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Perspectives on personal care monitoring and smart surveillance

There are times when something happens to a loved one or somebody we care about, which profoundly influences how we feel and our state of mind. Issues with elderly parents, family members travelling, whereabouts of children, those close to us who have health conditions such as Alzheimer’s or Dementia, those with psychiatric conditions, and those with special needs of various kinds can be temporary or an ever-present concern.

When an event happens where we do not know where they are; they are in crisis, but we only find out later; or we cannot contact them for some reason, and we think something is wrong, we can endure panic and gut-wrenching feelings about what is happening. I will always remember the reactions of my parents when getting a phone call at 2:00 am in the morning from the hospital when my sister had a car crash, and it was before cell phones were available.

Subsequently, any phone call late at night used to create an electric response, probably reflecting post-traumatic stress, something they experienced again when I was involved in an accident in the early hours. We cannot always be with people close to us the whole time, but modern technology and smart surveillance have made this area of monitoring loved ones and those we care about a potentially ever-present and informative solution.

Smart surveillance can vary from everyday issues, such as using our cell phones to make a call or apps to manage contacts, to highly sophisticated technology and analytics. However, all of this is being applied to people. Institutions, including those providing care, may have a particular perspective in applying the technology, including a strong business interest, but for those of us who want to provide a solution to family members or others we care deeply about, we have a more personalised interest. This goes beyond what is in their ‘best interest’, to their emotions and experiences about the surveillance actions and methods. Monitoring is a personal experience, and we need to ensure that those involved are comfortable with the process. There is generally common agreement that getting informed consent is an important part of using smart surveillance devices, but particularly when it is someone close to you.

Smart surveillance ethics

Emphasising the importance of respect and emotional support in our personal relationships with those whom we are asking to be monitored is an essential starting point. This is especially important given that people subject to monitoring are often vulnerable and feel a loss of control in their lives. No matter how good our intentions are, people may also have reasons they do not want to be monitored. These may differ from a teenager who wants the freedom of not having his phone potentially tracked, to elderly people who see devices they have to carry as an imposition and a potential stigma. Others may simply not like having a device attached to them, while privacy may be seen as more important by someone than their family knowing if they were sick in bed.

Afflictions such as dementia may complicate matters where some symptoms include being confused, suspicious, or fearful. For anybody being monitored, trust in who may be looking at them or the information from monitoring devices, how information may be used, and what it means for them, can also play a part, along with a sense of losing control over their own lives. These are questions that anybody wanting to subject somebody to smart surveillance should be asking – what kind of data will be collected, where will it be stored, who will have access to it, how well is it protected, and what information may be used for.

Many methods and technologies can be used as part of a smart surveillance solution, with a combination of these probably working up to a more ideal solution. Ideally, they should be able to highlight potential risks, provide timely alerts, provide the basis for a quick response, and information on the issues and location of the person. One of the main differences between the smart surveillance options is whether they are passive or active detection approaches.

Ideally, at least some of the monitoring devices should provide an automatic alert that something is wrong. This can be through monitoring of health status like breathing, sleep patterns, vital signs (including heart rate, blood pressure or even oxygen saturation), movement (or non-movement) detection, which could include fall detection, and movement into zones defined by geofencing (whether a vehicle or your child is in a high-risk area, or a person with Alzheimer’s has exited the front door).

Things like smoke detectors or audio detection of events such as breaking glass to ensure safety are also passive technologies which are important for protection. Active detection is initiated by the person being monitored and could include using cell apps, intercom buttons, buttons on panic or medical devices, or wearable alarms. A key factor in active detection is how easy the alert device is to access and trigger, especially if a person has experienced a problem event where they may be incapacitated in some way.

The importance of cell phones

One of the key elements in many surveillance technologies in care monitoring is the use of cell phones. Whether a personal call, apps providing automatic two-way speaker calling, a receiver for transmitted information from cameras, GPS, or tracking, exception reporting on location and behaviour, and allowing details of vital signs. Using current techniques like ‘track my phone’, or similar features from phone suppliers, gives a GPS tracking option where people under care have a phone. Similarly, a number of apps have a ‘share my location’ that can be used across different ages, from small kids to the elderly, although they can also cause pushback from teenagers and others who do not want their ‘freedom’ compromised.

Cell phone monitoring and communication options are the easiest and probably the most affordable, but do not address a key factor, especially for those under care who have dementia, Alzheimer’s, or general memory loss, and may not take their phone with them if they do leave premises. In an increasing world of IoT, cell phones can also allow remote access to see if automatic medicine dispensers have been used, food is still in the fridge or has been accessed, kitchens have been used for food preparation via CCTV, and facilities like lights and power are working.

Extending the reach of communication further than hand-held cell phones and having smart assistance can be done through voice-activated assistants, including Alexa and Echo, and the use of Google Assistant on different devices. These can help monitor the home or room environment, function as a way for people to interact with a broader environment, be set up to give reminders of activities that need to be carried out, and serve as a communication medium more broadly as well as a help point.

A host of alternatives

The early introduction of monitoring had security control panels or intercoms allowing panic notifications or emergency buttons. These became relatively common, especially in places like residential estates and apartments. The limitations on getting access to an intercom in an emergency soon saw the introduction of portable and wearable devices such as bracelets, pendants or devices on lanyards. Wearable devices have got a lot more subtle since they first came out, with watches designed around this purpose, which include emergency calls and communication, items that can be tied to shoelaces, and even the inner soles of shoes which are unobtrusive. These not only provide emergency contact options, but many can also serve as health monitoring devices which can provide health alerts.

A key factor in care monitoring is that these devices should incorporate some kind of GPS, wireless or RF function, or a combination of these to assist in tracking. They can help locate someone, tell if they have gone beyond an expected boundary or safe zone, are in a dangerous area, and their movement (or lack thereof). The range and where these can operate are important factors in selecting which is going to be most suitable.

Getting people to wear these monitoring devices can be an issue. A younger teenager may think a feature-rich watch or band that helps with exercise training monitoring is pretty cool, but an elderly lady may turn her nose up at something that does not fit her carefully prepared look, particularly when these are bulky or get in the way. They may also be removed from the body, either accidentally or deliberately, to the extent that some have catches that prevent this, potentially opening up other issues around duress.

Having something like an Apple tag in the inner pocket or lining of a bag or dressing gown makes it less obtrusive and less likely to be discarded. Unfortunately, the item or clothing the tag is attached to may not be worn at the time of an incident, such as the shoes in some cases. For example, people with dementia or Alzheimer’s may show unexpected ‘wandering’ behaviour and consequently may be quite unprepared to deal with situations they get into.

For this reason, behaviour observation of favourite or commonly worn items or clothing and tagging these with the monitoring devices can increase the likelihood of them wearing the items being monitored – people have their favourites. Battery life should also be considered, as wearable devices have a range of battery life, and charging or replacement may be an issue.

Whether it is cell phones or smart devices, the person responsible for charging the devices needs to be clearly defined to avoid ambiguity. Poor signal reception can also impact false alarm rates or inaccurate location data, and any monitoring device needs to be checked out for strength and consistency of communication. For cell phone charging for the elderly or those with ailments such as Dementia, wireless cell phone charging pads, which can be easily used with compatible phones and allow a regular location to place the phone, can also be advantageous.

Broader monitoring capabilities

Area monitoring systems or devices get around issues with wearable devices by monitoring both movement and activities that may be of concern within or at exits to an area such as a home or a care ward. CCTV cameras are probably the most prominent and most used in this respect, but things like pressure pads next to a bed or doorway to confirm movement, sensors at exit points like doors and windows, and motion detection devices are all potential contributors in this respect.

CCTV raises particular questions about privacy. People under care would probably rightfully reject cameras in the bedroom and bathroom no matter how much they are told it is in their best interest. However, cameras in other accommodation areas such as the hallway, in the passage on the way to the bathroom, the kitchen and the sitting room, can all provide indications of movement, or, importantly at times, the lack of movement.

Similarly, CCTV analytics may be able to detect a person lying on the floor that may indicate a fall or other medical condition, although one needs to appreciate that it may be a yoga position. Facial recognition may be an important part of giving or restricting access when those cared for may be forgetful and have impaired cognitive thinking, and may not relate to other handheld or worn identifiers for access.

The potential for AI to work out typical behavioural patterns, movements, or even postures, and detect when there is significant deviation, can be extremely useful. While cameras currently dominate this visual monitoring, there are a range of other options and data sources that can be used along with infrared or thermal cameras which expand viewing options. The use of radar imaging using RF, millimeter-wave (mmWave) technology, or ultra-wideband (UWB) low-power radio waves are becoming part of monitoring solutions.

These generate electronic images that can represent the human body and its parts, and can assist in viewing people under care, without the privacy issues relating to the more lifelike imaging produced by cameras. Things like movement, positioning, postures and gestures are potentially recognised. While monitoring quick changes in movement, which may be associated with things like falls, these viewing technologies could also potentially detect designated gestures for help and identify problematic body positioning, for example, people lying on the floor, or a combinations of these.

Millimeter wave technology is already used at airports as a substitute for X-ray screening and produces a representative rather than true image of the person along with things they may be carrying; partly to alleviate privacy concerns among passengers. In live viewing using such technologies, however, there may be issues in picking up more subtle behaviour, especially in complex environments.

The use of identifying behaviours such as facial expressions, which may indicate somebody’s state of mind or that somebody needs help, is best done by CCTV rather than imaging technology. Currently, the initial potential for false alarms is probably high, and the cost of software and tailoring the analytics is potentially expensive. For high-end care home solutions, pricing may be more acceptable, but for personal individual monitoring, the costs may be seen as too high. Monitoring costs by service providers in the US that I looked at are relatively expensive. However, we are moving to AI doing self-learning and correcting, which may make CCTV and these other technologies significantly more useful and feasible in the future, albeit with a lot of input and tweaking.

The right choice for the situation

If you want to put in a smart monitoring system for life and health care using surveillance technologies, it would be fair to ask how far you want to go. Cell phones and various apps are the starting point. Health monitoring devices that track vital signs are relatively easy to do with wearable devices. This can include sleep tracking. Sensors can assess movement activity levels, including motion detection devices, pressure plates, camera monitoring of areas of expected movement such as a food preparation area or passage to the bathroom, and imaging technologies.

IoT enables communication of anything from medicine dispensers, fridges, and toothbrushes to entertainment systems, which can feed back into monitoring lifestyle activities. GPS geofencing and tracking is feasible with a range of wearable devices or vehicle tracking. All of these have their strengths and weaknesses, and many have their own data analysis and communication facilities. However, ease of integration across different devices and technology still seems an issue.

Accuracy of alarms and notifications with an integrated set of behaviour indicators from different systems also appears far from perfect, although integrated systems, which cost much more, probably build some of this into the products and services. AI needs a delivery system, appropriate data input, and analytics to establish and detect unusual behaviours. Ideally, conditions required for notification should have information and cross-verification from a number of sources, including health signs, confirmation of movement and position, and lifestyle checks. Above all, these need to be implemented with the acceptance of the person being cared for; maintenance and things like battery charging of devices should be managed to ensure things are operational.

Smart surveillance can be as simple or complex as you want, with a pricing structure probably parallel to this. Putting the technology in place is not the solution, though. It needs to be set up in such a way that it works, integrates with the lives of people being cared for as seamlessly as possible, and is used by them. Information coming out of surveillance devices needs to lead to analysis and intelligent notifications to caregivers or whoever is concerned about the person being looked after.

There is a danger of over-reliance on technology, and there may be a feeling that having the same levels of contact or supervision on the site is unnecessary. However, despite the advantages of smart surveillance technology, physical visiting at certain times may still be one of the best measures to ensure the care and well-being of somebody close to you. Personal interaction can be expanded into physical contact, socialising activities with simple conversational exchanges, gifts, shopping requests, etc. For all that technology can do, simple visits and interpersonal contact are still what those cared for probably desire most of all.

Dr Craig Donald is a human factors specialist in security and CCTV. He is a director of Leaderware which provides instruments for the selection of CCTV operators, X-ray screeners and other security personnel in major operations around the world. He also runs CCTV Surveillance Skills and Body Language, and Advanced Surveillance Body Language courses for CCTV operators, supervisors and managers internationally, and consults on CCTV management. He can be contacted on +27 11 787 7811 or [email protected]

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