Quantified Wellness and Assisted Living
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This document discusses quantified wellness and assisted living. It outlines a research project exploring wellness management through technology. The project team aims to use technology to improve resident wellness, quality of care, and staff behavior. Key questions are posed around establishing baselines, interpreting signals, integrating technology with care processes, and managing organizational change. Factors related to resident biological, psychological, and social wellness are identified.
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Quantified Wellness and Assisted Living
- 1. Quantified Wellness & Assisted Living Joan Cahill School of Psychology, Trinity College Dublin (TCD), Dublin, Ireland Sean Mc Loughlin Oneview Healthcare, Ireland
- 2. 2 Topic & Objectives Quantified Wellness & Assisted Living 1. Background 2. Research project and team 3. Exploring wellness & posing questions 4. Wellness management approach 5. User Interface Examples 6. Discussion 7. Conclusions 8. Technology demonstration 9. Questions
- 3. 3 Background
- 4. 4 Starting Point: Room & Technology
- 5. 5 Lets Start Again: Person, Experience & States of Being
- 6. 6 Home, Community & Care Experience
- 7. Assisted Living 7 Care Process • Pre move in • Day of admissions and initial assessments • Detailed assessments • Care planning and specification of care tasks • Day to day care • Care/safety events • Discharge • End of life Aged Care Setting • Home • Assisted Living Community • Post Acute Care • Residential care (full time, respite) • Palliative care Person (Resident) • Level of independence (ADL) • Functional ability • Communication & sensory • Cognitive ability (early cognitive decline, Dementia) • Mental health • Health conditions – multiple morbidities Social Situation (Resident) • Single • Living spouse/partner • Widowed • Family • Friends/community • Experience of carers Funding Model • Public • Private Staff • Workload & fatigue • Training & competence • Teamwork
- 8. 8 Theory • Wellness (biopsychosocial) • Relational autonomy • Relationship centred care • Social connection and community • Self management • Ability • Ethics/rights • Professionalism • Patient experience • Safety • Performance • Behaviour change
- 9. 9 The Thin Edge of Dignity (Dick Weinman) https://www.youtube.com/ watch?v=UciTFCPCivI
- 11. 11 Human Factors Research • Wellness research conducted as part of a broader human factors research project • The participatory design and evaluation of new technology to enable independent living, social participation and quality of life for older people domicile in residential homes and/or assistive living communities • Technology for residents and other actors (nurses, care assistants, family)
- 12. 12 Objectives • Use technology to improve resident wellness & quality of care • Use technology to change/improve staff behaviour and action – Person centred care – Attention to wellness – Focus on ability – Focus on social/relationships – Self management • Directly address issues around user acceptability and ethics
- 13. 13 Team (TCD & Oneview Healthcare) Joan Cahill Sean O’Loughlin Anne Marie Cole Niall O Neil Daniel Nogueira Stephane Paes Mary BattleburyRaul Portales Delaine Blazek
- 14. 14 Methodology • Action research (qualitative) • The human factors design approach is premised on the assumption that the solutions for seniors and other actors are necessarily interrelated • Stakeholder evaluation involving use of a Community of Practice (COP) • Lifespan perspective – home, assisted living community and residential homes • Ethics approval 1: Core Assisted Living Study 2: Fairview Community Unit (Post Acute Care) 3: USA (ROI, Care Models, Culture) 4: Implementation
- 15. 15 Studies 1: Core Assisted Living Study 2: FCU (Post Acute Care) 3: USA: ROI, Care Models, Culture • Lit review • Industry analysis • Interviews n = 47 • Observations (day hospitals) • Co-design phase 1, 2, 3( N=15) • Co-design phase 4 • Evaluation: Residential Home • Observations (5 weeks) • Interviews: residents (N=11) • Interviews: staff (N=10) • Co design in PAC (ongoing) – patients and staff • Industry analysis • Workshops & interviews with stakeholders • Process mapping • ROI and business models
- 17. 17 Person, Experience, States of Being, Home/Community & Care Experience Failures of professionalism, burnout, compassion fatigue Place where I feel comfortable and safe Freedom to do what I want – live as I would at home Place where I am minded Just like home – door always open to family and friends Not a hospital I would hope to get on well with staff and other residents (new family) Nervous/dread/avoid … If not get on well with staff and other residents…impact care/quality of life Home away from home
- 18. 18 Delivering States: Residents Wellbeing Promote/Support Manage/Mitigate/Reduce Avoid • Quality of life • Wellness • Independence • Social participation • Communication • Safety • Identify • Empowering person • Dignity and respect • Purposeful activity • Sense of purpose • Sense of usefulness • Resilience/coping • Self-management of health • Engagement • Sense of confidence in own ability • Awareness • Continuity • Nurturing person • Citizen participation • Active and healthy living • Loss of identity • Loss of physical liberty • Physical discomfort • Communication difficulties • Fear • Sense of powerlessness • Difficulty with new information • Restlessness • Feeling lost • Stress • Apathy/loss of interest • Wandering • Frustration • Confusion • Agitation • Negative thinking • Depression • Aggression/anger • Sleep disturbances and sundowning • Suspicion and delusion • Self-neglect • Deception • Infantilization • Isolation • Elder abuse • Objectification of the dementia patient • Unsafe behavior • Reduction in human contact • Neglect
- 19. 19 Delivering States: Staff Professionalism Promote/Support Manage/Mitigate/Reduce Avoid • Teamwork • Compassion for patients • Healthy challenges about patient care issues • Effective communication • Attention to patient wellness • Attention to patient safety • Dignity and respect • Process compliance • Awareness of patient ability, needs and identity • Trust in team • Patient centred care • Attention to medical ethics • Compassion fatigue • Communication problems • Burnout • Poor teamwork • Fear of speaking out about patient care issue • Stress • Lack of understanding about patient identity, need and ability • Safety events • Procedural non compliance • Breakdown in team trust • Objectification of the patient • Elder abuse • Compassion fatigue • Communication problems • Burnout • Poor teamwork • Fear of speaking out about patient care issue • Stress • Objectification of the patient • Elder abuse • Procedural non compliance • Breakdown in team trust • Lack of understanding about patient identity, need and ability
- 20. Wellness Management: Objectives & Rationale 20 • Enable holistic health care delivery • Attention to resident wellness (behaviour change for all…) • Predictive risk management • Support staff communication (staff briefing and handover) • Support resident/staff communication and care delivery • Gather data about (1) individual residents, (2) all residents – to improve care planning/quality of care Everybody involved in care/report on resident wellness (resident, family, nurse, Dr, care assistant, admin) Provide everybody (resident, care staff and family) with a high level indicator of resident wellness
- 21. Initial Product Approach: Wellness 21 Product considers requirements of older adults across different aged care settings & cultural contexts (Europe, USA & Australia) Residential Home (Full time) • Zena (61) • Mid Stage Dementia • Supporting purposeful activity, family participation, behaviour and mood • Tracking falls, wandering Assisted Living Community • Richard (77) • Active and healthy • Supporting independence, social connection and participation, education & self management of health Residential Home (Respite) • Frank (71) • ECD, FD, Diabetes • Supporting independence, re-enablement, social connection and participation, education, self management of health
- 22. Resident Centered Technology 22 Bio SocialPsychological Entertainment Medication Management Digital Signage Communication Meal Ordering Wander Management Health Record & Careplan Telehealth Education & Coaching (Self- Management) PIR Sensors Bed & Clothing Sensors Data Analytics Independence Engagement Safety Connection Ability Resilience Belonging Active Living Wellness
- 24. 24 Technology Overview Smart Buildings & Sensors My Circle of Care mobile app Care Team Dashboard and POC solution Resident TVs and Tablets Analytics Sales CRM & Resident Platform
- 26. 26 Wellness Questions & Communications Zena to family • Is it you Jane (daughter)? • The pain in my side is getting worse • I can’t eat this dinner • Where am I? • Can I leave? I want to leave! Zena to nurse/assistant • I’m not feeling well? • When is Jane (daughter) coming to visit? • What can I do today? • Can I leave? I want to leave! Zena (behaviour/activity) • Zena Fidgeting • Zena spitting out food • Zena Wandering • Zena ringing call bell 7 times in 3 hours Carer/Nurse to Zena • Hi Zena - how are you feeling today? • How is the pain? • How did you sleep? • Are you not hungry? • Stroking Zena’s arm and eliciting response
- 27. 27 Wellness Questions & Communications Zena’s Nurse to Jane (Daughter) • Zena fell yesterday – her mobility is getting worse • We think Zena might have a UTI and are doing some tests? • We need to change Zena’s care plan • Zena’s needs more care/help Jane (Daughter) to Nurse • Mum seems in more pain • Its hard to tell whether mum is doing any better – what do you think? • Mum seems off/not herself/not doing activities - could there be something wrong? • Is mum falling more these days? • Mums seems to be angry and doesn’t want to talk – what should I do? Between Staff (Nurses & Care Assistants) • How is Zena – any improvements? • I’m having problems with room 10 • Can you ask Dr Larche to have a look at Zena when he arrives? • I need two people for room 10! • Have we checked Zena for a UTI? • I think we need to look at Zena’s care plan again..
- 28. 28 Questions 1: Process & Technology • How establish baseline/change? • What evidence/data is collected? • What factors are most important/relevant? • Time period? • What counts as minor, significant and major change? 3: Technology, Human Factors & Ethics • How use tech to collect data and generate assessments? – Devices – Sensors – Analytics • How do different actors make reports/access information • Sensors (permission/consent, ability to consent)? • Privacy? • Impact on the delivery of direct personal care? 2: Integrating with Care Delivery/Process • How integrate technology with care delivery – Care assessments – Care plan – Specification of care tasks – Care reporting – Events reporting 4: Managing Organisational Change
- 30. Findings: Wellness Management 30 • Wellness management = part of current practice • Ad hoc • Paper based • 3 pillars? • Principled approach: guided by care objectives/ethos • Focus on person centred care • Resident experience • Resident ability • Risk and safety • Partnership in care (resident and family) • Ethics • Integrated in care process • Admissions • Assessments • Care plan • Care tasks • Reporting
- 31. Findings: Wellness Management 31 • Not about how much…. • Rather, about whether there is a change from normal (i.e. the residents baseline) • Multiple reporting perspectives: – Resident – Family – Nurse – Care Assistants – Admin • Interpreting & acting on signals… • Care response/call to action (Monitor .v. take action….) • Need to be predictive – not reacting No change Minor change (monitor) Significant change (action required) Major change (action required)
- 32. 32 Findings: Wellness Management (Interpreting Signals & Taking Action)
- 33. Findings: Wellness Management (Interpreting Signals & Taking Action) 33 What signals? • For each pillar, lots of different factors • Inter-relationship between pillars and factors • Maybe not necessary to go into minute details on all factors • A number of key ones might be enough.. • Personalisation for specific resident Hard to interpret signals (quantify wellness) • Change to any one factor/specific pillar influence the others • Change to any one factor/specific pillar might be enough to initiate response/call to action • Individual differencesnth) • If there a reason for change – impact on care response (monitor or take action) Hard to know whether interpreted signals correctly and acted correctly… • Wait/monitor • Try different things, individual differences • Need help with this – analytics?
- 34. Accessing Wellness Information & Reporting On Wellness 34 Older Adults • Different levels of ability • Simple and intuitive • Voice/touch • Issues around who has access to information Nurses & Care Assistants • Embedded in process • Fast and efficient • Reduce time spent documenting situation – more time for direct personal care Family • Fast and efficient • Mobile… • Enhance sense of partnership in care • Issues around privacy/protection of personal sphere
- 35. Managing/Implementing Change 35 • Digital transformation = process transformation • Acceptability to staff? • Implications for staffing/training? • Changing culture? • Cost and business model? • Compliance & regulation? • Implementation plan? Change is welcome, but will be hard!
- 36. Biological Pillar (Factors) 36 Factor Time Period Changes to Mobility ADL Support Week? ADL Support/Dressing ADL Support /Feeding ADL Support /Toileting ADL Support/Hygiene Night Sleep 24 hr? Not sleeping as normally do • Sleep (Bed Exists) • Sleep time Fatigue & Day Sleep 24 hr? Sleep routine during the day (being in bed during day or level of sleep during day) Eating and drinking 24 hr? What eating How much eating How much drinking Refusing food/drink Issues with swallow Toileting 24 hr? Changes to elimination/typical patterns (constipated etc) Pain 6 hr? Level of pain Comfort being dressed/showered
- 37. Biological Pillar (Factors) 37 Factor Time Period Changes to Pressure sores 24 hr Change in pressure sore status? New pressure sore? Body temperature 2 hr Basic level Physical activity Several days? Leaving bed/sitting out in chair Leaving room Physical Exercise Several days? Taking walks outside Engagement in exercise activities Wandering Several days? Falls Week? No of falls Nurse bell requests 24 hr?
- 38. Psychological Factors 38 Factor Time Changes to Mood Several days? Difference in mood Sad, Anxious, Depressed Cognitive Several days? Difference in Awareness Understanding instructions Memory (person, place, time) General Behaviour Several days? Difference in Level of stress, confusion, agitation Level of physical or verbal aggressiveness Ticks Crying Withdrawn Self-neglect
- 39. Psychological Factors 39 Factor Time Changes to Dementia specific behaviour Several days? Specific challenging behaviour Wandering Self-harm Nurse bell requests 24 hr Increase in no of calls/help requests Engagement: Hobbies & Interests Several days? Not performing hobbies/exhibiting usual interest in hobbies Not watching TV/listening to radio when normally do Not reading books? Not knitting Engagement in education Several days? Engagement in self-management activities Several days?
- 40. Social Factors 40 Factor Time Changes to Personality/level of social engagement Several days? Normally outgoing and talk to people – but change? Time in room Several days? Change in typical social patterns – not leaving room, spending more time alone than normal Club events & hobbies Several days? Not attending/following normal patterns of attendance for club events Not responding to RSVP’s Family visits Several days? Not having visits, refusing visits, cancelling visits Travel outside Several days? Not leaving facility – irrespective of whether out hours permissible Engagement: Communication with staff Several days? Engagement: Communication with other residents Several days?
- 41. Proposed Process/Patient Centred Service 41 1: Establishing Baseline • Pre-admissions Who are they, what is normal for the person (specific factors) • Day of admission: Specific factors and baseline agreed (personalisation) • Finalisation of baseline (+ 1 or 2 weeks): Monitoring over trial period & updates 2: Gathering Evidence: Current State • Resident feedback • Nurse observations & notes • Care assistant observations • Family feedback • Sensors 4: Notifications on State & Change • Staff, Resident & Family 6: Assessments & Care Planning • Monitoring state • Monitoring intervention (worked/not worked) • Requesting new assessments • Following assessments, making changes to care plan and assignment of daily care tasks • Discussions with resident and family5: Immediate Care Actions & Interventions • Care activity and reporting – Talking to resident and family – Arranging social activity – New walking aid – Request UTI/blood test – Relax (aromatherapy, exercise) 3: Evaluating Current State • Comparing evidence with baseline 8: Evaluating & Improving Care • Using analytics to learn about care delivery – interventions and profile types, staff challenges 7: Updates to baseline • Baseline changing as age/condition changes • Monitoring & assessment
- 42. Proposed Approach 42 • Phased delivery (different options/levels of intelligence) • Phase 1: Everybody reports on wellness and wellness information is available to all (integrated in existing reports, surveys, specific wellness reports) - manual • Phase 2: (1) and staff report on actions taken to manage wellness • Phase 3: (1), (2) & system automates a basic summary wellness evaluation/status (for 3 pillars) – based on analysis of parameters provided by ALL (resident, nurse, care assistant, family) • Phase 4: system does (3) and also recommends care actions (spanning 3 pillars), which can be accepted or alternatives proposed – all actions documented by staff using system • Phase 5: system does (4) and also requests reports from relevant actors on status of care actions – if successful/improvement in wellbeing • Phase 6: system does (5) and provides intelligence as to care outcomes, requirement for reassessment, other interventions • Phase 7: Wider reporting and analytics over time for care facility, per issue, per intervention, per patient
- 43. Initial Implementation 43 • Start with a simple method (1, 2 and potentially 3) • Objective: promote awareness and action (minimum level requirement) – Staff obtain information about resident wellness – Staff report on action (also monitor action) – In addition, weekly report on wellness
- 44. Wellness Pillar Type Source Bio-medical Health profile, ability, medications and medical directives Care Plan and Assessments Diet and nutrition, modified diet and allergies Care Plan and Assessments Current Vitals/health status Nurse report, health monitoring wearables Daily care status Caregiver and nurse reports, Sensor - care calls, care visits Medications status Nurse report Current physical activity Sensors – falls, bed , Self-reports, Caregiver and nurse reports Current Frailty and ADL Caregiver and nurse reports, Sensors – activity, fall Social Communication ability Care Plan and Assessments Daily Routine Personal Profile, Care Plan Bio: personality and preferences Personal Profile Family and friends Personal Profile Interests and Activities, Club Memberships Personal Profile Current social activity – events/clubs Events calendar (attendance, level of, change) Current family visits (recent and upcoming) Family visits log, Events calendar Current visits outside Events calendar, Concierge requests (taxi, bookings) Permissions (information sharing/access) Admissions agreement Psychological Mood Self-report, Report from nurse/caregiver and family, Social activity (level of, change), Sensor - nurse calls, activity Behaviour & challenging behavior Report from nurse, caregiver, family, Sensors – bed, activity, Care Plan and Assessments (triggers and soothers) Bio: who you are and what matters, important/meaningful dates, entertainment preferences Personal profile
- 46. Resident: Tablet & Phone (Dashboard) 46
- 47. Wall Mounted Display (Outside Room) 47
- 49. 49 Nurse Tablet: Resident Details/Updates & Profile
- 50. Nurse Tablet: Reporting on Resident Wellness 50
- 51. Nurse Tablet: Wellness Management 51
- 55. 55 Discussion Points • Making progress in collaboration with stakeholders • Still lots of questions! • More learning in implementation • Questions of values: (1) promoting autonomy, wellbeing and social participation for older adults and, (2) protecting dignity and privacy • Changing nature of care and care roles • Concern: reduction in human contact and quality of care • Systems not replace person centred care or time staff spend with residents • Sociotechnical context - technology is not the only solution! • Change not easy – small steps • To promote positive states of wellbeing for residents, the overall solution needs address all three pillars of wellbeing • Reporting involve all stakeholders.. • Consider wellness status (awareness) and associated actions taken to address wellness • Start with simple method
- 56. 56 Conclusions
- 57. 57 Quantified Self & Assisted Living? • Beyond technology and sensors… • Beyond the user interface (usability) • People, care experiences and care delivery • Reporting: multiple perspectives • Taking action (and monitoring – working/not working) • Community dwelling, social participation, identity, rights, lived experience, care models etc Technology Implementation = Societal Vision and Values = Ontological Design Günter Ropohl (1939 – 2017)
Editor's Notes
- Research seeks to establish the appropriate balance between enabling the independence and well-being of residents (including supporting their privacy) and protecting residents from potential hazards
- Research seeks to establish the appropriate balance between enabling the independence and well-being of residents (including supporting their privacy) and protecting residents from potential hazards
- Participatory Design spans – tools for residents (preadmissions, admissions, daily life), and for family and nurses etc Ethics approval for all Post Acute Care Service = Mater Hospital (TCD and hospital approval Residential Home = Strathmore Lodge - Private Nursing Home (TCDl approval)
- We are mindful of the complexities and challenges of ageing and understand the opportunities to advance technology that manages and mitigates potential challenging states and behaviours while optimising positive states. During our requirements gathering stage, we address: The states, or lived experience, to be achieved for each of the relevant end users and stakeholders How Oneview’s technology will support this. This means working with you to identify each of the states and outcomes to be achieved by implementation of the Oneview solution. This exercise will inform the ultimate solution design and implementation plan. Our implementation team includes a number of Outcomes Managers who will work with your facility/facilities to assist in the change management process and track achievement against the target states and outcomes.
- We are mindful of the complexities and challenges of ageing and understand the opportunities to advance technology that manages and mitigates potential challenging states and behaviours while optimising positive states. During our requirements gathering stage, we address: The states, or lived experience, to be achieved for each of the relevant end users and stakeholders How Oneview’s technology will support this. This means working with you to identify each of the states and outcomes to be achieved by implementation of the Oneview solution. This exercise will inform the ultimate solution design and implementation plan. Our implementation team includes a number of Outcomes Managers who will work with your facility/facilities to assist in the change management process and track achievement against the target states and outcomes.
- Other aged care technology providers have developed solutions from a base of billing management or electronic medical records. To truly deliver care that meets the needs of consumers who want to age with dignity and retain control over their care, a resident-centred solution is needed. This is our key differentiator. To this end, we are conducting extensive human factors research into the role of technology in enhancing and enabling resident-centred care within an aged care environment. Each component of our technology solution maps to one or more of these three pillars of wellness, to provide a truly resident-centred solution.
- Other aged care technology providers have developed solutions from a base of billing management or electronic medical records. To truly deliver care that meets the needs of consumers who want to age with dignity and retain control over their care, a resident-centred solution is needed. This is our key differentiator. To this end, we are conducting extensive human factors research into the role of technology in enhancing and enabling resident-centred care within an aged care environment. Each component of our technology solution maps to one or more of these three pillars of wellness, to provide a truly resident-centred solution.
- Access to holistic resident information at the point of care (e.g. likes, personality, clinical information) to informs how care is provided to each resident. Sensors and analytics enable predictive care. In-room resident tablets promote resident independence and engagement. Digitising processes and interaction between stakeholders helps care teams spend more time on meaningful work. Facility and organisational level data and analytics support information-based decision making.