Laurie Orlov's blog

The halfway point -- research about Future of Care Work. Each interviewee was asked for thoughts in the context of the categories suggested by ChatGPT and any other categories that will improve the work processes for those in the care-related industries – home care, home healthcare, senior living care (including nursing homes), and hospital discharge processes to any of those. Few conversations focused on ChatGPT – instead it became apparent that innovation, including AI, is underway to optimize care work, focus on the workforce, and help keep care recipients at home:

You may know someone of Medicare age with a phone?  Since age data is widely available, and even well-organized lists are available for purchase, it is not surprising that phones of older adults ring multiple times per day. Did you know that 60% of all phone calls in the US are robocalls or spam? This, despite ostensible government efforts to prevent continued use and/or resale of the lists. Sometimes the call begun with a recording about possible additional Medicare Advantage benefits that are available. But this is sloppy scamming based on weak data – maybe the caller only knows phone numbers, despite spoofing the geographic location so that it appears to be a neighborhood call.  Next, the robocall is then transferred to a ‘supervisor’ in a noisy call center who then attempts to obtain actual age, and whether the call recipient has Medicare. Presumably after that step is successful, the so-called ‘Medicare Advantage’ pitch can begin.

It's news -- 600 nursing homes closed so what’s the strategy to fix? Rant on.  You may have read a depressing article this morning in the Wall Street Journal about the number of people stuck in hospitals with no place to go because there are no nursing homes to take them – which is the status in the UK’s National Health System (NHS).  That was an embarrassment in the UK – and this is a scandal in the US. It never should not have gotten to this point. So many factors crushed nursing homes -- Covid and Private Equity nursing home ownership were big players, followed by government strategy to undermine them. For 14 years, Florida banned new nursing home construction. The federal “Money Follows the Person” was introduced in 2005 to enable seniors to avoid them and receive Medicaid-paid services. Reauthorized repeatedly, it is now authorized through 2027. 

Social isolation has become an insidious problem among older adults. It’s at the point where the surgeon general recently declared it to be a serious health risk: "29% increased risk of heart disease, a 32% increased risk of stroke, and a 50% increased risk of developing dementia for older adults. Additionally, lacking social connection increases risk of premature death by more than 60%.  Certainly one factor is the growth in the number of older adults living alone, including 44% of women aged 75+.  Technology’s role in mitigating it is being studied in research programs and healthcare. In one study of studies, the authors concluded that while it seems apparent that it can be helpful, specific technologies were not studied separately.  In another pilot program, Talking Tech, participants were surveyed as being less lonely following increased technology literacy and access to tools to connect with others and boost social interactions. And in New York State, the rollout of AI companion robot ElliQ to 800 seniors reportedly resulted in a "95% reduction in loneliness."

You may not have noticed much about the death of landlines. But it has been underway for a while, and now the government is supporting their demise. For some time now, telephone companies like AT&T have been trying to eliminate landlines and are no longer required to maintain these copper connections. You probably think, well that must be good, because those landlines cost as much as $55/month. So that’s a cost savings, right? But wait.

Taking stock of the tech market for older adults – what’s happened? Past the halfway mark in 2023, it’s increasingly clear that the older adult tech market has been disrupted by changes in demand. Its increasingly transformed by new technologies emerging from new funding sources, tech disruption, and entrepreneurial initiatives. Some might say that tech adoption is still slow in some sectors, but it is not for lack of widespread funding sources and innovator motivation. What is the context for technology change in 2023?

And in other news, CMS really wants older adults with dementia to remain in their homes.  The government agency seems to have given up on improving the quality or affordability of dementia care in senior living or nursing homes. The new GUIDE program will support caregivers and ‘enable people living with dementia to remain in their homes and communities.’ But is that the best setting for dementia care? No way to share meals with others, access staff-run activities, and build on the expertise of caring for people with dementia that the senior-related industries already established?  Never mind enabling caregivers to enter a robust job market away from their homes. Just asking. Here are the posts:

New progress for dementia care.  Home Care Magazine provided details about the just-announced Dementia Care policy changes, called the GUIDE Model, including care coordination services, support and payment to family caregivers to help keep care recipients out of nursing homes, as well as obtain respite help.  This is an 8-year program, and a part of the CMS Innovation initiatives. Notably, the GUIDE Model currently does not note or suggest any of the available technology, including home automation, that could improve dementia care. So here are five new technology offerings or update announcements, information from company websites or news media, that may help in the care of those with dementia:

Long ago 'aging in place' terminology emerged with a different meaning.  Forgotten now, it was briefly in Wikipedia to define the benefit of a continuing care retirement community where you did not have to leave the community if you required higher levels of care. And the term wandered over briefly to assisted living.  But it eventually stuck as remaining in your own home through thick and thin. And in 2013, it was promoted on the book circuit by former HUD director, Henry Cisneros about his 87-year-old mother – they were both insistent that she 'age in place.'  Which she did, until she died after a fall, isolated in her huge house after all her neighbors had died or moved away. 

The care continuum that serves older adults is an ignored reality.  The stove-piping of care-related services is a myth. It is perpetuated in associations, venture capital and public policy lobbying. Examples: Some believe family caregivers are a standalone entity that does not use care services. That committing to aging independently at home is a permanent decision. Or that home care a parallel universe to senior living. Or that workers in each of those do not also find work in nursing homes. Reality check: Family caregivers may hire home care services. Or they move loved ones to senior living. Senior living companies (and families) augment limited staff with home care workers. And depending on health, wealth or financial planning, many older adults will one day move to nursing homes, where the worker pool matches that in the other care services. Each part of the continuum wants to use technology to deliver better, more efficient, and health-aware care. Here are five– information drawn directly from the websites: