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Hi Dr. Fliegel, thanks for your questions! The avatar's voice is the same all the time because it's synthesized. Now that the easy question is out of the way...

As far as how the service works, technically it's a "zero-UI" app running 24x7 on a specialized tablet device, controlled and monitored by a unique real-time hybrid of software and human intelligence in the form of a 24x7 globally distributed, specially trained team who are in turn guided by complex sets of evidence-based protocols and algorithms (targeting everything from medications or chronic disease self-care at home, to preventing delirium in the hospital) that are tailored to each individual and caregiving scenario....but what I think is even more important to us at this point for the purposes of OpenIDEO is less about how it works at this low/technical level, and more about how the whole branding/marketing and conversion experience is designed from the user perspective, which indeed may include some tweaks to functionality, but more likely will involve higher level thinking about how to frame/describe what our service is, and indeed how to decide/structure the fee for the service.

To elaborate a bit, we know empirically that the service does work to support and relieve stress from the family caregiver, in many cases transformationally (e.g. see the recent comments from a couple of GeriJoy customers at https://www.linkedin.com/feed/update/urn:li:activity:6328276088166449152/ ). And we know that when you actually give the service a shot in a disciplined way, the success rate of building a long-term supportive relationship with an older individual can be as high as 82% (see http://leadingage.org/sites/default/files/Element%20Care.pdf ). We've even been independently estimated to be able to save a typical family caregiver far more $ in respite/home care costs than our service costs ( see https://www.payingforseniorcare.com/financial-assistance/companion-care.html ). So the way I see it, our biggest challenge in making greater impact with family caregivers for dementia is design thinking around how to successfully connect with, educate, and then convert family caregivers, which is a very challenging process we've found, due both to issues with timing during the "caregiving journey" and personal bandwidth on the caregiver's side, as well as the unique and complex nature of our service, which has no direct comparable or simple explanation. Through business and clinical thinking, care.coach has addressed these challenges by working with hospitals and health plans, but I believe through design thinking combined with the right partnerships, we can indeed see more success in getting GeriJoy to family caregivers directly.

To answer your question though, as a rough ballpark, we are able to provide essentially a 24x7 non-physical "in-home family caregiver's assistant" position for about 2% of the cost of actually hiring such a team.

For more info about how GeriJoy works in family dementia care scenarios, please feel free to check out these consumer-oriented reviews (though our technology/service has improved in many ways since these were written):

http://healthitmhealth.com/race-take-care-growing-number-elderly/
http://dailycaring.com/review-gerijoy-companion/