Recycling: Two Big Ideas in the Care of Older Adults and Other People with Disabilities

November 29, 2010

By Andrew S. Dibner

What do you do when you’ve already done the best that you can? I thought that I had reached my pinnacle nearly half a century ago. I was a young psychology professor in the new field of gerontology in the 1960s. An idea came to me that seemed to have the potential to benefit thousands — as it turned out, millions — of older people who wanted to remain in their own homes, even though they might be alone and facing decline in their abilities and increase in their health problems.

Suppose that an older person living alone needed help in a hurry, but she could not reach the phone or talk. Our family had experienced such a situation. A relative of mine had lain on the floor for two days after a stroke before someone found her. She barely survived but not for long.

My solution to this problem was a device that would cause the phone to dial for help if the consumer pressed a button or did not perform normal behavior in the home. Lo, the Lifeline personal emergency system was born.

Everyone I talked to about Lifeline loved it. But how would I make it really happen? How would I make this new idea known? How would I make it acceptable to those who need it?

I realized that merely publishing an article in a psychology journal wouldn’t be enough. How many people read those articles? It had to be a company thing. It had to be nourished and promoted. It had to be pushed. And so Lifeline became my obsession.

But I knew nothing about business. My wife, a sociologist, and I had to learn. And we learned that the time and money needed to become successful entrepreneurs were enormous. Entrepreneurs must learn law, engineering, accounting, financing, management, marketing, and sales while they continue their “day jobs” and raise a family. They must call on all of their experiences and networks and dig into their own pockets to find the resources to make things happen. It is a 24/7 operation.

The Founding of Lifeline Systems

Lifeline’s birth was a typical basement or garage operation, though in our case it was the dining room. The first prototype for a signal button to push for help was made from a child’s plastic toothbrush holder in which I mounted a button and a switch. Our first prototype of the emergency calling unit was a tape recorder built into a briefcase which, to my dismay, started calling for help while I was in a busy elevator.

How does one get suggestions to answer the thousand questions that are always coming up in starting a business? At first I used the public library (remember, 30 years before Google). Luckily, there was a business library in Boston. There were books about writing a business plan (a highly structured 3- to 5-year plan covering everything — the need for the product, competition, market approach, financial needs, and sales predictions).

Luckily, I was a patient and optimistic person, obsessed with the goal of success for Lifeline. Over a period of 2 or 3 years, I approached more than 25 potential sources of financial support — individuals, venture capital firms, foundations, and municipal, state, and national government agencies. In the 1970s, the financial environment was difficult for new start-ups. Lifeline was a new idea. Although most people thought that it was needed, it was impossible to predict who would pay for it.

The hardest thing was learning that a sale or offer of support could not be counted on, despite keenly expressed interest and enthusiasm. Most would-be investors faded away because of tight funding or competing needs having little to do with our product.

Like most psychologists, I did know how to seek research grant support. After many starts, I finally found some grant assistance with the help of the Hebrew Rehabilitation Center (HRCA; now called Hebrew Senior Living) in Roslindale, MA, and the Boston University Gerontology Center. With their experience in sociomedical research, HRCA was able to obtain a substantial grant from the U.S. Department of Health and Human Services. With a 2-year study of 200 seniors living alone and a matched comparison group, we were able to demonstrate that use of Lifeline did indeed postpone or prevent nursing home care and that it also reduced hospital admissions and emergency room use. Every dollar of investment in Lifeline resulted in savings of more than seven dollars.

Having achieved some sales and launched the research project, we were finally introduced to a successful businessperson who had recently sold a company of his own and who could find other financial backers to grow our company. It was hard to give up ownership and control, but we realized that doing so was necessary to meet our goal — to help elderly people to remain in their homes.

Launching an industry at its founding in 1974, Lifeline Systems was the first personal emergency response system in the country. It affected the lives of millions of people; it saved lives, brought help, and reduced anxiety in loved ones and caregivers. In 2006, Lifeline was bought by the Philips Corporation.

Although I was the inventor and co-founder (with my wife) of Lifeline Systems, Lifeline’s success was to a major degree the result of engineering competence and excellent business management by experienced corporate leaders. Driven by a company spirit dedicated to health promotion, Lifeline Corporation was a success not only because of its leadership but also because of the pride of its employees in providing an important social benefit to the needy aged who wanted to live in their own homes.

Retirement: My Career in Art

Upon retirement from Lifeline Systems in 1990, I pursued other inventive ideas, all of which were exciting, but none inspired the degree of passion or elicited the same impact as my Lifeline experience. I started a new “career”; I happily devoted myself to creating art and supporting art education.

Creating art had been a lifelong interest for me. I took courses in visual art media wherever I lived or worked. I was constantly drawing or shaping clay, metal, or wood. As I grew older, my productions grew more and more abstract. Because I am red-green color-blind, I did little with painting.

About a decade ago, a community-sponsored course in welding provided an epiphany. I found that constructing a cube of stiff steel wire offered a stage for drawing in that space. Guided by drawings on paper and using a brazing method employed by jewelers, I cut and bent wires and connected them to each other and to the cube frame.

Layering the wires gave depth and body to the drawing and provided the added effect of different perspectives as a viewer would walk by. The work was light enough to hang on the wall with simple nails. I had never seen art like that; I felt that I had found my art. It was sculpture without a footprint. I participated in several shows, won some awards, and sold quite a few. Some viewers said that my work reminded them of Calder.

The Second Big Idea: Introduction to MedMinder.

At a community-wide art show, I exhibited some of my brazed wire sculptures. There I met a young man, Eran Shavelsky, who told me about his new idea and project. Eran was starting a company called MedMinder to produce and market a smart pill box to help people take their complex medications on time and in the right dosage. He told me about the huge problem of non-adherence to medication regimens, the resulting premature deaths, and the enormous financial costs.

The seriousness of this problem has been known for many years. Its complexity is staggering. Why don’t people take their medicine as they were instructed to do? Forgetfulness? Costs to the consumer? Side effects? Drug interactions? Lack of support systems?

Even finding out the reasons is complex. For example, the most commonly presented reason for failing to take a medicine on time (forgetfulness) may mask a conscious decision not to take the medicine because the patient doesn’t believe that it is necessary at the time. In listening to Eran, I felt that what was missing was not just a technological solution but also a better educated, more motivated, more supported patient.

With their emphases on health promotion and sharing of medical information, the recent federal reforms in health care provide new opportunities for success in medical adherence. The technology and clinical services provided by MedMinder fit perfectly with these reforms.

Many times since my retirement I had been asked for advice from entrepreneurs in gerontology, but this instance was different. Eran Shavelsky seemed like the ultimate entrepreneur: educated and experienced in corporate affairs, finance, engineering, and the health field. He asked me to join Woodie Flowers as advisors to MedMinder. (Woodie is a retired professor who had mentored Eran at MIT.)

As I talked to Eran, I could see the direction of the advice that I could give him, both as an entrepreneur with Lifeline and as a psychologist interested in the problem of non-adherence to treatment. The problem was not simply an issue of behavioral change but also of the patient’s and family’s education, motivation, and acceptance of the need for medication. The intense spirit that drove me in Lifeline took hold. I could see myself reliving the excitement of the building of a new company to help people as they aged — but with the arduous, detailed agenda of the entrepreneur assumed by a much younger, talented person.

The nature of the system.

MedMinder’s pill dispenser (named Maya) can hold pills needed for administration up to 4 times a day for 7 days. It has an embedded cellular phone that can send reminders by phone, text mail, or E-mail. It has lights that blink and sound alerts that beep. One can program it to send reminders in any or all of these formats — and not just to the patient. The reminders can also go to a trusted family member, a caring provider, or both. These alternatives are easily programmed on the company Web site. You load a week’s worth of medications, and off you go. If you forget to load the medicines, you can schedule an alert about that step.

Importantly, the performance of the patient (e.g., the times when the pill cups have been opened) is recorded for analysis by the MedMinder system for report to the patient, family, or healthcare providers. The MedMinder system provides review by its clinical nurse for continuing education of the patient and family.

Gaining confidence.

The hardest thing to do when introducing a new product or a new idea is to gain the consumer’s confidence that it works. But who is the customer? Is it the patient (the end user)? Thinking of the person using the device as the customer raises the bar to success tremendously. We learned this lesson with Lifeline, and it is also true for MedMinder. Elderly people with disabilities are often relatively unaware of the dangers of their unhealthy behaviors, relatively unwilling to try new ways, and relatively unwilling (and perhaps unable) to spend money on a new idea.

With Lifeline, we found that family members and healthcare providers are the best customers. Lifeline succeeded in distributing its products and services through hundreds of hospitals that offered the service to their patients on discharge.

MedMinder will focus its marketing on insurance providers as customers.

Organizations that assume primary responsibility for their patients’ health will save money if their patients take their medication on time and thus avoid expensive hospital time.

An example is the Metropolitan Jewish Health System in New York City, an organization that takes full responsibility for the health needs of its patients. Metropolitan Jewish Geriatric Center has been using the MedMinder pill dispenser with a small number of patients who have received kidney transplants. They must take medicine to prevent rejection of the new kidney by the body’s immune system.

The medication adherence rate for the transplant patients using MedMinder was more than 90%. They felt more confident and empowered to deal with the disease. Members of patients’ families talk about their peace of mind when they know that pills are taken and when. Nurses are pleased that they can provide better care.

This year MedMinder will be conducting a controlled clinical trial in Boston to increase medication adherence and blood pressure control in 150 elderly patients with hypertension. We hope to demonstrate reduced costs of health care as a result of increased adherence to treatment and greater family involvement in medication education.

Working After Retirement

One of the greatest things about retirement is the freedom of time that one has. Free to be as busy — or as unoccupied — as you wish. Free to schedule appointments at any available times. Free to mix pleasure time with work time.

With the many communication devices now available, location is a matter of little importance. Living all the way across the continent from MedMinder’s corporate office, I have been able to become a part-time employee and to be in touch 24-7 by conventional telephone, conference calls, FAX, and E-mail. MedMinder Systems has been able to sub-contract clinical research services to highly competent, experienced professionals at universities in different parts of the country.

Why am I spending “retirement” time in work? Because it’s not work; it’s pleasure! It satisfies my deeply held desire to help people and to do so on a grand scale. It satisfies my constant interest in inventing, creating, and problem-solving. And I think that it keeps me healthy, too.

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