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Laurie Orlov's blog

The doctor and staff are remotely controlled – literally

Crises drive health innovation. The presumed potential and much-publicized looming shortage of doctors is worrisome – or at least their lopsided geographic distribution is a concern. Or there are not enough medical schools to train new doctors. Or doctors are tired of being doctors.  Or is it the problem of keeping down the cost of actually seeing a doctor or a nurse practitioner? Is it that population health risks drive the need for improved chronic disease management?  Is it that there are or may soon be so many new patients? Or is the problem one of wasting the time of so many human staff in a hospital doing back-breaking and/or mundane tasks?

Aging in What Place – Oversold concept or the refuge of denial?

The Washington Post article about aging in place was, uh, provocative.  It provoked me, anyway. The concept of aging in place has been oversold, says Professor Stephen Golant, author of a new book called less provocatively Aging in the Right Place. The Post encapsulation included a few gems from his book, noting that seniors who prefer to age in place have 'residential inertia' --  and paraphrasing their thinking as 'I’d rather rot in my own home.'  The premise that the concept was oversold to the public, however, makes a nice headline, almost sounding like a marketing campaign -- but that simply is not what has happened in the recent past. What else was going on?

Technology and older adults, new studies, but no news

The more studies emerge, the less news there is.  Rant on. You probably have read it in university study after university study. You probably read those milestone surveys from AARP, Healthy@Home in 2008 and Healthy@Home 2.0 in 2011.  Maybe you read the Linkage Study from 2012. All of those studies report the same thing in one way or the other: Seniors would like to benefit from technology to help them manage their health and stay longer in their own homes.  They listen to news and echo the buzzwords, they worry about costs. But do interest and willingness make a thriving market?  However, you will be reassured that large consulting firms and banker studies agree:

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For seniors stranded by geography, improve service and technology

The census highlights difficulty for family caregivers and the 80+.  Last week we posted an analysis of US Census data revealing those locations in the US with low Caregiver Support Ratios (CSR) – in other words, seniors aged 80+ stranded with limited care availability. CSR (discussed in this landmark AARP report) represents the population aged 45-64 who could (though they may not be) able to help seniors aged 80+ and includes both family and professional caregivers.  The AARP report indicated a current nationwide average of 7 people available to help care for 1 person aged 80+.  The report warned about those future years when baby boomers turn 80 and the ratio drops to 4:1 and lower. However, further analysis reveals a current potential problem in locations such as:

Stranded by geography: today’s caregiver support ratios and the 80+ population

Now is the winter of discontent. Neighborhoods disappear under the weight of snow piling up and billions of dollars are adding up in lost business (think car dealers and restaurants). But what of mitigating the isolation and providing care for the elderly, especially for those seniors aged 80+, living in communities overwhelmed by bad weather? Is the likelihood of having family to help related to geography? That topic was addressed by state in the August, 2013, AARP INSIGHT report, The Aging of the Baby Boom and the Growing Care Gap, introducing the term and an infographic for the caregiver support ratio (CSR) – "the number of potential family caregivers aged 45-64 for each person aged 80+." The report prediction: given future population changes, CSR would decline from its 2010 level of 7 potential caregivers for each person aged 80+ (7:1) down to a ratio of 4:1 in 2030 and 3:1 in 2050. Today, those low ratios have been reached around the US – in both locations that are warm…and snow-covered.

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Caregiving technology needs a version 2.0 upgrade

The dilemma of distance -- boomers have parents who live in, for example, Florida. The oldest boomer is 69. They’re not all that healthy. The still-living parent(s) may be even less healthy. In this age of medical specialization and long distance families, many aging women living alone: they need to see doctors, perhaps multiple doctors. Even if the children of aging parents live nearby, experiencing enhanced intergenerational proximity (!), the aging parent may ultimately live alone. With life expectancy for woman now averaging 88+, it is safe to say that older boomers are still involved in coordinating the care of their aging parent/mother. And they’re doing it from a distance – since the boomer woman with a career may not reside in Florida. Consider that Florida is now on track to become the 3rd largest state – with population growth primarily from migration. The state now has a median age of 74 for its 65+ population, one-quarter of that population widowed. But the dilemma of distance criss-crosses the country from California to Maine, from upstate New York to New Mexico.

The CCRC concept is an ageist nightmare -- and it’s not just the name

Maybe you have Ann Clinton stuck in your mind too.  This woman and her husband spent $351,424 plus $4600 per month for the 'security' of having access to the continuing care of a CCRC. The 'continuing' of the CCRC was in one direction – she discovered that returning in a motorized wheelchair from the nursing home section to the independent living bingo game engendered big protest – from the other residents as well as management. You may have seen this yourself – people putting wheelchairs and walkers at a dining room door and limping in so that they could eat with friends in the 'independent living' dining room. These are well-documented -- if not well-understood -- policies. The message, perhaps constructed by CCRC marketing?  Independent living residents don’t wish to see people who are not as 'independent' -- or at least who don’t appear as independent as themselves.

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2015: From Niche to Norm -- Technology for Aging in Place

What is the line between a distinct product market and tech customization?  In 2009 when the original Market Overview was published, the search began to identify the small group of entrepreneurs focused on serving seniors – from the AirGuru SV1 Video Phone and Big Screen Live all the way to WellAware and Wellcore.  Why note such a market, you might ask? All of those companies and many others had the heart and focus to try to craft something usable by and for an older adult. In many cases these were inventions compensating for a gap in care and oversight, but most often filling a gap in internet access and/or usability of devices and software.

Five Recent Technology Announcements for Aging in Place

There is more to the world of aging-related technologies than CES. Seriously, can that be true? And yes, I actually know several people who asked me in the past week -- what is CES? My explanation was weak -- there were no follow-up questions. Anyway, these five companies that have been focused on technology to help older adults made recent announcements of changes to their business strategies, products, and/or branding approaches. Each in its own way offers a milestone for the industry -- but taken together, the announcements demonstrate a focus on the older adult population and new ways to deliver benefit for them by providing additional products, service innovations and partnerships during 2015. Text comes directly from company websites:

CES 2015 Part 3 of 3 – Six more innovations useful for older adults

So many companies, so much press.  So far, even though the gadget gadfly media has produced multiple post-CES articles, they are mostly of the gizmos-for-you and even for those health tech companies like Withings, press caught them in the activity-tracking ‘fun’ wearable category. Some write-ups were good visual tours, and some press folk offered up a ho-hum, nothing new to see here view, like the NY Times – Everything Old is New Again. Which is silly. There were a gazillion new things to see at CES, but no way to make sense of them. The floor layout in both convention centers we were in could best be categorized as dart board random -- except for booth numbers and mega-broad categories. So to finish off this trilogy of post-CES blogs, Part 1 addressed a few tech offerings in the aging-related space. Part 2 took a look at a few of the health-related technology innovations. Finally, a few others that could assist in the older adults market, here some additional picks, only OnKöl and VideoforAlle targeting the senior market. As Ars Technica noted about CES 2015, that's a wrap.

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