The sensors are hardly noticeable in Wilma Evans' cozy condo. Yet they are stuck on walls, under the refrigerator, around the toilet and over closets and doorways. Thin pads are hidden between sofa cushions and under the mattress in her bedroom.
The 86-year-old St. Paul woman isn't always keen on having her movements tracked. But for daughter Sally Evans, the monitoring system provides some peace of mind.
"There was a lot I was missing," Evans said of her mother, who has dementia. "Plus it was super stressful if there was a fall or something else. There's that overlay of guilt: If only I'd known, if only I'd gotten back earlier, stayed longer."
The University of Minnesota is turning to families such as the Evanses as part of a five-year, $1.25 million study to see whether remote monitoring systems might help those with Alzheimer's disease and memory loss stay in their homes longer, reduce stress on family caregivers and potentially avoid costly emergency room visits or hospitalizations by spotting problems earlier.
"When you look at the landscape of services available to people with memory loss, a lot of them are reactive — something bad happens and then you get support, such as seeking out adult day programs or other long-term care services," said Joe Gaugler, professor in the University of Minnesota's School of Nursing and leader of the study.
"What attracted me to this technology — if it works the way it says it does — is that this is an option that can actually prevent these negative things from happening and maybe serve as a proactive option for families to consider," Gaugler said.
As the nation faces the specter of a rapidly aging population, rising medical costs and a future shortage of caregivers, technology may be a vital part of the solution.
The university's study centers around a monitoring system developed by Healthsense, a Mendota Heights-based health IT company whose technology is being used by 23,000 people in 33 states.
Using sensors placed throughout the home, the wireless system tracks a person's normal daily habits — such as when they eat, how much they sleep and how active they are during the day. Alerts sent to a caregiver's phone or computer flag immediate concerns, such as a fall or the opening of the front door.
But data collected from the sensors, combined with computer analytics, can detect significant changes in routines that might be a precursor to more serious health issues. If toilets are flushing more than usual, it might be a sign of an easily treatable urinary tract infection when caught early. The system also might notify caregivers if the refrigerator hasn't been opened for long stretches, which could mean Mom has forgotten to eat.
"We're not diagnostic," said Healthsense CEO A.R. Weiler. "We're like the tap on the shoulder saying, 'Hey, something's going on here, you might want to check it out.' "
About 65 families are currently enrolled in the U's study, which launched in August 2013 and is still in its early stages. Gaugler aims to sign up 150 to 200 people with memory loss. Some families will use the technology free of charge for an 18-month period. An equal number of families will not get the system, serving as a control group to see if their outcomes are any different.
Gaugler believes the rigorous design of the study, which is funded with a grant from the federal Agency for Healthcare Research and Quality, will give researchers a less-biased window into the ways technology influences a patient's care and the stress on family caregivers.
The study includes people with memory loss who are living alone as well as those who live with spouses or other caregivers. Some participants live in houses, others in apartments; at least one is in a mobile home.
"We wanted it to be pragmatic," Gaugler said. "Does it work in the real world?"
Healthsense was founded about a decade ago, funded with a federal grant, and has grown into a $10 million company backed by venture capital, Weiler said. Recent growth has been fueled by the Affordable Care Act, which is driving a move away from the traditional fee-for-service business model, where doctors get paid by the number of treatments, to one where medical providers are rewarded for keeping people healthy and costs down.
The Healthsense monitoring system costs about $1,400 to purchase and install and another $60 a month to use. It has been used by nurses and other health care clinicians, insurance companies and in nursing homes or assisted-living communities. Minnesota insurers Medica and UCare have recently done a trial to see if they can help people with chronic diseases head off hospitalizations.
"The last thing insurers want is to have any of their members show up at the emergency room of the hospital," Weiler said. "They would love to get some early warning of that."
Weiler said health care economists have shown that the Healthsense system can reduce medical costs 7 to 10 percent.
There are some challenges, including training family members to use the technology.
Unlike remote monitoring in a more controlled environment, such as assisted living or a nursing home, the system requires more upfront customization in a home setting.
There also needs to be an intermediary — such as a nurse, social worker or technology expert — to help families identify medical problems or tweak the system to handle the individual needs of someone with dementia.
"The technology itself is great, and the idea it's based on is great," Gaugler said. "But there needs to be that human element, or it's not going to work. That's my gut feeling."
It will be at least a year before Gaugler will have preliminary results, and he will continue to recruit families for the next two to three years.
Sally Evans, 54, who took a sabbatical from her Atlanta law practice in 2011 to become a full-time caregiver, has been an eager and active participant in helping to fine-tune the Healthsense system.
The wall sensors needed lowering, for example, because her mother was becoming so stooped.
They joke that Wilma, who had 15 children, is the "stealth resident" because she can get up with her walker and move around without a sound.
The sensor pads in the chair send a signal to Sally's cell or home phone letting her know that Wilma is up and about. Sally sleeps in her own bedroom down the hall from her mother, and relies on a camera, audio monitor and phone alerts during the nighttime.
"No system prevents every incident, but I've found it to be positive," she said. The family expects to continue using the system after her time in the study is completed this summer.
"You've got one chance to do right by your parents," she said, "and I'm going to do it."