Divergent Perspectives in Care Dyads on Remote Monitoring and What That Portends for Older Adults

Increased use of passive remote monitoring technologies is based on the assumption that diminished privacy, autonomy and other risks are outweighed by new efficient means of enhancing safety, reducing hospitalizations, and allowing people to remain living in the community; however, the potential benefits and harms of these socio-technical practices fall differently to older adults and family caregivers. We report findings from a dyad study that employed cognitive-based interview probing and value-centered design techniques to understand how older women and their adult children think about GPS location tracking, activity sensing, and webcameras – three categories of technologies that are now covered in the U.S. through Medicaid home and community-based services programs in some states. Individual interviews were conducted with 18 Meals on Wheels clients and 10 adult children. We compare their assessments of each technology’s impact on privacy, safety, independence, freedom, relationship with family member, social life, and identity, as well as the meanings each participant attached to “privacy” and “independence.” Older adult participants found each technology less appealing than did their children, and children underestimated their mothers’ ability to comprehend the technologies. This underestimation influenced the extent to which children reported they would seek their consent. Adult children perceived that they have the ability to persuade their parents to adopt those technologies that the adult children found useful despite anticipated resistance. For both groups, privacy was the most-cited concern, but participants perceived overlap and interdependence between values of privacy, independence, identity, and freedom, highlighting privacy’s instrumental role in enabling and protecting these values. Differences in perception of need for and comfort with these devices have not previously been examined. These findings describe significant differences that should be understood to promote remote monitoring practices and public policies that are consistent with older adults’ values and to prevent conflict and caregiver overreach.