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Receiving personal care at home, as opposed to in a nursing facility or other institution, is not possible without two things: Somebody to provide the assistance and an appropriate place to live. A southern Virginia minister has come up with a possible solution to the second.

MEDCottage is a portable, modular self-contained 24x12 dwelling that could be attached to the home of a family member, friend, or other caregiver. The home contains a small kitchen, bathroom, and bedroom, as well as high-tech assistive devices, video monitors, and a lift. It is designed to rent for $2,000-a-month. The Washington Post ran a nice article about it yesterday, or you can check out the company's own Website here.

This seems to be an ingenious solution to a vexing problem. Some people may be able to retrofit an existing space to care for a frail or disabled relative. But that can be expensive and complicated. A solution such as a modular add-on may be less costly and, in many cases, more appropriate. This may be especially true for people who need intensive personal care for a relatively short time--perhaps because they are recovering  from a severe illness or because they are dying.

Modular living spaces such as this are no panacea. They are probably not suited for very long-term care arrangements, and family caregivers need to be well-trained in how to use all the equipment.

They also face two other issues, One is money: Will Medicaid or private long-term care insurance pay for dwellings such as this? The newly-enacted CLASS Act will since will offer a cash benefit. 

The second issue, reports The Post, is the NIMBY problem. Sadly, but not surprisingly, local Virginia officials oppose the dwellings, claiming they violate zoning laws. Here is what one Fairfax County (Va.) official had to say:  

"Is it a good idea to throw people into a storage container and put them in your back yard?" said Fairfax County Supervisor Jeff C. McKay (D-Lee). "This is the granny pod. What's next? The college dropout pod?" 

This sort of thinking is beyond depressing, but it is out there. I hope that as time goes by, technology, financing and perhaps even some good common sense will combine to create some important new alternatives for people to stay at home.     

How much can technology help the frail elderly live independently?

The promise of high-tech assistive devices and monitoring systems has attracted the attention of many long-term care families, desperate for new ways to keep an eye on mom. Not surprisingly, some big companies, including GE and Cisco, as well as smaller start-ups and university research labs, are increasingly interested as well.  

We have come a long way from that old late night TV ad: "Help, I've fallen and can't get up."

Old-style push-button pendants and bathroom pull chords are being replaced by passive wireless sensors that automatically report unusual activity to a central monitoring station. If someone falls, spends too long in the bathroom, or doesn't open the fridge at their usual time, these devices can notify a caregiver, assisted living facility staff, or even the police or 911.

Even more sophisticated devices embedded in the floor can tell when someone's gait has changed: an important warning for someone who has a history of small strokes.

Monitoring equipment is not cheap--the cost for a typical system is about $100/month. While they can be a lot less expensive than an aide, high-tech systems are not reimbursed by Medicare. Some private insurance policies may pay if they allow a flexible alternative plan of care. Medicaid often will pay.

New devices can also remotely monitor weight, blood oxygen levels, and blood pressure. The problem is: Who do they report to? The information could go to a physician's office, but nobody will pay that doctor for either the equipment she needs or the time it takes for a nurse to track this data.

While monitoring is getting increasingly sophisticated, there are some key chores technology cannot yet do. For instance, there is still no reliable way to know whether someone has taken the right pills at the right time. Lots of people are trying but, in truth, we are not doing much better than we did with those $10 plastic pill boxes.

And, in the end, the best monitoring the world won't improve someone's quality of life if there is no-one to provide hands-on help when she is in distress. That still takes aides or family. And it is the biggest reason why, for now, the most appropriate places for these devices are assisted living facilities and nursing homes, rather than people's own homes.

This equipment would not have helped many of the families I met while writing Caring for Our Parents. But one woman, Caroline Foye, might have benefited. Caroline lived a mile down the road from her son, had an aide for only part of the day, and was alone the rest of the time. I'm not sure what Caroline would have thought about having a house full of sensors following her every move, but they might have made her life a bit more secure.  

When it comes to assistive technologies and long-term care, we are making progress, but still have a long way to go.