Smart care: safety and support thanks to AAL

Average life expectancy keeps increasing, while birth rates are declining – at least when it comes to most industrial nations. The coming decades will see a decreasing number of gainfully employed people versus more and more senior citizens and people in need of care. It's a trend that already pushes healthcare to the brink. That's why we desperately need new concepts. One of them is Ambient Assisted Living.

The field of Ambient Assisted Living (AAL) utilizes different – typically technical – systems, products, and services to foster more independence in the daily lives of older adults, sick persons or people with disabilities. The key objectives are to promote self-determination and the safety of those in need of care and to reduce the overall burden on caregivers. This applies to both residential settings and facility-based care services.

AAL tends to use smart home technology. While lighting and blind solutions via tablet controls primarily enhance the comfort level of physically and mentally healthy persons, they also enable older adults to live more independently in their own homes. But AAL is so much more than that. Assistance systems range from building measures and smart devices to complex technical systems. Ideally, solutions involve a combination of multiple measures. Examples of these types of assistance systems include automatic stove shut off features, sensor-based fall detection, automatic night lights, telemonitoring or medication reminders. Some products are already available on the market, while others are still in the research and development stage.

Some of these products are presently being researched at the Ambient Assisted Living Lab at Kempten University of Applied Sciences, a residential living laboratory located in a retirement home equipped with various technology-based assistance systems. In the kitchen, residents will find mobile upper cabinets. The bathroom features a smart toilet that can track vital signs, while the bedroom has a stand assist bed. "Not all senior apartments require all of these systems. Settings depend on the disease, the specific needs and – obviously – hinge on financial facets. Technical support must be as unique as each human being," says Alexander Karl, laboratory engineer at AAL Living Lab, in an interview.

Next to supportive equipment in residential settings are wearables, which also play a major role in AAL. They remind wearers to take their medications or measure their heart rate for example. The devices are frequently equipped with GPS sensors, allowing caregivers to always know where the patient is located. The moio.care system also features this type of tracking function. "The system is comprised of a flat and flexible sensor module that people in need of care attach on their back via special patches. Thanks to its unique shape and soft material users are unable to see it and barely notice it's there. This makes our device the first wearable that is also accepted and tolerated by people with dementia as they don't even know that it's there," explains Jürgen Besser, CEO of MOIO GmbH.

Many systems use habit tracking for analysis and sound an alarm if the behavior deviates from the normal routine. Moio.care also tracks the wearer's movements during sleep to prevent bed sores (pressure ulcers). The continuous collection of data always goes along with data protection concerns. Jürgen Besser reassures skeptics and says, "the sensor manages this process and only communicates the required information – any other data is lost. Not only is this important to us for ethical reasons, but also conforms with our approach to data minimization and data protection." It also increases consumer acceptance.

Having said that, people still don't fully trust the use of new technologies in the homes of people in need of care. This is not just due to data privacy concerns, but also a result of older adults shying away from technology they are not familiar with. Though cost is perhaps the biggest hurdle in this setting. On the one hand, many innovations are not available on the market because nobody is willing to make investments. On the other hand, equipment acquisitions and conversions are associated with a high price tag that care facilities and private households are unable to afford. Most notably, there is a lack of support from the health care system. "AAL is more or less a new issue for everyone involved – policy-makers, health insurance providers and caregivers. The latter tend to be skeptical about technology-based assistance systems. Even insurance companies have not yet fully broached the subject," explains Karl. "This is where I still see a great need for improvement as health insurance companies also stand to benefit when people are able to live longer in their own homes and don’t need inpatient care settings."

Health economists and a study commissioned by the German Federal Ministry of Health also predict that technology-based assistance will delay or even prevent nursing home placement. Generally, investments in technology-based assistance systems pay off in the long run. The CIBEK Company charges 3,500 euros to convert a small apartment. That roughly equates with the average cost of a room in a nursing home for one month. Yet oftentimes AAL is destined to fail due to a lack of social acceptance when it comes to technological versus human support in daily life. Many people are worried about machines taking control of their lives.

"Many developments don't address the real need and don't solve the right problem. Or you have technical solutions to problems that have already been solved or are actually not problems at all. That's why we need a critical analysis to determine whether the developed systems truly yield an advantage in practical settings,” Besser sums up the status quo. Medical alarm systems are a great example of technology that has already proven successful in care settings. AAL can work if all parties agree that it is necessary. Hopefully, more helpful assistance systems will be developed in the near future, proceed to become a covered health care benefit and ultimately make their way into nursing homes and households. Even though AAL is unable to counteract staff shortages in healthcare, it can make aging in place much easier.