Post CES reflection on role of technology and Alzheimer's.
Boston, mid-May, 2016
The sound of one hand clapping. We're apparently headed into a wave of hiring of home care workers, according to a new Senior Helpers study. Yay, I guess, for the job 'opportunities' for 100,000 additional in-home senior care workers in 2011. It's a good thing that the article offered up an observation by one franchise owner who "said many of the caregivers employed were middle-aged women who were in the job because they wanted to help, rather than for the money." Yes, of course. They can't be in it for the money. Note the Bureau of Labor Statistics about the fastest growing job occupations. Note the only one with an annual average wage below $20K -- yup, that's the personal care worker, one of the few on the list with only 'on-the-job training'. One in three have no health insurance, which for a single individual (healthy) under the age of 65 requires an average premium cost of nearly $3000. And sure enough, the industry is lobbying to be exempt from requirements to insure their workers, also admitting that for those who are currently insured, that the coverage “is probably not up to what will be required.”
So getting to the point, this blog is about technology. Industries change very slowly, and the home care industry, with its labor-intensive model, limited oversight, limited pay and 'on the job' training, may be no different than other industries with supply-demand pressure. If you stand back and observe, however, this industry has that 'frog in cold water' feel -- surrounded by change but not able to detect it or even be sure what it is. The surrounding cold water is a population aging at home (5 million need services right now, according to a new AARP fact sheet). These folks have a longer life expectancy, higher expectations (we hope) from family/observers as to what constitutes adequate care, and lack of payment sources for extensive middle class home care (see Medicaid eligibility rules in the AARP fact sheet) or senior housing. And let's not forget the price of driving to the home, which right now must be amazingly painful. What does this industry need most, besides more workers? How about an aware and information-sharing consumer base, creating national transparency even when service is local. And this must be online -- where the customer and provider are present in the same forum. That way a critique and the response to critique are co-located -- you know, like hotel reviews on a gazillion websites. If you know a website with a well-populated trove of actual consumer reviews of home care, please advise.
Health IT soldiers on toward telehealth adoption -- the computer will see you now. Sure thing, the sheer cost and inefficiency of the health care system has spawned an industry of hopefuls, expecting to exploit camera and monitoring tech advances so that the patient doesn't have to go to the doctor. In the US, this technology is inextricably tied up with reimbursement. But it is inevitable that patients will be remotely monitored at some point and somewhere simply because the doctors and health centers they may need are elsewhere. And so too are family members -- elsewhere, that is -- when it comes to home care. Can reviews of home care organizations expose some information about how they will keep people informed (including friends, aging cousins and siblings, not just their children -- think CaringBridge. Let's expose criteria used to ensure that caregivers are background-checked. If the organizations become more efficient as a result of better communication with family members, smarter scheduling, tech-enabled medication management (as an example), use of webcams, motion sensors and other efficiencies for monitoring and exception-based alerting -- then shouldn't care evolve and be optimized, with more pay available for the most important resource, the home care worker?
The only way an industry changes is if the ultimate consumer insists. The disconnect between job growth, pay, and need will be closed, not just by demand versus supply, but with the assistance of well-honed processes and technology assistance, appropriately placed. How quickly that happens will depend on industry consolidation and a large number of consumers raising their expectations. What will it take to raise expectations to a level demanding a more structured and transparent process? Because of the fear factor that many family members struggle with, they possibly believe they can't complain because then workers might take it out on their relative. Whether that's true or not, speaking up later would would still help make a difference, after a relative is gone. While obviously late for their loved one's care, they would still be in time to impact an industry that is growing, but it does NOT appear to be thriving.