News| Volume 20, ISSUE 3, P16-17, April 2019

Personalized Interactive Technology for Residents Connects Generations

      Several years after securing grant money to install the It’s Never 2 Late (iN2L) computer system in 24 of Signature HealthCARE’s skilled nursing facilities in Tennessee, Angie McAllister says she was spot on. She and her colleagues wanted an engagement technology that was “dignified,” met their person-centered care values, and “could really promote relationships and create a sense of community.”
      Today, Ms. McAllister, the director of quality of life and culture change at Signature, sees long-term residents who were previously not very vocal or engaged enjoying interactive games, puzzles, music, trivia, karaoke, travel videos, and a host of other applications and content items on the iN2L system, which integrates hardware, software, and media — and which features a picture-based, touchscreen interface.
      The iN2L technology sits amid a growing array of innovations and technologies that are designed to socially engage and cognitively stimulate elders in long-term care and other settings. “Overall, we think of older adults not adapting to technology, and we need to dispel that myth,” said Sheri Rose, cofounder, CEO, and executive director of the Thrive Center, a Louisville, KY–based not-for-profit experiential center that showcases products and technologies for the elderly, particularly those with dementia (
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      The iN2L technology sits amid a growing array of innovations and technologies that are designed to socially engage and cognitively stimulate elders in long-term care and other settings.
      Photo courtesy of It’s Never 2 Late
      “We need to make technology simple for them — there has to be a simple interface,” Ms. Rose said. When there is, many elders embrace it. “We’ve seen 92-year-olds using a Breezie tablet telling [executives] exactly how they use that tablet.”
      Ms. McAllister, who started her career as a certified nursing assistant in 1995, said she’s been struck by the intergenerational nature of the iN2L technology. “It’s really awesome when a grandchild can come in and spend an afternoon with her grandmother and they can really engage in something that speaks to both of them,” she said. Similarly, she said, staff have told her they’ve used the technology to forge better relationships with the residents. And the residents’ well-being has improved as well — scores on the Eden Alternative Well-Being Assessment increased 6% over the first 12 months of the computer system’s implementation.
      The grant that funded the iN2L system (a civil monetary penalty grant from the Centers for Medicare & Medicaid Services) has been appreciated by all. At the Signature HealthCARE building in the small town of Erin, TN, the staff connect the mobile iN2L unit to the dining room’s big-screen television for music during meals, and they move it around as needed for blackjack or solitaire games, karaoke, and movement and exercise sessions. “If someone’s having a bad day, we might find broadcasts of old radio stations they used to listen to or an old TV show they used to watch, or we might visit the aquarium or listen to therapeutic music,” said Lisa Moore, the quality of life director at the Erin community.
      “When one of our veterans was having a bad day, he [used the system’s flight simulator] to fly an airplane — something he used to do,” said Ms. Moore. “When you know your elder, you know what’s going to bring back good memories.” She recalled another resident with dementia who worried constantly that her home had been destroyed. “We Google-mapped it on the [iN2L] system and were able to say, ‘your home is still there,’” she said. “Many residents miss their homes, so we’ve done this with others as well.”
      About 70% of the system’s content is group-oriented, and 30% is geared for individual use. Jack York, the founder and president of It’s Never 2 Late (, said the company tracks what’s being used across the 2,700-plus subscribing SNFs, assisted living communities, and memory care units, and it updates the content every other month. In addition to music, trivia, and games, he said, experiential programs for individuals with dementia and therapeutic activities for speech and occupational therapy are popular.
      At any one time, 60% to 70% of the 3,000-plus applications and content items run offline, Mr. York said. The system can also be customized so that individuals or their families can maintain personal collections of favorite iN2L content as well as links to photos, voice recordings, or videos of grandchildren or other loved ones. Recently, the company released its own tablet to sync with the system, and Mr. York said they’re following advances in voice technology and virtual reality, always looking for system enhancements.
      Signature, in the meantime, has been pilot-testing Amazon’s voice-activated Alexa with nine long-term residents and nine short-term residents of Jefferson Place, its skilled nursing community in Louisville. Each resident received an Echo Dot or a TV Fire Cube with training on how to use simple terms and specific word orders to talk to Alexa and access Memory Lane, Vintage Radio, Bingo, and other skill sets. “We saw smiles on the face, and tears in the eyes, because it was that easy,” said Christopher Houser, chief information officer of Signature HealthCARE Services and the leader of the Alexa pilot program.
      In addition to cognitive engagement and empowerment for the residents, Mr. Houser sees potential with smart speaker technology to facilitate more efficiency and job satisfaction for the staff. By building community information into the system, a resident could say, “Alexa, ask Signature, tell me the activities — are we having a bingo night?” or “Alexa, ask Signature to bring me a glass of water.” Some questions will be answered by Alexa (with answers shown on the TV Fire Cube when it’s there); others will be answered by the nurse or another staff member on the other end.
      Alexa has also been tested in retirement communities by the Front Porch Center for Innovation and Wellbeing, which is part of the Southern California provider Front Porch. And an Alexa-powered platform called Aiva is being piloted in Cedars-Sinai hospital in Los Angeles. Ms. Rose of the Thrive Center said she’s following Aiva with interest because it appears to be compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPPA).
      Sunrise Senior Living’s December 2018 announcement of a nationwide rollout for SingFit, its digital therapeutic music program, is another sign that communities and their future residents and families are increasingly looking for engagement technologies, Ms. Rose said. She is planning to bring to the Thrive Center a proactive social robot called ElliQ (Intuition Robotics, Israel), which uses artificial intelligence to offer personalized, cognitively stimulating activities and games and daily routine reminders. She also is looking into new virtual reality products for individuals with dementia and Alzheimer’s disease. Such products will sit alongside iN2L, various types of companion pets, the SingFit program, and other technologies.
      Although there’s still a need for more products and programs for people with Alzheimer’s and more advanced dementia, “we’re really getting creative overall on products and solutions that can engage and stimulate the mind,” Ms. Rose said. While some products are costly, not all innovations are necessarily high tech or high cost, she noted. This August, her center will be hosting sessions for members of the Pioneer Network when they gather for their annual meeting.
      For skilled nursing and other settings, Mr. Houser of Signature envisions viable economic models for integrating engagement technology. For instance, facilities that have a high-speed internet connection could replace cable and satellite TV with live-streaming TV and various voice-activated skills and services that are useful for that community, he said.
      Christine Kilgore is a freelance writer in Falls Church, VA.