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Avatars Focused on Care

May 25, 2019

LOWELL — “Have you been a good girl today?”

That was one of the questions Judy Leiman had for Jerry upon waking the “sleeping” feline avatar on the tablet at Element Care Wednesday.

“Oh yes,” the white cat responded, a big red heart appearing over its head on the screen.

Leiman, 62, of Chelmsford, is a client of Element Care, a PACE (Program of All-Inclusive Care for the Elderly) that provides comprehensive health care for people 55 and older, the majority of whom are low-income and on MassHealth and Medicare.

Leiman is also one of 65 participants in the organization’s Avatar Program. Through the program, clients receive tablets with their own personalized cat or dog electronic avatar, which provides them with friendly companionship, reminders to take their medication and stay hydrated, and much more.

For clients like Leiman, with behavioral needs, the avatar helps her with interpersonal relationships and boundaries and provides calming breathing exercises, said Cely Rosario, an Avatar Program administrator and occupational therapist.

For those like Domingo Alvarez, who needs assistance with organizing and keeping up with tasks, the avatar helps him to stay focused on taking his medications and attending health appointments, Rosario said.

Alvarez, 76, of Lawrence, was a technology professor in the Dominican Republic earlier in his life. He’s aware he’s interacting with a computer when he speaks with his cat avatar, Mingo, but delights in treating him like he’s a real pet.

Alvarez, speaking in Spanish translated by Rosario, said his daughter had given him a real cat, but he prefers Mingo, who has no physical needs. He said it’s also a good way to connect with his grandchildren, who enjoy interacting with Mingo.

The only problem he has with Mingo is when Mingo tries to tell him to go to bed — Alvarez likes to stay up late, and he doesn’t always listen.

“But I love it because he stays consistent and firm in his decision, and he never fights with me,” Alvarez said via Rosario. “He’ll tell me when I’m wrong, what I should and should not be doing, especially with my food, my diet, he gives me advice.”

The avatars are provided by care.coach , a California-based company Element Care staff first learned of a few years ago at the National PACE Association Conference, according to Director of Clinical Services Ken Comeiro.

Element Care decided to do a small pilot study with its clients, and found it helped patients increase medication compliance and reduce avoidable hospital trips, Rosario said. Since then, the program has grown to help clients with fall prevention and behavioral health supports, she said.

Clients can request avatars or care teams can recommend them to patients, who can decline them if they choose, Rosario said. Some patients who initially decided they didn’t want to participate later joined after hearing how much others enjoyed their avatars, she said.

Element Care staff will program the avatars for individual patient needs, and care.coach provides 24/7 psychosocial care via trained health advocates who listen to and read text of what the patients say and respond to them through the avatars.

“It’s another set of eyes that’s helping to maintain good quality of life,” Comeiro said.

Following programmed medical intervention protocols, the avatars ask the patients daily questions, and the information is reported back to Element Care to follow up with the patients, Rosario said.

She said the avatars help them with social skills and building relationships with their medical providers. Many times, she said, they will open up about things to the avatars that they’re not ready to say otherwise, providing deeper detail about what’s going on in their lives.

The program keeps log of conversations, and gets to know the personal preferences, such as music, and conversational styles of each client, Rosario said. In Alvarez’s case, it has caught onto Dominican phrases that aren’t widely used by other Spanish speakers, she said.

There is also a family portal that allows caregivers to access the patient’s interactions with the avatar as another means to check in on their loved one and address their portion of the plan of care, Rosario said.

Clients can wake or put the avatars in sleep mode whenever they want, but the avatars are programmed to wake a certain number of times each day to check on the patient and scan the room, she said.

Patients are encouraged to tell their avatars when they will be away from their tablets during usual check-in hours, Rosario said. If a patient hasn’t interacted with the avatar in 24 hours, Element Care is alerted to perform a wellness check, she said. It can also connect to Element Care’s 24/7 call line.

Rosario said the program helps to keep the clients as independent as possible and living in the community.

“The goal of the avatar is not to do for them, but to do together,” she said.

Director of Marketing Bruce Jankowski said they hope to grow the program to 250 participants across all Element Care locations.

Follow Alana Melanson: @AlanaMelanson on Twitter

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