CareBank:

The Power of PeerCare in the Palms of Our Hands!

Introduction

Today, almost half of all American women 75 and older are living alone, afraid that something may happen and no one will know. Loneliness is a key predictor of a cascading range of co-morbidities, including: cognitive decline, depression, substance abuse and suicide. Medication nonadherence has been associated with 125,000 deaths, 10% of hospitalizations, and excess costs of $289 Billion annually.[1] PeerCare tools, empowered by innovative Internet of Things (IoT) technologies, may synergistically solve medication adherence, loneliness and social isolation problems while closing growing gaps in unfulfilled eldercare services.

One resource we have that can scale-up to help fill this eldercare workforce gap is elders themselves. CareWheels’ CareBank empowers people with technology to participate in the Care Sharing Economy. The CareBank Platform integrates TeleCare IoT sensors with a TimeBank, using Behavioral Economic Principles to reward people for exchanging PeerCare services, like medication and safety monitoring, from the comfort of their homes. CareWheels is piloting the CareBank to demonstrate how we may serve our growing population of aging Americans with trustworthy, tech-empowered PeerCare that strengthens social connections and improves medication adherence, helping us save lives and money.

CareBank Pilot Project
Lake Oswego, Oregon is Ground-Zero for disruptive U.S. Aging Demographics. This graph[2] shows how the population age distribution has changed between 2000 and 2010 using Census data. Observe that the only population segments showing significant growth are those aged 55 to 75+ while children and Generation X segments are in decline.

Lake Oswego demographic trends resemble those of Japan – the world’s oldest nation and a harbinger of America’s aging future – making this an ideal place to develop and test the CareBank. A distressing New York Times article[3] describes the “4,000 lonely deaths a week of the world’s most rapidly aging society” in which Japanese elders “died without anyone knowing, only to be discovered after their neighbors caught the smell.” Is this a fate that awaits 14 million older Americans who are living alone?

Welcome to Greenridge Townhomes

Greenridge is a Naturally Occurring Retirement Community (NORC) in Lake Oswego, Oregon. Established in 1970, many of Greenridge’s original homeowners still live there though their families have grown up and moved away. Neighbors have grown older together and the time has come when they ask themselves, or their adult children ask them, whether to stay or move away.

Art is one of Greenridge’s first residents and an active member of the Lake Oswego Adult Community Center, where he facilitates the Technology and Learning Special Interest Group meetings. Last autumn, Art invited me to the Adult Community Center to present the CareBank Project. He then helped recruit a group of widowed Greenridge residents, ages 80 to 94, to participate in a three month CareBank Pilot.

Now in its tenth month of operation, the Greenridge CareBank Group provides mutual monitoring and first response services to support their shared desire to help each other live safely in their own homes. Should something happen to any member while alone at home, their PeerCare Group will be the first to know and respond. The Greenridge CareBank Pilot demonstrates how these elders are using technology to help take care of themselves and each other, so that they may all live safely at home and prevent the ultimate indignity of a lonely death.

Greenridge NORC Elders use a variety of personal computing devices to run the CareBank App including: Apple iOS and Android smartphones, tablets, and Windows laptop computers. CareBank Pilot surveys have revealed elders’ higher levels of personal engagement when using hand-held computing devices, reinforcing the notion that the CareBank App puts the power of PeerCare in the palms of our hands.

CareBank App on Laptop & Tablet

CareBank Participant Testimonials

 

It’s like an Advanced Directive – you want to get this set-up before you need it.

You don’t want to wait for a crisis to implement something that will help you stay safe at home.

It feels like someone’s looking out for you. Yeah! Someone cares. So you have to keep up your routine to let them know that you’re okay.

I think it’s very beneficial because what goes around comes around. If I’m going to be a good, helpful monitor, someone will do the same for me.

That’s what life’s all about – The Golden Rule: Do unto others as you’d have them do unto you.

I would definitely recommend it. It’s a brilliant idea!

 

The CareWheels PeerCare Idea

Dr. Bill Thomas, geriatrician and founder of The Green House Project, wrote: “The best new ideas, the ones with the most potential to disrupt and transform the experience of care and caregiving are also the most likely to be rejected out of hand. Capable people with strong credentials and deep expertise in a field are often the quickest to dismiss the ideas that have the greatest potential to change everything.”[4]

The PeerCare idea began when a group of engineers and scientists from CareWheels, Intel, Kaiser Permanente Center for Health Research, Oregon Graduate Institute and Oregon Health & Science University interviewed stakeholders from aging service organizations, including Kaiser Permanente Expanded Care Managers and Home Health Worker Staff. When we asked about their use of technology, they told us about their experiences using a Personal Emergency Response System (PERS), best known for the hysterical television ads in which an elderly woman yells: “HELP! I’ve fallen and I can’t get up!”

The Care Managers explained that these familiar PERS Buttons did not work about a third of the time. When our engineers asserted that they could build a much more reliable button, the Care Manager explained that the buttons work only when they are pushed – and gave three reasons why that often failed to happen: (1) incapacitation, (2) not wearing the button because of its stigma, and (3) falling but failing to push the button for fear that would result in having to move from home to institutional care.

The problem with PERS persists today, as recounted by MIT AgeLab Director Joe Coughlin[5]: “When [PERS] subscribers fell and remained on the floor for longer than five minutes, they failed to use their devices to summon help eighty-three per cent of the time. In other words, many older people would sooner thrash on the floor in distress than press a button—one that may summon assistance but whose real impact is to admit, I am old.”

Our idea was to replace the PERS Help Button with a computer and smart home sensors that would track normal daily activities and generate alerts automatically if anomalies were detected. CareWheels participatory design research participants discovered that, in addition to personally benefitting from their sensor information, they could help each other live more independently by monitoring and responding to each other’s alerts. This new method of tech-empowered PeerCare revealed the transformative potential of interdependent care, confirming the social science research findings that people in peer support groups take better care of themselves when they take good care of each other.

The CareBank Solution

The CareBank is a cloud-based Care Sharing Economy Platform integrating TeleCare IoT Sensors with a Virtual TimeBank and Behavioral Economic Incentives into an easy to use Mobile App that puts the power of PeerCare in the palms of our hands. PeerCare connects elders to transform individual frailties into collective strengths. The CareBank is designed to empower people with technology that provides innovative tools to improve medication adherence and life-affirming behaviors by engaging elders in PeerCare to strengthen social connections, promote healthy behaviors and support their wellbeing.

Unlike PERS Help Buttons, the CareBank generates alerts to summon peer help when nothing happens:

The CareBank is peer-based, not fear-based like PERS Help Buttons. We place Wireless IoT Sensors on important objects like the refrigerator and medications to sense normal patterns of daily activities. If nothing happens during the timeframe when an activity is expected, the CareBank detects the anomaly and sends an alert to all members of the PeerCare Group. Our patent pending Method and System for Social Care Networking uses the IoT Sensor Net to catch potential problems before they become crises. Problems are detected and reported automatically to the PeerCare Group members’ smartphones and tablets, empowering them to provide affordable and trustworthy mutual monitoring and first response services from the comfort of home.

How CareBanking Works

The CareBank implements 3 distinct goals of the 2016 President’s Council of Advisors on Science and Technology Report on Independence, Technology, and Connection in Older Age[6]:

  • Online tools can help older adults to participate in the sharing economy.
  • Remote monitoring and sensors can help seniors age-in-place while ensuring their safety and maintaining their health.
  • Time Banks allow seniors to donate services now in order to access help from others when they need it.

The CareBank App’s Main Screen graphically presents the PeerCare Group as a CareWheel: a hub-and-spokes social care network. Each PeerCare Group member appears at the center of their CareWheel, surrounded by their fellow members, so that everyone sees themselves as the hub of their CareWheel on their CareBank App. When the sensors detect anomalies in patterns of important daily activities, such as missed medications or meals, the background color surrounding that member’s image changes to indicate an appropriate yellow or red alert status.

Tapping a member’s photo on the Main Screen invokes the TeleCare Status Screen, which reveals the member’s status and cause of the alert. Tapping the Call Button dials the member’s phone, providing a quick way to check if they are okay. If they just forgot to take their meds, the peer’s call will provide a necessary reminder. Failure to answer the phone indicates the possibility of a more serious problem requiring a personal visit to check if they have fallen, become ill or been incapacitated.

Most of the time, everyone is fine. However, if a member has stopped eating or forgotten to take their medication, their trusted peers will be the first to know – and respond. The first responder’s CareBank account is credited automatically for taking good care to call and help resolve the problem before it escalates to a crisis. While peers are actively engaged in monitoring and responding, their CareBank accounts are automatically credited for the time they contribute, eliminating the effort to manually record their services. Accumulated credits may then be exchanged, as with a conventional Time Bank, for a variety of additional peer-support services to help sustain independence, such as transportation, errands and household repairs.

A 2015 Stanford Social Innovation Review article: The Time Bank Solution[7] defines time banking as:
“a mode of exchange that lets people swap time and skill instead of money, providing a new way to link untapped social capacity to unmet social needs.” With respect to Eldercare:

  • Time Banks typically offer services needed by people who are older or who have disabilities: friendly visitation, telephone companionship, shopping, transportation, minor home repairs, reading mail, assistance with paying bills, relief for family caregivers, peer counseling.
  • The need to fill that widening care gap makes time banking a solid investment for government, philanthropy, and individual households. Time [credits] could be to long-term care what windmills and solar panels are to the nation’s energy supply.
  • The growth of time banking reflects a shift from profit-driven modes of production to network-based modes of production that rely on peer-to-peer collaboration.


Behavioral Health Benefits of CareBanking

Medication nonadherence has been associated with 125,000 deaths, 10% of hospitalizations, and costs $289 Billion annually.[8] These negative health and economic effects of medication nonadherence and social isolation may be prevented by implementing time banking and Behavioral Economic Principles to incentivize PeerCare services. The CareBank applies Behavioral Economic Principles by leveraging social incentives to help remedy the negative health and economic costs of medication nonadherence.

For example, when a pilot participant said: “You have to keep up your routine to let them know that you’re okay” she explained how forgetting to take her medication caused her to bother her buddies to have to bother to call and remind her. After a few such reminder calls, she became extra diligent about taking her meds on time. We have named this mutual PeerCare experience “positive peer-to-peer pressure” and found that its benefits have been reported in Behavioral Economic Research literature.

The 2018 National Academy of Sciences, Engineering, and Medicine Proceedings of a Workshop: Behavioral Economics and the Promotion of Health Among Aging Populations[9] reported that:

  • The behavioral economics framework is ideally suited to system change, can provide scalability, and can aim at large parts of the population to improve the health of aging and older adults.
  • Social incentives, such as a “medication buddy” or “support partner,” call for people to be accountable to someone else in trying to achieve their desired goal.
  • Volunteering has been used as an intervention to address the decline in social engagement among older adults due to the thinning of social networks. Older volunteers in formal programs have higher levels of human, social, and cultural capital. They are motivated by opportunities for giving back, meaningful engagement, and social interaction. Especially for older people, volunteering is positively associated with physical, mental, and cognitive health.

Social Health Benefits of CareBanking

Social isolation is now recognized as an epidemic public health problem.[10] Older Americans are aging in place by choice or necessity at historically unprecedented rates, amid a growing caregiver gap with fewer healthcare professionals and family caregivers to provide support for their rising needs. Elders are especially at risk because they are likely to suffer from health problems and shrinking social connections due to the loss of friends and family. Immigration restrictions are undermining the caregiver workforce, further expanding the caregiver gap.

The 2019 Health Affairs Report: Care For America’s Elderly And Disabled People Relies On Immigrant Labor[11] cites immigrants’ roles as health care and long-term care workers: “More than one in four direct care workers are immigrants, including nearly one in three direct care workers in home health agencies. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.”

Socially isolated older adults, who lack meaningful contacts, are at greater risk for poor health and death than connected elders. Medicare spending data has revealed that a lack of social contacts among older adults is associated with an estimated $6.7 Billion in additional federal spending annually.[12] In addition to differences in the cost and use of healthcare services, researchers found that risk of death is about 50 percent higher for socially isolated elders. The researchers concluded that interventions should explore the desirability and feasibility of using technology to reduce isolation among older adults.

Social relationships affect health behaviors, cognitive function, mental health and mortality risk. The CareBank helps resolve the growing caregiver gap at its source by using IoT and connective technologies to empower elders with new PeerCare tools to live healthier, safer and more interdependent lives.

Financial Benefits of CareBanking

According to the Social Security Administration, 21% of married Social Security recipients and 43% of single recipients aged 65+ depend on Social Security for 90% or more of their income. One-third of senior households has no money left over each month or is in debt after meeting essential expenses.[13]

The National Council on Aging, United States of Aging Survey[14] asked 2,250 U.S. adults aged 60 and older: “Are we as individuals and communities ready to address the challenges of an aging population?”

According to the U.S. Census, 40 percent of all U.S. seniors aged 60 and older are considered to be of low or moderate income – less than $30,000 per year. The survey results revealed that nearly half of low- and moderate-income seniors face the possibility of severe financial hardship and will struggle to manage their health over the next five to 10 years. Additionally, low- and moderate-income older adults who are most in need of health care, economic security and support services to remain independent are the least confident of all survey respondents that they will be able to get the help they need.

The CareBank regards elders as assets who can help “pay it forward” by banking their PeerCare services when they are healthy to pay for their future services. It monetizes PeerCare services by converting surplus human capital to shared social capital. Simply by checking their CareBank App and responding to alerts, peers earn and accumulate time credits that they can use to purchase services when needs arise. Time banking has been found to be particularly well suited to elders, since they are often in need of more services, have free time to give, and can benefit from mutual exchanges and social interactions.[15]

CareBank Platform = Apps + Sensors + Server

The CareBank is a cloud-based Care Sharing Economy Platform that integrates TeleCare IoT Sensors with a Virtual TimeBank and Behavioral Economic Incentives into a simple, easy to use Mobile App that puts the power of PeerCare in the palms of our hands to help save lives and money.

Thanks to the generosity of Social Venture Partners - Portland and their Encore Fellow Engineers for the CareBank Development, the Consumer Technology Association Foundation for funding the Pilot Project and the Pilot Participants for engaging with me in the CareBank Project.

Download this article: CareBank-The_Power_of_PeerCare.pdf

References


[1] The New Landscape of Medication Adherence Improvement: Where Population Health Science Meets Precision Medicine. Patient Prefer Adherence, 2018; 12: 1225–1230. Published online 2018 Jul 13. DOI: 10.2147/PPA.S165404 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049050/pdf/ppa-12-1225.pdf

[2] Change in Population Graph http://censusviewer.com/city/OR/Lake%20Oswego%20(Oswego)

[3] A Generation in Japan Faces a Lonely Death. New York Times, November 2017
https://www.nytimes.com/2017/11/30/world/asia/japan-lonely-deaths-the-end.html

[4] Bill Thomas, The Age of Disruption is Here. https://www.edenalt.org/the-age-of-disruption-is-here/

[5] Adam Gopnik, Can We Live Longer but Stay Younger? The New Yorker, May 13, 2019 https://www.newyorker.com/magazine/2019/05/20/can-we-live-longer-but-stay-younger

[6] President’s Council of Advisors on Science and Technology Report: Independence, Technology, and Connection in Older Age. 2016 https://obamawhitehouse.archives.gov/sites/default/files/microsites/ostp/PCAST/pcast_independence_tech__aging_report_final_0.pdf

[7] Stanford Social Innovation Review article: The Time Bank Solution. 2015 https://ssir.org/articles/entry/the_time_bank_solution

[8] The New Landscape of Medication Adherence Improvement: Where Population Health Science Meets Precision Medicine. Patient Prefer Adherence, 2018; 12: 1225–1230. Published online 2018 Jul 13. DOI: 10.2147/PPA.S165404 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049050/pdf/ppa-12-1225.pdf

[9] The National Academy of Sciences, Engineering, and Medicine Proceedings of a Workshop: Behavioral Economics and the Promotion of Health Among Aging Populations. 2018
https://www.nap.edu/catalog/25190/behavioral-economics-and-the-promotion-of-health-among-aging-populations

[10] The Loneliest Generation: Americans, More Than Ever, Are Aging Alone. Wall Street Journal, Dec. 2018
https://www.wsj.com/articles/the-loneliest-generation-americans-more-than-ever-are-aging-alone-11544541134

[11]Health Affairs Report: Care For America’s Elderly And Disabled People Relies On Immigrant Labor. 2019 https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05514

[12] Medicare Spends More on Socially Isolated Older Adults. AARP Public Policy Institute, November 2017
https://www.aarp.org/content/dam/aarp/ppi/2017/10/medicare-spends-more-on-socially-isolated-older-adults.pdf

[13] https://www.ncoa.org/news/resources-for-reporters/get-the-facts/economic-security-facts/

[14] The National Council on Aging, United States of Aging Survey. https://www.ncoa.org/wp-content/uploads/8-3-12-US-of-Aging-Survey-Fact-Sheet-Low-Income-FINAL.pdf

[15] Engagement of the Elderly in Time Banking: Potential for Social Capital Generation in an Aging Society. Journal of Aging & Social Policy, Vol. 20(4) http://people.usm.maine.edu/collom/collom2008JASP.pdf