IoT poses ethical dilemma for carers of vulnerable people

Newcastle University, Institute for Ageing, have questioned the ethics of monitoring older people living alone with mundane household appliances, such as kettles. The Internet of Things (IoT) now has the capacity to place sensors unobtrusively and collect data continuously, generating concerns about “informed consent”. Four were identified:

• Smartphones passively monitor activities and send alert to families or carers in public spaces outside the control of the observed person;
• Potential stigmatisation of the observed person;
• Greater liability to the carer who has constant availability of data;
• Reduced face-to-face or telephone communication.

However, they urge caution to avoid over-emphasising potential harms compared to the likelihood of improved outcomes.

Innovate UK funded the study, which also included a focus group report of the Kemuri® Wellbeing Monitor. This is an IoT smart power socket that senses temperature, motion, and power used by kettles and microwaves in kitchens. Web software learns patterns of behaviour and checks for changes from normal behaviour every hour. The objective is to reduce NHS and Social Care costs by families identifying the risk of hypothermia, dehydration, malnutrition and unattended falls.

The focus group from VOICENorth were all carers of older people who had symptoms of dementia. The findings included:

• “… an overwhelmingly positive response that the three types of information was the most appropriate to support carers to provide reassurance that all was well”;
• “Most felt the kitchen was a place where ordinary day-to-day activities happen”;
• “… there was unanimity that the device was user-friendly in terms of the user interface (screen, readability, and instructions)”.

The full report, “Ethics of passive wellbeing monitoring and focus group report“, is available to download.

Digital Catapult Showcases Kemuri

The KemuriSense smart power socket was invented because it did not exist.  Older people living alone are not all the same, you would not expect this with 2.5 million over the the age of 75.  Some will refuse to wear telecare devices and most will not accept continuous video surveillance.

One is now on show in the Digital Catapult in 101 Euston Road. It has been honoured by the presence of at least three Government Ministers: Francis Maude, Vince Cable and Ed Vaizey.  Look at the Digital Catapult Showcase presentation.  It gives the rationale for passive predictive monitoring for reducing the risk of hypothermia, dehydration and immobility.  And it has a ten year vision for ubiquitous networked power sockets for offices, industry and smart homes.

KemuriSense Smart Power Socket

Downturn in Telecare?

Tunstall, is possibly the largest supplier of telecare services to UK Social Services. The newsletter of “Telehealth and Telecare Aware” tells us of rising debt and “an air of turmoil and uncertainty”.  This is not good news at a time when the proportion of older people is rising.  Companies in financial stress often draw in their horns and cease to innovate.  The opportunities of the Internet of Things and predictive monitoring should not be missed.  New technology can save or destroy businesses – just look at Kodak and Nokia.

There is no reduction in demand for Telecare, we may be observing a supertanker unable to change direction quickly.

Kemuri: IoTLondon Showcase

The buzz at the IoTLondon showcase demonstrated the huge energy of entrepreneurs.  Kemuri was able to demonstrate tangible progress since the original presentation in February.  The strapline was a bit tacky, “Granny Monitor”, but all better suggestions are welcome.

People were interested in poking their fingers into the working demonstrator, thankfully it was in battery powered mode and not connected to the mains.  It contains:

• Temperature sensor – for hypothermia risk
• Power sensor – for dehydration or nutritional risk
• Motion sensor – for immobility or fall risk
• Controller board – to schedule data transmissions
• Communications board and aerial
• Power socket

All fitting into a UK standard double socket enclosure.  Mission accomplished.

We had genuine enquiries about selling to the general public.  The answer has to be “No”.  The equipment must be professionally installed and the first units will go to telecare companies or care agencies.  Furthermore, it was just a demonstrator and it has to go into a prototype, certification and pilot phase before it should be introduced at scale.

As pointed out in the Marketing Flyer, we are “seeking supporters, collaborators and funders” before taking the next steps.  Tell your friends.

Kemuri: Benefits First

Kemuri Can Save Lives.  That bold statement was not contradicted by last night’s sell out audience at the IoT Meetup in Shoreditch.  It was the first presentation open to the public. The organiser asked for a non-techie talk, and got one – apart from the fact that everybody there would know that IoT is the “Internet of Things”.

Grannies living alone were the star turn.  As they grow older, the risk of hypothermia, dehydration and immobility increases.  After a fall or a stroke, they can lie on the floor unattended for hours or days.  In the worst cases they are discovered dead.

The first putative customer gave the benefits case.  She was taken into hospital on Sunday night.  ‘If I had installed the Kemuri kit, I would have seen that her heater was broken on the Monday before, had it mended, saved enormous distress and the saved the State the high cost of an emergency’.  He drew the chart in the slide pack.  He can have the first off the production line.

All the techie stuff was missed out, leaving time for plugging Adrian McEwen’s book, simplicity, design and teamwork.

Funding a Social Enterprise

Ideas are free.  Concepts are beguiling and an excuse for inaction.  Improving the wellbeing of an ageing population seems to be a noble social enterprise.  People don’t want intrusive monitoring – but digital technology can help.  Kemuri has taken the first steps in providing a passive wellbeing monitoring service that will cost less than £1000 in the first year and less than £500 in subsequent years.  One year in a residential care home costs at least 10 times this amount, or more likely, 20 or 30 times.

The technology for Kemuri’s simple well-being monitor uses the Internet of Things.  It may be a buzz word, but when Google invests £2 billion on such products, it is not just hype.  Adrian McEwan’s book on the Designing the Internet of Things has helped to identify the action needed for a start up.  The chapter on a Business Model Canvas provides a nine point process for showing what must come next. The benefits are clear, the costs are containable, so how can funds be raised to deliver at scale by 2016, when the impact of the Care Bill becomes clear to the general public?

The proposition is that funding should be forthcoming if there are sufficient provisional orders.  Provisional orders would be financially risk-free for care commissioners.  If the products and services do not meet pre-determined conditions, then the order need not be fulfilled.  The financial risk is taken by the funders.  The big question is the size of the market at the price point selected.

In the UK, here are approximately 2.5 million people aged over 75 living alone in own homes, sheltered housing or care homes.  Any one of these is a potential beneficiary of passive wellbeing monitoring.  2,500 provisional orders would be just 0.1% of the potential market.  2,500 provisional orders represents a turnover of £2.5 million.   Is this attractive to Angel funders or Venture Capitalists?  Time will tell.

Ageing: Put the Social back into Care

At last, some recognition from people who understand the need to put the Social back into Care.  The “SmokingChimney” prototype won a £2000 prize for the Kent Connects challenge “How can we make it easier for people to help each other?”

It was not led by Technology – but a real life story from one of the attendees who joined the team.  He was so impressed that he wants the first version off the production line.  He created the strapline and enthusiastically gave the winning presentation.  It is an example of how designers should listen to people who want something very simple – the refinements can wait.

Have a look at the SmokingChimney slide pack to see the simplicity of the prototype.

Ageing: Prepare for self-funding

One of the biggest sources of health care costs is dementia, £23 billion according to Age UK.  Falls currently cost £1 billion for health and social care, rising to £2.2 billion in 2050 (AKTIVE).  Adult social care costs for the Elderly are £8.9 billion (HSCIC).  The nation cannot afford to increase funding to meet these levels of growth.

Budgets will be capped in 2016, without annual increases.  It is inevitable that more social care costs will be paid by private individuals – self-funders in the jargon.  The Dilnot Commission “Fairer Care Funding“, provides much evidence for changes in policy.

• The current system is confusing, unfair and unsustainable. People are unable to plan ahead to meet their future care needs. Assessment processes are complex and opaque. Eligibility varies depending on where you live and there is no portability if you move between local authorities. Provision of information and advice is poor, and services often fail to join up.

To protect people from extreme care costs, Dilnot recommended capping the lifetime contribution to adult social care at £35,000, increased by the Government to £72,000.  Thereafter, people should be eligible for full support from the state.   In practice, it means that self-funding will increase and that many people will not get any state contribution to care costs.  As has been observed – there is a risk of smart people ‘gaming’ the rules to obtain earlier access to state funding.

Dilnot also recommended a statutory duty placed on local authorities to provide information, advice and assistance to all people, irrespective of how their care is funded or provided.  This must include local knowledge about care homes and care services.  In addition, people should be made aware of assisted living technology that is emerging from innovations in the Internet of Things.  Older people living independently and their distant relatives can obtain better outcomes by embracing new concepts of care.

 

IoT sensor price crash

TI is producing a sensor device with six functions for $25.

• Temperature
• Humidity
• Pressure
• Accelerometer
• Gyroscope
• Magnetometer

That’s less than $5 per measurement.  Most would be useful in a home environment connecting to a smart phone or personal computer.

Such low cost equipment could be part of an infrastructure that helps families to support independent living of older and other vulnerable people.  The data from such a device could be combined with data from smart meters, and other equipment monitors, to give insight into daily behaviour patterns.

Predictive Healthcare: Innovative growth in USA

McKinsey have analysed the applications of big data technology in US healthcare and show that direct intervention and predictive power is increasing:

Big Data in Healthcare

 

“If early successes are brought to scale, we estimate that big-data applications could eventually strip more than $300 billion in costs from the nation’s health-care system and improve transparency to drive better patient outcomes. Such applications might help avoid costly readmissions, enhance the understanding of chronic diseases, and ensure that patients are treated in the care setting that best meets their needs.”

This should encourage UK and EU investment in smart software to help in diagnosis and treatment to improve health outcomes.  There’s big money for those innovators that provide scalable machine learning and prediction.  The Internet of Things is capable of generating more data than can be analysed easily by traditional techniques.  Singapore is doing it.