Aging and Health Technology Watch

The articles are beginning to appear here and there.  In the time of Covid-19 lockdowns, some are talking about an increasing use of technology in their nursing homes. Others are discussing the race to enable ‘televisits’ -- noting outreach from AARP to CMS to boost the requirement for enabling technology in nursing homes.  And numerous other articles have appeared that showed nursing homes receiving donations of technology. The State of Florida gave tablets to 150 nursing homes. The attorney general of Massachusetts supplied 750 tablets to nursing home residents. And Texas provided $3000 per Texas nursing home for tablets, webcams, and headphones. The pictures associated with some of these introductions of technology were bleak. Fortunately, some states are now allowing families to visit residents in designated areas outside.

Will results change when older adults are surveyed later this year? So we know that ‘remote care’ and ‘caring’ in its various forms, including telehealth, seem to be heating up as a priority, whether for senior living organizations, families, healthcare provider organizations, and putting more emphasis on the need for home healthcare and home care, especially in times in which the care workers hesitate to enter a home and which families are locked down and not visiting.  Here is where we were on technology adoption at the start of the pandemic, and the wave of telehealth interest heated up.  As one tech company told me, a one-year-pipeline compressed into a month of demand.  And a plethora of companies raised their hands to offer their engagement technology for free.  So if this is the baseline of adoption, what’s next when the surveys come around again?

May was an unmerry month of angst and abject failure. All around, we have been locked down beginning in March. We have been incredulous, watching older adults die alone in a nursing home, and then dying in many nursing homes. Then half of the 30 million small businesses shut down temporarily. Then hospitals limited admissions in anticipation of an onslaught – and limiting their revenue-generating business – and some shut down completely. And on and on. In May came the trickling of re-openings and beginning of renewed life, though very different from that previous life.  We wait and watch to see what will be different, especially for older adults and their access to technology, moving forward. Here are six blog posts from a May unlike any previous:

Technology usage has climbed sharply during Covid-19. Pew Research notes 53% of responders in April consider the Internet as ‘Essential’– although, no surprise, the oldest did not. And Nielsen observed that the pandemic was a catalyst for the rise of tech use for working at home and shopping, among other uses. In addition, telehealth usage has skyrocketed, with virtual doctor visits expected by Forrester Research to top 1 billion by years end. The spike has been attributed to a) the declaration of a state of emergency in March; b) introduction of Medicare/Medicaid coverage matching in-person visits; and c) encouragement from hospitals and medical practitioners.

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: