Connecting at all hours

Senior living leaders are starting to push for technology that allows residents, families and caregivers to connect.
Senior living leaders are starting to push for technology that allows residents, families and caregivers to connect.

In the wired and wireless world we live in today, connections are ubiquitous. But long-term care often has been slow to join in. Even now, many seniors living in nursing homes are spending their remaining years in “relative” obscurity, looking forward to weekly or monthly visits from family and friends.

There are bountiful studies documenting the challenges of resident-visitor-provider connections. One recent survey of residents' families by the University of Chicago, for example, found that 54% hear from providers only in emergencies. 

“It's no different than your kid's school. If you get a phone call from your senior living property, it's usually bad news,” says Sarah Hoit, CEO and co-founder of Connected Living. “It's not someone telling you this fabulous story of how Grandma fell in love with Granddad. It's likely about some adverse event.”

As Caremerge discovered after commissioning a University of Chicago Booth School of Business study, even in the world of presumably progressive non-acute senior living, communication with families is a touch-and-go proposition. Relatives of many assisted living residents told researchers they felt stymied by poor facility staff communication and wanted greater accountability, and indirect communications such as calls or emails often failed to address their concerns. Queries about medications, daily activities and overall moods often went unanswered or inadequately handled.

When Hoit started her company at the height of the great recession in 2008, “everyone was disconnected. It wasn't just the seniors. It was the whole triangle of administrators, staff and families.” When she told anyone who'd listen her ambitious plans for connecting them all, the ensuing silence was deafening, as the saying goes.

“I have no problem being just as vocal, because we're not going to go small on this. It's about social justice,” says Hoit, the Harvard Business School's first public service fellow in social entrepreneurism. “What we have already done to isolate and disconnect elders is a shame, given all the wonderful technology we have.”

Passion like this is common among virtually every company McKnight's researched and interviewed for this story. All emote a reverence and respect for the experience that comes from aging, and the value of sharing and connecting with families and staff. 

Take, for example, the story of Caremerge founder Asif Khan, an IT professional who had fretted over the condition of his chronically ill mother several continents away. It took Khan three days to get to his mother's bedside, only to realize his father didn't have his mother's medical information. Or the story of Touchtown founder Jeff Pepper, a former software company CEO whose ailing father moved into a retirement community after a lifetime of living in close-knit communities in Long Island, NY, only to quickly decline while missing the old friends and routines he'd left behind. Or the story of Charles de Vilmorin, who helped conceive Linked Senior after his grandmother was diagnosed with Alzheimer's and moved to a nursing home.

Hoit is no less passionate about her mission. “When I started seven years ago, so much that had been developed for an aging population was either about dying, being sick or being cared for, and really that's not the conversation many people want now,” she says. “They want to live and they have lots to share. When you go from disconnected and isolated to being in the conversation, it's life changing for everything.” 

While it's wonderful to see a resident get a picture of their newborn great-grandchild on their own TV set, it is only one piece of the social engagement puzzle, says LifeShare Technologies Vice President of Sales Chip Muston. 

“Technology needs to take the path of least resistance for intended users, whether that is the care provider, the resident themselves, or the families. Since families range in age, location, and tech adoption, it's important to have tools that will enable all stakeholders convenient access,” he says. 

A decade ago, software platforms that allowed residents and their families to engage and connect in meaningful ways were sparse. Not so today. Even companies like MatrixCare, a company that etched its imprint as a leading electronic health record provider, and Yardi, a property management software giant, have their own integrated platforms that allow two-way communication and sharing over myriad channels. MatrixCare was piloting its program at press time, said Mark Welch, senior product manager.

It's also been noticed by relative outliers like TheWorxHub by Dude Solutions, which encourages residents to file maintenance requests digitally.

Seismic shift

“Patient and family information portals are fast becoming table stakes for senior care facilities to provide residents greater independence and allow families to be more engaged in their loved ones' care,” notes Josh Malbogat, Senior Living Director at TheWorxHub by Dude Solutions.

“In our work enabling residents and family members to submit maintenance requests online we've seen attitudes toward adoption of this type of technology shift significantly over the last 10 years from something that communities would laugh at because they didn't think residents would have any interest in it, to something they wanted to run from, fearful that they would be inundated with requests,” he says. 

Senior living leaders are pushing to help improve day-to-day care and resident satisfaction, and also to use this as a marketing differentiator, Malbogat notes.

Savvy providers are learning that having such platforms can differentiate themselves in the market, agrees James Jansen, technology solutions product manager at Direct Supply.

“America's seniors have historically been late adopters to the world of technology compared to their younger compatriots, but their movement into digital life continues to deepen,” notes a recent Pew Research Center study. 

In addition, the Booth study found that family members today want, and expect, real-time information about their loved ones — on everything from upcoming physician appointments and activity attendance to any abnormal trends or emergencies. And they highly value those communities that provide it. The study also found most are interested in receiving resident updates on their mobile devices and that receiving automated updates would influence their choice for a senior living community.

“There's a seismic generational shift among adult children and the newer demographic moving into senior communities that there should be a digital way to communicate and access information,” says Tom Kissane, director, client experience for Caremerge. “The former is incredibly busy. Both are incredibly mobile and hungry for news all of the time.”

Offspring angst

As much as seniors are entering settings with tablets and smartphones craving connection, their kids are even more persistent.

“My 91-year-old grandfather is still independent in Florida for the winter and I continue to worry about him,” Kissane adds. “But if he were living in a long-term care community, I would constantly be wanting to know how he's doing and whether he's being taken care of.”

IT solutions have unique features and vary in sophistication and capabilities. Many systems are a cloud-based “software-as-a-service” (SaaS) accessible via wired or Wi-Fi connections. All are HIPAA-compliant. Some use features like GPS (for tracking and locating people), while others tie directly into a facility's EHR system. Some, including Caremerge and Connected Living, offer closed social networks that allow more privacy — a “must have” among many seniors.

Once they are trained on feature-rich platforms, facility staff generally become more productive and efficient. 

“Providers affectionately call our Community Engagement product their single source of truth — a place for the community to aggregate all of their documents, calendars and events into one central location,” Kissane says. Caremerge re-launched its Family Engagement platform the first week of November at the LeadingAge Annual Meeting and Expo in Boston, he adds. Among the new features are enhanced family connections.

More important are the new and powerful ways these platforms allow staff to engage residents.

“From a staff perspective, we know that turnover is high. People fill out reams of paperwork to move in, and that paperwork goes into a drawer,” says Hoit. “Does anyone really know who my grandmother is over there in the corner or in her room? If you met her for the first time and had this kind of tech at hand, you'd know that she loved Frank Sinatra, was a visiting nurse, loved animals, lived in New York for a while and loved the theater. If you were connected, you'd walk in that room and have a very different conversation.”

The litany of benefits for residents cannot be overstated. Most solutions connect seniors not only to far away family members, but to their local communities as well.

One of the most profound outcomes of resident engagement can be found in memory care. Linked Senior, a dedicated platform that uses customized content specific to each memory care resident, has shown many benefits — from engaging families and residents in games and activities that “spark a connection to the past,” to documented reductions in the need for and use of psychotropic medications, de Vilmorin says.

Mistakes, misconceptions

If many IT solution providers miscalculated anything, it was the dearth of Wi-Fi. 

“The whole notion of connectivity was a complete anomaly when we started seven years ago,” Hoit says. “Even today, many buildings we walk into have very limited Wi-Fi or none at all.”

One of the biggest misconceptions continues to be ageism, and the notion that seniors know and care little about the “Internet of Things.”

“The biggest misstep of all is how so many have underestimated their level of interest and capacity for inclusion and adoption,” says Welch. 

That became quite evident, Welch says, when he was recently offsite working on a telemedicine deployment in seniors' homes. 

“My team took a support call and it turns out it was the senior on the call. His caregiver's technician didn't know what to do, but the senior did and took things into their own hands.”

Julie Holden oversees a community of more than 800 residents as associate executive director of Friendship Village in Tempe, AZ. The level of engagement among residents using Touchtown's Resident Apps is abundantly clear. “We have a centenarian who's completely cognitive, still walks, and is fully equipped and mobile,” she says. “He has a Mac, an iPad and an iPhone.” 

Another challenge: Caregivers who fret such IT solutions will create more work. Many are less tech literate than the seniors under their care, and they can be easily intimidated by the bells and whistles in such systems. For that reason alone, most providers offer modular solutions that can be deployed slowly, Hoit says.

Still, the feature-rich, 24/7 connectivity in so many platforms can leave staff feeling they can never tune out or turn off. Able to put her cell on “do not disturb” when she's at home at night, Holden says that doesn't stop the regular barrage of emails. 

“Six years ago when I was a healthcare administrator, I didn't have families emailing me three times a night and wanting to communicate about Mom's care and stuff,” she says. “I just usually handled it in a phone call or face-to-face.”

Global endeavor

About 17 million people over 65 are currently offline and disconnected. Some are among the approximately 11 million who live alone. Hoit wants to change that and wants to do so in a very public way. Her company was to release a free app called “Ever” on the Apple iTunes store the week of Thanksgiving.

The Ever app, described as an exclusive, more private, intimate social network of residents, family and friends, is intended to approach connectivity in an even more global way.

“We have this crazy, audacious goal to transform the experience of aging not only inside senior communities, but the larger world outside,” Hoit says.