In July 2010, N2Care, Salem, Va., unveiled the first prototype of its MedCottage, a modular medical home designed as an alternative to multi-unit care facilities. Dubbed the “granny pod,” the 300-sq-ft, three-room, specially equipped temporary shelter can be purchased or leased and placed on the property — probably the backyard — of the inhabitant’s caregiver. Already authorized for use in Virginia, it is designed to comply with local zoning ordinances throughout the nation.

The basic package for the MedCottage includes a host of smart and/or robotic devices, including a virtual companion that relays health-related messages (such as medication reminders), a video system that monitors the floor at ankle level for falls or other mishaps, and pressurized ventilation that can keep airborne pathogens in or outdoor air out. Knee-high lighting illuminates the floor to help residents avoid tripping — the most common cause of falls. A computer provides entertainment for the resident, offering a selection of music, reading material, and movies. Optional items include a lift attached to a built-in track in the ceiling to help the caregiver move the occupant from bed to bathroom. The technology is hard-wired in the unit, which connects to the single-family residence’s electrical and water supplies.

“Research demonstrates that end-of-life care is emerging as the most pertinent concern for the baby-boomer generation,” says Rev. Kenneth Dupin, the inventor of MedCottage. “Boomers have a particular fear of being isolated from family and institutionalized in the final stage of life. Consequently, there is a need in the market for an innovative alternative to care for the aging population unlike any current options for end-of-life care.”

What you already know

A 2006 report by AARP, the Washington, D.C.-based nonprofit, nonpartisan membership organization for people age 50 and over, revealed 89% of older Americans want to remain in single-family residences as they age, a trend called “aging in place.” Many of these seniors will settle in smaller, single-story abodes, while others will remain in their own homes. Many of the latter will have to renovate their houses in order to do so.

As a result, the National Association of Home Builders (NAHB), the Washington, D.C.-based trade association that helps promote the policies that make housing a national priority, is predicting aging will be the second-biggest influence on the remodeling industry in the next five years, just behind finding enough skilled labor. Research firm InMedica, Wellingborough, England, projects that the telehealth market, also sometimes referred to as “telewellness,” will grow 55% per year in the next five years. Some estimates are predicting that by the year 2020, the health-monitoring market will reach $20 billion.

Currently, many remodeling firms are already involved in aging-in-place projects. A recent survey by NAHB reveals 75% of remodelers have seen an increase in requests for this type of work, while 60% of remodelers already perform such work. Most residential electrical contracting firms already have the skill set to perform basic aging-in-place modifications. The most common include adjusting the height of home controls, such as light switches and thermostats. Firms involved in consumer electronics and integration are already able to install the life safety and alarm systems, audio, video, communications, and remote monitoring.

“We wanted to expand significantly but also to stick to the knitting,” says Thomas Ardolf, president of Cybermation, a St. Cloud, Minn.-based custom technology, entertainment, and security integration firm that recently began a venture in the telewellness market. “On a scale of 1 to 10, with 10 being the most difficult, the level of technology for us with these types of systems, compared to what we do when it comes to new construction and retrofit, rates only a 4 or 5, at most. It’s just not that tough for the technicians to learn.”

According to Ardolf, the telehealth packages are a composite of security and control systems, with a varying amount of features (Telewellness Devices for the Future). “It’s the same form of technology,” he says. “In some cases, the exact same devices.”

Many of these units use existing protocol-driven sensors, such as the Z-Wave mesh network and Bluetooth technology. In a conservative estimate, Cybermation budgets about one hour of labor for setting up a basic system, plus 45 minutes per wireless sensor.

More sophisticated than traditional personal emergency response (PER) systems, which typically use a push-button pendant and a console to call for help after an incident has occurred, these systems report data about the senior living at home to a caregiver or health care provider and sound alerts to prevent serious problems. Home monitoring systems connect monitoring devices, deploying in ASP mode with web interface including emergency response, fall detection, passive motion monitoring (for persons with dementia/wander risks), and bed monitoring (for fall risks and incontinence). Telewellness devices include blood pressure cuff, weight scale, and pulse rate monitor connected to a main platform that communicates information to the caregivers or medical centers. These can be combined with the home monitoring technologies. Coffee makers, which require a multi-step process, are a popular appliance for alerts in telehealth packages.

“As soon as you begin to plug in devices — a blood pressure cuff, a pill dispenser, motion detectors — you’re going to start to gather information and monitor the individual living at home,” says Ardolf. “So the caregiver can rest easy until something deviates beyond the settings, at which time he or she gets a call, text, or an e-mail. At other times, you can log in and see what’s going on with that person.”

The more comprehensive packages also include communications components designed to be the bridge between the resident and the caregiver and provide entertainment options for the resident. This is usually viewed by the resident on a television or touch screen, enabling the caregiver or the patient to play games on it or call up videos on demand that have been added. These systems can be easily customized. “The benefit is the social interaction, which contributes a lot to mental health,” says Ardolf.

According to the Pew Research Center’s Internet & American Life Project, larger percentages of older people are logging onto the Internet. The biggest increase in Internet use since 2005 has been in the 70- to 75 year-old age group. “You suddenly have seniors, who never knew what a digital picture, Skype, or e-mail even was, participating at a level all of us are accustomed to, even if they’ve never been accustomed to using technology,” Ardolf says. “It’s just a very simple touch screen.”

What you need to learn

Retrofitting for aging in place requires more than advanced technologies. Features such as sustainable design, future-proofing, and home integration play a vital role in meeting the needs of clients who want to remain in their homes as they age. The National Council on Aging (www.ncoa.org), the National Aging in Place Council (www.ageinplace.org), and www.ageinplace.com are just a few available resources.

Although intended for public spaces, the provisions in the Americans with Disabilities Act (ADA) offer a guideline for these type of residential retrofits for aging in place. In addition, NAHB has compiled a checklist for aging-in-place design (Aging-In-Place Design Checklist). Universal Design, the fundamentals of which include communicating effectively regardless of room or user’s sensory abilities, minimizing living hazards, and promoting low physical effort for the end-user, can also be used as an informal standard.

Furthermore, in 2002, AARP and NAHB developed a certification, Certified Aging in Place Specialist (CAPS), for firms that want to specialize in modifications for aging in place. The program teaches the essential “technical, business management, and customer service skills” needed to serve the market. The three-day program covers marketing and communication strategies for aging and accessibility, design/build solutions, and business management for remodeling work. Approximately 1,115 students have graduated from the course. AARP provides a directory of CAPS to its members.

But perhaps the most difficult part of becoming a telehealth provider is learning the industry protocol and finding customers and partners, including third-party payers. “I spent months trying to figure out how home health care agencies (HCA) work,” Ardolf says. “There’s a humongous government bureaucracy. You have to figure out who the gatekeepers are.”

Cybermation has tapped funds and grants from private and county agencies, and the company is working with a local home HCA. The firm is able to offer its system package free of charge on a trial basis to potential clients. If the client decides to keep the system, they pay only the $50/month fee for system hosting and software maintenance.

Without grants and reimbursement from HCAs, telewellness systems sell for about $3,000 for a basic system. From there, other docks and stations can be added for an additional cost, up to $5,000 or more. But when compared to the cost of assisted living, which can range between $3,000 to $8,000 a month, aging at home seems like a bargain.“But nobody likes to outlay cash,” says Ardolf.

Currently, there are approximately 44.4 million caregivers in the United States who are struggling to care for their aging loved ones because of the high costs of assisted living and full-time nursing care. Generally, the purchaser of the system is the younger relative, usually a son or daughter, of the senior. “They tend to be in the 30 to 50 crowd,” says Ardolf. “Whom you really market the product to versus who needs and uses the product are two different parties.”

Still, the transaction is rarely about finances. “If you want to consider it on a quantitative basis, the money you save is tremendous,” says Ardolf. “But it’s not the sales pitch. When people sit down and compare it quantitatively and qualitatively, qualitative trumps it.”