REMOTE PATIENT MONITORING

The Other 148 Hours

What passive care changes for seniors between visits

By Alex Qi

Most homecare happens when no one is there. Visits cover the mornings and midday hours, but the falls, the restless nights and the slow declines happen in the evenings, on weekends and in the long stretches when family is away. A client receiving 20 hours of care each week is likely alone for the other 148. That is a long time between visits—and too often it is when a caregiver arrives to find someone on the floor.

The other math is just as stubborn. Three-quarters of adults over the age of 50 want to remain in their own homes as they age, and 73% want to stay in their communities, according to AARP’s 2024 Home and Community Preferences Survey. Most do not want to move to a senior living facility. Meanwhile, the workforce cannot simply grow to fill the space: PHI projects that 9.7 million direct care positions will need to be filled between 2024 and 2034, with demand for home health aides rising more than 40%.

Agencies cannot close the between-visit gap by adding hours alone. The question becomes: How do you keep clients safe and well during the hours no one is there?

Why Wearables & Cameras Fall Short

Clinicians prescribing homecare therapies should focus on the individual patient to ensure they receive the best treatment for their unique needs. As with many conditions, respiratory therapy is not one size fits all—age, disease severity, secretion characteristics and comorbidities all need to be considered in the treatment approach for any given patient.

For instance, cystic fibrosis patients often master airway clearance techniques in childhood, whereas bronchiectasis generally presents later in life across a wide spectrum of adults with varying medical histories. Since pediatric, adult and aging populations requiring respiratory care have different daily routines and needs, any device designed for home use must accommodate the lifestyles of the intended users.

User experience is therefore inherently intertwined with the development of any solution intended for independent use. Design considerations such as the physical characteristics of a device, its user interface, how it integrates with other treatment modalities and how engaging it is during use all factor into how a patient experiences the therapy day after day.

Comfort and a frictionless experience can affect adherence directly, as even the most effective therapy will be avoided if patients find it unpleasant to use.

An ideal way to discover the driving factors for optimal user satisfaction is to keep patients involved in the development process from the start, and constantly iterate with additional patient feedback. The goal is a simple-to-operate, intuitive design with the ability to deliver proven clinical efficacy.

What Actually Changes Between Visits

Passive systems surface two kinds of information, and the distinction matters when evaluating them. The first is events: a fall, a bed exit at 3 a.m., a door opening at an odd hour. The second is patterns: gait slowing over weeks and months, more frequent overnight bathroom trips, disrupted sleep. The patterns are where most of the between-visit value lives, because changes in routine often precede the crisis. Falls, urinary tract infections, and broader decline often show up in the data before they land someone in the emergency room.

For a caregiver or care coordinator, this is the shift from snapshots to trend lines. A visit shows a moment; passive data shows the week. That evidence can feed directly into care planning, flagging when a client may need evening coverage, a fall-risk assessment or a conversation with family, rather than leaving those calls to anecdote.

The stakes of the unattended hours are well documented. Yale researchers studying older adults who fell found that those unable to get up on their own faced sharply higher risks of hospitalization, death and loss of daily function. The longer a person is on the floor, the worse the outcome.

Honesty about the evidence matters here, too. A 2025 multiprovincial randomized controlled trial published in the journal JMIR Aging found a promising but statistically nonsignificant trend toward homecare clients with passive sensing at home avoiding admission to higher levels of care. Smaller cohort studies have reported large reductions in unplanned hospitalizations and emergency department visits among high-risk older adults using these systems, but those were not randomized trials. The early evidence is encouraging, but not settled. That is exactly why agencies should ask hard questions before adopting anything.

What Agencies Should Ask Before Adopting Any In-Home Technology

First and foremost: Is this technology designed from the senior’s perspective? Too much of what is on the market is monitoring for someone else’s peace of mind. That has value, but it quietly treats the senior as a burden to be watched. The first goal should be helping the person live a healthier, longer, more independent life. Ask any vendor to explain how the product serves the senior, not just the people around them.

Consent and privacy come next. Does the client understand and agree to what is being collected? Will they feel watched? Research on older adults’ acceptance of in-home technology is clear that acceptance rises when seniors keep control over what is observed, when and where and that cameras and microphones raise the sharpest privacy concerns.

Then the data itself: What exactly is collected, who owns it, how is it stored and what happens to it when the relationship ends?

Then alerts and workflow, which is where good pilots go to die. Who receives an alert, and at what hour? Professional caregivers have their own lives and families; most do not want to be on call at 2 a.m. So who is responsible when something happens overnight: emergency medical services (EMS), a neighbor or a family member who simply wants to know so they can call the ambulance themselves? If the answer is unclear, the data will be ignored at precisely the moment it matters most.

Finally, weigh the evidence and cost. Ask for outcomes data or peer-reviewed studies, not testimonials. Understand the full cost model, including hardware, subscription and per-client pricing, and be clear on who pays: the agency, the family or a payer.

The Job To Be Done

The technology is secondary to the job to be done. Falls remain the leading cause of injury and injury death among older adults, according to the Centers for Disease Control and Prevention. Seniors want to live in their own homes, on their own terms and the hours between visits are where that wish is won or lost. The task for our industry is to make those hours safer in a private, dignified way. Aging in place is absolutely achievable if it is done thoughtfully and respectfully, in a way that lets seniors live in peace, where they are.

Alex Qi is a pioneer in the homecare industry. His company Pontosense provides passive, contactless care technology for home care agencies, while Silvie brings that technology directly to families. Inspired by his family experiences, Qi helps older adults age safely, privately, and independently at home, on their own terms. For more information, visit pontosense.com.