Take Nursing Home, add a Dash of Innovative Technology and Futurism

What I want to do today is try and stitch together several of the innovations I’ve been thinking about, and try to knit them all together, so we can all sit back and imagine the idealized, technologically-savvy nursing home of the future. Futurism is fun. Given as heavily regulated as nursing homes are, in my humble opinion its difficult for a culture of innovation to thrive in these sorts of places. However, I’m going to try.

What will the nursing home of the future look like? What will it offer its residents?

Social robotics and the use of ‘virtual companions.’ Whether it’s by introducing use of devices like the Paro robot (which I’ve written about previously here), or via the use of virtual companions like ALICEBOT (friendly chatterbots), nursing homes will increasingly make use of technologies to outsource some of the work involved to keep residents happy and socially engaged in their world. Like it or not, social technologies and social robotics are niches (albeit small right now) that’s here to stay and will become only larger as time goes on. I predict that AI will allow the introduction of virtual companions in the nursing home world as well that will be increasingly convincing and useful in that regard as well. Both will allow us to stretch our limited nursing home dollars that much further.

Virtual reality. I recently attended the 2014 American Psychological Association conference and saw no less than three different booths demonstrating commercially-available virtual reality software and hardware designed for clinical purposes. That being said, use of virtual reality technologies for clinical purposes is definitely novel and is largely being used for addressing things like simple phobias and posttraumatic stress disorder (e.g., basically virtualized exposure therapy).

My thinking is that virtual reality can be used for other purposes in long term care. Some applications include:

 

  • ‘Virtualized mobility.’ Basically in all the years I’ve been working in long term care, one of the most frequent (and mournful) things I hear from my older adult clientele is that they would give anything if they could walk ‘just one more time.’ Well, what if we could do that for them? Or how about one better, what if we could provide them with the experience of running, or flying? What if we could recreate the experience of them ambulating around their own homes, or a favorite vacation spot?
  • Pain management. One of the more compelling demonstrations I’ve seen is using virtual reality, which is a very immersive, highly transportive technology (I’ve experienced it myself) as basically the ultimate distraction tool – and reserve it for specific, highly painful interventions, such as wound care (video on this approach is here), or perhaps lymphedema therapy. Wound care happens regularly at our facility.
  • ‘Virtual Snoezelen rooms.’ A really novel idea proposed by one of my Recreation Therapy colleagues (when I was excitedly recounting my experience with touring the VR booths at APA) was the idea of a virtual Snoezelen Room (more on Snoezelen rooms here). Snoezelen Rooms are basically a very systematic and well-developed method of offering dementia patients sensory stimulation, with the aim of calming and distracting them from whatever agitation or state was driving their behavioral issues. Its been found to be effective – but one of the big downsides of Snoezelen Rooms is that they tend to require something that many long term care facilities have in very short supply – physical space. Virtual Reality technology obviously is a great workaround for this basic logistical issue.

Information technology “hubs.” This was an idea I proposed a week or so ago. The idea here is that there are several simple, tried-and-true interventions for addressing behavior issues in dementia patients (or, really, just addressing risk factors for depression and loneliness in LTC). The idea here would be to outfit all residents in a nursing home with tablet computers mounted near their beds. These tablet computers could nominally function as televisions and be hooked to cable television. However, they would also be computers hooked to the internet, so that residents can:

  • Utilize videoconferencing technology to communicate with staff and family.
  • Send and receive emails.
  • Watch ‘internet TV’ like Netflix, Youtube, Hulu, etc.

However, these tablet computers could also be outfitted with specialized technology that is hooked to the facilities’ intranet. The idea here would be to allow staff to ‘push’ content to residents computers, specifically the ones who are more impaired and require more assertive intervention by staff to manage behavior issues. Family would be encouraged to supply content to nursing staff members so that staff can provide

  • ‘Reminiscence therapy.’ A tried-and-true nursing-driven mental health counseling technique (not actually psychotherapy, but related to the psychotherapeutic technique of Life Review), it involves engaging the patient in discussion of treasured, pleasant memories. Family and friends could assist staff in encouraging pleasant reminiscence by providing the following kinds of content which could be ‘pushed’ to the residents tablet computer:
    • Family photos, photos from the residents’ childhood, and other visual cues
    • Music, such as favorite songs from when the resident was younger and ‘of age’
    • Videos of family and friends, maybe favorite movies.

 

  • ‘Simulated presence therapy.’ A powerful use of internet-connected devices in residents rooms would potentially be ones where staff could push pre-recorded audio (or even video) recordings of family, friends, and others saying encouraging or calming things to residents who have dementia. Simulated presence therapy already has a powerful literature base but it’s probably not used frequently enough in long term care due to logistical and practical issues. A seamless information technology strategy implemented in the LTC environment could easily help to facilitate the use of this technique.

How would it work? Say you have a resident with dementia who becomes agitated during ADL care (e.g., cleanings after brief changes, for example). Staff already knows that this resident becomes much more calm and cooperative if he is able to hear his daughter’s voice when care is rendered. What if staff could simply tap a button on the residents room tablet computer to play various prerecorded statements by the residents daughter while they are rendering care, ones that the daughter recorded in her own home or at work on her iPhone, and emailed in to the nursing home?

Cognitive orthotics. This is an intervention with increasing popularity with younger brain-injured patients, but has some obvious applications with older adults with mild cognitive impairment or mild dementia in long term care (which I have written about previously here). The basic idea here is that (at least in my opinion!) the overriding philosophy, or goal, in long term care facilities is for residents to be as independent as possible given their physical, functional, and cognitive limitations. So, for example, if a resident requires a walker for mobility, we encourage them to use a walker, as opposed to a wheelchair. Likewise, if the resident has mild memory problems, we encourage them to use external memory aids (such as cognitive orthotics) to assist with their cognitive functioning, rather than solely depend on nursing staff to supply them with cues and reminders… which, of course, nursing staff don’t have a lot of time to do anyways!

RFID technology (and FitBits, perhaps!). The idea here is that there is often a lot of time spent trying to locate patients in the long term care environment. Some patients even engage in “wandering” or “exit seeking.” Oftentimes they are just stubbornly independent and uncooperative people (sarcasm) who want to do their own thing and visit with friends or go outside and spontaneously sunbathe (or what have you) when they are supposed to be at the nursing station for their afternoon medication pass. Or something.

Well, what if nursing staff could easily locate residents on the premises without having to physically search for them? Moreover, if residents were outfitted with three-dimensional activity tracking devices (the FitBit being an obvious commercially-available technology) staff would have available to them a wealth of information that could be used to inform care planning. For example, residents who are sundowning could be identified quickly. Weak points in the facility could be identified to improve security when it comes to persistent wanderers. These monitors might be used to more accurately alert nursing staff when residents are unsafely ambulating (as opposed to using the annoying bed and chair pressure alarms which tend to offer so many false positives!). Sleep disorders could be diagnosed more quickly via actigraphy. The possibilities, like many of the technologies proposed here, are potentially endless!

What other innovative technologies would you like to be seen employed in the nursing home of the future?

Implementing IT “hubs” in nursing homes for families and patients?

Been awhile since I’ve posted, lots of personal taking me away from focusing on the professional (although contributing to my blog is what I consider pleasure, and not business!).

Anyways, I was having one of those “water cooler” type conversations with Recreation Therapy staff at the Livermore Community Living Center (the CLC, where I am, of course, employed as their staff Geropsychologist and have been for the past 7 years). We had been discussing some strategies for how to implement “simulated presence therapy” (or SPT for short) more efficiently and effectively in our CLC (AKA VA nursing home) and as we often do, we began to discuss how technology and mobile applications could possibly help facilitate the use of non-pharmacological interventions with our veterans.

Let’s just back up and talk about SPT for a second. What is it? It’s not really therapy per se (e.g., as in a set of specialized techniques that only trained therapists can deliver). SPT is a technique, really, used with patients who have moderate to severe dementia, to help to reduce their agitation or other behavior issues, by typically playing them recordings of family members or friends voices. In the case of the veteran we were working with, we simply obtained a recording of the daughter saying to her father, “Dad, this is X, you’re doing OK,” and reportedly this calms this veteran down immediately – a big relief given this particular veteran has lots of issues with physical combativeness and psychotic behavior.

My personal belief in the many years I’ve been working at the CLC and in nursing homes is that SPT is a highly underutilized intervention, and that a big reason for this is a combination logistical and technological barriers and lack of outreach by nursing staff. It usually requires an enterprising and energetic social worker or psychologist to get something like this going with a resident. Requires that the resident be identified as having a discrete behavior problem that would actually be amenable to SPT in the first place – which, in the “throw pills at everything” culture that still remains embedded in many nursing facilities, is a difficult thing to accomplish.

As I chatted with the RT staff, it occurred to me that there’s a potential here for technology to help facilitate the use of these and other techniques in nursing homes. Not just SPT, but also via use of music therapy (e.g., offering specialized music to patients based on individualized preferences), reminiscence therapy via use of family photos and video files.

How would this be accomplished? The simplest and cheapest “fix” I considered was simply just having each nursing station be outfitted with their own tablet computer, that has its own email address where family can send sound files, pictures, and music that staff might be able to use for personalized interventions with residents.

A more expensive but comprehensive fix that I envisioned (and may become the subject of another VA Employee Innovation Proposal) is that of creating “hubs” that can be visited online (say, through a Facebook page, or via a custom-build Sharepoint site), family can sign up for with a secure account.

The idea there, as I envisioned it, would be that the family could then freely upload all of the content they wished, which would then be accessible to nursing staff for the purposes of calming or entertaining the resident – ideally via networked devices located in patients rooms (with client software loaded and enabled).

So far I’ve mentioned this idea to one or two nursing staff members here at the CLC – they have responded that in their opinion, cohort issues would prevent such a system from being widely utilized by families of our current crop of veterans. Truthfully, a majority of our veterans are from the Central Valley, have very modest means, and their average age is somewhere in the 70s. Although older adults are increasing their use of information technology and mobile computing at a faster rate than most other age groups, the increase is still from a relatively small base, AND this is a population (lower SES) where technology adoption is pretty limited anyways.

But is this idea viable and just ahead of its time, or could there be some other, more immediate way of using technology to facilitate greater use of SPT, reminiscence, or individualized music therapy with nursing home residents? Curious what you think.