Abstract
BackgroundContinuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data.ObjectiveThis study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions.MethodsContinuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes.ResultsDuring the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use.ConclusionsMost continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use.
Highlights
Factors associated with older adults’ moves to residential facilities have been well described [1,2,3,4], our understanding of the reasons for changes in the level of care in persons who live in continuing care retirement communities (CCRCs) is limited
Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use
We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use
Summary
Factors associated with older adults’ moves to residential facilities have been well described [1,2,3,4], our understanding of the reasons for changes in the level of care in persons who live in continuing care retirement communities (CCRCs) is limited. Decisions about care needs and transitions in the levels of care for older adults living in CCRCs rely on communication and coordination among professional staff members. These decisions are based on the evaluations of relevant health and behavioral changes. Georgiou et al [10] identified barriers to optimal communication in residential care facilities, which may have a negative impact on the provision of quality care related to efficient and timely transitions to different levels of care Another challenge to judicious care transitions is the relative inability to detect changes in a resident’s care needs before an acute event occurs. Care decisions can be based on objective, systematically assessed real-time data
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