Care at home – the continuum of oversight needs a reality check

 Okay, okay, we get it – everyone wants to age at home.  How do we know?  AARP say so. Forget that AARP’s survey sample might be skewed towards the younger end of fifty- and sixty-somethings, not 80-90 year olds. Forget that life expectancy is lengthening -- the good life or the not-so-good – apparently indistinguishable among the life expectancy extender-types, aka the healthcare system.  Forget that this is a gloomy and isolating picture for those with limited transportation in their 80’s and 90’s, those living alone with mild to moderate dementia, and those for whom it is a great chore just to get up and about. 

Tech and service vendors (want you to) believe home can trump assisted living.  So if one more vendor tells me that the monthly cost of their (monitoring, sensor, chronic disease checker, whatchamacallit) subscription service is one-tenth (one-fifth, half, or whatever) the cost of a month in assisted living, I may just lose it. Does their product/service offer up group activities? Trips to the park? Shared dining experiences?  Redirection and therapy programs for the mildly disabled or those with dementia?  Is there a dietician on staff?  How about an activities director? Need I go on? This sales pitch is designed to make adult children and the vendor feel self-righteous, but all that their products do (hopefully) is in the specs – sense this and track that, and hopefully forward the info to someone who can react. Someone who can react is certainly an improvement over no reaction, but on the continuum of oversight, it skews to the left.

Home care is booming and there is a mini-boomlet in home care tech.  From Ankota to Virtual Health, from Intel/GE Care Innovations to J&J and Philips, to other startups talking to me about standardizing workflow processes for home care agencies and home health care  – the home is where it is at and will be for a while. Pendulum momentum is all in that direction and even the senior housing folks must recognize and acknowledge. So let’s see the vendors fill out all four quadrants (partnerships and referrals are fine, no need to create from scratch) of successful aging at home. Think and talk about communication and engagement (beyond talking with the doctor!), health and wellness (telehealth folks, please partner with fitness tech), safety and security (PERS is not dead – but amazingly non-mobile and minimally linked to telehealth or the xHealths). As for contribution and learning, well, that segment of the world which depends on improved tech communications capability for older adults – is, well, in another world.

Imagine the caregiver – home or professional – overwhelmed with tech options. For those lucky enough to have an engaged family or professional caregiver, let’s consider how absolutely daunting it must be for caregivers to discover that they are a growing target market – the bottom apex on an inverted triangle of software vendors, services, platforms, and mobile tablets and tools. Consider the approach of plotting a continuum of frailty for home-based care recipients, mapped to a continuum of care, mapped to a continuum of supporting technologies and fill out that map for yourself and your prospects, or the marketplace if you are considering what to buy.  Look at the fragmented telehealth solutions being assembled (and I use that term loosely!). And if that seems daunting, check out the Market Overview, last updated in May, on this website.

Seniors Aging At Home

Seniors want to age at home for many reasons, probably the main reasons are independence and remaining an adult, not a child. Yes, some seniors/elderly people must move on to assisted living or group homes or nursing homes, or living with their family members. But whenever possible prefer to stay in their own homes. What takes away their independence? First and foremost not being able to drive anymore themselves or not having a spouse that is able to drive them. When this happens seniors/elderly must either depend on their children or other family members to take them to doctors and shopping or rely on transportation services that can be expensive and time consuming. Also, if the senior lives in an outlying area there may not be a transportation van that comes to their area. Without transportation, loneliness can set in and depression. As long as they still have transportation other independent living aids can be added to the home as necessary. First of all, the home should be a one floor residence, or if a 2 story, then a bedroom with bathroom should be set up on the first floor. You may notice that mom or dad, grandma or grandpa keeps saying they can't get through to the doctor's office, or they are showing up at appointments on the wrong day or time. This could be a simple case of having a high tech phone that they don't fully understand, or they are hard of hearing and can't hear the instructions accurately on the telephone. In this instance, purchase a very simple, amplified phone. Are they at a risk for falling? Then have them use a walker and buy them a side pouch and or a walker tray so they can transport everything from food and beverages to a small stack of laundry from room to room.

There are also emergency alert devices they can wear so that if they fall they can push a button and reach 911 or family members, some without monthly fees. There are also stand assist products to help them get out of a chair or sofa without requesting help, and grab bars for the bathroom. But now we are back to that all important transportation. When seniors/elderly have limited access to transportation then they are at a real disadvantage, and then the next step to consider is the group home, assisted living, moving in with family or if medically necessary a nursing home. First of all scout around and find a few of the best in each group - then take them to visit. Your senior/elderly family member may be completely against leaving their home, especially if you take them to something that seems cold and institutional, or smell like a hospital. But if you take them to places you have visited that meet your expectations first and they see the guests talking to one another and sitting together at tables socializing - they may actually feel that this socialization, and ability to have friends may actually be better than sitting in their own home independent, but lonely. I have read recently about some of the newer group home designs that seem senior friendly. These group homes only house perhaps 5 or 6 people, giving them the feeling of a home, not an institution. They have individual bedrooms with bathrooms, a dining area with a large kitchen that opens to the dining room so the staff can watch them and the seniors can see food being cooked and talk to the staff - giving a friendly, homey atmosphere. These are worth checking out.

One of the missing pieces to aging at home is socialization.  My mother(89)  and her husband(86)  moved out of state to be near me, but she misses her "group" - couples that were in a widows and widowers group.  There doesn't seem to be anything out here in the Phoenix, AZ area like what she had in Ohio and she really misses going to dinner with friends.  There needs to be more organized groups to allow socialization among seniors and the elderly.  There are of course, Senior Centers, but that isn't what all seniors are looking for.  She and her husband live in a 55+ community, but even that doesn't seem to offer the kind of socialization she is looking for.  They go down to the pool and no one is there, or they go to the exercise room to see if there is someone to meet and it is empty.  Some seniors just want a group that they can meet with for lunch or dinner, or an occasional movie - this keeps them socialized and having something to look forward to.  If aging at home means just staying in the house all the time, that isn't good either.

We are in a world that keeps

We are in a world that keeps on revolving, engineers and scientist continue searching for new technology, cure for illness and a lot more.. internet i would say a great help specially with communication because there are families that dont live together internet is the quickest way to do that. No need to wait for days or weeks for the mail to get through to your loves but yes it is not an easy thing for elders or adult. They may not learn it all but at least something they can use everyday.

Good post, but I don't get one piece.

"As for contribution and learning, well, that segment of the world which depends on improved tech communications capability for older adults - is, well, in another world."

What does this mean?

Surely you can't be saying that the coming technology can not be engaging and instructive and helpful? In the preceding sentence you allude to some very exciting tech for elders, e.g. fitness tech as part of telehealth.

I get the, the primary thesis - that the extent to which technology alone can be THE answer is way overstated by the breathless hype of the vendors in the space. That's an important point, but to say that tech can't help with contribution and learning is also overstated.

What I was trying to say...

The point I was making was to look at the penetration of use of PCs and internet access among the oldest age cohorts (80's and 90's), It's is pretty low for these seniors to participate in online learning and online mechanisms for online learning, volunteering and working. Taking survey numbers from Pew Research's Generations and their Gadgets, 28% of adults over age 75 and older use a desktop, 10% use a laptop.  However, Internet access has been growing each year.  

What about 5 years from now.

Thanks for the clarification, Laurie. I get your point now. I agree that the numbers aren't super compelling today, but as you mention the trends might be. I think many people in this space are getting in "ahead of the wave" and are thinking about what the playing field will look like 5 years out. If elder populations increase by 30% and adoption rates double, there is a real market there.

As emerging markets go it's all changing pretty quickly. If technologies can bring positive results and cost savings adoption will be facilitated. I'm also hopeful that usability improvements from tablet UIs will speed along adoption rates too.

It doesn't seem like a crazy idea to me for companies to start working solutions now to gain an advantage (in IP, patents, etc) in this space. There is little doubt that it will arrive whether it's 3, 5, or 10 years and the winners will do very well.

Very interesting point

Hi Laurie,

Interesting point...we hear so much about "Aging in Place"...I think you've appropriately presented the other side to the story. Something for all of us in healthcare to think about.

stay in home vs stay in enhanced independent living

I came from marketing PERS(emergency button) to marketing Independent Senior Living. You are so right- the pieces that are missing to the Aging in Place is that it needs to be a community setting where there is companionship, activities, staff who are like extended family, services in place to help prevent injury and so much more.

I feel the same way about the decline in cognitive function also. I worked for years trying to get a widow to move into our independent living which is also closer to her family- she loved it here but was resistant. Now she's developed dementia and the family has placed her in assisted living. There was so much she could have enjoyed here and maybe it would have stalled that onset.

Thanks Laurie for writing these kinds of articles.

Linda Kunicki
www.LaGrangePointe.com
Go to our website to see the Health-e-Care system being piloted at LaGrange Pointe

Home versus Assisted Living

Your comments in this article are EXACTLY RIGHT! Realistic! I was a long distant caregiver for my 80 year old father and now my mother, 93 old (yes OLD, she is NOT 93 years old YOUNG) is living at home with serious dementia and 24 hour care (private pay). It is a NIGHTMARE and I truly believe this now, that after my father died, my mother would have been much better in assisted living--she has no one her age around her all day socially and I believe (no, I know) that my mother's dementia accelerated BECAUSE she DID stay at home. Friends stop calling when the word "dementia" or "Alzheimer’s" are part of the picture--it is truly amazing! Technology can't fix this situation; unfortunately death is the only option. Sad? Maybe, but realistic!
TECHNOLOGY VENDORS - you try leaving your elderly mother, grandmother alone while you watch her wander at night and then go turn the tea kettle on the back burner on HIGH and walk away...You live 350 miles away and are watching this unfold on your iPad...then what?...you can only call the neighbors and police so many times until YOU become THE BURDEN!

Integrating Technology in Senior Care Management

It may sound overwhelming for those who are just starting (or even those that already did) in home care business. Some business owners are always on the lookout for management toolkit that will improve their business by saving money, enhancing efficiency, and attracting new clients. The technology of care management software is fast becoming an indispensable tool for many senior care agencies. While you may be convinced that a 'smart' care management solution is best for business, the challenge is how to convince your employees and clients of the same.

Right on, buddy

Laurie, I love it when you are right, speak your mind AND agree with me. Would anyone buy a steering wheel and think they could use it the same way one enjoys a whole car? No way. Until people can buy comprehensive and integrated services delivered through a dynamic system they can rely on aging in place will not be a realistic option. When it happens we will call it Aging in Place 2.0.

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