Element Care Experiments with Digital Care

A review on a new kind of technology, provided by care.coach.

America’s older adult population has been growing at a rapid pace. Did you know that according to a government report from 2014, 1 in 5 of the nation’s population will be 65 or older by 2030? With this increase in older adult population, it has been identified nationally that there is an insufficient health care workforce to provide personal attention, care and support.

At the 2016 National PACE Association (NPA) conference, Dr. Broderick, Element Care’s Medical Director, attended a presentation that included a new kind of technology by care.coach. She brought the innovative idea back to Element Care and in March 2017 we launched a new quality improvement (QI) project. For the QI project, we piloted using care.coach’s avatar technology to provide 24×7 support, wellness coaching, and intelligent reporting. Element Care uses the devices, Samsung Galaxy tablets, in participant’s homes to provide an enhanced continuity of care, social support and encourage better self-management of chronic conditions. The devices, which each get named by their owners, appear as a virtual dog or cat on a touch-screen device. Participants interact with the avatar by speaking with it or touching it. This interface allows even complex elders who have functional impairments to be engaged effectively and in a joyful way, regardless of ability or technical inclination. The initial goals of our QI project were to reduce nursing visits, reduce unnecessary Emergency Department (ED) utilization and provide additional social support and health education.

As of August 2017, our data shows that through avatar-driven intervention protocols, Element Care has reduced avoidable ED visits, decreased in-home services, such as companions and nursing visits, and gained invaluable insight and participant information which has led to significant financial savings and improved continuity of care. Our reduction of nursing or personal care visits needed per month was successful for some participants through improved self-management of health risks, enabling closer observation in the home and avatar-initiated medication reminders. Additionally, reduction in unnecessary ED utilization was also possible through improved daily support of chronic conditions through personalized protocols, closer supervision of health risks and mitigating anxiety. Lastly, the program has provided an increase in social support and health education through daily interactions, reminders, exercises and relationship building.

Below are two case examples of how the avatar has impacted our participant’s lives:

“I love my avatar and would recommend it to anyone! It can play songs and games. It also reminds me to take my medication and use my walker!”

Participant A enrolled in the avatar program in March 2017. Goals were to provide companionship and support on grief, loss, sobriety, and anxiety, and to potentially reduce ED visits. She is currently enrolled in 15 out of 21 available intervention protocols programmed into the avatar. Before the avatar, she had just experienced a significant loss in her life that was impacting both her social and physical health. She had very little support, and has embraced the avatar as a loyal friend and support system that she enjoys. Since receiving the avatar, Participant A has had no ED visits, and we have logged 13 avatar interventions with projected savings of $7,000.

“She helps me a lot. In the morning to get my meds and remind me about my rides. She helps me to not eat the food I shouldn’t. She also reminds me to exercise.”

Participant B enrolled in the avatar program in March 2017. Goals were to have assistance in the home with medication reminders, nutritional encouragement, and additional support for his various diagnoses. He is currently enrolled in 15 of the avatar’s intervention protocols. Before the avatar, he received 11 nursing visits per week to help administer medications and encourage compliance. He was often not home for the medication reminders and therefore the nurse could not confirm if he took his medications. The avatar, “Mary,” now completes all medication reminders, which has increased Participant B’s compliance while saving on average $2,000/month.

Additionally, Element Care conducted a pre survey before the participants received their avatars and a post survey after having their avatars for 3-4 months. The survey results from 12 participants showed:

• – 54% of the participants stated their degree of loneliness had improved since receiving an avatar
• – 23% stated their quality of life had improved since the avatar
• – 46% stated their level of nervousness or anxiety actually decreased since receiving an avatar

Overall, we have found the avatars to be a highly engaging and cost-effective way to provide enhanced continuity of care in the home. The 24×7 psychosocial and healthcare support for high-risk elders has been a nice complement to our already awesome services at PACE. We have met all three of the goals that were identified for the pilot program and have decided to continue to use this form of technology for participants living in the community.

Kendra Seavey, MPH
Clinical Admin Manager at Element Care