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December 2013 Year-end Wrap and 2014 Trends to Watch

2013 was a year in which issues percolated all around the world of older adults – health insurance and Medicare media interest dominated, but senior housing also made the news, caregiving received some exposure, and new tech to mitigate hearing and vision loss emerged. In terms of trends that could, would, and should impact the technology worlds of older adults, much has happened and more is ahead. From specific initiatives to government policy implications, the markets (money, innovation, and consumer interest) show signs of aligning in ways that can only benefit boomers and seniors. Here are trends that signal change:

Go forth and incubate. 2013 was the year of the boomer-senior incubator and competition.  Of course it was also a year of irrational venture capital exuberance, the lemming-like stampede of mHealth investment in startups and early stage companies. But while VCs clipped on their Fitbits and took their portable blood pressures, a smaller but notable parallel wave was underway -- incubators, accelerators and competitions focused on the boomer-senior market.  Anchored by AARP’s Health Innovation @50+ efforts to round up and encourage startups, other organizational efforts began popping up, including AgeTech West/LeadingAge, Aging 2.0 GENerator in San Francisco, AgePower in Minnesota, InnovateLTC out of Kentucky, Link∙Age Ventures from Ohio, and Institute for the Ages in Florida.

PREDICTION: This one is easy – more organizations will hop onto the boomer-senior innovator bandwagon. Angel investors have long been the backbone of funding for products targeting older adults – many startups and their backers fueled by that powerful 'It's about my grandmother' emotion.  But VCs, even though they have grandmothers too, have traditionally steered clear of boomer-senior and caregiving related offerings. (One caregiving startup exec noted an oft-repeated VC refrain: "I really hate this category.") Times change – Maveron LLC backed Lively – 2013's exception to the rule. And Care.com of the pet-sitting and babysitter markets, now declaring leadership in the senior caregiving market, will soon go public. But that site (along with many others) will unfortunately be about FINDING care, not vetting its quality. It is a comment on non-existent care oversight when home health care organizations and senior housing start voluntarily seeking independent accreditation.

Train seniors everywhere. 2013 was a year that tech training of seniors became visible, helped by the ubiquitous and relatively easy-to-use tablet and AARP. SeniorNet, libraries and senior centers have long provided volunteer-led tech training, but 2013 was a remarkable year for launching multiple initiatives, large and small. The iPad (and tablets in general) proved viable for older adults and thus training programs have blossomed. AARP’s TEK initiative was a tech-training splash at their Life@50+ event – engaging Philip Jordan and the traveling Senior Tech Rally effort he began in 2011 and has now converted to LiveTech, New tech training centers like the OATS Senior Planet Exploration Center in New York, Seniors Teaching Seniors (Orlando), and training programs in San Francisco, Delta County Colorado’s No Senior Left Behind, and AARP Foundation’s effort in Sioux Falls

PREDICTION: Hopefully with AARP TEK, the related Mentor Up program of young volunteers, the plummeting price of tablets (maybe the $49 Walmart tablet price was a bit too low), training programs all around will be even more widespread in 2014.  But without cheaper broadband plans, these new users are consigned to what I think of as crowded 'restaurant Wifi' – all Starbucks and Panera, but no home access – like learning how to fly a plane, but never owning one. An exception -- FreedomPop is trying to make the Internet more accessible. Programs like Connect2Compete, however, are only focused on children. According to a new study, high speed home access in the US is 100% more expensive than in Europe. For those older adults on fixed and/or low incomes, high speed access is just not happening. Lack of competition among carriers is one excuse. Are there other issues?

Smart phones are bigger but still lousy as phones and keyboards. Visiting a pair of active seniors this past week, both proudly sporting Samsung Galaxy S3s, they are still baffled and bamboozled by the devices, particularly camera and picture management: "I’ll just go back to the Verizon store tomorrow and ask.” I shudder to imagine folks out there getting an even bigger phone – you’ve seen the Nokia Lumina I presume – one of the largest screens and smallest market shares on record.  But maybe the flip phone will come back as an add-on device – Samsung thinks so. Of course Samsung also think a smart watch is cool. Maybe not in 2013 – but wearable TVs may show up in 2014.  Danger, sidewalk walkers. And you think cell phones are a driving distraction? Watching a Google Glass wearer talking to himself at a recent event was an eye opener for me - and not in a good way.  And typing on glass still, well you know, needs an auto correct.

PREDICTION: Boomers and seniors will sit out the smart watch, giant smart phone, Google glassy, 'driving under the Internet' hoopla in 2014, but as with all innovations, version 2 may emerge by next fall and actually be useful – how about a detachable feature phone-like thing for whatever is next in smart phone 'innovation.' Who knows, maybe it will be released in January at CES. Stay tuned to this channel. As one who keeps downloading new keyboard software, we want real keys to text on – maybe we’ll get them.

Wearables want to be worn.  But they must do something useful that makes us (and not just investors) interested in their existence.  In the exhibit hall at mHealth, there was the pairing of FitLinxx with Spark People. Activity trackers like Fitbit can be integrated with MyFitnessPal and Nike Fuel is integrated with LoseIt.  But of course, you have to have a way to upload the data on your smart phone or home wireless network. Oops -- thus there is another divide between the on- and off-line  infrastructure for baby boomers who want to weigh in.

PREDICTION: The mHealth shakeout will be big in 2014 – how could it not with so much hype?  There are too many apps, too few downloads -- and viable business models are still elusive. That may change during the coming year. Perhaps the beleaguered doctor and staff will become enthused about health tech usage in the homemaybe even for seniors and their families (though I doubt it). Ahead of us there are many health-oriented events, so we will likely find out who the target market is – and whether seniors are in the mix. Ironically, the mHealth crowd has not noticed the large installed base of PERS (likely 3 million seniors), its fit within the older adult market opportunity, the growing percentage of that market that is becoming mobile (likely up to 20% by end of 2014). PERS vendors were markedly absent in the Exhibit Hall at the mHealth Summit.

By the numbers, seniors want to remain at home – but who will provide care? Switzerland has been ranked the number one country for care of the elderly, but the price of dementia care makes some residents leave. And not just from Switzerland.  At an average of $41K per year for assisted living in the US, the sale of an average home in the US of $272K does not enable early move-in, especially for a married couple. According to the industry, however, cautious building of new units has kept overall occupancy high at 89%. Besides the cost of residential care, family caregiving is coming under increasing pressure; home care is pricey at $51K/year full time on average (never mind turnover and vetting), and we are headed for trouble from a population perspective – as boomers age, fewer people will be available to provide care. However, home care and home health workers received minimum wage and overtime protection in 2013 and so far, the world did not end.

PREDICTION: Still not much resident-oriented tech deployed in the senior housing industry and no sign that the home care industry is focused on equipping either workers or care recipients with technology in the home.  However, we have not seen the true impact of potentially changing Medicare/Medicaid coverage, doctor shortages, or the corresponding demand for low-cost 'telepresence' -- aka remote video consultation either in the home or senior housing – although remote consultation via roaming robots seems to be of interest to rural hospitals.  In fact, 2014 may be the year in which all of these trends begin tipping. From a resource perspective, too few medical professionals and too much demand will intersect.

Hope -- not a prediction: are free online courses a motivator to help get seniors online? An enormous library of learning has opened to everyone for free -- these are the MOOCs -- the Massively Online Open Courses, offered by Harvard, Stanford and many more.  These are not limited to computer science courses -- but include literature courses like this Shakespeare course at Harvard or a plethora of content found through this compilation across multiple schools.  So are there seniors in any of these classes?  Nope. Mostly male (88%) and the participants are in their 20s and 30s. Bless the 100,000 signed up for Stanford's AI course, where a professor quoted in today's NY Times admitted that knowledge about AI and the brain is extremely limited, even today, even since it was first hyped in the 1980s.  Hopefully the 700+ in-person attendees find what they need.  But why not recruit MOOC participants in lifelong learning programs at universities around the country -- like Stanford's, Harvard or Berkeley -- home of three of the largest MOOCs?

NOTE: This is the first month introducing a newsletter edition where it is possible to incorporate sponsored white papers! See this newsletter that includes a white paper about dementia care and It's Never 2 Late (iN2L).


I appreciate your insights and predictions for 2014. Do you have any thoughts about the technology impact in 2014 on nursing homes and home health agencies when the hospital systems and physician practices they do business with are faced with Meaninful Use Stage 2 requirements regarding Transitions of Care? It would seem that every hospital and physician practice working to meet these objectives will need to begin exchanging information electronically with those that care for their patient after they leave the hospital or physician practice. Do you think many LTPAC organizations are even aware of the need for Direct Secure Messaging as replacement for fax machines to exchange this information?

Jim Younkin, Director, Information Technology at Geisinger Health System

A couple of points, last one first: LTPAC organizations: EHR would be first on the list for them but the degree of implementation depends on size:

* in Maryland LTPAC:


* in largest senior housing organizations per Leading Age survey:


As for Direct Secure Messaging to replace fax -- no one has surveyed that to my knowledge -- but I strongly doubt that anything electronic has replaced fax to communicate with doctors post discharge -- unless long-term care organizations are part of and on the same system as the hospital or practice. That is possible, but unlikely.

I was surprised to see that remote caregiving was given little berth in your prediction: "Still not much resident-oriented tech deployed in the senior housing industry and no sign that the home care industry is focused on equipping either workers or care recipients with technology in the home."

Here in the Santa Rosa area we are featuring remote caregiving through our agency and see it as a way to take care of seniors using technology and less cost. I think it will be a bigger procedure than what you have predicted.

Still this is a very good article overall. Thanks for writing it.

Glad to hear that your agency is taking advantage of remote caregiving technology -- I have inquired of a few nationwide organizations over the past year and have been given no indication of growth in adoption.  It would be great for others who are considering remote caregiving if you mentioned what you are using.