Serving the home health, home care and hospice industry since 1999.

Untitled Document

Cheryl Fox follows a mantra that is on the cusp of becoming a cliché, "Lead, follow, or get out of the way." A passion to innovate for the benefit of her private duty clients guides her choices, both in hiring and in technology choices. Joe Bettencourt decided long ago when he acquired a home care franchise that he would never merely run it the way every other home care agency is run. He, too, is committed to innovation. After a thorough search, both of them gravitated toward the same patient engagement technology, but neither has been satisfied to use it the way everyone else does.

To continue providing quality care when clinicians are unwilling to see patients and patients are afraid to allow clinicians into their homes, many in-home care providers are turning to Remote Patient Monitoring technologies. Telehealth vendors are reporting a tenfold increase in sales inquiries over the last three months. A detail many newcomers to telehealth may not immediately grasp is that RPM is a big tent, with a plethora of monitoring technologies under it. Patient engagement systems can include measuring and transmitting vital signs but offer much more.

Cheryl's company is Advocacy Home Nursing in Santa Rosa, California. Joe operates the Interim franchise down highway 101 in San Francisco. We spoke with them both to learn how they were using Angela, a technology from San Diego-based Independa that had previously been thought of as a patient communication system for residential facilities such as assisted living and memory care.

Unlike traditional vital sign monitors, Angela is a patient engagement technology by Independa that works through any standard, HDMI-enabled TV. Through either an attached control box — the "Independa AnyTV Companion" — or embedded within some commercial TVs from strategic partners, Angela simplifies communications between a patient and clinicians, residential managers, or family, who use a laptop, tablet, or phone app. The patient, or any elder living alone, uses a familiar TV remote control, easily learned, and the caregivers or family work through an online interface or mobile app.

What Is Independa?

According to CEO Kian Saneii, Independa combines integration with health devices and other IoT devices to provide integrated remote care and social engagement through built-in video telehealth, voice integration (through Amazon Alexa), and a suite of services that help organizations remotely engage with their patients.

The system facilitates delivery of surveys, broadcast messages, livecasts, and informational, educational, or marketing videos. As a TV-based solution, no computers or tablets are required, adding to patient comfort and likelihood the system will be used. 

Independa has normally been used to deliver appointment and medication reminders, and facilitate secure, two-way video conversations with family members and clinicians. Some distant families may also send photos of birthday parties and Little League games to Grandma to keep her in the family loop. But even all that was not enough for Cheryl and Joe.

Both agency owners have found innovative ways to expand service offerings by leveraging the capabilities of this TV-based remote engagement and care solution. They have found that it can be deployed as a key differentiator during COVID-19, and have come to realize those emergency-level innovations can become part of the "new normal" that will follow.

Dementia, Exercise, and Music Therapy

The first objection many agency owners have to telehealth is that their nurses and aides resent being asked to act as "installers" or "technical trainers." Advocacy hired a technician on an on-call basis to take over the task of connecting the Angela control box to a new patient's TV and teaching them how to use the remote. That person is also available for telephone support as needed.

Next, Cheryl hired a dementia specialist, Laurie White, president of Dementia Care Consulting in San Francisco, to advise them on how to deal with behavioral issues in the Independa environment. As part of its Independa setup fee, Advocacy pays for an hour of Ms. White's time. "This is quite a big benefit because private homes and small residences rarely have that level of expertise available to them," she told us. "Sometimes, seeing someone's face pop up on your TV screen, even if it is your own daughter, is scary to a dementia patient. Laurie is a woman with deep experience who works both our with caregivers and patients. She can work slowly and gently with them to prepare them for Angela's functions."

She then found a group in New York City, DanceParade, a 501(c)3 organization that broadcasts live, dancing-oriented exercise programs. She arranged for their sessions to appear on Independa-powered TVs, and has found that her clients not only sit and watch but do get up and participate.

Another innovation came from a local group of volunteers who were traveling from one residential facility to another, singing, playing piano and other instruments, and engaging residents in their songs, a proven therapeutic technique. Cheryl has been speaking with them about recording their routines and broadcasting them via the Independa system to her clients who live in Residential Care Facilities for the Elderly, private homes with 6-8 beds that used to be known as "Board & Cares."

"These kinds of benefits have always been available in large facilities," she told us. "Before Independa, it was not cost-effective to share these kinds of things in smaller homes or the homes of individuals.

Taking Angela to Court

One of the most exciting innovations is using Independa in court systems. Psychologists and psychiatrists often work with frail elderly persons in the early stages of dementia who sometimes find themselves in dire straits. When court hearings are needed to determine is a person is still capable of self-management, a mental health professional is called in to make an evaluation and issue a recommendation to the court. "The problem," Cheryl explained, "is that transporting such a person to a strange environment alters the equation. They are more likely to be disoriented and score low on the evaluation."

With Independa, she has been able to convince courts to allow psychologists and psychiatrists to do remote evaluations, allowing the patient to be interviewed in their own home without the expense of the mental health professional traveling. "The psychologist or psychiatrist will train our nurse to assist with the capacity evaluation in the patient's home," she continued to explain. "A nurse will first do a routine health visit, then the evaluating professional will use a laptop or tablet we provide to call in and conduct the capacity evaluation.

About the Pandemic

In a time of virus sheltering, even doctor's office visits are happening only when no other alternatives are necessary. The physicians working with Joe Bettencourt's Interim clients and Cheryl Fox's Advocacy Home Nursing clients have taken to Independa without hesitation. They understand the reluctance on the part of older people, especially those with dementia, to leave home for any reason. They also appreciate the cost-effectiveness of seeing more patients per day by interacting with them on a laptop PC while the patient sits comfortably in front of their TV screen. Physician time is enhanced further when a home care nurse conducts the preliminary research for the doctor and hands over a package before each virtual visit. They appreciate the convenience, affordability, efficiency, and savings and gravitate toward using these agencies more often.

The next step will be to install an Independa system in the office. Prospective clients and their families will be able to "dial in" and try it out while they are in the process of deciding which agency to hire. Both Bettencourt and Fox told us that they have been able to price Angela so that most of their clients' families find it an affordable value. They foresee eventually deploying it as a standard of care.

A video describing typical uses of Independa, not including the innovations initiated by these two agency owners, is available at here. Listen to our podcast interview with Cheryl Fox here.


©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.