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The Harvard study describes a bleak care future. And the NORC study underscores the housing problem for the Forgotten Middle. Life expectancy for the 65+ is another 20 years on average.  But only 14% of Americans can afford long-term care in the home. And if they could afford it, only 4% of their homes are aging-ready. Nor are they telehealth-ready – where 36% of Americans do not have high-speed internet in the home. For low-income individuals, home and community based services may have a 3-year wait to obtain them. Further, 42% of women aged 75+ live alone. 

The more technology changes, it’s a step back for some.  You probably think the inevitability of tech change is mostly positive. And in a macro sense, maybe it is. But for some older adults, it’s one negative experience after another. The closing of thousands of bank branches in favor of online banking, the elimination of paper social security statements, the near-elimination of paper savings bonds for the grandchildren, and the ubiquitous introduction of the QR code in restaurants – saving labor.

The report is published, the feedback positive, observations strike a chord.  Necessity will drive AI usage in care work across all five care types (healthcare, home health care, home care, senior living, and Skilled Nursing Facilities). Issues of worker shortage, staff burnout, or migration of care work into the home will result in broader deployment of AI technology (whether explicitly or inside other software tools). And regulatory initiatives will help overcome trust issues for consumers. Over the next few years, care organizations will make more disciplined use of their own data that an AI technology such as a chatbot can access or present to a caregiver. The changes that are most likely within the next five years? See today-future comparison chart below and check out the report here.   

What a week – chaos at OpenAI plus the rise of scam innovation. This weekend exposed a conflict at OpenAI, the November 22, 2022 bringer of ChatGPT, between the board that wants to develop AI for good and perhaps another view, AI for commercial profit.  Sam Altman the founder is fired, begs to come back and instead is offered a job and a team at Microsoft (the other big funder of OpenAI.) He agrees to go to Microsoft and 700 of OpenAI’s 750 employees threaten to quit.  Guess they weren’t big fans of AI for Good.  Microsoft, which committed as much as $10 billion over time for OpenAI, might think AI for Profit might be a better strategy.  Watch for the next installment of this very public soap opera.

What changed in technology adoption of older adults? Ranting about technology adoption 15 years ago, it obviously was a different world.  There were dedicated email devices (Presto, Celery, Mailbug) – clearly the standard personal computer was not too friendly. The Jitterbug phone addressed the problem that cell phones weren’t too friendly, and the concept of ubiquitous access to the Internet through easy-to-use browsers was a glint in the innovator eye.  People still shopped in stores – the Mall of America was thriving compared to strip malls, bookstore sales were at their peak – not yet traumatized by Amazon. Facebook introduced Live Feed, wrecking Myspace.  Banks still had branches, the drop of 1700+ branches hadn’t happened yet, no doubt because the 2008 market crash hadn’t fully kicked in.

Trends worth noting about care work. You know the statistics and they are alarming. Doctors and nurses are burning out, especially in the ER. Turnover is highest in the lowest-paid care positions – home care is at a high point at 77% as of 2022. Pressure is growing in senior living to ‘keep people well’ in conjunction with a higher level of acuity of care needs. Demand and costs are up, and availability of workers is down. What will drive innovation in care?

Why AI will be an enabler for care work. Healthcare delivery is migrating away from the hospital. As care delivery and consumer expectations change, the traditional fee-for-service model has already morphed into the new era of health-care consumerism – a patient-organized mix of self-care, urgent care, and in-home care, avoiding emergency rooms or long wait for a doctor visit. More seniors used telehealth at home during the pandemic – and today the landscape is set for growth in the use of AI in care delivery to augment, assist, and in some cases provide care:

For those few who still have landline phones, scammers make them ring. It has become a source of entertainment in our home to string scam callers past the bot to the frenetic-sounding call center. Or we just let the phone ring 3 times – bots have limited patience. But there is one benefit of having an actual conversation with a call center rep, as well as watching TV Medicare Advantage advertising. These unsolicited caller scripts (‘is anyone in the home between the ages of 65 and 85?’) and ads are built on stereotypes of older adults (mostly women) and the premise that they are just plain stupid. Apparently they can’t do their own research and are desperate for advice. By the way, if CMS is ‘restricting’ Medicare Advantage plan advertising, that is not yet visible to a TV viewer.  

What is care coordination and why is it so elusive? Catching my eye – a relatively new company, Sage, offers a ‘care coordination’ platform for senior living, just received another $15 million. Sage apparently launched in the context of replacing the traditional PERS pull cord alerting system with rapid communication and updates through software. The term, care coordination, is vague and depends on context. But at its core, it means sharing information about care recipients across disparate care provider entities. Inside senior living, that may mean across members of care teams (was that not being done?), as well as across an senior living organization, with outside service and health providers and with families. 

The US population is aging and will be needing more care. You read it every day in the popular press – the bad news about the 65+ and their future care burden and the good news about the 65+ and their wealth (22% of US spending in 2022). Even with wealth, older adults at some point in their lives will need some level of assistance. While professional care providers will play a key role, increasingly their work will be augmented by software -- apps, machine learning and conversational AI. Why?