Project Description

In 2020, at the height of the COVID pandemic, Care Resources received a grant from the Michigan Endowment to explore new ways to incorporate technology into its program. At that time, Care Resources began to partner with care.coach to assist the interdisciplinary team in enhancing the lives of the participants and work on improving participant outcomes, maintaining function, and maximizing safe and independent living within the community via this technology. Care Resources started with 25 participants to receive care.coach’s remote support services in the home.

Socialization Modality

The care.coach platform offers a range of socialization modes, including video chat, audio chat, photo sharing, event/activity sharing, life stories, games, exercise, rehabilitation, music, communication facilitation, and companion conversations with the care.coach Avatar™. These socialization modes help participants feel more connected and engaged, leading to a higher quality of life.

System Embodiment

The care.coach system incorporates a fixed tablet/touch screen running a digital Avatar, with voice activated assistant technology and captioning. This system provides 24-hour service seven days a week, providing psychosocial and health care support for participants within their homes. The Avatar is designed to provide compassionate engagement throughout the day, providing companionship to mitigate the effects of depression and social isolation. Research published by Stanford University has shown the care.coach Avatar significantly reduces loneliness by three times among older adults, and the American Medical Informatics Association reported an average reduction in depression of 25%.

Business Model

As a Program of All-inclusive Care for the Elderly (PACE), Care Resources provides affordable holistic medical care and home health services to eligible older adults. Interactive telehealth and telemonitoring devices are used to complement the wraparound supportive services Care Resources provides to enable older adults in the program to stay safely in their own homes—and out of nursing homes.

Implementation Approach

Care Resources has been serving and supporting the older adult population of Kent County and surrounding zip codes since 2006. In 2020, Care Resources began partnering with care.coach to incorporate technology into their program.

Care Resources started with 25 participants to receive care.coach’s remote support services in the home. The program was initiated and overseen by the recreation therapy team, with members of the social work and home care teams as support. The rehabilitation/therapy department and the pharmacy department later added additional use cases to the program.

Initial goals of the program:

1. Utilize the ability of the care.coach Avatar to provide compassionate engagement and companionship to mitigate the effects of depression and social isolation during the pandemic.

2. Harness the trust and relationship built between PACE participants and the Avatar to support

3. Support center initiatives for care plan assessment completion and increased security through escalation of emergent needs.

Outcomes

In 2022, Care Resources began a strategic partnership with care.coach to create a technology-based service delivery model to support over 50% of the participant census. The integration of care.coach Avatar and Video Visits™ services provides support to both participant and interdisciplinary care plan initiatives to create the digital “12th member of the interdisciplinary team.”

The outcomes of the program have been positive. At the onset of the program, emphasis was placed on supporting psychosocial needs with the care.coach Avatar. The supported participants interacted on average 25 minutes per day, receiving reminders, engaging in activities, and benefiting from health coaching. Along with positive feedback from the participants, Care Resources observed improvements in compliance with medication reminders, a 40% decrease in falls from the fall prevention programming, and improved utilization of emergency services, compared to the previous year. Care Resources also saw reductions in hospitalizations, ER visits, participant anxiety, and depression. Based on the initial program results from 2020, Care Resources started to expand its technology integration.

Currently, there are 100 active devices, with four used for video visits only, five issued to Spanish speakers, and one adapted for use by a participant who is blind. Care Resources has assembled a group of Telehealth Champions, with one to two representatives from each discipline, to provide support to participants. They have also created a new position, a technology coordinator, to issue devices, monitor escalations and interactions, provide continued staff, participant, and family interaction, and facilitate conversation and awareness in interdisciplinary team meetings.

As part of its strategic relationship with care.coach, Care Resources continues exploring and expanding the ways the technology can be used for enhanced support. Its findings will help other PACE organizations across the country better utilize care.coach services to promote healthy and independent living among participants.

Challenges and Pitfalls to Avoid

Cognitive limitations, psychological issues, family in clients’ homes all can affect ability to successfully install devices. Cognitive limitations can affect the ability to follow through on cues and reminders made by devices at times, and there is a point where participants still need to be physically assisted despite reminders. Cognitive limitations can also lead to the device being unplugged, making it insufficient at times. Psychological issues or belief systems of participants can be a hurdle as well, as the participant may believe the device is watching them.

Devices in homes with multiple family members can also have this issue. We have placed a few devices in assisted living units with participants that self-isolate and are not too involved in unit programs. Getting permission from the assisted living staff is essential, as many will focus on the camera and be concerned that their care/quality of work is being monitored rather seeing the benefits to the participant. Another challenge is just getting all staff in the organization to see the benefits of the device and find ownership. We have developed a technology committee that helps with development and communications within the company to help promote the usage and follow through with each device and monitoring of the data and performance of the devices.

Lessons Learned/ Advice to Share with Others

1. Start your technology committees early to get the buy-in from staff and organization. Once a team has a vision the process goes quickly and much more smoothly.

2. Hire a person to take care of the technology full-time. Care Resources hired a full-time technology coordinator, which was helpful in relation to developing and working with the team but also the care.coach company. This position follows up on devices and holds the team accountable but also champions the project. This position is also on the interdisciplinary team (IDT).