I spent two days participating in a conference in Stockholm on the topic of welfare technology. Welfare technology is a term that encompasses a wide range of information and communications technologies, alarms, aids, devices in the home, and other technologies that help the elderly or people with disabilities. The official definition states,
“Welfare technology is the knowledge and the use of technologies that can contribute to increased safety, activity, participation, and independence for people with disabilities and their families. Welfare technology can also support independent living, and it can prevent or supplement healthcare and social care needs. Welfare technology can help to improve resource utilization and quality in the welfare sector, and it can be economically viable.”
This conference was the first in Stockholm on the theme of welfare technology. I hope it will become a permanent and annual event.
The conference featured panel debates, lectures, and a round table discussion. Companies showcased their latest products. Economists lectured on the economics of technology in healthcare and social care. Lawyers described the legal framework and the regulation of technology. Participants exchanged ideas and networked.
As a researcher for ACCESS Health, I immersed myself in the latest thinking on welfare technology. I examined how the fusion of a bicycle, a computer game, and a chair can improve the health of the elderly. Read about the company that has developed this bicycle that allows a biker with poor balance to cycle in a three dimensional environment of his or her choosing.
The idea of the bike is to stimulate more exercise. Equipment like this can turn exercise into an enjoyable experience for those who have suffered injuries and face months of painful rehabilitation. It can also encourage exercise in those who feel uncomfortable at a normal gym. Several municipalities in Sweden purchase the bikes, and the spinoff product, a treadmill that comes with a rounded screen to create the illusion of outside walking. This treadmill takes the person into a three dimensional reality. It works like a game. When the person looks to the left, the picture moves to the left. The user experiences a simulation of taking a stroll outside. The images are developed with Google street view. The tablet on the treadmill allows the user to play a quiz game while strolling in the forest. The questions are viewed on the large curved screen. The answers are recorded on the tablet. Developers believe that the gamification of exercise can enhance the user experience for the elderly.
The municipalities allow elderly citizens to come to community centers and to keep physically active. Perhaps we are witnessing the infancy of gyms with equipment developed for people over the age of seventy. This age group can benefit from exercise that strengthens muscles and trains the heart. Most public gyms do a poor job of installing exercise equipment and designing facilities that suit the needs of the elderly. I have been pleased to observe that developments in this area already benefit active older citizens.
I looked at the newest products on the market for safety alarm watches for patients who suffer from dementia, such as watches with positioning systems and alarms. I examined intelligent beds, which hold sensors in the mattress. The sensors notify caregiver personnel or are connected to your computer at home. The sensors highlight where there is pressure in the bed so that a caregiver can make adjustments and help the user avoid ulcers, which are a common result of pressure and poor blood circulation in certain areas of the body. The economists who participated in the conference, including Dr. Åke Dahlberg, calculate that these sorts of devices are so cost effective that the payer or user breaks even within one year of use. These calculations factor in the costs of treating an ulcer, which may demand that a patient visit a hospital twice a week.
The intelligent bed is an innovation produced at the Health Technology Center in Halland, in the south of Sweden. The bed is just one of many new technologies in the field of homecare and elder care that shows how patients can use smart technologies at home to prevent diseases and ulcers. These images display what nursing homes of the future may look like. The sensor, which goes under the mattress, can record your breathing and your pattern of sleep. To the right, a computer screen is visible. Doctors can use the data remotely to check up on you in the middle of the night and decide if you may need assistance at home.
You can read more about welfare technology in my upcoming case studies on the ACCESS Health website. I will shed light on the legal aspects of the use of technology in elder care. I will also examine the ethical aspects and discuss the economics behind the introduction of more technology in sectors like homecare, which largely center on personal meetings between caregivers and patients. This is an exciting area of development and shows promising results already. Patients, caregivers, and society at large stand to benefit from the technological advances in this sector. On the other hand, these technologies must be developed with the users in mind. The users are the healthcare staff, the homecare personnel, and the patients. A careful examination of patient needs and user friendliness for all of these groups must precede any introduction of technology in elder care and homecare. Far too many applications are developed without the involvement of the relevant consumers.
Previous waves of technology in these sectors illustrate that technology is powerful, and it will find users and needs for its applications. Previous waves of technology show that, in some areas, technology comes first and needs of the users come second. Developers apply technology from other fields to the elder care sector. This technology may not always be aligned with the needs of the users. The needs of the users must be the point of departure. Ideally, technology is not adopted from other fields; it is purposely constructed for older consumers, for caregivers, and for relatives. This is why the debate around technology is so important. The lecturers at the welfare technology conference stressed that they wanted to see technology that aligns with the needs of the users.
The previous generation of safety alarms for older people illustrates the point that technology does not meet the needs of users. The previous generation of safety alarms was connected to landline telephones. These alarms were a great invention for those who needed help at home. An older person who fell at home could use the alarm to contact a caregiver. The caregiver could come to the house and assist the person after the fall. However, the safety alarm could not be used on the balcony or outside of the house or apartment because it relied on the landline telephone. Sweden is introducing digital safety alarms on a large scale right now. The introduction has caused difficulties in many parts of the country, including disruptions in the signals to homecare personnel. Despite these difficulties, many municipalities are examining new digital alarms. In this process, some municipalities are introducing digital alarms that cannot be brought outside. The use of these types of alarms is a mistake. They confine the elderly to their apartments instead of encouraging an active lifestyle, which requires leaving the house.
Some new safety alarms, which often come in the form of watches to wear on the wrist, have Global Positioning System (GPS) technology built in, which allows a caregiver to turn on the navigation in his or her phone and navigate to the users, wherever he or she may be. The user can also talk into the watch and reach a caregiver, just like you would talk with someone on a mobile telephone. The image below illustrates a safety alarm with a positioning system and a clip on battery charger to ensure that the user does not lose the alarm when he or she charges the battery. Older versions of these watches must be taken off to be charged. A person with a cognitive impairment might easily forget to put the watch back on. Of course, the user must accept that he is traced when he wears the watch with a positioning system.
The new technology raises issues of privacy, data storage security, and surveillance of our elderly loved ones. Are we reducing or increasing their freedom with these alarms? As with any technology in the elder care sector, we must look at alternative solutions. No technology is perfect. Some technologies improve quality of life. If a technology has the potential to improve quality of life, we ought to examine the technology carefully.
In the case of wearable alarms with positioning systems, we either prohibit our loved ones from leaving the house alone because we are afraid that our elderly who suffer from dementia will become disoriented and wander off, or we allow these people to leave the house with a portable and traceable alarm system. Some people will be inherently skeptical of these technologies, perhaps more so in the wake of national programs on mass surveillance. There are arguments on both sides of this debate that need to be examined further, but the technologies show great potential.
The other ethical aspect we must think about carefully is consent. How do we obtain consent from users with cognitive disabilities? Is consent from relatives enough to allow the use of a safety alarm outside? It is impossible to offer one answer for all users and for all relatives. We must develop national guidelines that caregivers can follow. At each developmental stage, we must allow public lawyers to evaluate the legal implications of each technology. This will take time. We must be patient.
We must also allow individual caregivers and family members to decide what is best for their loved ones. What works for one user may be completely inappropriate for another user. Perhaps the user is bothered by a large safety alarm watch, scratching to take it off. In this case, I would think it wise to find other solutions. The elderly, like all of us, have different preferences. Common sense in the use of technologies will allow us to incorporate technology into sectors such as elder care and homecare. At the conference for welfare technology, nurses, lawyers, developers, and other participants raised these issues for debate.
Telia Healthcare, one of the largest telecom companies in Sweden, brought four showrooms to the technology fair in Stockholm. The product range HomeCare includes sensors in your bed. This bed is equipped with sensors in a pad that goes underneath the mattress. The pad warns if the patient lies still for too long or needs assistance to rise up. This pad is intended for use in care homes to guide the staff to the patient when the patient needs assistance. The blood pressure device on the bedside table can measure blood pressure and blood oxygen saturation. This information can be linked to patient records.
The sensors send signals via the Telia Healthcare application to caregivers or to the user. It is up to family members or users to decide where the text messages go. The bed below is equipped with a lamp gradually adapts to your sleeping pattern. It turns on a light in the morning to help you wake up. In cold, dark countries like Sweden, this may be a welcome device, although its healthcare application seems limited.
A smart sensor at the front door of a person’s house can notify a caregiver if the user leaves his or her house and wanders off. The text message alert, combined with a traceable and wearable alarm, like the safety alarm watches discussed above, helps the caregiver to locate a person that may have gotten lost. Technologies like this could help an aging population to live at home for longer. They can also improve the sense of well being and safety for users and for family members. Telia intends to sell these products to public caregiver organizations in the spring of 2015. Municipal organizations develop new guidelines on public procurement, which includes data encryption for this type of product.
The small white sensor in the top left corner of the medical cabinet will send a notification if the cabinet has not been opened for a certain amount of time. The scales in the images below send weight information to your computer or to your caregivers, via Bluetooth. Fluctuations in weight are an early sign of declining health in patients suffering from chronic obstructive pulmonary disease, for example. The text message alert will act as a reminder for you to take your medication or visit your doctor before you develop more serious symptoms. All of these technologies will help patients with chronic diseases to live at home for longer in the future. The scales for home use stores information on patient weight. The scales can notify caregivers if a patient collects additional fluids, which is an indicator of rising blood pressure. The scales send the information via Bluetooth to the caregiver’s mobile telephone.
Now, Telia is just one of many companies entering the growing market of homecare devices. It remains to be seen whether these specific products serve the needs of these patients, or whether Telia must improve or change their products. Telia runs pilot studies with several Swedish municipalities where they evaluate their products.
Telia installs cameras for use at home during the night, when someone might otherwise need to visit the person to check that everything is in order. Several municipalities in Sweden work with eHomecare. eHomecare uses a camera that is switched on for a few minutes at a time throughout the night to check that the user is alright. This type of technology replaces short visits by homecare personnel in the middle of the night, and several users prefer a camera to personal visits. My upcoming interviews with the managers of eHomecare in Västerås stad will be posted on the ACCESS Health website.
In summary, the welfare technology conference stimulated important debates on technology for the elderly. I will keep you up to date on this important topic in future blog posts and in my case studies. I hope to see technologies that benefit the elderly. I want to see more companies that involve all users early on in product development. As one participant in the conference put it, “only when all groups benefit from the technology, including the doctors, the patients, the caregivers, and the relatives, can we expect large scale adoption.” One final reflection comes to mind the day after the technology conference. Many municipalities had representatives at the conference. Few county councils were present. If counties and municipalities want to stay up to date on the latest technology, this conference is a good starting point!
In my previous blog post, I described the work of the Mobile Team for the Elderly in Uppsala, Sweden, a municipality of two hundred thousand. In this blog post, I will discuss some of the tangible benefits of the Mobile Team to the municipality, to patients, and to patients’ families.
Before I get started, I want to explain how healthcare and government is managed and financed in Sweden. Sweden is organized into municipalities. Several municipalities comprise each county. Uppsala County includes eight municipalities, including a municipality called Uppsala municipality (see the maps below). Uppsala County manages healthcare provision for all citizens in the county. The County Council in Uppsala is the payer of healthcare in the county. An autonomous government governs each Swedish municipality. Municipalities are responsible for social care for the elderly. The Mobile Service offers healthcare to the elderly, thus touching on the responsibility of both Uppsala municipality and Uppsala County. The Mobile Emergency Team serves the elderly only in Uppsala municipality, not the entire county.
Since the establishment of the Mobile Team in September 2011, fewer older patients visit the emergency room at Uppsala University Hospital. The Mobile Team started as a pilot project, which became a permanent unit in Uppsala, in January 2014.
Uppsala University Hospital is the only hospital with an emergency room in Uppsala County. Uppsala University Hospital is a public hospital financed by county taxes. Fewer visits to the emergency room thus save costs for the county. One visit to the emergency room is assumed to cost the county hospital 2,500 Swedish kronor (350 US dollars). In a conversation with the Mobile Team, one of the team’s two physicians, Magnus Gyllenspetz, explained to me that Uppsala County saves costs if the team makes three home visits per day. The savings come from reductions in the number of ambulance trips and the number of treatments provided in the hospital.
The total yearly cost of the Mobile Team is 3.5 million Swedish kronor (five hundred thousand US dollars). Uppsala County saves 2.5 million Swedish kronor (350,000 US dollars) on reduced outpatient treatments of the elderly alone. The largest savings are in the area of reduced hospitalizations for this group. Estimates for 2012 indicate that the Mobile Team saves Uppsala County over nine million Swedish kronor (1.2 million US dollars) annually on inpatient treatments for the elderly, excluding the costs of the Mobile Team.
Without the Mobile Team, an estimated 460 patients would have traveled to Uppsala University Hospital for treatment during the pilot phase, from September 2011 to January 2014. These 460 patients are “avoidable inpatients,” patients who can avoid a stay in hospital with treatment or social care assistance at home.
Apart from the economic benefits, patients like the Mobile Team. Fewer patients need to travel to the hospital. Fewer patients need to wait in emergency rooms. Fewer relatives worry about the health of their elderly loved ones. Fewer relatives must take time from work to help their relatives get to the emergency room. The Mobile Team cares for the ill residents in nursing homes. Because ill nursing home patients are the responsibility of the Mobile Team, the nurses in the nursing home are able to continue to care for all of their patients. If the nurse from the nursing home had to travel with the resident to the emergency room, then that nurse could not care for other patients.
Considering all the benefits, why is there only one Mobile Team with this setup in Sweden? Why do some older patients who need urgent care still travel to the emergency room? Is the Mobile Team too good to be true? How can we explain the fact that there is only one Mobile Team financed by a municipality and a county in Sweden?
There are many answers to these questions. Some older patients feel safer in emergency rooms. Most patients want the freedom to choose where to obtain treatment, at home or in emergency rooms, and some older patients feel safer in emergency rooms. People do not like to be told what kind of healthcare is best for them. Some simply do not know about the Mobile Team. Healthcare personnel follow routines. Some employees of the county do not work with the Mobile Team simply because it is not part of their routine. In my conversation with the five members of the Mobile Team, they expressed a desire to develop a new promotional strategy that would help the team reach out to more patients and partner organizations in the county.
The Mobile Team in Uppsala became a permanent unit one year ago, on January 1, 2014. I hope that other municipalities will establish Mobile Teams in the future, as more people become aware of the many benefits a Mobile Team can bring.
This is a happy thought for the New Year.
Happy New Year to all readers!
 “Final Report on the Mobile Emergency Team for the Elderly, 2013”. Author of the report: Swedish Association of Local Authorities and Regions (Slutrapport för projekt kring de mest sjuka äldre Mobila hembesöksteamet i Uppsala, SKL)