The proportion of all Veterans 65 and older who enroll in the VA health care system is projected to increase from 31% in 2003 to 43% in 2013, indicating more Veterans will need assistance with activities of daily living (ADL) and, therefore, long term care (LTC). A defining value of LTC, and the preference of most Veterans, is to receive care in home and community-based rather than institutional settings. Remote behavioral monitoring (RBM) technology has been developed to help older adults live in their own homes by conveying information that encourages self-management and timely interventions.
The objective of this study was to better understand the role that RBM can play in supporting the independence of Veterans who need LTC and want to continue living at home. The primary aims were to assess:
(1) Veterans', informal caregivers' and Home Based Primary Care (HBPC) nurses' interest and satisfaction with RBM technology.
(2) Change in Veterans' perceived safety and well-being when using RBM.
(3) Barriers and facilitators to implementation of RBM in HBPC programs.
We conducted a one-year longitudinal pilot study in two VA HBPC programs in the Pacific Northwest. The target populations were Veterans aged 50 years and older, their informal caregivers and their HBPC nurses. Intel Labs provided and installed the RBM technology that gathered information about Veterans' ADLs in their homes. For three months, sixteen Veterans, their caregivers and their HBPC nurse were to receive summary information about specific Veteran ADLs on a display screen or via encrypted email. In-person interviews were conducted at baseline and at three months, with a brief telephone interview one-month after installation. Descriptive statistics were used for analyzing quantitative data. For qualitative data, Atlas.ti was employed for content analysis of common respondent themes.
Thirteen Veterans, seven caregivers and eight HBPC nurses completed the study. Worry about well-being and safety when alone improved among thirty percent of Veterans. Veteran satisfaction with the system was moderate with most Veterans reporting that they would use the system in the future (60%), and would recommend it to others (70%). Among informal caregivers, all found the information at least somewhat useful, over forty percent worried less during their usual activities away from the Veteran, and seventy percent would recommend it to others. Caregiver responses to the technology were most positive among those caregivers who did not live with the Veteran. Technology problems (e.g., connectivity) created barriers (e.g., lack of trust in RBM data) for all Veterans and caregivers. For HBPC nurses technical problems (e.g., unsuccessful encryption) meant that the nurses did not receive the Veteran information, hence findings for that audience are inconclusive.
RBM technology appears feasible to implement and useful for HBPC Veterans and their caregivers. It is particularly useful for informal caregivers who provide support to Veterans receiving LTC in the home, but who do not live with the Veteran or are not available on a full-time basis. Technical problems need to be corrected prior to further implementation.
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