Long before the fall that breaks a hip, there are bruises nobody can explain and a daily routine that has quietly shifted. Steve Popovich talks about why people play down what has happened to them, what his father-in-law’s infection cost before anyone caught it, and why he puts the caregiver at the center of everything.
Key takeaways
- Waving off help is its own emergency. Popovich is researching what to do when someone declines help and is still on the floor 5 minutes later.
- Unexplained bruises usually mean the falls have already started. He watched his father-in-law wave off questions while the falls behind them grew more frequent.
- Changes in sleep and bathroom trips can show up before an infection does. He is careful about the limits: this is not clinical, and it is not in any product sold today. In his own family, a missed infection ended in a hospital admission. More on caring for someone with dementia.
- Everything routes through the caregiver. The data only matters if it reaches the person who can act on it.
- People accept help when they can see what it gives them. Three years on, he still has not talked his mother into a hearing test.
Disclaimer: This article is general information, not medical advice. Changes in sleep, bathroom habits, balance, or memory should be discussed with a doctor. If you think someone has an infection or has been injured in a fall, contact a medical professional or call 911.
Steve Popovich founded Clairvoyant Networks in 2015, after a family member’s Alzheimer’s diagnosis sent him looking for technology that could tell him how they were doing between visits. He could not find it. It was his fourth company, following a career in connectivity and the Internet of Things. Clairvoyant builds and sells under the name Theora Care, out of Austin. Its fall detection and fall risk platform, Theora 360, was named a finalist in the Longitude Prize on Dementia, a competition funded by Alzheimer’s Society and Innovate UK that gave each of its 5 finalists £300,000 to build a working prototype. Popovich was named a Fellow of the Texas A&M University Center for Population Health and Aging, and his company has an NIH-funded grant to develop next generation fall risk prediction using new technology with Texas A&M University as the research partner. Here he explains what shows up before a serious fall, and why so much of it never gets reported.
This conversation has been edited for length and clarity.
On the person who says “I’m fine”
A fall detection system can do everything right and the outcome can still be bad. Walk me through how.
When you have a solution where you have a professional call center, you also have scenarios where an emergency occurs, say the fall was detected, or somebody just pressed an SOS button with a watch, and a professional operator comes online. Hey, Steve, are you okay? And they say, well, yeah, maybe I’ve fallen. But I’m fine. Don’t send the EMS and all the other guys with the flashing lights. I just don’t want to be a burden.
My father-in-law was like that always. He grew up the tail end of the depression. It was never about me. His arm could be falling off, literally, and he would still be saying, take care of that person over there.
One of the challenges in the space is that people don’t want to be a burden and they think they can handle the situation on their own. And they think they’re going to be able to get up and recover on their own.
So what do you do about it?
Part of this going forward, as far as research, is to figure out, okay, the call occurred, they waved off help, but 5 minutes later they’re still on the ground. We’ve done this already, we just haven’t done exhausted testing on this yet.
And then they might pass away because, let’s say they had a heart attack and then they collapsed because of the heart attack, but they think it’s just something less significant. It’s something they think they’re going to be able to handle.
I didn’t think about that until about a year ago. I didn’t even think about that either, because one person asked me, well, can you tell if they got up? And I’m like, well, I guess we could do that. But I said, well, tell me why you’re asking me that question.
On the bruises nobody can explain
What does a decline actually look like from the outside, before anything serious happens?
You’re going to have patterns that develop. What’s going to happen with people that eventually will do something like break a hip is that you’re going to see certain pattern changes where their frequency of falling is going to increase. So let’s say they keep waving you off.
This happened actually with my father-in-law who had Alzheimer’s. He was living in an assisted living toward the end, because he didn’t want to be a burden to the family. So we helped him find a facility nearby where we were. I’d go over there maybe a couple times a week and he’d have bruises on his body. And I asked, I said, well, where did you get the bruises? And he’s like, I don’t know. I’m fine. Don’t worry about me.
But what was going on is that he was falling more and he was less stable as time went on. So we got physical therapists to help improve his quality of life. And I think that made a change as far as pushing off the ultimate broken hip issue, where you had a more catastrophic fall.
On what a change in routine can reveal
Beyond the falls themselves, what else shows up in the data?
There’s other things, they call them ADLs, activities of daily living changes. Even detecting things like infections, like a urinary tract infection, with what we have today we can do those kinds of things. Now, not clinically. We don’t. That’s an FDA type thing.
And it turns out that doing academic research on this, UTIs cause instability which causes the falls. There’s been lots of papers now written about this. These correlations are important for maximizing the quality of life for those kinds of folks.
Is that available on any device today?
Not commercially yet, no. Some of the pilots that we’re doing here in Central Texas, we have that ability, actually easily. It’s kind of a no-brainer really, once you start understanding people’s body movements. But not in a product that’s being sold today, no.
You’ve been through this in your own family. What happened?
I’ll give you an example, again, my father-in-law with a UTI. Urinary tract infections are everywhere. If you can get in front of these things, you don’t have an ER visit.
The first time it happened with my father-in-law we had what I would call the dinosaur version of what we have today to be able to detect changes in ADLs on sleeping and bathroom trips. We didn’t know what was going on. So we called over there. Hey, dad doesn’t want to go to the doctor. He thinks he’s going to sleep it off. He’s an ex-Navy pilot, so he was going to beat it on his own. And I said, well, if you’re not healthy in the next couple of days, I’m going to take you to the ER.
Sure enough, nothing got better, got worse. And I dragged him out of his assisted living facility. It was a long hallway that day because he was a big guy. We got him to the ER and the doctor said, look, his infection is out of control. We need to admit him to the hospital immediately. And people with dementia, they get an infection and they can become delirious. It’s a real big problem. So what started as a little problem became an explosive, huge problem.
And after that first episode?
After that point, we understood how to look for this, the markers or whatever you want to call it from a data perspective. And we never had to have him go to the ER for a UTI again. And he probably had 6 to 10 more after that point, because in the middle of all that was COVID too, which made things a lot harder.
We would get so far in front of the, I would call it diagnosis, because that’s an FDA type of a doctor medical thing. But from our perspective we could see what had changed in his body movements, the bathroom trips, the sleeping. And we were able to treat it with a $20 medication that had no bad side effects. It was generic. It’s basically the common way you fight a UTI from a doctor prescription.
So you’ve got a $20 medication. And I think the whole cost to Medicare for that first episode was 20,000 plus. And you had somebody that was really completely delirious. We had to have a family member around the clock with him to keep him from pulling the IVs out of his arm and trying to get out of the hospital. Very night and day difference.
On what happens between doctor visits
Why does the time between appointments matter so much?
You might see the doctor for your physical therapy half an hour a week or something like that. He or she is going to ask you questions and try to make assessments. But you get a little snapshot of time. That’s not enough.
If you can digitize what happened between those visits, you can say, well, Steve, it looks like we need to do more. Or it looks like we’ve reached the best we’re going to be able to do with this kind of therapy. Then we can shift gears, rather than just mechanically booking your 30 minutes with me every week for the next 12 months.
You think about even things like Parkinson’s and some other kind of neurological challenges, to be able to understand if medication makes a difference. The other thing to keep in mind is that these folks with different kinds of dementias may also have diabetes, or some kind of joint issue. It’s just not uncommon.
And there’s a cost to the visit itself.
How many times do you want to go see the doctor? It’s not on my bucket list to see the doctor more.
And when you get to people that have dementia, arranging for them to go see the doctor is not an easy feat. If you’re the son or brother or whatever family member that’s becoming that caregiver, taking some of that responsibility or all of it, it’s okay, I’ve got to take the whole day off work. We’re literally going to see the physician for maybe 15 minutes. We’re going to spend 30 minutes in the waiting room.
On the caregiver as the center of everything
You’ve said the caregiver side is the story behind the story, and you credit Alan Stevens, PhD, of Baylor Scott & White Health, for that framing. Why the caregiver?
One of the things I was taught by Dr. Stevens is the caregiver is kind of like the center of the universe in all this. So whether it’s professionally paid or it’s a family member or some kind of a care team where you combine folks, the data that comes from these devices, the information, is all providing connectivity to the family members typically. That is really the key element here, to be able to maximize success with the quality of life for your loved ones and for the caregiver.
Because the other side of it, if you don’t have these kinds of tools, then you’re always like, is that okay?
On knowing what’s going on when you’re not there
Why did you start the company?
When we started the company, Theora Care, the idea was situational awareness, which is now being used a lot in healthcare for different reasons. But the idea is kind of knowing what’s going on when you’re not there.
My mom is 90 years old. She just turned 90. She lives up in the mountains in Big Bear, California. She doesn’t want to move. She still drives, which is really scary. She’s a good driver, don’t get me wrong, but it’s kind of just scary because she’s 90.
We call them notifications. My mom takes the device off the charge cradle, I get a notification, mom took it off, mom put it back on. And I’m looking at the time stamps thinking, okay, mom is suddenly putting it back on the charge cradle at 2 o’clock in the morning. Something’s wrong. So, call mom. Hey, tell me what’s going on with you. Well, I can’t sleep right now.
The last time we had that conversation it was because it was too hot. It’s high desert, so you have very low humidity but you have higher temperatures sometimes. And she doesn’t like to open her doors because the bugs come in. This is a real life story. And I’m like, mom, it’s cold at night, open the windows to let the fresh air in.
Is that a common problem?
I was talking to a guy in England, because we were a finalist for the Longitude Prize on Dementia. The way it works in the UK, you go an hour outside of London and you’ve got these little towns. They might have a gas station. They always have a pub. And people grew up there, just like Middle America, and they just want to stay there. They’ve got family there. They want to age in place there.
But because those homes in England sometimes were built hundreds of years ago, they didn’t have things like insulation. There was a lot of stonework, which is really cool, you look at it historically. But the houses don’t have good ventilation. So some of the folks there don’t get fresh air. It’s like the situation my mom had early in the summertime, where I had to force her to open the windows just so she could be healthier. I could tell it was starting to affect her strength levels.
So maybe mom needs more help on the physical therapy side. Maybe mom needs more help on the ventilation side. Sometimes it’s simple stuff. It’s not always take a pill. A lot of it is just kind of like, oh, well, I should have thought of that.
On who pays, and who should
Dr. Marcia Ory’s team at Texas A&M is working on the return-on-investment case for insurers. Are health insurers paying for this kind of technology, and should they be?
The short answer is they should be, yes, more and more. Of course you have to be selective. But there are some policies where they’ll provide PERS type devices, and that’s kind of it. Usually that’s the limit. So a smart PERS device, or the fall detection stuff we’re talking about, usually is not included today, unfortunately. So I think that’s kind of the next step.
Some of the work that Dr. Ory and her team do, and other academics in the space for geriatric care, they’re starting to be able to provide what we would call in the business world a return on investment from an insurance company perspective.
What about long-term care insurance?
Basically nothing covers that scenario unless you have what they call long-term health insurance. And that’s very seldomly sold in the last several decades, because the guys that figure out how to make money in insurance realized this was coming, and it was like a hockey stick as far as cost goes. So they just priced out those policies. There’s a few players that still have it, but the average person could not afford that kind of long-term care insurance anymore. It’s just priced out, because the cost of supporting those folks later on, if they get something like Alzheimer’s, is just prohibitive.
The Alzheimer’s Association valued unpaid dementia caregiving in the US at more than $446 billion in 2025. Is any of that money reaching the technology families rely on?
There’s not a lot of reimbursement on the technology side to help the caregiver, because they’re focused on the patient. And that’s one of those things that, when I talk to the NIH people and other folks in that kind of leadership, state or federal, that has to change. Because this is impacting the country economically, and it’s all nations, not just the US.
Are states filling any of that gap?
If you go to places with the retiree demographics, like Florida or Arizona, the state programs work like this. Okay, we’re going to help you live at home, but we’re going to take possession of your homestead property when you pass away. So they do that and they start providing some basic services. That to me is not a great solution.
On caregiver burnout, and what actually helps
So what actually helps the family member doing the caring?
It’s about enabling the people who love you, who care for you, and making it so this isn’t a burden on them. Because that burnout, that’s the other thing that happens. Okay, we’re going to do this, and then you get burned out. And then who takes the ball after that? So caregivers need respite care too.
Some families might have multiple people that step up to do this, so they can work together as a team rather than just one person getting burned out or having to quit their job so they can take care of dad.
I’ve spoken across the country. I was in the San Francisco area once, and a lady came up, and she was probably 21, 22, but she had actually quit college. She was going to university and had to take care of her grandma because nobody else would take care of her. I thought that was great and it was terrible. But it had to be done. And she was actually using that experience, her grandmom had passed away by then, to do things in the space to help other caregivers.
Does any of that hard-won experience get passed on?
I was at an NIH conference in DC and they had caregivers speak. Dr. Ory was there and a bunch of other people we work with. I was probably the only guy in the room that didn’t have a PhD. They had some caregivers speak and I talked to one of them after, because their loved one had passed away and they had spent years caring for them.
It’s really a crime not to be able to share that experience with others who are maybe new caregivers, so they don’t make the same mistakes you made, or just from an emotional standpoint. Or maybe there’s other resources you can draw upon that you didn’t know about.
It doesn’t matter what kind of ailment you might have, usually you’re not trained for that. I got cancer a few years ago. I wasn’t trained for that. I thank God every day that I’m cancer free today. But when that happened I had the benefit of lots of people I know who were physicians, people who helped in different ways to guide me through the process. Not everybody could do that.
With most of these caregiver situations, especially Alzheimer’s, there’s no cure. When you have Parkinson’s or some of these things, what you’re doing is managing a decline, and it’s more radical with those kinds of scenarios versus just the average age type decline.
On getting someone to accept help
Do you have any thoughts on getting people who need help to accept it?
The short answer is I don’t have the perfect answer for that. I’ve got some ideas. But in life, things that really help us, that we can see help us, we’re obviously more open to that.
I have to remind my mother that I’m trying to help her do what she wants to do. A lot, actually, come to think of it. And that’s age in place.
I’ll give you a simple thing that’s going on right now. Hearing aids. I’ve been trying to get my mom to get a hearing aid for 3 plus years now. She hasn’t even got to the point where she’s gone to the audiologist to get tested. She knows her hearing’s bad, and she’s getting more and more frustrated with it, which leads to more of a downer type thing.
With hearing aids you’ve got like 4 different kinds of models, the ones that go inside your ear and the ones that go over the ear. My mom was kind of flipping out because she wears glasses and can’t do the over the ear thing. Well, I just have to get you there so that you can try it. But I know that when she tries it, it’s going to be like, oh my gosh, this is so great. I can hear everybody now. I can hear the TV. Clearly, all those kinds of things. Those kinds of encouragement things are really important.
On where technology should stop and people take over
Where should technology stop and human care take over?
At the end of the day, we are providing better and better tools for assisting family and professional caregivers to help them be more proactive. We provide human-to-human connectivity and information so caregivers can do a better job, and also enjoy some improvements in their quality of life and their loved one’s.
Our own COO has talked about the shift toward predictive analytics in senior care. What does 5 years from now look like?
I think that 5 years from now it will be totally different. The caregiver wins. The retiree wins because they could probably stay in their home longer, or have less ER visits, which are costly. And the government wins because they’re the ones that are sometimes paying those costs.
It’s a win-win-win type deal. I love that from a business standpoint. The patient wins because they’re going to have a higher quality of life. The caregiver gets to be a little less stressed, because they don’t have to imagine what’s going on when the curtain’s down. They can say, okay, mom is doing this, as far as an activities of daily living profile.
I still think we’re on chapter one of this. We’re certainly not getting closure on how we deal with the issue. And we’re not going to run out of things to do as far as caring for people in that respect.
