WIN-Worker Interactive Networking

USA (Massachussets)

2001

2004

The WIN aims were to determine the feasibility of implementing a technology based intervention in the workplace and to assess the effects on participants (businesses, carers, old persons).

The WIN project wanted to link working carers with their loved impaired old relatives throughout the use of a system that monitored the health and behavioural conditions of old persons at home, transmitted data to carers when they were at work and sent alarm in case of emergency situations. The decision to carry out and fund the project was driven by the progressive population ageing and by the awareness of the difficulties faced by carers in reconciling work and care tasks.

 Care Recipients
 Informal carers
 Paid assistants
 Formal carers

Not available

 Independent Living
 Information and learning for carers
 Personal Support and Social Integration for carer
 Care coordination

The project provided two kinds of services:

1) Internet based home module for monitoring at distance the old persons’ functional health patterns. Old persons’ movements and health parameters were registered and a transponder sent collected data to a computational server site via the wireless modem. Data were stored in a easy to read on-line report that carers could access from the work place via internet. If a monitored event (such as getting up in the morning) did not occur within the time parameters set by the family, an alert notice appeared in the report and the system sent an electronic alert. Carers could decide the place where installing the sensors and the time within the elderly’s movements had to be monitored.

2) On-line information, discussion and support group module for carers. It included four functions:

-posting and reading messages as part of a bulletin board discussion group where a live chat room was activated.

-sending e-mail

-linking directly to a counsellor at the Alzheimer’s Association

-linking directly to a geriatrician

The monitoring home module was installed by a nurse and the equipment included a transponder, similar to a laptop, plugged into an electric outlet, a computer interface, a transceiver plugged into an outlet approximately in the middle of the house and up to five motion event sensors (located according with recipients’ needs and preference).

The on-line group needed internet connection only.

Public only

Public service funding: Government, Regional, Local Authorities, non-profit public entities

U.S. Department of Commerce Technology Opportunity grant from the Office of telecommunication and Information Applications, National Telecommunication and Information Administration.

Other: please specify

Not applicable

Not applicable

The project was publicly funded to test the feasibility of the experimentation. Nevertheless, at the end of the experimentation users were asked to report their availability to pay the service out of pocket in order to assess the eventual sustainability of similar initiatives. The results showed that users were willing to pay $130 at month for the enhanced version of the service comprehensive of discussion group, home monitoring and a online access to a geriatric nurse to gain support and counselling as additional supplies. Results suggested a specific niche market for remote home monitoring. (Mahoney, 2008).

Today the costs would be cheaper than at time of the WIN project and thus the chance of similar initiatives to be sustained by users paying out of pocket for the service would be greater than in the past.

The technology research and development component approximated $300,000 USD

 Authorities
 Private Care Sector
 Health and Social Care Systems
 Third Sector
 Private Companies

• Massachussets General Hospital, Institute of Health professions, Boston
• Research and Training Institute of the Hebrew Rehabilitation centre of Aged.
• Citizens Bank
• Jordan’s furniture
• Eastern Bank in Massachussets
• Alzheimer Association (Massachussets chapter

Not applicable

 Informal Carers
 Health Professionals
 Social Care Professionals
 Privately-Hired Care Assistants (inc. Migrant Care Workers)
 Volunteers

A total of 27 dyads (care recipients + carers) were involved:

-27 workers with low status occupational were specifically targeted for enrollment. Working carers were middle aged (mean age 49 years), female (89%), white (93%) and were the adult child of the care recipient (78%).

-27 care recipients were on average of 78 years of age, the majority were female (63%), white (96%), widowed (59%) and their health status was rated fair to poor (70%). They had few impairment in the Activities of daily living (such as bathing and eating) and more commonly they needed help with the instrumental activities of daily living such as driving and shopping (Mahoney, 2004).

Volunteers from Alzheimer association were involved to test web and training manual pages, as they matched the characteristics of target users concerning the level of digital literacy. The test was useful for designing easy and readable material for training.

11 - 100

54 persons (27 dyads).

Not applicable

The service had a positive impact on the quality of life of:

- Informal carers, as it helped reconcile care and work and provided useful information by participating in the on-line information group.

The workers said that the project gave them peace of mind.

Usage and satisfaction with the technology: The Home Monitoring groups were very appreciated and this is clear from the number of activities (more than 2000).

The 44% of carers expressed satisfaction for the User manuals.

Almost all found simple learning how to use the system. The 85% reported that the system was very useful to help them in providing care. The 72% said that the technology was helpful in finding the balance between work and care tasks.

All carers would recommend the use of the system to other working carers.

The system increased the carers flexibility at work to manage personal and family responsibility. Carers reported that their companies showed concern for their situation by offering supports (personal assistance or resources) and often received personal support also from colleagues: being part of the study led carers to seek out support at work.

The system enhanced the communication between carers and care recipients.

The system reduced the carers stress: before the study they felt on duty 11 hours a day and after they felt 8. The WIN technology helped some working carers feel more in control of their situation, emotionally stronger and better prepaired for their responsibilities (Mahoney, 2008).

- The project had a positive effect also on elderly people, as it helped them live safely. The elders felt the system helped them continue living independently and safely and it gave them a sense of security (Mahoney, 2008).

Another benefit was the increased acceptability of the ICTs, as they convinced themselves about the usefulness of the computer and the internet: prior to the study only the 84% of the cares( 19) had a pc at home and after it the 100% had it. Prior to the study none of them had an Internet connection at home and after it they all opted to subscribe to it (Mahoney, 2004).

 

The project had a positive effect also on companies, because the workers' productivity increased. Data showed a reduction in days missed at work, a reduction of worrying about relative while at work and that carers were accomplished more at work and worked more carefully. Furthermore, there was an increase of workers’ computer skills and this played a role in increasing the Productivity (Mahoney, 2004).

The effects of the project on the NHS were not evaluated.

Strenghts

1. The nurse visit and her follow-ups were very appreciated by elderly. This was a positive aspect because it met the need of users to receive a personal visit and special attention.
2. The project was innovative, at time in which it was carried out, because it designed the partership with business to promote consideration as an employee benefit option to foster the market for home monitoring technology.
3. It was the first technology based intervention for working carers in 2004
4. The study recruitment allowed to design a map of the actual working carers since companies did not know which and how many of their employees were carers, till the study did not ask for this information.
5. The project tested the wireless technologies in the real world with real carers and old persons in need and not in laboratory.
6. The researchers were able to design and deploy a completely wireless internet based system driven by research and caring principles and not by marketing vision.
7. The technology system was designed taking into account the learning need of the end users, as they were older adults computer illiterate: friendly user manuals were delivered.
8. User manuals were carried out (Mahoney, 2004).
9. Great attention to the privacy was paid (Mahoney, 2004).

Weaknesses:

1. The employers’ lack of trust due to the concern about the internet misuse by employees and the consequent loss of productivity. This aspect led to a number of work sites participating to the project smaller than that expected.
2. At company level was difficult identify working carers meeting the selection criteria.
3. Several carers eligible to be enrolled on the study, refused to participate because of parental and family concerns about the loss of privacy of care recipients.
4. There were several technical problems due to the temporary lack of signal from the home placed sensors because of dead zones and intermittent variability with the cellular signals.
5. The small sample limited statistical power for quantitative analyses.

Threats:

1. A similar initiative may work if there is the availability and the willingness from the side of employers. Perhaps they are not so aware about the burden carried out by informal carers and even today lacks the needed culture for understanding what being a carer means. This could be an obstacle for replaying the experience.

Challenges:

1. Overcoming the met technical problems by using remote diagnostic and repair capabilities for next generation wireless Technologies (Mahoney, 2006).

The project ended in 2004 and was not repeated in the next period.

In the meantime the gerontechnologies changed and bettered a lot and today other kinds of sensors and remote control systems would be used and the scalability and transferability of this service would be easier than in the past from the technical point of view.

The greater obstacle for the project scalability and transferability may be the lack of willingness of the employers in approving and supporting the use of technologies for linking workers and their relatives at the work place. Even if the results show an increase in the productivity, perhaps not many employers would be so open mind for opening the doors to similar initiatives.

References

Mahoney D.F. and Tarlow B. (2006), Workplace response to virtual caregiver support and remote home monitoring of elders: the WIN project, Consumer centered Computer Supported Care for Healthy People H.-A. Parker et al. (Eds), IOS Press.

Mahoney D.F. (2004), Linking home care and the work place through innovative wireless technology: the Worker Interactive Networking (WIN) project, Home Health Care Management & Practice 16: 417.

Mahoney D.F., Mutschler P. H., Tarlow B. (2008), Real World Implementation Lessons and Outcomes from Worker Interactive Networking (WIN) Project, workplace based online caregiver support and remote monitoring of elders at home, Telemedicine & E-health.

Mahoney D.F. (2010) An Evidence-based Adoption of Technology Model for Remote Monitoring of Elders’ Daily Activities. Ageing International 36(1)66-81; doi:10.1007/s12126-010-9073-0

 

Mrs D.F. Mahoney

E-mail:dmahoney@mghihp.edu