Home Care System Research Articles

Non-invasive arterial pressure monitoring by a new pneumatic sensor and on-line analysis of pulse waveforms for a modern medical home care systems.

The development of the third-generation devices for medical home care systems is in the center of discussion. The results of developing non-invasive arterial pressure monitoring channel on the basis of the unique pneumatic sensor are discussed in detail. In particular, the main principles of operation, design features and testing results of a pneumatic sensor are considered. Namely, the issues of the stable air flow regime in the sensor’s working chamber are discussed. It is shown that the miniature size of the sensor and the possibility of its precise positioning directly in the measurement zone on small (< 1 mm) areas of the skin elastic surfaces result in improved quality of pulse wave shape recovery, the parameters continuity measured and the disturbances reduction. Measurement examples for some human superficial arteries are given. The possibility of continuous measurement of the actual value of blood pressure for radial and temporal arteries is confirmed.

Home care rehabilitation therapy services for individuals with multimorbidity: A rapid review.

Multimorbidity refers to the co-occurrence of two or more chronic conditions, where no one disease is considered the central disease. Individuals with multimorbidity experience increased patient health complexity, increased disability and functional decline, and increased health care utilization. Rehabilitation therapists are well positioned to address the complex functional needs that can contribute to disability for people living with multimorbidity; however, it is not well understood how they address these needs within the home care setting. A rapid review was conducted to identify and synthesize the existing literature on home care rehabilitation services for clients with multimorbidity and the effect of those services. Two electronic databases (Medline and CINAHL) were searched. The Journal of Comorbidity was hand-searched for thoroughness because this journal focuses on populations with multiple chronic conditions. This rapid review included observational and experimental studies that focused on rehabilitation therapy interventions embedded within existing home care systems for adults with multimorbidity. Four studies were included in the final review. The results revealed that therapists delivered interventions aimed towards improving functional outcomes related to activities of daily living and instrumental activities of daily living. Physical therapy interventions were the only therapy delivered in three of the four studies included. Furthermore, 50% of these studies explicitly included people with chronic conditions impacting the musculoskeletal system only. This review offers an important perspective on how home care rehabilitation therapy interventions and outcomes are operationalized for individuals with multimorbidity. Despite the varying definitions of multimorbidity, therapeutic intervention supported functional improvements.

Running Palliative Care Services at the Institute of Palliative Medicine, Kozhikode, Amid COVID-19 Pandemic: A Strengths, Weaknesses, Opportunities, and Threats Analysis.

Context:COVID-19 pandemic and nationwide lockdown has affected the health system. Many health-care facilities are prioritizing their services, and hence, those suffering from life-limiting conditions will have difficulty in accessing health services.Aims:The aim of the study was to perform a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of the palliative care (PC) services provided by the Institute of Palliative Medicine (IPM), Kozhikode, amid COVID-19 pandemic.Settings and Design:A SWOT analysis of PC services provided by IPM.Subjects and Methods:The data for SWOT analysis was collected by brainstorming and review of records and registers.Results:Good prioritization and documentation system and routinely adhering to infection control practices are notable strengths. Lack of funding and interrupted supply of personal protective equipment are notable weaknesses. Availability of established communication channels with active community participation are a few opportunities available to improve the services. Working with high-risk groups, return of Non-residential Indians (NRI), lack of transparency and stigma among the general public are the threats that can affect the service delivery.Conclusions:Having good prioritization and documentation system, reinforcing infection control practices, already established emergency homecare system, presence of a well-developed network of community-based PC services, and a vast network of community volunteers and awareness and cooperation of families had helped IPM to quickly reorganize its services and transition smoothly to continue to provide PC for those suffering from life-limiting illnesses in this pandemic situation.

Homecare System for Demented People using IoT

Internet of Things (IoT) provides many homecare systems and makes an easier life for humans. Some homecare systems are really useful for aged people. In our society, many aged people are suffering from a disease called dementia. Dementia word describes the set of symptoms that may contain memory loss and difficulty with thinking. The demented people are unable to recognize their family members. Also they have difficulty to deal with day to day activities. Taking care of such people is not a dominant task if assigned to a caretaker, but some people may not afford these much of expenses. Even if it is assigned to the caretaker, they may be burdened with the amount of care required. In this work, to reduce the burden on the caretakers, a homecare system using IoT is designed. An android camera phone installed at the door recognizes the face of the arrived person and sends an unique identifier wirelessly to an android watch wore by the demented person. The android watch alerts the user with vibration. Also, it opens the locally stored image using the unique identifier and announces the name of the arrived person. Reminder application is also used to remind the day to day activities with voice commands.

Public preferences for home care services for people with dementia: A discrete choice experiment on personhood

Dementia is a progressive and debilitating neurodegenerative condition which significantly impacts on quality of life and the ability to live independently. It is a leading cause of disability in older populations and carries significant economic and social costs. It is no wonder, therefore, that dementia has been identified as a major global health and social care challenge, especially with prevalence projected to triple by 2050. In many countries, the stated policy aim is to care for people with dementia in their own homes for as long as possible and practicable. However, home care systems vary significantly across countries in their approach to personhood in dementia, particularly the extent to which care provision reflects the needs and preferences of recipients. In this paper, we undertook a discrete choice experiment, with data collected from 551 individuals in Ireland between November and December 2018, to elicit public preferences for personhood-oriented home care services for people with moderate dementia. We capture the concept of personhood with two attributes, one that refers to whether care provision is flexible and tailored to the individual needs of the person with dementia, and a second that refers to whether communication with the person with dementia is expressed in a personalised manner. Using mixed logit models, we find that flexible service provision, personalised communication and increased home care hours are highly valued by citizens. While people are indifferent to a means-tested co-payment for home care relative to no co-payment, they are opposed to a universal co-payment. We also estimate the welfare impact of a move from the status quo to alternative personhood-oriented home care arrangements, providing useful insights for policymakers regarding the future design and funding of home care services. The paper has significant implications for the recalibration of health and social care systems towards personhood in dementia care.

RF-Based Noncontact Respiratory Rate Monitoring With Parametric Spectral Estimation

Respiratory rate (RR) monitoring of an adult or an infant during sleep or in steady position can be lifesaving, especially in home care systems. In this paper, we examine the potentials of wireless radio frequency (RF) signals to monitor the RR. A new noncontact RR monitoring system is proposed. The system includes a simple motion detection algorithm based on adaptive thresholding to eliminate the effects of the large-scale body movements on the RR estimation. In the proposed system, the high resolution subspace-based parametric spectral estimation approaches, estimation of signal parameters by rotational invariance technique (ESPRIT) and multiple signal classification (MUSIC), are presented as the RR estimation algorithms. According to our knowledge, the ESPRIT algorithm, which estimates the spectrum without searching, is used for the first time in this paper for RR estimation. It is shown that ESPRIT is computationally efficient and works approximately 49 times faster than the MUSIC algorithm. It is also shown with various experiments conducted with ten volunteers that the proposed noncontact RR monitoring system attains 0.13 breath per minute (bpm) error rate with the limited number of data and outperforms the periodogram method commonly used as the benchmark.

Real State of the Terminal Care of Lung Cancer in the Integrated Community Care System after Medical Fees Revision 2018

Abstract Background After Medical Fees Revision FY2018, movements from Integrated Community Care Ward(IW) to Long-term Treatment Ward(LW) are not regarded as going home, but we foresaw in the last annual meeting that the Integrated Community Care System(IS) might still function well in the terminal care of lung cancer if home care system and LW were effective. So we verify the predict by examining our additional practice over the last year. Methods We investigated medical records of 164 dead lung cancer patients treated in Tokyo Kensei Hospital(THp) (35 IW beds, 64 LW beds) and Ooizumi Health Cooperative Hospital(OHp) (47 IW beds, and 47 acute ward beds) in the last 6 years, and checked the state of cooperation between hospitals and clinics, the places of death. Results 41 of 66 THp patients passed away in LW, and 12 in IW. Such cases are still increasing due to introduction for BSC from acute hospitals. In FY2018 we saw a lung cancer patient who enjoyed the terminal care under the cooperation among acute hospital, IW, home care system, and LW (case presentation). In OHp no patients move to hospice or LW in FY2018, 32 (with 3 additional) cases of 98 patients passed away at home, and 8 (with 5 additional at one year) cases died in IW. Since FY2015 when IWs were opened in both hospitals, 1632 patients of all diseases stayed 28.4 days on average at IW in THp, and 1995 patients 29.4 days in OHp, significantly longer (P Conclusion After revision 2018, definition of going home has been more strict, but we recognize that IS where IW centers actually functions well under the close cooperation with home care or LW.

Developing a random forest classifier for predicting the depression and managing the health of caregivers supporting patients with Alzheimer's Disease.

Supporting the caregivers of dementia patients is an important issue in the field of public health. This study established a model for predicting the depression of dementia caregivers while considering the sociodemographic and health science characteristics of South Koreans. The results of this study provided baseline data for developing and applying a caregiver management App. This study analyzed 2,592 adults (⩾ 19 years old; 1154 men and 1438 women) who were caregivers (e.g., family and caregivers) of demented elderly (⩾ 60 years old). The results of developed random forest model showed that gender, subjective health status, disease or accidence experience within the past two weeks, the frequency of meeting a relative, economic activity, and monthly mean household income were the major predictors for the depression of caregivers. The prediction accuracy of the model was better than K-NN and support vector machine. It was proved that the developed random forest-based App for predicting and managing the depression of dementia caregivers used an algorithm that has a high predictive power. It is required to develop a customized home care system that can prevent and manage the depression of the caregiver.

An example of a neglected child who constructed a special safe place both at home and at school

According to the Ministry of Justice Research and Training Unstitute Institute, White Paper On Crime 2007 (Ministry of Justice Research and Training Unstitute Institute, 2007), the number of consultations in relation to child abuse has been increasing yearly over the last decade. Of the child abuse information received at child consultation centers, 21% comes from family members or other relatives, 14% comes from neighbors and 13% comes from school teachers. (Kozu, J., 1999) However, given that in 75% of cases the abuser is the child's natural father or mother, family reporting cannot be relied upon to give a true picture of the incidence of child abuse. (Kouno, A. and Johnson, C. F., 2001) With the gradual depopulation of rural areas, it is predicted that the number of cases of abuse reported by neighbors will decrease, and that conversely the number of cases of child abuse noticed and reported by school staff, especially yogo teachers (school nurses), will increase. In basic terms, it is difficult for a single yogo teacher to keep a close eye on all the children who visit the school sick bay (yogo teacher's room). There will be situations in which the yogo teacher will need to receive assistance from specialists such as child consultation center counselors, welfare office staff or school counselors. In recent years the number of students who need medical support and/or nursing support at school has been increasing.(Hayashi, N., 2009) However, these students still study the standard curriculum. It is reported that 5 percent of students who have been labeled overly selfish, lacking in application or from problems at in fact have been suffering from pervasive development disorders. (American Psychiatric Association, 2002) The medical home care system was established in 1992, and following a review of the school attendance standards in 2002, students with special needs based on pervasive developmental disorders became able to attend mainstream classes. (Fujioka, H., 2009) The system of special needs education has shifted from focusing on a level of education according to the degree of the individual's disability to providing individual support for the variety of types of An example of a neglected child who constructed a special safe place both at home and at school Kanako Yamauchi, Tadahiro Kato and Yasuo Mukai

Impact of the Japanese Disability Homecare System on ALS Patients’ Decision to Receive Tracheostomy with Invasive Ventilation

Research has documented the influence of ALS patients families’ attitudes on patients’ decision to accept or reject TIV (tracheostomy with invasive ventilation), a treatment that in many cases will allow them to live long enough to experience locked-in syndrome (LIS); under Japanese law the use of a ventilator cannot be terminated once it is essential to a patient’s survival, so to choose TIV means to choose the possibility of entering a locked-in state. Previous studies have not, however, elucidated the changes in family members’ attitudes that take place after they receive pertinent information about the social systems and services available to them. This study aims to fill this gap by collecting and analyzing patients’ and family members’ narratives. In Japan, about 30% of ALS patients utilize TIV. This rate is much higher than in most other developed countries. Patients’ narratives illuminate the psychological and especially the contextual factors of their decision-making. Many Japanese patients who currently use a ventilator say that their family members encouraged them to prolong their lives through ventilation. These family members have done so because patients are able to use long-term ventilation for only ¥1000 (around $11) per month, and can also access the latest communication devices and round the clock caregiver services in their homes at very low cost. Japanese caregivers who are supported by social systems and services including communication assistance (systems, training methods, funding), empowering factors such as patients’ associations, care provided by people outside the patient’s family, and a public nursing care system are able to encourage patients to decide to use longterm ventilation (provided that they are aware of the possibilities offered by these social systems and services).

Cross-Resolution Feature Fusion for Fast Hand Detection in Intelligent Homecare Systems

Fast hand detection plays an important role in Intelligent Homecare systems due to its close association with many human-related tasks, such as human activity and behavior recognition. In the last decade, although hand detection has been studied widely, fast hand detection has remained a challenge. In this paper, we employ a single shot multibox detector (SSD) as the base architecture and propose a novel cross-resolution feature fusion (CFF) approach to add contextual information and semantic information to shallower layers for fast hand detection. Our approach helps improve performance significantly, especially in small instances, owing to the inclusion of two important modules: a narrow atrous spatial pyramid pooling (N-ASPP) module and a richer semantic information generation (RSIG) module. The proposed N-ASPP module employs atrous convolution to capture multiscale context information by adopting different atrous rates. The proposed RSIG module uses a resolution-matching submodule to enlarge an input feature map and a ResNeXt block to exploit richer semantic information. In verification experiments, the proposed 2CFF-SSD model achieved 66.41% average precision (AP) in the Oxford hand test set conducted at 55 frames per second on a GTX 1080 Ti graphics processing unit, which is superior to the original SSD method and many other state-of-the-art methods in terms of accuracy, while maintaining the high speed.

Technology for visualizing the local change in shape of edema using a depth camera

The change in the edema condition is visualized considering the three-dimensional shape. Continuous treatment and observation are indispensable for patients with edema. The measurement and evaluation of the three-dimensional shape of the leg are thus important in evaluating edema of the leg. Such an evaluation can confirm the therapeutic effect and assist in the planning of treatment by confirming the change in local capacity. Additionally, the depth camera of Structure Sensor used this study is feasible for use in home care systems due to its very low cost compared with other depth cameras. We obtain a point cloud of the leg and register shape models. We conducted an experiment to measure legs swathed and not swathed in bandages, with the former representing a leg with edema. In addition, for visualization of the edema condition, the change in shape was color coded according to the change obtained in the proposed analysis of the three-dimensional shape. Our experimental results show that our proposed visualization technique is effective in conveying the change in shape visually and clearly.

Increasing Usability of Homecare Applications for Older Adults: A Case Study

As the world’s population is ageing, the field dealing with technology adoption by seniors has made headway in the scientific community. Recent technological advances have enabled the development of intelligent homecare systems that support seniors’ independent living and allow monitoring of their health status. However, despite the amount of research to understand the requirements of systems designed for the elderly, there are still unresolved usability issues that often prevent seniors from enjoying the benefits that modern ICT technologies may offer. This work presents a usability assessment of “HeartAround”, an integrated homecare solution incorporating communication functionalities, as well as health monitoring and emergency response features. An assessment with the system usability scale (SUS) method, along with in-depth interviews and qualitative analysis, has provided valuable insights for designing homecare systems for seniors, and validated some effective practical guidelines.

Conhecimentos e perceções públicas acerca do acolhimento familiar: Contributos para o desenvolvimento da medida

O acolhimento familiar é uma medida de promoção e proteção de crianças e jovens que tem ganho crescente expressividade na Europa nas últimas décadas. Paralelamente, a investigação tem evidenciado um maior ajustamento desta resposta face às necessidades desenvolvimentais das crianças em perigo. Não obstante, em Portugal, esta é ainda uma medida com muito pouca representação. A capacidade de promover o Acolhimento Familiar, para além de muitos e complexos fatores de ordem política, legislativa e financeira, estará também dependente dos conhecimentos e perceções que a população em geral possa ter sobre a problemática. Assim, este estudo analisa os conhecimentos e perceções de uma amostra da população portuguesa (n=270) acerca do acolhimento familiar. Os resultados demonstram poucos conhecimentos acerca da realidade do acolhimento, mas uma atitude favorável face ao acolhimento familiar e uma elevada disponibilidade dos inquiridos para se tornarem família de acolhimento. A discussão dos resultados é feita tendo em conta as suas implicações para a promoção de uma cultura de acolhimento familiar e para a criação de condições que viabilizem a adesão à medida em Portugal.

Implementation of Fall Detection System Based on 3D Skeleton for Deep Learning Technique

In recent years, the fall detection system has become an important topic in the homecare system. Compared with the traditional fall detection algorithm, the method used by neural network is more robust and has higher accuracy. However neural network consumes a large amount of energy due to a huge number of computations, and needs more memory to store parameters as compared to traditional algorithms. In this paper, we propose a fall detection system in combination of the traditional algorithm with the neural network. First, we propose a skeleton information extraction algorithm, which transforms depth information into skeleton information and extracts the important joints related to fall activity. Also we have modified the skeleton-based method with seven highlight feature points. Second, we propose a highly robust deep convolution neural network architecture, which uses a pruning method to reduce parameters and calculations in the network. The low number of parameters and calculations makes the system suitable for the implementation on an embedded system. The experiment results show the high accuracy and robustness on the popular benchmark dataset NTU RGB+D. The proposed system has been implemented on NVIDIA Jetson Tx2 platform with real-time processing.

Amyotrophic Lateral Sclerosis (ALS): Telemedicine system for home care and patient monitoring

The development of a new domotic healthcare system for patients with Amyiotrophic Lateral Sclerosis (ALS) to improve home-based clinical follow-up through the identification of functional loss worsening and complications, preserving interaction between patients and caregivers. The following electromedical wireless sensors were developed to analyse breathing, nutrition, motility and communication: Pulse Oximeter, surface EMG sensor associated to a dynamometer, Laryngophone, EEG-based BCI device. The project was divided into: (1) User centered design; (2) development of wireless sensors, remote terminal units, central server; (3) pilot clinical project and medical validation. Visual Analogic Scale (VAS) and SUS scales were used to analyse the user-friendliness and the satisfaction of each sensor. The domotic interface was tested on eight patients with ALS. SUS and VAS scores indicate a good system usability, both in satisfaction and in ease of use. The usability of the Laryngophone may be improved, even if ratings of recorded audiofiles performed well. The data collected, born from the collaboration between neurologists and biomedical engineers, led to innovative home medical devices and original algorithms that recognize alterations of vital parameters of patients with ALS at different degrees of disability, overcoming the current clinical follow-up deficit and giving patients a chance to recover interaction with environment.

Development of Textile-based Pressure Sensor and Its Application

Smart textile industries have been rapidly developed and are being studied for home care system. Particularly, the healthcare field has been highlighted in the smart device industries due to an increasingly ageing society, and pressure sensors can be utilized in various elderly healthcare products such as flooring and mattress because they can obtain a variety of pressure information in a large-area at indoor without infringing privacy. In this study, the novel type of conductive textile was fabricated using vapor phase polymerization (VPP) of poly(3,4-ethylenedioxythiophene) (PEDOT) to apply a textile to the pressure sensing device. The morphology of the PEDOT-coated conductive textile was observed through the field emission scanning electron microscope (FE-SEM). Moreover, the resistance was confirmed to be adjustable to various resistance ranges depending on the concentration of the oxidant solution and polymerization conditions and measured using 4-probe system. The 3-layered 81-points textile-based pressure sensor was fabricated using the PEDOT-coated conductive textile prepared herein. The visualized system by Matlab was developed to evaluate the sensitivity, multi-pressure recognition, and position tracking. In addition, the developed system can record the data so as to track the moving pressure and detect the event considered to be an emergency. Finally, we confirmed the possibility that PEDOT-coated conductive textiles could be utilized by pressure sensors.

The principle of help to self-help in Sweden A study of representations and norms regarding old age and care needs and their moral and ethical implications for care work

ABSTRACT The purpose of this article is to describe and analyse the principle of help to self-help in care work and the representations of and norms on old age and care needs supporting the principle in relation to moral and ethical aspects. The article is based on the results of a study conducted in a small rural Swedish municipality in 2006–2008 and a study conducted in a big city in 2014 and 2015. The material consists of interviews with first line managers, care workers and care receivers. The results of this article show that the principle of help to self-help in the care of older people exists in both public sector home care in a small municipality and a home care system in a major city with customer choice system. The results also show that representations of and norms on old age and care needs highlight the normative value of help to self-help, which has both ethical and moral dimensions. In the care of older people this is translated into care receivers maintaining their mental and physical strength which challenges the value of care receivers’ self-determination.

INNOVATIONS IN LONG-TERM SERVICES AND SUPPORTS: THE VIEW FROM THE WEST COAST STATES

Washington and Oregon historically have been national leaders in LTSS. Over the past four decades, both states built robust home and community-based care systems (HCBS). California – the nation’s most populous state – is often seen as a trendsetter as the impact of its policies are often closely watched by the rest of the nation. Several recent policy developments build on this rich history. In Washington, these efforts include an attempt to establish a new LTSS funding mechanism, while Oregon enacted a new framework for data collection and quality metric benchmarking as well as new caregiver training requirements. Meanwhile, California and Oregon were early adopters of the ACA’s Community First Choice Option, which further expands access to Medicaid HCBS. These developments all have potentially significant implications for the provision of LTSS.

Negotiating Relation Work with Telehealth Home Care Companionship Technologies that Support Aging in Place

In response to a perceived caregiver shortage and need to support aging in place, telehealth home care systems are being developed to provide remote care and monitoring to older people. Though research has examined the experiences of teleoperators delivering care through these systems, we know less about the experiences of older adults receiving this care. We report findings from a three-month study of a tablet-based telehealth home care system that provides support for aging in place. We find that there is a mismatch between the designer's conception of how care should be delivered and the ways that participants were interested in using the system. This mismatch exists in four areas: participants' interest in getting to know the human teleoperators and rejecting the virtual avatar, interrogating the interface to figure out the inner workings of the platform, pushing for a more symmetrical relationship, and negotiating the relation work that they were willing to perform in the "sacred space" of their homes. We draw on the concept of heteromation to understand the political dimensions of telehealth aging in place technologies. We also provide implications and future directions for technologies requiring relation work as well as the design of avatar-based remote companionship.