After her mother had a nighttime fall, Ana Londoño spent weeks on night watch, listening for signs of stirring so she could quickly respond to nighttime wandering. But Londoño was listening from afar over Skype—she lives in Missouri while her mother is in Colombia.
With limited sleep and prolonged anxiety about her mom, Londoño knew her 24-hour vigil couldn’t continue. She realized she “can’t control everything, which has been very difficult because I kind of want to be there without being there.” Londoño installed bed sensors that will trigger the lights to come on when her mom gets up and is trusting that the system will help prevent missteps.
While Londoño’s experience is extremely long-distance, her caregiving anxieties are common for families across the country. Nearly 55% of Americans live within an hour’s drive of extended family, so the chances are good that long-distance caregiving is, or will be, a reality for many.
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Today, 15% of caregivers in the United States, or 5 million to 7 million adults, live more than an hour from care receivers.
There are ample opportunities to remain connected to aging family members who live nearby. Rituals like Sunday dinners or monthly fishing trips create opportunities to see if Aunt Grace is becoming more forgetful or if Dad’s walking is unsteady.
However, for those who live away from family, regular face-to-face outings are often replaced with phone calls. Unfortunately, mounting health issues— missed medication, more clumsy daily walks, or skipped meals—are easy to overlook or downplay.
“With long-distance caregiving, the biggest challenge is just knowing what’s occurring on a day-to-day or even weekly basis,” says Alyssa Weakley, assistant professor of neurology at the University of California, Davis.
Implementing electronic tools like home-installed sensors allows for remote monitoring that gives unobtrusive updates to caregivers miles away from their loved ones. These tools can help organize care, recognize concerning changes, and increase clear communication between care team members, relieving caregiver stress.
‘Electronic eyes’ monitor in-home activity
Long-distance caregiving limits the ability to consistently monitor changes in a loved one’s behavior or actions. Gradual changes in behavior can often indicate a more serious problem. Caregivers may instead rely on “electronic eyes” to help monitor the care receivers.
While some of these sensors are stand-alone products, other systems will require an internet connection and possibly WiFi. This can be a limitation to some homes, as reliable and affordable internet may be out of reach. This is especially the case for some rural Americans who received subsidies for internet access from the Affordable Connectivity Program. Without additional funding allocation from Congress, the program is set to wind down this month.
Understanding the availability and reliability of the internet is an essential step in deciding what sort of home monitoring is best for the care receiver. In some cases, stand-alone monitoring systems that do not require the internet may be sufficient. Pressure sensors like the one Londoño installed on her mom’s bed are attached only to the lights and don’t require connectivity. For now, this system provides her mother with the right tools to prevent falls.
In other cases, monitors that are connected to the internet are more crucial. Londoño keeps an eye on her mom with cameras installed in her mother’s home. While they give her an instant view of what’s happening in the house, the cameras are a double-edged sword.
“Cameras have been very useful because I can see where she is and what she’s doing, but there’s also a stress related to it—you see things happening and cannot act immediately,” she explained.
Many care receivers will balk at cameras in their home, saying it eliminates their privacy. Some companies have developed motion-activated monitoring systems to avoid embarrassment or resistance to home monitoring.
Unobtrusive sensors around the size of cellphones can be placed around the home, detecting and recording a care receiver’s movements and activity patterns. These sensors can track how often someone goes into a room, note increased sedentary behavior, or even when someone makes coffee.
Research has shown that tracking a person’s movements and activity patterns over time can detect cognitive decline, Weakley said. With remote monitoring programs, sensor data is often compiled and artificial intelligence software starts to learn daily behavior patterns. When a person’s behavior changes, caregivers can receive an alert.
While these sensors detect movement, they cannot reveal exact activities. “With the overhead sensors, we know that somebody’s in the bathroom, but we don’t really know what they’re doing in the bathroom,” said Weakley.
She and her team are developing vibration sensors that can give finer-grained information. For example, a sensor might be placed on a countertop. “[The sensor] can detect when something is picked up and put down,” Weakley said. “Different objects have different vibration patterns.”
From these patterns, Weakley said they can explain what is happening in a room—whether someone is filling a pillbox, washing their hands, or showering. The system is being tested in a simulated home environment and vibration measurements are being calibrated.
Ultimately, all this information will be gathered and available on a web-based caregiving portal called Interactive Care, or I-Care. “It’s an online secure system that both the caregiver and the care receiver can use interactively,” she said. The user interface builds on previous technology advances and tools developed over the past few years.
The site will include easy-to-use tools like calendar management, bill tracking, video chat, and notes to help keep all important information and communication in one place. The system would also provide alerts to the care receiver and the caregiver, reducing the need for crisis-driven care, and easing the minds of long-distance caregivers.
The project is still in pilot testing and is available only for those enrolled in their research projects. While Weakley said the system could be helpful in long-distance caregiving, she noted that there will always be unknowns and limitations with caregiving technologies.
While she doesn’t want to oversell the I-Care system, Weakley said she believes the team is creating a system that helps many long-distance caregiving relationships. Ideally, the system will not only allow care receivers to keep living more independently but also “provide the caregiver a sense of ease, which is going to reduce a lot of extra stress and also that care guilt for not being there and present.”
