Hearth: a care circle for Alexa+

Hearth lets an older adult manage her medications and daily check-ins by voice on an Echo Show, and keeps her family in the loop from wherever they live. It is a self-hosted MCP server (spec 2025-11-25, Streamable HTTP) with MCP Apps visual cards, proactive announcements over resource subscriptions, a purchase flow with explicit confirmation, and an Agent Skill that carries the care rules.

Built for the Build, Ship, Shape: Amazon Developer Hackathon (Alexa+ track, Open Source mini challenge). Demo video: https://youtu.be/INpCtqBra5s · Simulator: ShowBench (open source, built alongside Hearth)

For judges: test it in 3 minutes

git clone https://github.com/acirema792/hearth-alexa && cd hearth-alexa && npm install
npm test            # 9 end-to-end tests over real Streamable HTTP (~5 s)
npm start           # MCP server → http://127.0.0.1:8787/mcp
# in a second terminal, from the same folder:
npx github:acirema792/showbench --server http://localhost:8787/mcp --intents showbench.intents.json \
  --skill skills/hearth-care-circle/SKILL.md --companion http://localhost:8787/companion
curl -X POST localhost:8787/demo/reset -H 'content-type: application/json' -d '{"set":"08:20"}'   # start the story at 8:20 AM
# open http://localhost:5173 and click the suggestion chips, then:
curl -X POST localhost:8787/demo/clock -H 'content-type: application/json' -d '{"set":"19:35"}'   # the Echo speaks up on its own

No API keys, accounts or hardware needed. Node 20+ only.

Why

• In 2025 Amazon retired Alexa Together, its paid remote-caregiving service (Amazon). The need didn't go away.

• 63 million Americans are family caregivers, up 45% in a decade (AARP & NAC, Caregiving in the US 2025). Many care from another city.

• Half of the 3.2 billion US prescriptions are not taken as prescribed, at an estimated $100–300 billion a year, and poor adherence drives 33–69% of medication-related hospital admissions (Bosworth et al., American Heart Journal, 2011).

• Someone already pays for adherence. Medicare Part D Star Ratings score plans on adherence to exactly Rosa's three drug classes: diabetes medications, RAS antagonists (lisinopril) and statins. Each measure is triple-weighted (AJMC). That gives Hearth a credible route to market: free for families, sponsored by Medicare Advantage plans and pharmacies, which could also ship it as their own branded Alexa+ experience.

The Echo Show is already in the kitchens of the people who need this most. Alexa+ can finally hold a real conversation. Hearth is the care brain behind it.

Related MCP server: CareCircle MCP Server

What it does

For Rosa (78, lives alone, Echo Show in the kitchen)

• "Alexa, I took my morning pills." Logs every dose due, updates her streak, tells her what's next.

• "Did I take my metformin? I can't remember." Answers from the record, never logs, and tells her not to take another one. A double-dose guard is enforced in the server, not just in a prompt.

• "Let's do my check-in." Three big-button questions (mood, sleep, pain), one at a time.

• "Order more metformin." Quote → read-back → explicit yes → order. Tokens expire after 15 minutes.

• Unprompted: "Rosa, it's time for your blood sugar pill." and "Daniel sent you a message…"

For Daniel (son, Seattle) and Ana (daughter, Chicago)

• Push/SMS when something needs them, following an escalation ladder: reminder on the Echo at +30 min, primary caregiver at +60 min, the whole circle at +120 min. Family quiet hours are respected for non-urgent alerts.

• Closed loops: when Rosa takes a late dose, everyone Hearth worried gets "✅ Rosa took Metformin. No action needed."

• A family dashboard (MCP App): 7-day adherence grid, mood/sleep/pain trend, refills to confirm, and a note box that speaks on Mom's Echo.

• "Alexa, how's Mom doing this week?" gives a spoken summary.

On its own (the care loop) run_care_rounds runs every 15 minutes, like an Alexa+ routine. It checks every dose and the daily check-in against the ladder, forecasts refills (quotes one when supply drops under 5 days), and is idempotent: every step has a dedupe key, so nobody gets texted twice.

How it uses the Alexa+ stack

flowchart LR
  subgraph Home["Rosa's kitchen"]
    Echo["Alexa+ on Echo Show<br/>(ShowBench in the demo)"]
  end
  subgraph Family
    Phone["Daniel's phone<br/>(companion page)"]
    EchoD["Daniel's Echo Show"]
  end
  Echo -- "MCP 2025-11-25<br/>Streamable HTTP" --> H["Hearth MCP server"]
  EchoD -- MCP --> H
  H -- "ui:// MCP Apps<br/>resources/updated" --> Echo
  H --> Store[("Care record<br/>JSON, durable")]
  H --> Notify["Family notifications<br/>webhook → push/SMS"]
  H --> Rx["Pharmacy adapter<br/>(sandbox)"]
  Notify --> Phone
  Loop["Care loop<br/>every 15 min"] --> H

Run it (2 minutes)

Requires Node 20+.

git clone https://github.com/acirema792/hearth-alexa && cd hearth-alexa
npm install
npm start                      # MCP server on http://127.0.0.1:8787/mcp + family app on /companion

Then open the device simulator in another terminal:

npx github:acirema792/showbench \
  --server http://localhost:8787/mcp \
  --intents showbench.intents.json \
  --skill skills/hearth-care-circle/SKILL.md \
  --companion http://localhost:8787/companion \
  --device-label "Rosa's kitchen" --companion-label "Daniel's phone"
# open http://localhost:5173

ShowBench runs offline with Hearth's intent rules out of the box. The demo video uses this deterministic planner so it is exactly reproducible. For a real LLM planner, set ANTHROPIC_API_KEY, or OPENAI_API_KEY (+ OPENAI_BASE_URL for Gemini, Groq, OpenRouter or Ollama). The planner then uses Hearth's server instructions and Agent Skill.

Try: "what's on today?", "I took my morning pills", "let's do my check-in", "did I take my metformin?", "order more metformin" → "yes", "tell Daniel the roses are blooming".

Jump the clock to see escalation and proactive announcements:

curl -X POST localhost:8787/demo/clock -H 'content-type: application/json' -d '{"set":"19:35"}'   # Echo reminds Rosa
curl -X POST localhost:8787/demo/clock -H 'content-type: application/json' -d '{"set":"20:05"}'   # Daniel's phone buzzes
curl -X POST localhost:8787/demo/reset -H 'content-type: application/json' -d '{"set":"08:20"}'   # fresh morning

Docker (self-hosting). docker build -t hearth . && docker run -p 8787:8787 -v hearth-data:/app/data hearth

Other MCP hosts. Any MCP-Apps-capable host can use Hearth: Claude, VS Code, Goose, MCPJam and others. Point it at http://<host>:8787/mcp. For a remote host, expose it with a tunnel (for example cloudflared tunnel --url http://localhost:8787) and set HOST=0.0.0.0 and HEARTH_ALLOWED_ORIGINS.

Tools

Safety and privacy by design

• No medical advice. The rule is in the server instructions, in tool descriptions, in the Agent Skill, and in code paths that return safe wording. Pain or low mood triggers "a call might help", never a diagnosis.

• Emergencies first. The skill tells the assistant to direct chest pain, falls, breathing trouble or confusion to 911 or emergency calling before anything else.

• Purchases need a yes. Quote tokens are single-use and expire.

• Uncertain questions never write. check_medication is read-only.

• Minimal data. It stores medication schedule, logs, check-ins and messages only. No audio is stored.

• Demo safety: the pharmacy is a clearly labelled sandbox. Demo clock endpoints can be turned off with HEARTH_DEMO=0.

Tests

npm test     # 9 end-to-end tests: real server, real MCP client, real Streamable HTTP

The tests cover:

• protocol negotiation (2025-11-25)

• MCP Apps metadata

• the morning flow and the double-dose guard

• the pain flag

• the escalation ladder and its idempotency

• the purchase flow

• cross-session persistence

• proactive resources/updated push

• read-only check_medication

Configuration

Project layout

src/        index.ts (HTTP + sessions) · tools.ts (MCP surface) · care.ts (care engine) · services.ts (notify, pharmacy) · clock.ts · model.ts (types + seed)
views/src/  MCP Apps views: today, checkin, refill, family (vanilla TS, bundled by esbuild into single HTML files)
companion/  Daniel's phone: live family feed over SSE
skills/     Agent Skill: hearth-care-circle
test/       end-to-end tests
docs/       product feedback, friction log, feature requests

Built during the hackathon

Everything in this repository and in ShowBench was written during the submission window (Oct 2026); see the commit history.

Roadmap

• Alexa+ account linking (OAuth) and per-speaker identity (Rosa vs a visiting caregiver).

• Real pharmacy integrations behind the existing adapter interface.

• Ring: a front-door "Rosa went out for her walk" activity signal as a gentle check-in input.

• Fire TV: the evening reminder as a picture-in-picture card during her shows.

• Spanish voice and UI (Rosa's first language).

License

MIT. See LICENSE.