Imagine a house that could be aware its resident was staying in bed too long, having trouble walking, or getting out of the house less frequently. The house could be fitted with adjustable counters whose digital surfaces gave them multipurpose uses, moveable wall components for spatial flexibility, and medical nooks for receipt and analysis of health care information. Using microchips embedded in walls, ceilings, floors, and appliances, the house could help counter isolation or save a frail resident from breaking a hip.

Such a home could have a real impact on home health care, and it is less a house of the future than one currently undergoing some fine-tuning.

“Thousands of people are being monitored on a daily basis in their homes with home medical technology,” says Schuyler Hoss, president of Northwest Health Care Management Inc, Vancouver, Wash, which consults with health care companies. For example, a user group meeting held in Georgia by a device manufacturer drew 42 health care provider organizations that all used such advanced in-home technology, Hoss says.

“The devices that ascertain the status of the patient have been on the market for several years,” he says. “But these devices are now moving to the next level, so in addition to taking the basic vital signs, they are now doing some pretty sophisticated diagnostic or laboratory analysis in the home.”

Into the Unknown
House_n, a Massachusetts Institute of Technology (MIT) project—so named by architect Kent Larson using the mathematical symbol “_n” for the unknown—is one example of that next level. The project seeks to incorporate the latest technologies to create a home that is not fully automated, but rather focuses on helping occupants do things for themselves.

House_n uses advanced materials and technologies in new ways to create an intelligent home that adds to the well-being of its occupants. “Right now when we build, we focus on amenities like Jacuzzis and high ceilings, rather than on how livable a house will be 20 years from now when the occupant is perhaps confined to a certain part of the structure,” says Stephen Intille, a research scientist with House_n. “We are looking for solutions [to enable us] to live in our homes longer, rather than being forced to move because our space is no longer accommodating. We want people to stay in an environment where they are comfortable even as the medical system changes.”

Keeping patients in the home is, of course, also in the interest of home medical equipment providers. But technology’s impact on the future of home health has been largely unreported by mainstream press.

“When people write about the home of the future, they usually focus on the fact that it will automate many things. We have a different focus,” Larson says. “We are interested in designing a home where people learn to do tasks by themselves.”

The House_n workshop prototype is approximately 18 feet by 18 feet and is being constructed inside a laboratory at MIT in Cambridge, Mass. Researchers designed the prototype to allow occupants to engage in many of the same activities they would perform in the typical home. However, unlike the typical home, House_n is able to display digital information on almost any surface and can adapt to different people’s needs. For example, a senior who relies on a wheelchair to get around may need wider doorways and lower kitchen counters than a 30 year old. House_n would make “renovating” for new purposes simple.

“This test home is being designed using a model based on the automobile, with a chassis and any number of fill-in components,” Intille says. “This makes it easier to replace elements of the home by pulling out old parts and plugging in new parts. Ideally, the homeowner could go to the Web, answer a number of questions about their situation, and learn whether their home might accommodate them down the road.”

The project’s architects are also working on computational algorithms for sensors embedded in the home and are exploring how changes in the community, such as home delivery of products and services, will impact future home design.

Next month, the House_n team plans to hold a workshop to look at how home health care will affect someone living in this type of home in the future, Intille says.

Preventative Care
The project already incorporates some health issues, such as the greater expense involved in treating people who have a gradually developing condition and do not see a doctor until they have a medical breakdown. “By the time they see a doctor, often more damage has been done than if their condition had been caught earlier,” Intille says. “If we can catch problems before the crisis point, we can have more use of medication and less hospitalization.”

Catching problems early depends as much on giving occupants an environment that takes prevention of injury and illness into account as it does on monitoring their health status once they do have problems. For example, Intille says the project is looking at whether softer floors could reduce injuries from falls and whether bigger windows that let in more light to offset depression might cause glare as vision declines. The House_n team is even considering how to program the home to pick appropriate times to remind residents to engage in healthy behavior, such as exercise.

“The sensors embedded in the environment can relay information about the resident’s everyday activity, and can include information entered into the system directly from the occupants,” Intille says. “All the data goes to a database that can predict whether the occupant is developing a certain problem, or is at a certain level of risk. It can then notify the resident or the doctor.”

But while data on blood oxygenation, temperature, and pulse certainly are useful, physicians say the most useful information is that indicating a big change in daily activities. “For instance, in cases of congestive heart failure, people often fall asleep suddenly in their chairs,” Intille says. “So we are looking at a cessation of activities, such as when patients stop brushing their teeth, phoning friends, or going outside.”

Home Care’s Role
All the elements of House_n center on giving the resident control, which Intille sees as the greatest benefit in terms of health care. “When you take control away, you are often hurting more than helping,” he says. “We really want to empower people and make them feel they are accomplishing things.”

The vision of a future that gives back control over health care issues to the patient is an extension of what the home health care provider is already doing.

“We have made significant progress in terms of returning to the home as the primary site of health care,” Hoss says. “We have new devices such as a spirometer to measure lung function on a daily basis in the home rather than the clinic setting, and a device to measure warfarin levels in patients. The latter in particular is a sophisticated, laboratory-grade device that allows for careful titration of those levels, which previously required a nurse to draw blood and take it to the lab.

“In some cases, though I haven’t seen the actual applications, I have seen prototypes for devices that would use technology to adjust low rates of drugs in infusion pumps or adjust heart rates,” he adds. “We are on the eve of doing interventions in the home, and the concept has already been discussed of having something that allows the addition of technology in pieces. This is already happening and there are HME dealers participating in that market as we speak.”

And as far as future predictions go, Hoss says he sees this type of home-based high technology as the fastest growing segment of home care.

“Today we have a couple thousand home monitoring systems in place. By 2005, I suspect there will be 500,000 of those in place. Potentially, by 2010 this could be a $10 billion industry,” he says.

In part, that is because the target market for the use of home medical technology is so large. Those who are candidates for consistent monitoring are considered medically fragile, or at risk of having health-related problem in the next 6 months. That adds up to more than 18 million people who would benefit from some form of medical technology in the home, according to Hoss.

“I wouldn’t necessarily advise my clients to invest in the idea of a fully automated home just yet, but they should certainly understand the concept, and decide how they want to participate in it,” Hoss says.

Liz Finch is a contributing writer for Dealer/ Provider.