This story is part of Home Bound, a series that examines Americans’ fraught relationship with their homes—and the once-in-a-lifetime opportunity to hit the reset button. Read more here.
Rob Gorski’s grandmother was an independent woman. She lived alone in Youngstown, Ohio, far from the city center. When her memory started failing, he decided to move her into a nursing home near him. He says one of the main reasons was because she struggled with her medication.
“She couldn’t keep them straight. She knew what they were, but she would sometimes confuse a.m. with p.m. and think she took them when she didn’t—common things,” he says. The transition to a nursing home was difficult for her, he wrote in his blog. She didn’t know where she was or how she had gotten there. Six months after moving in, she died.
Since then, Gorski has started using a smart medication management system called Hero for himself. He takes a combination of treatments for depression, cholesterol management, and pain, as well as an assortment of vitamins. The device holds up to 10 different kinds of medication and dispenses doses on a programmed schedule. It’s connected to Wi-Fi, can send reminders to a mobile app, and can alert a family member or nurse if a person hasn’t taken their meds.
“This could have given her more time at home,” he says.
Hero is one of several technologies that promise to make growing old at home possible. Once, technologists and designers believed the future of health would be embedded into the core architectural design of the home. Instead, an array of gadgets and services has emerged, and the pandemic has accelerated their adoption. According to the National Poll on Aging conducted by AARP and the University of Michigan, only 4% of adults between the ages of 50 and 80 had tried telehealth as of May 2019. Between March and June 2020, that bounced up to 26%.
The pandemic may be waning, but the desire to stay out of long-term care facilities is still pressing. A third of all U.S. deaths from COVID-19 so far were connected to nursing homes, according to The New York Times. Are the high-tech devices on the market enough to usher in the future of care at home?
Designing for seniors
In 2015, there were 1.6 billion people over the age of 50, according to a joint report from AARP and Oxford Economics. That number is expected to double by 2050, and technology products are increasingly being created with this group in mind.
In 2018, Apple Watch debuted fall detection, which can both recognize a hard fall and alert emergency services. It has since experimented with using its device to watch for and possibly prevent stroke. A company called Vayyar also launched fall detection, using a wall-mounted device to detect movement with low-frequency radio waves. Google is working on updating its Nest Hub for seniors; among other improvements, it’s adding a shortlist of emergency contacts. The company has reportedly reached out to senior living facilities for advice on other ways it could better tailor Nest Hub Max to older Americans.
Seniors like technology as much as younger generations, reports AARP. However, they gravitate toward different kinds of devices than their younger counterparts. Less than a quarter of all Americans owned a smartwatch in 2019, according to Pew Research. Among those, only 17% were over the age of 50. By contrast, tablets sell much better with older adults. A recent study showed that elderly Americans are interested in health tracking but don’t engage with wrist wearables because the devices don’t feel designed for them. For example, in the aforementioned study, older Americans said they have a hard time seeing the tiny icons and font sizes that dominate smartwatches.
“Maybe instead of calling older adults technological Luddites, we should acknowledge that bad design is when all consumers can’t use it,” says Joseph Coughlin, director of the Massachusetts Institute of Technology AgeLab.
He says too much technology for seniors is beige and boring: “I do hope that in the so-called retirement years, there’s more to do than remind you to take your medications and your blood pressure.” Coughlin says designers and technologists should be making aging-in-place technology for more than medical purposes. It should be designed to assist the way they live. He thinks the home should have strategically placed sensors that alert service providers who can help adults keep their house stocked with essentials and their home appliances running.
“We might see UPS not just delivering stuff to your door, but bringing stuff into the house based on the smart sensors that are in your fridge, your bathroom, your living room—wherever it might be,” he says. “We want to really think that the house is a platform.” Companies are starting to embrace the idea. Walmart just announced that it’s expanding its in-home delivery service to more markets, where employees will put items away in the fridge for customers.
Taking advantage of existing tech
Until tech designed specifically for seniors improves, some people are taking advantage of existing tech and making it fit their needs. In 2017, Amazon launched its video-equipped Echo Show with a “drop in” feature that allowed friends and families to essentially activate the camera and peer into a loved one’s living room. It faced immediate criticism for being a privacy nightmare, but the elderly community saw it differently. An article published by AARP noted that if it’s used correctly, the drop-in feature could actually help with caregiving even though it wasn’t expressly designed for that. Families are looking at ways Google’s Nest Hub can be engineered to help seniors with daily tasks, such as setting up reminders or connecting to smart light bulbs that can be turned off and on with a simple tap.
Meanwhile, to manage hypertension or diabetes, doctors are recommending wearables, apps for logging meals, and the like—for instance, blood-glucose monitors and at-home blood pressure cuffs. Seniors are increasingly interested in the range of smart pillboxes available, such as Hero (with a $99 initiation fee, plus a $30-per-month subscription, it is easily the most expensive), MedMinder, Livi, and MedReady. Older Americans are more likely to suffer from multiple chronic health issues and therefore tend to be the main demographics for these kinds of technologies.
Devices such as smart thermometers, pulse oximeters, and other at-home wireless medical instruments will be increasingly important if telehealth keeps growing. During the pandemic, as doctors were overwhelmed and patients were afraid to go outside, telehealth appointments exploded. Doctor on Demand, a virtual platform for primary and urgent care, saw a 140% increase in use; bookings on MDLive jumped 300%.
But the main complaint from older adults is the limitations of an online visit. According to the National Poll on Aging, 75% of those surveyed were concerned about not receiving a physical examination. A majority also felt that the care wasn’t as good as in-person care, and a quarter was concerned about privacy. Devices that can reliably and consistently monitor one’s health might help ease some of these concerns.
“There’s a need to offer and support more home-based medical care, because of how challenging it is to go into medical settings,” says Ishani Ganguli, an assistant professor at Harvard Medical School and a researcher who looks at the future of primary care. “There’s every reason to think that we can succeed at doing it.”
Companies are also figuring out how to affordably bring healthcare services into the home. Last year, online pharmacy Ro bought a company called Workpath, a platform for scheduling at-home nursing visits or blood draws. Currently, the company is using the platform to dispense COVID-19 vaccines to homebound seniors in New York. Another company, called Ponto Care, has created transportable devices for diagnosing eye problems. The company plans to do blood draws and ultrasounds in the future. Other companies, such as DispatchHealth, Medically Home, and Contessa Health, are already bringing urgent care, emergency, and hospital services to the home. Rather than turning homes into miniature versions of a doctor’s office, there’s hope that a combination of on-demand medical services and smart home devices may provide the right environment for seniors to comfortably age at home.
Ponto Care CEO Fabio Thiers thinks medical technology will get smarter, smaller, and more mobile. Medical technicians will bring tests and diagnostics to you, and doctors will consult you via telehealth. Already, machines for taking x-rays, ultrasounds, and EKGs have been reduced to portable sizes.
“We don’t want to reinvent medicine,” says Thiers.
The future of home health
Still, Stuart Karten thinks there’s a lot of untapped potential in the home itself. For years, the founder of Karten Design has been predicting that the home—specifically the bathroom—will become an extension of the doctor’s office. He sees an opportunity to build technology directly into the bathroom tiles and mirrors with the goal of creating an environment where health information is extracted passively over time.
For many years, consumer tech companies have been tinkering with this Jetsons-like future home. In 2002, Sunbeam Products, originally known for its kitchen appliances, patented a bathroom scale that could be installed underneath floor tiles so a person wouldn’t even have to think about weighing themselves.
This invention never came to be, but the idea held strong. More than 15 years later, Google patented a “health monitoring” bathroom mirror that could track changes in skin tone to watch for dermatological issues. The patent mentioned a floor mat that could sense weight and electrical signals for capturing heart health. It also discussed technology that could follow a person’s gait as a way to catch developing spinal issues. These devices would passively track your health status—your weight, skin conditions, heartbeat, temperature, spine health—and send updates to your doctor. In 2016, the company filed an additional patent for a toilet seat that measures heart health. However promising these may be, Google has yet to turn the patents into working technology.
Other companies have developed technology that can monitor aspects of health at home. Toto created a smart toilet that could analyze urine and stools (although it’s been discontinued). Panasonic developed a similar toilet that could measure body-mass index. Meanwhile, researchers at Stanford Medicine designed a toilet that looks for signs of disease. There are smart refrigerators that can order groceries and smart attachments that can shut off a stove when a person has stepped away for too long.
But these devices are limited in their availability to consumers, and even when they’re mass-produced, they can be prohibitively expensive. Smart mirrors, which have the potential to monitor people’s health, are for now mostly novelty items that control room temperature and play music in upscale hotels. They also cost more than $5,000. The founder of Mirror, the fitness-class smart mirror, has expressed interest in getting into telemedicine, but it hasn’t done so yet.
Karten says one of the reasons this technology hasn’t caught on in a big way is because builders and designers aren’t putting the devices into homes. “We need more architects and interior designers to start the integration at earlier stages of design to see more uptake,” he says.
There are other roadblocks. Privacy is a major concern, because smart speakers, video portals, and security kits have the potential to absorb the intimate details of your day-to-day life. Worse, apps that integrate with home devices can sometimes access that information too. A recent review of Amazon Echo’s “skills” found that nearly a quarter of these apps requested sensitive user information without disclosing it.
For seniors, however, the benefits of bringing technology into the home may outweigh the costs.
“Nobody wants to leave and go to a senior citizen home or assisted living,” says Karten. “The silver tsunami is coming.”
Where the connected home falls short
While telehealth services have seen a dramatic increase, and more companies are jockeying to help seniors age in place, there are still major gaps in care that haven’t been filled. Telehealth and smart devices can help support people who are self-sufficient. But they can’t replicate the kind of oversight that a nursing facility offers.
Home healthcare can also be prohibitively expensive. The median monthly cost of a home health aid is $4,576, according to senior-care insurer Genworth. While some insurance plans cover long-term at-home care, Medicare does not.
For aging in place to truly be a viable solution in the United States, there will have to be an affordable way to receive nursing care at home. Technology may be able to help here. Japan is experimenting with using robots to assist care workers in nursing home facilities. In the meantime, interior home security cameras and sensors that can detect when something is amiss—such as a running faucet or a carbon monoxide leak—may at least help families watch over their aging loved ones.
Coughlin says he sees an opportunity for futuristic retirement homes and nursing care to be packaged together into affordable subscription packages.
“We call it home logistics or home-as-a-service,” he says. “We want you to start thinking in terms of branded experiences and services being brought into your home.” In this version of the future, people will rent an array of products and subscribe to services, all of which will be available on demand. Delivery services—whether it’s UPS or Amazon—may automatically deliver milk or paper towels based on cues from sensors placed strategically around the house. Amazon currently allows smart-fridge owners to easily reorder their most regularly used products through a feature called “your essentials” (an iteration of its now-deceased Dash button). In the future, Coughlin posits, that fridge will do the reordering itself. This wouldn’t just help seniors, either.
“What we’re headed to is not a home for aging in place,” Coughlin says. “We’re headed for an ageless home—one where all the conveniences, the design, the connectivity, the ability to provide care—they’re all wanted by every age.”
Rob Gorski sees this firsthand. He takes care of his three children, all of whom are on the autism spectrum. He says that kids with autism who transition into adulthood often need similar devices as the elderly to assist them with the little tasks of everyday life—such as remembering to take medications.
“Having something [that’s] automated can give them that little bit extra to maybe have their own apartment or [be] able to manage some things in their life on their own,” he says. “There’s just a little security in that.”