Aging and Health Technology Watch

Try staring at the NY Times list and its murky map.  The NY Times decided that tracking down and mapping the list of nursing home deaths nationwide required more than 30 contributing writers for the story. The ‘Nursing Homes in Crisis’ collection is about Covid-19 in 2020. Actually in each recent year, the New York Times has looked at nursing homes and found them to be a problem in 2017, wanting for a great deal in 2018, just a bit in 2019, then an onslaught of investigation most recently.  Amid the outcry, the negative comments about bad management, bad physical design of the buildings, bad for-profit ownership, bad Covid-19 testing, etc., etc. -- very little deep thought about why people live there and what change is likely.

Companies continue to invent and introduce technology. In the face of the devastation and economic collapse precipitated by the pandemic, many tech firms soldier on, finding opportunity, re-spinning products, and announcing new capability. It is encouraging to see this sheer quantity of free offerings, accelerated interest in telehealth, and other innovations in smart homes, healthcare and robotics that have emerged in the past few months of the Covid-19 pandemic. Here are just five focused on older adults:

How essential has the Internet been during this pandemic? Read down the April Pew report with the moniker, “53% of Americans say the Internet has been essential during the Covid-19 pandemic. Go past the concerns about whether students can complete work, past the political debate about whether the government should provide Internet access -- there are some interesting nuggets and puzzling findings. During the Covid-19 outbreak, only 31% of the 65+ said the Internet was essential; 49% said it was important but not essential, and 20% said it was not too/not at all important, with likely those with more education believing it to be essential.   Given that response, it also followed that those over age 65 were not too worried about being able to pay the bill for smartphone or broadband use. 

Is sixty-five the new eighty-five – and is ageism trendy?  Note the interesting behavior of ‘leaders’ during the time of Covid-19.  Consider the EU guidance: "The chief of the European Union's executive has warned the block's elderly that they may have to stay in lockdown till 2021 due to the new coronavirus." And in California, as seniors use more technology to communicate with others, the executive director of the Village Movement California, Charlotte Dickson, observed that EU guidance is consistent with Governor Gavin Newsom’s thinking for California and his March 15 order telling the 65+ to isolate at home: "You’re basically disappearing almost 30% of the state of California, and ageism is all about disappearing people … once you retire, you’re done. If seniors are being asked to continue physical distancing for the better part of the next year or two, divisions between generations may calcify."

Nursing homes – consternation, condemnation are words that rule the day. Rant on. It must be tough to be focal points for nursing home policy these days. Even as a task force is being set up to focus on nursing homes, on the one hand, that seems positive. On the other hand, Leading Age CEO was 'enraged' about shortages of PPE.  And seniors (AARP) who are most likely NOT in nursing homes, demand that workers have adequate PPE, that the public be notified which nursing homes have cases of Covid-19, workers are striking at nursing homes, and so on. Go back to 2019, for just a moment. What were the top issues early in the year?  "Challenges facing nursing homes serving primarily long-stay residents covered by Medicaid; workforce challenges, which are unlikely to dissipate; nursing home regulations; and the growing popularity of Medicare Advantage."

The title should not surprise. The month of April had only one subject – no matter where you looked or what you read. Covid-19 and its impact and implications, starting early in the month following event cancellations, travel bans and stampedes, telehealth insurance changes and senior living visitation lockdowns. That was followed by a collection of companies offering free services for use of their technologies in the context of an increasingly isolated older adult population in senior living communities, nursing homes and at home. But it was a conundrum: so many of those older adults lacked access to or knowledge of technology, let alone the ability to acquire it, learn how to use it or participate in family Zoom sessions. In case you missed them, here are five Covid-19 blog posts from an April that was unlike any other:

No understatement, these are very difficult times for nursing homes. First off, thousands of residents have died, and news media organizations are now obsessed with counting and re-counting, totaling up the numbers (more than 10,000 as of today) and then counting some more. So many of the 1.5 million residents of nursing homes were already very frail people, needing help with 3 or more ADLs. 72% of residents are women, most are age 85+, and as noted, 'many also have only a small group of family and friends for support.' Yet there are people who should know better lined up to bash their performance at managing this virus: "If there was any type of senior-care facility that should have been most equipped to manage the COVID crisis, it should have been skilled nursing facilities," said Brian Lee, a former Florida long-term care ombudsman who currently is a member of an advocacy group called Families for Better Care." Right.

Seniors and technology – change is in the airwaves. In ways that could not have been anticipated six months ago, the technology marketplace (sellers and buyers) for older adults is accelerating in interest level and adoption. And that is likely an understatement. Following the reimbursement changes after in-person visits disappeared and numbers of visits exploded, firms with telehealth tech are finding a one-year-pipeline compressed into one month. The odds are, not confirmed yet, that Wi-Fi deployment, donation of tablets and online video tools, are all accelerating in the time of Covid-19, which will be confirmed in a future survey. Consider six intriguing examples – please send or comment with others if you have them:

Saving seniors from Covid-19 means worsening isolation. In an article in the NY Times, Paula Span’s title said it all: Just What Older People Didn’t Need: More Isolation. The article attempts a number of references to mitigation, including the use of GrandPad in two Pace programs. These are compelling, but the overall story is about the oldest on the wrong side of the Digital Divide, which is notable and particularly pitiful in settings like nursing homes, Note in the Johns Hopkins Covid-19 guidance about nursing homes, at the very end, authors acknowledge the risk of social isolation and make a few (lame) recommendations. These do not include, unfortunately, providing usable technologies to connect isolated seniors with families. What might they be to help with loneliness? Here are six that businesses and non-profits serving older adults should provide for each of their constituents. Please nominate another six -- especially consider those with dementia.

The older adult coronavirus statistics skew toward oldest. There are more than 69 million people aged 60+ in the US. The oldest adults that appear to be at greatest risk dying from Covid-19 are not those of a specific age, but those in the oldest age ranges, particularly with 'underlying conditions.' From the CDC released April 8: Rates of hospitalization (4.6 per 100,000 of population) during the month of March indicated 13.5% of those hospitalized were aged 65+. And 90% of hospitalized patients identified through COVID-NET had one or more underlying conditions, the most common being obesity, hypertension, chronic lung disease, diabetes mellitus, and cardiovascular disease. The US statistics do what nearly all US data analysis does – 'older adult' equals 65+. But look at South Korea (in an article intended to make millennials nervous), the death rate in Covid-19 patients ages 80 and over was 10.4%, compared to 5.35% in 70-somethings, 1.51% in patients 60 to 69, 0.37% in 50-somethings.