Staying Home: A Look at Assisted Living Technology

The baby boomer generation has entered the period of life when it needs assistance to live comfortably and independently. Just in time, assisted living technology could offer a pathway to what boomers want most.

Chances are, you’ve already encountered the reality of aging in America, through a family member or on your own. And unless you’re very wealthy or live on a commune, it’s far worse than what you expected.

The agony is real. As many Americans hit their seventies and on, they’re caught in a worsening spiral of home care costs and emotional angst. Here at Green Builder, we have staff whose parents pay $12,000 a month (each) to reside in an assistive facility. Their large retirement “nest egg” no longer seems sufficient.

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To worsen matters, one in 10 people over 65 has some form of dementia, such as Alzheimer’s. This makes living without regular care all but unthinkable. And although researchers have made some progress in solving the dementia riddle, it’s still an elusive, frustrating condition. We can’t just wish it away, any more than we can deny the diminishment of age. Perhaps it’s best chronicled by Shakespeare: We grow from “mewling and puking” infants to “second childishness and mere oblivion; sans teeth, sans eyes, sans taste, sans everything.”'

Must it end this way? Perhaps not, if we begin to combine smart technology with building science to prepare homes for our golden years. Think of that Shakespeare quote. New tech can replace old teeth with new ones, repair and augment aging eyes, vastly improve lost hearing—and still many more advancements are forthcoming. No longer housebound, seniors can use virtual technology to explore the universe or their old neighborhood, learn a new language, or ride in a self-driving car to visit a grandchild. Motion sensors, fall detectors, water-use analyzers, on-demand home diagnostic tools—the list of potential non-human “aides” goes on and on. But they must go hand-in-hand with better building design.

Dora’s World

Before we launch into prescriptive ideas on how to help the aging stay home longer, let’s dive into a real-world situation. I spoke with Gary Krause recently. He’s an engineer in Michigan, who is caretaking his 80-year-old mother—we’ll call her Dora—with the help of several connected technologies. Krause has set up a small accessory dwelling unit (ADU) for his mother near his house.

“I’ve got her set up with Amazon Alexa, and she loves it,” he says. “It allows her to do certain key things, [such as] the ability to change the channel on the television.”

But that’s also a problem, he confides, “because if she doesn’t get up to do things every day, then she loses mobility, which makes her more likely to fall and hurt herself.”

Krause says he feels somewhat cornered. “Any time she gets up to do anything, such as turn off a lamp, that’s a risk,” he says. “She’s not very mobile, and if she falls, she can ask for help [using] Alexa, but that’s really her only option.”

Krause deals with other basic life-related problems, such as how to keep an eye on Dora without making her feel she has no privacy, and keeping her refrigerator stocked with food. “I can buy her some groceries,” he says, “but at present, I have no way of knowing whether she has anything to eat in the house, or whether she’s eating at all.” He also doesn’t know when or if she has taken her medications.

Without tools to help him, Krause says he has had to come up with his own system of checking up on Dora. “Because the Alexa account is in my name, I can actually see what and when she is saying to it; what commands are given. I’ve found that this is a way of tracking her mental acuity—although I’d be happy for a less-obtrusive way to do it.”

Another problem is climate control. “She’s always cold,” he explains. “But dealing with a thermostat across the room is beyond her. My thought is to put in a Nest thermostat. You can control those with voice.”

The good news for Krause and his mom is that technical solutions—in most cases, better than what he has—already exist. What’s missing is a filter to sift the novelty junk from the useful stuff. That’s my job. From smart fridges that keep track of food to passive water-use observation, the assisted living market needs exactly what certain tech makers have to offer.

Beyond the Wheelchair Standard

If you’re in the building business, you know what “ADA-compliant” means. This long list of specifications from the Americans with Disability Act applies primarily to commercial properties, but it also covers residential ones of four or more units.

Historically, the ADA has offered a good baseline for building any housing designed for elders. The ADA and Assisted Living Technology (ALT) overlap in many ways. Both seek to remove obstacles to ordinary patterns of life. Both seek to enable frail people to feel safer in their homes. Both seek to allow people to stay independent longer. But the ADA is rooted in the Old Days, when people didn’t live as long, and frankly, had no options for living at home—other than to depend on regular caregiver visits.

Other than making spaces compatible with wheelchair restrictions, the ADA does little to make the house actively helpful, the way ALT does.
In an ALT house, some smart devices act as prosthetics, augmenting and sharpening faded senses. Other devices perform simple or complex tasks, from operating televisions to opening and closing toilet seats. Still, others monitor the vital signs of the occupants, and send alerts when they sense erratic or sudden shifts in usage. This non-invasive data gathering avoids the life-in-a-fish-bowl effect of 24-hour video surveillance.

To be effective, ALT needs to address priority items for seniors first. These include feeling safe, preparing food, staying connected, not falling (that’s a big one) and retaining a sense of purpose and self-worth.

Too often, smart-gadget designers approach tech from the perspective of the person “managing” the aged person, not the person being managed. And they miss the mark. For example, more than once at CES last year, I had eager sales staff demonstrate indoor cameras that would “keep an eye on older family members, 24 hours a day.” But research indicates that no one wants to be watched. But they will tolerate passive observation, within limits. A study of older people published in Gerontology five years ago, for example, found that more than 72 percent of participants reported acceptance of in-home and computer monitoring, and willingness to have data shared with their doctor or family members.

The caveat, however, is that after a year of passive observation, 60 percent of this group said they had privacy concerns. As seniors learn more about smart tech, they become more cautious. But they’re still willing to embrace passive monitoring, provided they feel secure that only doctors and family members get the data.

Like video cameras, the tech industry also believes that seniors need and will use wearables, such as wrist devices, smart shoes and pulse-checking clothing. They’re ramming this idea forward with their marketing budgets, but seniors have been slow to accept the idea of strapping on gear. That’s partly because these marketers tend to think like colonizers who don’t listen, not guests in seniors’ homes. For example, a recent article in mobihealthnews carries this headline: “Half of seniors believe wearables will improve health care.”

Read the actual article, however, and what you find is that seniors hope that by requiring their caregivers to wear monitors, they won’t be overcharged for hours or billed for services they didn’t get.

Marketers, take heed. If you want to seniors and their family caregivers to accept technology, you can’t decide in advance what’s good for them. The more invisible and unobtrusive the tech, the less you depend on the end user to play an active role in wearing and using it—and the more likely it will have long-term viability.

Prepare the House, Not the Ambulance Driver

The commercials about “The Clapper” give the impression that if an older person falls and “help is on the way,” things will be okay. But that’s often untrue. Once a fall happens, a downward health spiral may begin.

If falls are so deadly, are wearable “fall sensors” the solution? Aren’t they treating the horrific outcome of the fall, rather than preventing it? One tech company has taken a shot at this problem, for example, with a wearable hip-belt that inflates like a car seat bag to prevent broken hips in a fall. It’s too pricey at $800, and has been criticized, because seniors won’t wear it.

The Helpful House

We think there’s a better way. An ALT house should assist the resident, even if they don’t remember (or agree) to wear a certain piece of fancy hardware. Take the Walabot Home. It’s a fall sensor that goes on the wall, instead of on the person.

Such a product tells us that when a person falls, it’s the floor that’s the real problem, right? And of course, gravity. We can’t alter gravity (yet), but we certainly can alter flooring.

What if, in senior-ready housing, floors are designed to absorb the shock of a body falling? The nursing home industry has studied this problem, and you can find articles about what they term “compliant flooring.” Another study by the Swedes offers a snapshot of how important flooring is in a fall. They put down a special floor in a nursing home, made with 12-mm-thick closed cell flexible polyurethane/polyurea composite tile, and evaluated injuries from falls. Because the impact is about 65 percent reduced from a typical floor, there were far fewer serious injuries.

Not surprisingly, most modern nursing homes have the wrong kinds of floors to prevent injuries from falls. They tend to go with commercial, easy-to-clean vinyl sheets and VCT (vinyl composition tile) over concrete, a most unforgiving combination. One concern is cost. Another reason is that softer floors make the work of caregivers slightly harder, and in certain cases could lead to more falls, albeit fewer fractures.

But there’s no reason homebuilders should follow this bad example. Private homes are an easy fix. A Korean study on floor impact absorption notes that many other flooring materials perform much better in fall situations than vinyl tiles. The study recommends different, softer materials for different uses. Researchers note that, to date, cork is the number one candidate, because it meets their four elder housing criteria: function, economy, sensibility and sustainability. For bedrooms, they suggest rubber, wool and nylon carpets. To avoid increased risk of falling, deep-pile carpets should be avoided, in favor of low-pile carpets.

Of course, to be “helpful” to seniors, the house also has to make priority activities easy: adjusting temperatures, turning lights on and off, locking doors and so on. Depending on the cognitive and physical condition of the resident, these features can be partially automated.

Vocal Advocate

Here’s where voice-activated technology, in my view, finally finds utility. I’ve written critically about voice control in the past, which, for the able-bodied, often represents a step backward in efficiency—and still lacks a genuine commitment to personal privacy. Tech companies are only now beginning to see the “white space” in the senior market.

That’s because, according to Aging in Place Technology Watch, most new tech goes through a cycle of “Hype, Disruption and Adoption” that ignores the senior market. In fact, the push has been to engage millennials almost exclusively, because they’re considered the easiest sell—although the big sell is “fun,” not need.

In the world of seniors, however, voice control can improve lives. Amazon Alexa, Google Home or Apple HomePod are poised to become part of the invisible mesh of the ALT house, with regular listening stations at key intervals.

Voice controls can not only give the resident access to the home’s systems, they can create instant “portals” to the outside world—to family, friends and emergency aid— addressing feelings of isolation. Research shows, however, that it’s still important to retain a backup method of connection: an oversized tablet or other touch device that can accomplish the same goals.

Instead of paying for artificial intelligence diagnoses, what we really need is a robo-caller that’s the nemesis of claims adjusters everywhere. 

Also, the issue of privacy looms especially large in this aspect of ALT. The smart tech industry continues to bulldoze its way past privacy concerns, intent on evermore-intrusive harvesting of individuals’ information. Consider this prediction from Aging in Place: “Moving forward, profiles are likely to become more robust, linking across environments like health and travel records and preferences that extend beyond ‘Would you like to book the trip?’ to a deeper examination of preferences that can launch a follow-on set of questions.”

That sounds a lot like the same playbook that has Cambridge Analytica facing a class-action lawsuit.

Until the tech industry stops promising that owning our souls will help serve us better, they risk a backlash of tech rejection from users. Voice tech for seniors holds promise, but nobody wants to be profiled and categorized. Don’t think it can’t happen. New data about online browsing finds that three out of four people now reject any and all “cookies” from websites they visit, and VPN software sales are booming.

What’s needed is an ALT approach that puts privacy first, period. The whole point of ALT is to make people feel safe, fulfilled and independent in their homes. ALT can extend the time when they can live “at home” without caregivers—but should not prey upon them as unwitting participants in building and selling data to marketers, insurers and scam artists.

Virtual Reality: Doorway to Health?

As we age, things break down. But the right behavior can slow that process. People well into their 80s and 90s have shown major health improvements with regular exercise. Seniors spend most of their time at home. How can we help them get the workout they need?
For many, a double obstacle keeps them from getting on a treadmill or stationary bike. First, it seems “too late” to do anything physical, because they’ve developed infirmities that hold them back: a bad heart, arthritis or fragile bones. Second, they simply don’t have the will or the interest, or the self-discipline to get on a treadmill at home.

That’s where new technology can intervene. Several studies have found that virtual reality technology, combined with exercise equipment, can not only restore health among seniors, but also make them sharper mentally.

Virtual reality exercise is wide open. It can “virtually” accommodate any level of physical limitation. Users can start small, such as by simply lifting an arm, and “advance” to higher levels involving treadmills and rapid movements. Good virtual-reality exercise creates a narrative that fuels the desire to improve. For example, in a virtual bicycle tour of Rome, a user may need to pedal a little farther each day, as stepping stones to visit the Sistine Chapel.

A European study of seniors conducted last year compared their physical improvement from three types of exercise: physical exercise (PE), virtual reality-based exercise (VRE) and brain exercise (BE).

They found that while old-fashioned PE helped the most, VRE was a close second and also helped with cognitive function. Perhaps more importantly, participants preferred virtual exercising to other forms. This solves the second challenge: motivation.

And, expect VRE to keep getting better. Game makers are getting in on the action. For example, take a look at Beat Saber, a rhythm-based light saber game you play with two kinetic swords in hand.

The possibilities of VR for seniors go on and on. A study reported in The Lancet found that seniors who train on a VR treadmill reduce their typical number of falls by 42 percent. The VR program presented participants with obstacles they had to practice stepping over.

Active Health Monitoring

Even with VR-encouraged exercise, elder health will often need support and observation. New technology monitors vital signs in the background, dispenses medications in a timely manner without nagging, and provides regular, non-invasive “checkups” to catch potential problems before they get serious.

The best of these new tools integrates with normal activities. For example, scanning technology embedded in mirrors can analyze the human body for dozens of risk factors. Is the person overweight? Is their spine misaligned? Do they have inflammation of certain glands?
Scanning technology does this not with cameras but with sophisticated 3-D modeling, “multispectral” cameras and gas sensors. The mirror is yet another version of what used by the fictional “tricorder” seen on “Star Trek” for many years

The category of health and wellness, of course, is exploding within the world of gadget innovation. Much of this innovation certainly has relevance to aging in place, but it hasn’t understood (or doesn’t care about) the huge boomer population’s needs. It’s one thing to create a Smart Bra that will monitor your heart, but that doesn’t mean your 80-year-old mother will strap it on. What’s needed are more devices that simply integrate with the home, and don’t depend on daily behavior modification.

For example, why can’t the grab bars in the bathroom check the vital signs of the user? Something like this already exists, aimed at fitness fanatics. It’s called the Insta Pulse 105 Heart Rate Monitor Grab Bar. When will big tech companies realize they’ve got to look at how older people actually live, and base the tech around that?

Another example would be a full-blown health station, designed to look like a vanity. As the user sits down to brush their teeth and wash their face, they are being weighed and checked for cholesterol levels, blood pressure and even cancer. This technology is right around the corner, although perhaps too expensive for homes—for now.

Ultimately, the best and most humane healthcare for seniors is one that emphasizes good health to forestall or avoid as many of the infirmities of old age as possible. The U.S. system is heavily skewed toward treatment of disease, rather than prevention, but the ALT home of the future doesn’t have to adhere to that short-sighted model. But we should insist on the right combination of privacy safeguards (limits on who gets the data) and features that serve the elderly, not simply the caregiver. Manufacturers should not double dip and profit by selling the data collected, as so many do currently.

The Challenge of Mobility

Seniors face many obstacles in our auto-centric world. Failing eyesight, anxiety, forgetfulness—these can make navigating a vehicle too risky.

Virtual reality can help them feel connected, yes, but it’s hard to imagine a future where “in-person” contact is not valued.

Are autonomous vehicles the solution? The self-driving car “industry” seems to have sprung up out of nowhere in the last couple of years, and apparently corporations intend to ram the idea forward, despite very low acceptance by the public. According to AAA, in 2017 only 22 percent of people said they would ride in a driverless car. That number went up 15 percent in 2018, thanks to an ongoing marketing blitz.
At CES this year, at least a dozen companies rolled out self-driving vehicles. Assuming this technology reaches the point of commercial viability and affordability—which is still uncertain—it offers new possibilities for seniors and the disabled. Perhaps instead of owning a vehicle, they simply touch a big screen pad saying where and when they want to go, and a driverless car shows up. This is not science fiction: It’s already happening. A retirement community in Central Florida, called “The Villages,” offers driverless taxi service for residents.
Another option would be small, one-person electric or hybrid vehicles that whisk elders to a holiday dinner, then return them safely home before bedtime.

One downside to the self-driving vision, however, is how it could negatively impact public transit. Buses and metro trains currently serve as a critical lifeline for both seniors and people of modest means. Will public transit funding be cut off as resources are pumped into autonomous vehicles and all they entail?

Another solution for seniors might be a hybrid model. An autonomous vehicle or shuttle deposits them at a safe location, where they transfer to public transit for the bulk of their trip.

Crisis Management

No article about ALT would be complete without including a plan for when things go wrong.

For health crises—such as a fall, a stroke or a heart attack—a combination of passive monitoring, and in the case of high-risk people, an active monitor or two, such as a smart necklace or a ring with geofencing built in, could offer a backup and rapid response. Voice control, assuming the person can talk, offers yet another lifeline.

Older people also become vulnerable in natural disasters. An ALT home with a power outage during a snowstorm may become a deathtrap. Critical systems must remain operational to create a “safety net,” if weather, wildfire or other scenario leaves them cut off.

The most obvious top priority is electricity, not just to keep the lights on, but also to keep the Wi-Fi modem operating and heating or cooling systems operational. Cooling is perhaps the biggest challenge. Even heat pump systems require a lot of power to cool a house, although one of the rare, solar-powered models such as the DC 48v may do the job—if the sun is shining.

Think of the ALT house as a part-time survival station. Drop it into a blizzard situation in Antarctica. Which systems would stop working immediately? In what priority should various electronics be kept “online?”

Every ALT house needs a reliable uninterrupted power supply (UPC) in the form of a battery backup. The preferred power source would be renewable solar photovoltaic panels, but it should be grid-tied as well, so that batteries are never below peak when the outage hits. It’s also a good idea to have some sort of Wi-Fi backup source. For example, a low-cost cellular data hotspot could be programmed to activate automatically when the normal Wi-Fi signal is lost.

Self-contained, self-monitoring and respectful of the long, eventful lives of their inhabitants, ALT homes are possible, affordable and inevitable. We expect to see some real innovation from manufacturers in coming years, and some great designs that give seniors a chance to enjoy their golden years at home.