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Automated Activity Monitoring for Elderly Home Care


First Printing Nov 18,  1992
Last Printing Dec 28,  2011
By Glen A. Williamson
Printable Version
The manuscript for this paper was last revised as of  November 18,  1992. 

Since then there have been such tremendous changes in the attendant technologies that the whole concept must be revised/rethought.

However, this paper serves as a primer, a reminder of the basics to be considered when designing the "Perfect" system.
 

Abstract
A computer (PC) based, nonrestrictive activity monitoring and emergency detection system for the elderly or infirm is proposed.  The intent of this system is to allow a population of people, meeting certain criteria of mobility, to continue to live in their own homes beyond a time when they might move into a retirement or nursing home. The effect of such a system would be the reduction of the direct-care nursing home population, having the obvious benefits both economic and psychological.  The system is meant as an adjunct to - not a replacement of - social services such as person to person call-in programs, "Meals on Wheels," visits by social workers, care givers, etc. This paper discusses the need for research aimed at making such a system totally non-intrusive to the user, providing security and, at the same time, preserving a feeling of autonomy.  The costs of this system, when compared with a live-in companion, for example, would be significantly less.
The FreedomAlert 911 System  NEW (External link)

Elderly CALL BUTTON System

TABLE OF CONTENTS
Abstract
History and Need 
System
Things to be Monitored
Communications with Client
Scenarios
System Description
Business Implications
System Costs
Installation
Head-End 
Salient Points
Future Implementations

Appendices
  A-1 Sensors
  A-2 Sensor network
  A-3 System to head-end communications
  A-4 Voice recognition/natural digitized speech
  A-5 Head end station costs
  A-6 Anecdote, accidental fall 
  A-7 Heating air conditioning monitoring
  A-8 Burglar & Fire Alarm

Summary
Conclusions

Addendum

..

HISTORY AND NEED:
As the population in the United States, as well as the rest of the world, ages, more and more people are leaving their own homes and moving in to nursing homes, retirement homes or moving in with their children.  Often this change is premature, and done for the wrong reasons.  Sometimes it is based on unreasonable fear of living alone, sometimes it's more "convenient" for the children: "now they don't have to worry about Mother living alone." There are some retirement or nursing homes that recruit clients using fear and guilt as part of their selling strategy.  Some studies indicate that life expectancy for this population is reduced, as well as an increase in health problems.  The longer these people can remain independent in their own homes, the better off they are: they benefit and society benefits.

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SYSTEM:
1. This system will constantly monitor the activity of the person(s) living in the house or apartment.  Simple things like the use of light switches, throughout the house, with their simple switch closure, inside and outside door opening and closings, and kitchen cabinet activity are monitored.  Activities such as using appliances like the stove, the microwave range, the washer and dryer, opening the refrigerator door, watching television and using the telephone are also detected by this system.  Water usage at the kitchen sink, bathroom sink, shower, toilet, etc., would also give useful data on the client's activities.  Anything that is used in day to day activity is a candidate for this type of monitoring.

2. The sensors, used in this system, can be anything from highly reliable low technology micro switches - with their low initial cost and low maintenance; to high tech infrared motion detectors, and anything in between.  Also, smoke detectors and a burglar alarm can be incorporated into the system as well.  For those clients on a tight budget, the installation of this system can start out using the simplest and the least expensive sensors and be upgraded later by adding the more complex and expensive sensors.

3. Its key feature is the use of a form of Artificial Intelligence (AI) software that has the ability to learn habits and routines of the house's occupant(s).  It could track these routines and create a profile which would be used as a base-line to compare any recent activity.  Adjusting for daily as well as seasonal variations, some adaptive threshold would be used to determine that some situation may exist that required reporting (dial up the head-end).  Also, it would have the ability to make some logical assumptions, e.g., a bathroom stay of greater than 20 minutes - while normal at 3:00 P.M. - is too long at 3:00 A.M.: therefore possible illness.  Such decision making would, of course, be biased in favor of reporting verses not reporting.

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HUMAN FACTORS RESEARCH:
l. The hardware is, by far, the least novel feature of this system.  It is the interface to the client that will determine the usefulness or success of such a device.  The prime directive is not to interfere with the client's peace of mind under any circumstances.  Such a system can succeed only if its use is completely transparent to the user.  If the user is made to feel uncomfortable or in any way encumbered, large numbers of potential users will opt not to use the system.  The people living with this system should never feel a lack of privacy, but should feel secure.  This will require understanding of the environment in which it is to be used, the population to be served with their special needs and problems.  Before one sets out to design a system that is this psychologically complex and so fraught with the potential for mistakes, it is crucial that they have a very good understanding of the dynamics and the human factors relating to this population.

2. Most people in this population have a fear of - or just do not like - high tech equipment or devices; they would be scared to death of a keyboard or even having to key in extra numbers on the telephone.  Therefore there should be every effort made to protect the client from the "hardware" of this system.  When and if the client ever has to interface with the system, it should be done in a way that is most compatible with his/her life-style.  For example, communicating with the system can be done using the telephone which could respond using the prerecorded voice of a loved one.  One possible strategy might be to start off installing the system in steps, starting with the least invasive technology and progressively adding to the system until it is either complete or the client has "had enough." One might install an entire system initially, but activate the more complex or more invasive features progressively over time.  This would give the client a chance to better acclimate to the system.

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3. Disclosure of the full capabilities and details of the system to the elderly client might have an adverse effect on their peace of mind.  The client should be prevented, if possible, from seeing the actual installation of the system.  Further, the sensors and any related hardware should not be visible to the client after installation, it's a case of "out-of-sight out-of-mind." For example, if the client is reminded each time he/she sees the hardware, that when they open that cabinet door "somebody" knows.  The effect of this would be that soon their day to day activities would be affected by the system - this should not be allowed to happen.

4. Whenever an attendant is summoned to the client's house by the system, the attendant should not be dressed in a uniform and should seem to be making a casual visit, "Good morning, how are you feeling today ... I was in the neighborhood and thought I would stop in to see you ..." This will help in preventing the client from becoming "gun shy." i.e., they can connect certain of their actions with the official visit of a uniformed attendant, it could have a very negative effect.

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5. We cannot design a system that ignores the concerns - real or imagined - that the client may have about any aspect of this system.  If something about the system causes worry or if there is a feature that goes unused because of a fear of using it, then there is something wrong with the design.  We must design it not using the engineer's medium, but the medium of the client: people don't like to use push buttons or touch screens, they prefer to do a more natural thing like talking on the telephone. [see A-6] If for example, we might communicate with the client by using voice recognition and a digital recording of a loved one's voice.

6. They should never be made to feel that someone is monitoring them or judging them or following their every movement.  There may be some people who could be classified as having an obsessive personality, so designing, a system that will not upset these people will be a real challenge.  R may turn out that each system will have to be tailor-made for each client, the degree of complexity being adjusted to each person's tolerance.

7. As part of the ongoing research into this system, and as the system matures, some selected clients might be encouraged to view the system with a critical eye.  They would be asked to report anything that is upsetting or annoying to them, and solicit their suggestions for improvements.

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THINGS TO BE MONITORED:

l. Low cost monitoring: switch closure, lights on and off, inside and outside door opening and closings, kitchen cabinet door monitoring, garage door.  Also, the use of the appliances like the refrigerator, microwave range, washer/dryer, TV, telephone, etc., can be monitored by current sensors.

2. Water usage: bath, dishes, bathroom sink, toilet, watering lawn, etc.

3. Infrared (IR) motion detectors can be used inside each room or only in certain rooms to detect the client's activity.

4. Outside monitoring of activity is accomplished by the use of IR motion detectors such that anyone leaving by an outside door would be picked up.  If it were desirable, their movement could be tracked within their yard.  By logical deduction, the system would discriminate between the client's movements and that of a visitor (animal, burglar, etc.).

5. The household environment is a very important parameter to monitor: inside temperature, electric power, furnace operation, air conditioning (see A-7), telephone, refrigerator/freezer's operation, water in the basement, smoke detector/fire alarm, burglar alarm, etc.

6. Signals from the sensors in the bed, if processed correctly, can determine if someone is in bed or not, can sense heart rate and detect breathing and normal movement.

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COMMUNICATIONS WITH THE CLIENT:
l. Communicating with the system, by the client when necessary, would be by telephone.  The system would use the pre-recorded voice of a loved-one to make the system seem more natural and less intrusive.

2. The alarm clock could take the form of a phone call - the voice at the other end: "good morning Mom, it's time to wake up... how are you this morning?" She responds, "fine thank you" or "not so good," voice recognition might be used to pick up on the words "FINE" or "NOT."

3. The system could initiate a "check up" call in those marginal cases where there might be some doubt as to whether there is a problem or not.  In this case, a call would be made by the system directly to the client's own phone, using a loved one's voice, and ask for an 'all is well" response and maybe a prearranged number to be dialed: the client answers, "fine" or 'not very well," and pushes any button on the phone: once if he/she is fine, two times if fair, or three times if not feeling well, as per instructions given by the voice. Alternately, a voice response could be requested which would be digitized and sent, via modem, to the head-end computer where the dispatcher listens to the message and then responds appropriately.

4. If their condition is fair, this would cause the dispatcher to make a "casual" call later that day - maybe 30 minutes later - so as not to make the client reticent about reporting feelings other than "FINE."

5. To let the system know that the client is leaving the house, he/she would dial a special number which would let them communicate with their system's computer.  As before, they would converse with the system, leaving a message as to their destination and when they expect to return.  This voice message would be digitized and sent via modem to the head-end computer where a dispatcher would listen and then send back the appropriate commands to the client's system.

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6. In certain situations the system may "lose" the client or become confused as to where the client is or if they are OK.  In this case the head-end computer would be notified, but before the client is phoned, the dispatcher may elect to use an interactive look/listen feature.  He would interrogate the client's system to replay the day's activities.  If this fails to get results, he would then use the listen feature which might use microphones in certain parts of the house to listen for any activity.  If all this fails, then the dispatcher will call the client direct, however, if the phone call fails to get the client then the final feature is used, the intercom.  The intercom would only be used if the dispatcher felt it was absolutely necessary.  Failing all that, then an attendant would be dispatched.  The use of microphones or the intercom is a hazardous tactic because it may go against the prime directive, which is not to interfere with the client's peace of mind under any circumstances, therefore this is a question still to be resolved.

7. The system could call the client and remind them when it is time to take their medication.  One method might be to ring the client and tell them which medication to take and suggest that they put the phone down then and there - go take the medicine - then return to the phone and let the system know that they have taken the right pill.

8. Normally two telephone lines are required, one for the client's personal use and one dedicated to the system. However, a single telephone line can be used if the client will except the inconvenience that it causes.  Of course, there is the incentive of saving around twenty dollars a month.

One would have to have the call waiting feature installed on the single line so when the head-end computer polls the client's system, if someone were using the phone, they would relinquish the line until the polling is complete, at which time they would be notified.  In the event the client's system needed to call out, and the line was either busy or off hook, the system would disconnect all other phones and take over the line (after an audible warning) and complete its call.

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SCENARIOS:
l. It is 7:15 A.M., the alarm clock goes off - when the alarm is turned off by the client, a measure of the response time is noted by the system.  Shortly afterwards the local system causes the phone to ring - the client answers, and a familiar voice at the other end says, "good morning, how are you this morning." The client answers, "fine" or "not very well," and pushes the # button on the phone: once if he/she is fine, two times if fair, or three times if not feeling well, as per the instructions the voice gives him/her.  If the client is not well, the system will dial up the head-end computer and they will be immediately connected with a dispatcher at the other end who will find out what the problem is and take the appropriate action.  If the client's condition is fine or fair this is noted, by the system, for use during the day for monitoring purposes.  If the their condition is fair, this would cause a call to be made by the dispatcher later that day (approximately 30 minutes later, this is so as not to make the client reticent about reporting feeling other than fine).  As the client turns on the light in the bed room, gets out of bed, turns on the bathroom light, uses the toilet, washes, brushes their teeth, showers, shaves, turns off the lights, turns on the kitchen light, opens kitchen cabinet doors, opens the refrigerator, starts the microwave oven, starts the toaster, brews coffee, answers the phone, etc., or does only some or none of these things.  All of this is recorded by the system and compared with their profile of the last seven days - for a measure of normalcy.  After breakfast the client would dial a special number which would let them communicate with their system's computer to let it know that he/she is leaving the house, they would converse with the system, leaving a message as to their destination and when they expect to return.  This voice message would be digitized and sent via modem to the head-end computer where a dispatcher would listen to the message and then send back the appropriate commands to the client's system.  When the client returns he/she dials the appropriate phone number and upon hearing instructions, in a familiar voice, dials several extra numbers, telling the system that he/she has returned and that all is well.
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2. One winter's day around 10:00 AM, with the temperature at 27' F, the client goes out the back door to the garbage can, and is outside for more than 10 minutes.  The night before there had been an ice storm and the ground is covered with ice.  The fact that it is winter and the temperature is 27' F would cause the system to give the client 8 minutes outside before alerting the head-end computer.

However, since the client's system, as well as all other systems on this network, were alerted of the previous night's ice storm: an alert is sent to the head-end computer as soon as the client goes out the door.  At this time an attendant is dispatched to the client's home and at the same time - and until the attendant arrives - the dispatcher continually tries to contact the client by phone.

3. The client is in their bed at 3:00 in the afternoon, the sensors in the bed indicate heart rate, breathing rate and normal movement.  The system checks the profile for a similar afternoon nap history - if one is found and is consistent over the seven day profile the system decides every thing is OK, and will expect the client to end their nap at about the same time as the profile.  However, if the client has no history of napping in the afternoon the system will/may phone the client to check on him/her.

4. At 1:00 AM in the morning the system senses the client in their bed,. heart rate and breathing and movement seem all right, but the bedroom light is still on - the system may see this as unusual and will/may take action.

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SYSTEM DESCRIPTION:
l. The system consist of an IBM compatible CMOS PC computer with one floppy drive, a Hayes compatible 2400 baud modem, a stand-alone fail-safe auto dialer alarm (with its own power and battery backup), an un interruptible power supply (UPS), an external hardware watchdog timer, internal multiplexor boards (for interface to the system sensors).  This system monitors various sensors like: microswitches (for monitoring things like kitchen cabinet doors and drawers), power-use sensors (for monitoring appliance use), infrared motion detectors, temperature sensors, water-use sensors, power on/off sensors (for monitoring light switch position), etc.

2. The hardware and software will be very reliable: The IBM compatible PC, modem and other hardware all use low power CMOS technology.  Also, everything has battery back-up, auto-boot after failure and diagnostic software running in the background.  The head-end periodically polls each client's system for its status and the results of self-tests run by that monitoring system.  When a failure occurs that could not be recovered from, after a given period-of-time there would be a stand-alone hardwired auto-dial alarm that would alert the head-end to the problem.  Failures are detected by the external watchdog timer hardware module, the diagnostic software running in the background pokes the watchdog timer via a serial port periodically, if this should fail to happen the stand-alone auto dialer dials the head-end and delivers the appropriate message.  If this fails because of telephone line outage, then the scheduled polling by the head-end would ultimately pick up the failure.

3. Interconnection of the sensors with the PC's multiplexor board can be done several ways.  The most reliable and most labor intensive is to hardwire the sensors directly to the multiplexor board.  The more costly and somewhat less reliable method is to use either IR, RF or carrier current communication links.

The main advantage of the latter methods is ease and speed of installation.  In the average installation a mix of all of these techniques will probably be useful.

4. Instead of using the telephone line to communicate with the head-end station, a cellular telephone could be used.  The main advantage of the cellular telephone is that the down time for cellular is normally less than for telephone lines.  Because cellular telephones are two-way radios, storms, ice storms, natural disasters and the dreaded back-hoe, normally don't effect them as much.  Some of the new cellular systems also allow data to be sent, eliminating the need for a modem.

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BUSINESS IMPLICATIONS:
l. As the population in the United States ages, larger numbers of the elderly are selling their homes and opting to live in retirement homes, nursing homes or moving in with their children.  Frequently this change is premature and irrevocable.  In many cases this move could be forestalled or prevented altogether, by some form of home care.  There are studies that indicate the life expectancy for this population is reduced as well as an increase in health problems with their corresponding costs.  The cost of such retirement homes are often beyond the means of the elderly or their families, and often they end up settling for a reduced quality of life.  Often when a person makes the decision to go into a retirement home they sell their house along with all their assets which goes toward their obligation to the retirement home, thus setting up a situation from which there is no return.  Sometimes these people out live their ability to pay, which ultimately puts a burden on their children - or tragically - they might have to move into a state institution.  The longer a person can stay in their own home before having to go in to a retirement or nursing home the more likely it is that they won't run out of money.

2. Home care, that is, receiving appropriate health and human services while living at home, is becoming a more popular alternative.  These services take many forms: a live-in companion, a day nurse, regular visits by a health care professional or some combination.  The addition of the system proposed here, could help to reduce the need for this labor intensive arrangement or, at the very least, be a supplement to it.  It might, in some cases, reduce the intensity of scrutiny, thus having the benefit of giving back some of the feelings of privacy and autonomy which resident care givers -  by their very nature - tend to diminish.

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3. The costs of this system when compared to, a live in companion - for example would have about a ten to one savings advantage or better.

4. This is, and will continue to be, a growth industry.  Health care costs are outstripping the CPI at an alarming rate.  Any system will be in demand, that can delay one's entry into the health care system, with its attendant drain on the economy.

5. Clients should purchase this service before they need it: in order to become accustom to having it around.  As some people get older and become more dependent on others, they might feel more vulnerable or fearful of this kind of system.

6. We are dealing with a population who is frail and prone to health problems as well as injury, thus liability for the system's possible failures will be borne by the company.  Some sort of indemnity will be required to protect both the company's assets and its employees.

7. A system such as the one being described in this paper might be developed in an environment of governmental altruism and be seen as a not-for-profit health care utility.  In this kind of environment it would be a top-down managed operation, isolated from market forces and the end-users' real needs.  The advantage of free market consumer directed environment is the system would ultimately be affordable by more people, the system's architecture would more closely reflect the consumer's needs and the ultimate test - whether the consumer really wants or needs such a system.  However, with the free-market comes the potential for sleaziness, if the people marketing this system see the bottom-line as the first order of importance, then the consumer is the big loser.  There should be a balance of profit motive and altruism resulting in the consumer - our parents and one day us - being benefited.

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SYSTEM COSTS:
l. System costs can take three forms: leasing, lease to buy and purchase. The advantage of leasing to the client is if they only want to use the system for a relatively short time or in the event they decide that this system is not what they want.  Rent to buy might allow them to try it out and if they like it then some of the leasing fees go toward the purchase price.  The purchase plan would prove the cheapest in the long run, because all of their money would go to the purchase of the system.  However, from the company's point of view, leasing could prove the most lucrative.

2. The costs fall into two categories: one-time nonrecurring costs like system hardware, system installation; and the ongoing periodic expenses such as home care services, system maintenance, monthly charges for an extra telephone line, etc.
 

System hardware:
Personal computer 
Modem 
Watch dog Timer
Auto-dialer
Sensors 
UPS 
Hardware installation
  --------------
Total price

$  650.00
$    90.00
$    40.00
$    65.00
$  150.00
$  325.00
$  350.00
--------------
$1,670.00
Monthly costs:
System maintenance 
Home care services 
Extra telephone line
  --------------
Total yearly cost 

$    12.00
$   100.00
$     20.00
--------------
$1,584.00

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INSTALLATION:
l. The client should not be allowed to see the actual installation.  Further, the sensors and any related hardware should not be visible to the client after installation.  This is in keeping with the idea of not burdening the client with the details of the system.  For example, if the client is reminded each time he/she sees the hardware, that when they open that cabinet door "somebody knows." The effect of this will be that soon their day to day activities will be affected by the system, not the other way around this cannot be allowed to happen.  For those clients on a tight budget, the installation of this system can start out using the simplest and least expensive sensors and be upgraded later by adding the more complex and more expensive sensors as time goes by.
HEAD END STATION:
l. The head-end is the part of the system where the dispatcher lives.  This system can take the form of a single user or a multi-user system. ft can be dispatched by the family, in the single user set up, or In some instances it might be staffed by trained volunteers.  In some communities it might be connected with the local police emergency department.  Ideally it could be dispatched by a commercial company staffed by trained and qualified professionals.

2. It could be a system where all of the equipment is in the client's home, and it would initiate a call to family or friends or, in certain circumstances, to the local emergency number.  It would have a list of numbers it would dial until it got results.

3. A set up for single client situations could allow the family of the client to have a PC computer running the appropriate software and connected to a second private telephone line.  This set up could have a call forwarding feature such that the family members would not be house bound.

4. The ideal system configuration would be where trained dispatchers would man a head-end computer twenty4our hours a day, and be able to respond to emergencies with qualified attendants or EMT personnel at a moment's notice.

5. Head-end hardware should be thought of in terms of single units or workstations.  A workstation would handle n clients, requiring m telephone lines and be run by one dispatcher.  Further, there would be one EMT type attendant for every x clients.  Because of our modern telephone network in this country, it is possible to operate out of the local area, while dispatching local attendants.

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SALIENT POINTS:

 l. The population in the United States is aging, and more and more elderly people are giving up their own homes and moving in with their children, or into a retirement home, or as is often the case - a nursing home.  This is a situation from which it is difficult to return.

 2. There are studies to indicate that life expectancy is reduced for this population, as well as an increase in health problems.

 3. The effect of such a system is the reduction of the direct care nursing home population, having the obvious benefits both economic and psychological.

 4. This system is meant as an adjunct to social services such as telephone contact programs, meals on wheels, visits by home care specialist, etc.

 5. The prime directive is to not interfere with the client's peace of mind - under any circumstances.

 6. Before one sets out to design a system that is this psychologically complex, it is crucial that they have a very good understanding of the dynamics and the human factors relating to this population.

 7. No system design should ignore the concerns, real or imagined, that the client has about any aspect of this system.

 8. Aftendants summoned to the client's house by the system should not be dressed in a uniform and should seem to be making a casual visit.

 9.  Such a system can succeed only if its use is completely transparent to the user. 

10.  Most people in this population have a fear of high tech equipment or devices.

11. Disclosure of the full capabilities and details of the system, to the elderly client, may have adverse effects on their peace of mind.

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12. The sensors and any related hardware should not be visible to the client after installation, it's a case of "out of sight out of mind."

13. One might install an entire system initially, but activate the system in steps starting with the least invasive features and progressing to the more invasive ones.  This would give the client a chance to better acclimate to the system.

14. Each system may have to be tailor-made for each client, the degree of complexity being adjusted to each.

15. If and when the client needs to communicate with the system, to make it seem more natural and less intrusive, it would be via the telephone and would use the prerecorded voice of a loved-one.

16. The system could call the client and remind them when it is time to take their medication, helping to prevent overdose or under-dose.

17. There are various levels of client sophistication: the most sophisticated - the researcher user - one who understands the system and will forgive its deficits and will furnish feedback to the researcher; to the least sophisticated: the frail and somewhat phobic elderly person living alone.

18. Low cost monitoring consists of sensing: lights on and off, door opening and closings, kitchen cabinet doors, garage door; use of appliances, TV, telephone, etc.

19. The household environment is also monitored: smoke detectors, burglar alarm, inside temperature, electric power, furnace, telephone, refrigerator/freezer operation, water in the basement, etc.

20. If an elderly or infirm person is subjected to extremes in temperature for even moderate periods of time, it can imperil their health.  A method of monitoring the Heating and air conditioning system in the client's home is of great importance.

21. The ideal system configuration uses trained dispatchers manning the head-end station computer twenty-four hours a day, and able to respond to emergencies at a moment's notice with trained attendants.

22. The head-end station polls each client's system for status of the home and results of self-tests run on the system.

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23. Normally two telephone lines are required, one for the client's personal use and one dedicated to the system.  However, a single telephone line can be used if the client will except the inconvenience that it causes.

24. Instead of using dial-up telephone lines to -communicate with the head-end station, a cellular telephone could be used, which has the advantage of less downtime than telephone lines.

25. Because of this country's modern telephone network, it is possible to operate the head-end station from outside of the local area (1-800-xxx-xxxx), while dispatching local attendants.  This might be a cost-effective approach in the case of small towns or rural settings.

26. A built in fail-safe mechanism uses a watchdog timer and a hardwired auto-dialer that alerts the head-end station when there is a client system failure.

27. The client's system uses an Un interruptible Power Supply (UPS), and the fail-safe circuitry also has battery backup.

28. The costs of this system, when compared to a live-in companion, would have about a ten to one -saving's advantage or greater.

29. We are dealing with a population who is frail and prone to health problems and injury, thus liability for the system's possible failures will be borne by the company, and some sort of indemnity will be required to protect both the assets of the company and its employees.

30. Rental, rent to own or outright purchase of the system, are options the consumer has.

31. The costs fall into two categories: onetime non-recurring costs like system hardware, hardware, system installation; and the ongoing periodic expenses such as home care services, system maintenance, monthly charges for an extra telephone line, etc.

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FUTURE IMPLEMENTATIONS:
l. In later systems, very high technology devices can be employed to improve system performance.  This could take the form of two way video phones, the greater use of voice recognition, more flexible and reliable artificial intelligence (Al) software, etc.  Also, a body sensor could be worn by some clients, this might report condition of the wearer: standing, sitting, lying down, heart rate, body temperature, breathing, if sensor is being worn, etc.


 

APPENDICES

A-1

 SENSORS:
l. The simplest sensor is a reed switch and magnet.  This would be used in kitchen cabinets, drawers, doors (doors that are normally opened and closed on a regular basis), it might even be used on the refrigerator door.  These are very reliable and are more easily concealed than other types of switches.

2. Water usage is measured by a contact microphone attached to the faucet or pipe of interest (if attached to the faucet it will detect both hot and cold water usage).

3. lnfrared (IR) motion detectors can be placed at strategic locations, such as
stairways, halls, outside of doorways, yard, etc. These IR motion detectors are the
consumer versions used for outside light activation and are available at a reasonable
price ($25 - $35).

4. Outside monitoring of activity is accomplished by the use of IR motion detectors such that anyone leaving by an outside door would be picked up.  If it were desirable, their movement could be tracked within their yard.  By logical deduction, the system would discriminate between the client's movements and that of a visitor (animal, burglar, etc.).

5. Bed activity measurement is accomplished using simple Inexpensive piezo-electric transducers in three axes, with proper signal processing (DSP) of these signals one can measure bed use (pressure and movement), breathing and heart rate.

6. An ideal device would be a very small body sensor worn by the client: one reporting their immediate vital signs - heart rate, blood pressure, temperature, breathing, etc.  Making a highly reliable, small and un encumbering body sensor is a project all in itself, and would prove very difficult.  Designing it so it will not encumber the wearer and give reliable readings is the hard part - not the technology per se.  In the near future, with the careful and innovative application of technology, it may be possible to make a body sensor that is both affordable and reliable.

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SENSOR NETWORK:
 
 

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SYSTEM TO HEAD-END COMMUNICATIONS
 
 

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VOICE RECOGNITION and NATURAL DIGITIZED SPEECH
l. To make communications between the client and the system more natural, the prerecorded digitized voice of a loved-one would be used by the system computer.

2.ln the other direction, voice recognition - if reliable - could reduce or eliminate any need for "button pushing" by the client.

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HEAD END SYSTEM COSTS
 
 

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ANECDOTE: ACCIDENTAL FALL
Several years ago my 85 year old mother fell in her bedroom injuring her sternum.  The pain was so intense she could not get up from the floor.  Some years before, in anticipation of just such and event, I had installed emergency alarm toggle switches along the baseboard several inches from the floor, in every room.  My mother in pain -needing and wanting help did not use the emergency alarm switches.  Instead she crawled on the floor the length of her ranch-styled house - for more than two hours - to reach the only telephone that was close enough to the floor for her to reach.

This woman is a sharp, vibrant, alert and intelligent person: as she was crawling to the telephone she was working out in her mind a strategy for getting the house key to the emergency squad personnel so they would not have to break in to her house - then why did she not use the alarm?  At first it is difficult to understand, considering the pain she was in and the panic she must have felt, why she didn't use the emergency alarm switch that was so accessible to her.  One might speculate that flipping that switch would seem too drastic a step: thinking, "I don't want to cause a situation over which I have no control, one that would place me at the center of attention of a group of strangers." 

Whatever the reason, suffice it to say: she chose her medium of communication - not someone else's.

There is a very powerful lesson here: before one sets out to design a system that is this psychologically complex and so fraught with the potential for mistakes, it is crucial that they have a very good understanding of the dynamics at play and the human factors relating to this population.

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HEATING AND AIR-CONDITIONING MONITOR
l. If an elderly or infirm person is subjected to extremes in temperature for even moderate periods of time, it can imperil their health.  A method of monitoring the Heating and Air Conditioning system (HVAC) in the client's home is of great importance.

2.. The failure mechanisms of these systems is either mechanical breakdown or power outage (in the case of electricity and fuel interruption in the case of gas - which happens much less often than electricity).  The Mechanical breakdown in air conditioners also fall into two categories: first is a sudden catastrophic failure like the compressor sizing up, or the fan motor burning out, or the power relay failing; the second being progressive failures like leaking or low refrigerant (Freon), or a fan motor slowly "burning out." The catastrophic failures, usually, are not predictable, the best we can do is to detect that type of failure as soon as it occurs.  The progressive failures are possible to detect and predict, allowing time to make repairs before total loss.

3. One simple technique to measure the "health" of a cooling system is by monitoring the inlet (warm air return) temperature and the outlet (cold air) temperature: by calculating the differential of the two temperatures one can directly measure the efficiency of any given system.  Therefore, detecting changes in this efficiency can predict an impending failure.  A similar method could also be used with heating systems, with differing results depending on the type of system, with heat pumps yielding the best results.

4. Where feasible, it is prudent to have a backup system, e.g., a window unit, etc.

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BURGLAR & FIRE ALARM
 
 
 
 

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SUMMARY:
 
 
 
 

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CONCLUSIONS:

 

ADDENDUM:

New Technologies useful toward improved Activity Monitoring.
1) Communications
    The Internet
                Dialup
                Cellphone
                Wireless
                xDSL
                Cable Mode

2) WebCam
    The Internet
 

3) Speech Recognition
    System Interactive Interface,
    Intercom, 
    Telephone, etc.
 

4) Remote Vitals Monitoring
        Microwave Interferometry

5) Client Tracking
        Motion Detection Far IR
        RFID (TIRIS)

6) SENSORS
 
 

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  --Elderly CALL BUTTON System
Links:

http://X10.com/   Alarm Systems, TV cameras

 




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