-six percent of the survey participants said they believed remote monitoring would have the biggest future benefit, whereas virtual nursing was considered the least valuable of the slate of technologies reviewed in the survey.

Not all technologies adopted in healthcare have been immediately beneficial or accomplished their stated goals. Many experts believe initial electronic health records systems were not designed to be user friendly, and thus created new problems and training needs. 

Healthcare leaders identified three broad goals for tech that they require in new tools: They must improve workflow, the must improve resident/patient outcomes and they must reduce costs.

The need to frame tech solutions in terms of return on investment and perceived value also is due to financial pressures organizations face, the Panda survey noted. Within senior care, that issue is most acutely felt in staffing concerns. 

“The current state of the healthcare industry has raised the stakes on hospital and health system leaders to ensure they are investing their limited resources in the most effective way possible,” Ryan Bengston, president and chief operating officer of Panda Health, said in a statement.

In addition to low enthusiasm for virtual nursing, the survey participants also rated chatbots or digital care navigators as having lower perceived value.

Based on those findings, it seems many healthcare leaders are on the same page with caregivers and residents/patients in terms of being wary of any tools that replace or diminish human, interpersonal interactions.

A mobile healthcare company is looking to partner with senior living and care facilities for its “Clinic Days” initiative. 

The program focuses on helping establish remote patient monitoring for older adults with chronic diseases, as well as offering care for older adults who lack a primary care physician. 

The Clinic Days program was launched this month by Hospital in Your Home, which is actively seeking long-term care partners for its events, the company announced. 

Almost 95% of older adults have at least one chronic condition, according to the National Council on Aging. The most common chronic diseases that older adults suffer from include hypertension, high cholesterol and arthritis, the NCOA reports.

A study by the NORC at the University of Chicago using NIC MAP Vision data to segment Medicare claims data found that nursing home residents average 16.3 chronic conditions, assisted living residents average 14.4 chronic medical conditions, memory care residents average 13.8 conditions, independent living residents average 13.2 conditions, and continuing care retirement community residents average 12.2 conditions.

Although many senior living and care operators have some form of monitoring in place — often to prevent falling emergencies — not all older adults take advantage of monitoring technology to keep track of their health, including those who have heart conditions.

Hospital in Your Home recently opened its flagship clinic in the Atlanta metro area, which is intended to be a hub for its virtual healthcare programs. 

In addition to helping enrolling seniors in monitoring systems, the Clinic Days program includes education and resources for seniors to learn more about healthier aging, and on-site wellness exams or screenings for older adults who lack access to a primary care provider, the company said.

Mobile health and telehealth providers, which became vital during the pandemic, have continued to cater to both at-home older adults and senior living and care communities, as those options can often be cost-effective and allow for older adults to get care and services without having to leave their residence. 

It is one example of a growing number of mobile care companies. Another mobile care startup, Vera Medical Vehicles, began deploying a fleet of healthcare buses all around Florida earlier this year for preventive care and dental services, and is hoping to offer similar programs in other states in the near future, McKnight’s Senior Living reported over the summer.

A new “smart” pillbox system can help older adults, their families and their caregivers coordinate to make sure they are maintaining a proper medication regimen. 

More than 40% of older adults take at least five prescription pills a day, and that figure jumps to 67% when over-the-counter medications are included, according to the AARP. 

Although missing medication potentially can be fatal, up to 50% of medications for chronic diseases are not taken as prescribed, and this problem is thought to result in 125,000 deaths annually, one study found.

When one factors in potential cognitive decline or memory issues that some older adults may have, potential tools for alerts or reminders become invaluable. A majority of older adults who are living with dementia take at least six medications, according to UCSF research last year.

The Prompter Connected Pillbox contains built-in sensors that detect whether the box has been opened and the pills have been removed. The tool was launched recently by health tech company Connected Caregiver. 

The sensor system appears to set the Prompter pillbox apart from other similar technologies, which have been around in some form for more than a decade.

Other high-tech pillboxes are Bluetooth-connected and send out phone reminders, such as TimeCap’s model, or are designed to deploy multiple alerts, including beeping and flashing lights, such as the MedMinder pillbox.

The Prompter box also includes bells and whistles to nudge the user into action. But in addition to letting the user know if he or she missed a dose, the Prompter pill box also alerts family members and caregivers who are connected via the Connected Caregiver app, the company noted.

Are digital health technologies moving too fast for healthcare providers to keep up?

Although innovations for older adults, such as remote monitoring sensors and disease screeners, have appealed to the long-term care market, the rapid pace of innovation often means the research validating them is too thin or unverified, researchers warn. 

In addition, long-term care operations overall still lack the knowledge and coordination to effectively implement new software solutions, such as those with artificial intelligence capabilities, a new report warns.

The study, which details some of the challenges to adopting new technology as well as some pitfalls regarding unproven claims, concludes by strongly recommending “development of a universal evidence framework” that could guide use of technology in long-term care settings.

“The implementation of digital health technologies within long-term care is usually done in the absence of a systematic process,” the researchers write, “as well as insufficient technological support and infrastructure, and inadequate staff training. This implicates a moral duty for scientists as well as for industry and long-term care organizations.”

The researchers called out falls-reduction systems, as well as certain dementia assessments, as being widely adopted without sufficient proof or research to back manufacturers’ claims about their clinical benefit. 

The researchers recommend that any new tool for long-term care must be:

• Sufficiently validated.
• Compatible with the current digital system or workflow of the organization.
• Aligned with the end-user’s knowledge and digital abilities.

Despite those concerns, many long-term care operators have adopted a guiding principle that tools provide interoperability and make sure all their health systems are integrated and working seamlessly. 

In addition, although some experts believe that initial adoption of electronic health records were not user-friendly and caused problems for staff members unfamiliar with the tools, newer software often addresses this problem. Although there is no universal program in the United States or elsewhere for senior tech literacy, many operators do provide training and courses to help residents. 

The call for digital health guidance was published earlier this month in the journal Age and Ageing, the official publication for the British Geriatrics Society. 

The US House of Representatives has joined the wave of federal politicians weighing in on artificial intelligence in healthcare. 

Rep. Brett Guthrie (R-KY) touted AI’s “limitless” potential in healthcare, including cancer screening tools, but also warned that leaders should not “let these technologies go without guardrails” during a congressional hearing Wednesday. 

Several healthcare leaders gave testimony, both on the new capabilities AI had afforded their organizations and also on the potential biases they can produce, during the hearing. 

Concerns addressed included worries about how transparent AI tools are and whether they are compromising patient privacy.

Although lawmakers broadly weighed potential legislation that could address concerns about AI, the hearing was not focused on any specific bill currently being taken up by Congress.

Several of the speakers insisted that federal regulation on AI would not be as productive as more localized limits and frameworks on how AI is used within organizations.

“While some would advocate for a centralized regulatory body, our experience suggests that local audits could be more effective in ensuring alignment with principles,” Christopher Longhurst, MD, and chief medical officer at UC San Diego Health, said during the hearing, “as these [AI] models must be evaluated within the context of the care they support.”

Speakers also echoed common hopes that AI be used to help aid clinicians and make healthcare workers’ jobs easier, as opposed to supplanting them outright.

The hearing, conducted by the House Energy and Commerce Health Subcommittee, comes several weeks after the Senate reviewed AI’s contribution to cyber scams that target seniors. The Senate Special Committee on Aging also released its eighth annual “fraud book” on the topic last month.

President Biden recently came out in support of both AI and potential regulation to ensure its responsible development in healthcare settings.

On the flipside, healthcare groups have begun to produce materials outlining the existing legal risks associated with AI tools, including how AI-enabled monitoring for health — something very common in the senior living and care industry — could create demand for updated privacy policies and procedures.