Laurie Orlov's blog

 A well-known consulting firm assesses the growing care gap. Boston Consulting Group analyzed the care crisis recently asserts that the lack of paid or unpaid care workers to provide care of children or aging parents may prevent them from filling unfilled jobs, noting the 99 million people today who are not in the workforce. y do an interesting analysis built around the premise that some people who could work do not because of care responsibilities. The conclusion -- the one hand, quality affordable care could be subsidized so that more would want to do the work, filling the unfilled care jobs (day care, elder care). And family members could thus remain in jobs that they would otherwise abandon to provide care. Okay, hard to argue with this macro view, but there are some key points missing. Take a look at Exhibit One in the document which asserts that nearly 50 million people, aged 18-64, could become part of the care labor force, particularly those that have children and remain at home to care for them.

This was conceived by Andrea Cohen, Founder and Vice-Chair of HouseWorks, a home care company started in Boston.  Andrea noted, "When employed to its fullest, remote care technology improves every aspect of how care is delivered in the home.  Imagine what's possible when every stakeholder wins."  The vision:  Change the work process to produce Engaged Caregivers, a Connected Care Team, and Informed Families.  Why does this matter now? The home care industry is enormously challenged today --  soaring demand, labor shortages and worker (and client) retention challenges.   At the same time, a vulnerable older adult population lacks adequate care in many parts of the country, sometimes due to wage issues, but more often due to the overall fierce competition for workers across industries. Yet the home care industry can attract those who care about older adults and provide them with improved working conditions that underpin their tasks with technology that improves efficiency and care effectiveness. [See report The Future of Remote Care Technology and Older Adults, where this graphic first appeared.]

PERS Insider helpfully listed the most common PERS Google searches. The result was bleak and informative. Their website identifies the top item (16,000 searches, results with ads) as a 'medical alert bracelet'. Except for the deep-pocketed Medical Guardian which bought ads everywhere, these were all bracelets to help emergency workers determine a health issue. The next one, Medical alert systems (14K searches) turned up ads for multi-vendor sales sites with names like 10 best, 5 best in Florida, and look, there's Medical Guardian! The US News site was not an ad itself, but the article was filled with ads for devices. Ditto for ConsumerAffairs.com.' Best and worst companies – more ads -- and Medical Guardian. Even 'I’ve Fallen and I Can’t Get Up' is one of top four search terms (4800), no doubt from those miserable LifeAlert ads. 

Is 2022 the tipping point for technology and older adults? Scanning through the collection of blog posts from April and May, the obvious has finally occurred. Baby boomers are aging and want to stay in their homes as long as feasible. Soon all 54 million of them will be over 65. Many will need to be monitored in their home for chronic diseases and in-home risk of falling – Amazon noticed with Alexa Together – Verizon noticed with its Care Smart Watch. Home care companies, senior living companies, skilled nursing facilities are all desperate for workers to address this overwhelming market. At the insistence of customers and prospects, technology offerings (beyond telehealth) will be required in all of these settings, especially at home -- and so as long-predicted, they must proliferate and improve. Consider these six blog posts from April and May 2022.

When it comes to people, the US Census has all the data.  From its American Community Survey (ACS) summary files and detailed tables, we know as of November, 2021, for example, the US population (315 million), the number of housing units (133 million) and whether they are owner-occupied. Further, it tells  the number of people in geographic locations, education and marital status, employment status (173 million), the percent aged 65+ (more than 55 million as of the date of the most recent survey).  The questionnaire is publicly available on the Census website. While many of the questions are intriguing (and used for redistricting) and the data results are much-reported, technology ownership is rarely discussed.  So here are some snapshots of changes in the ACS data from 2015 to 2021: 

Tech complexity for new users is getting worse. And it’s pretty obvious to anyone who is paying attention to Apple new releases, new versions of Android phones and other apps like Spotify. And then there’s the PC that runs out of memory – just encountered yesterday. You want to see what that means by checking the manual.  How naïve.  No manual.  So you do what everyone who has just encountered an error message does.  You search the tech forums, find the example of what happened and voilà, there’s the fix. Certainly that must be what senior living residents and older adults living at home do, not to mention the of-course sizable tech staff working in senior living and elder care. Oops.

ATA’s live event return to Boston. This week the American Telemedicine Association (ATA) conference, charmingly titled “What Now? Creating Opportunity in a Time of Uncertainty,” returned to a live format event in Boston. For those wondering, the event title relates to 'reimbursement uncertainties, workflow challenges, and investments needed.' Most of the exhibitor list of companies' focused on improving the efficiency and effectiveness of provider workflow and businesses. But some offered innovation for patients, whether in virtual visits and care, vital sign measurement, and improvements to patient experience. One might note that individuals 55 and older account for more than half of healthcare spending, with costs rising with age.  Here are five from the ATA event, content from vendor websites:

Covid-19 fallout pushed the care industries into the home.  A sweeping set of changes from that time that may have appeared temporary. But a number of these changes are likely permanent.  Telehealth vs. in-person:  the Covid-19 public health emergency declaration to reimburse doctors for providing telehealth services for Medicare recipients has been repeatedly renewed. Bills are in Congress will make it permanent.  Medical practices are now offering choices to patients – in person or telehealth?  Home care vs. assisted living – the demand is for home care.    Hospitals continue to close, especially in rural areas. Acute care delivery at home for Medicare recipients has been endorsed by the American Hospital Association – and bills supporting it may pass. Finally, the CMS-created codes for remote patient monitoring (RPM) can be used for reimbursement of chronic disease monitoring services.

We are used to citing population surveys to cite trends. Tech adoption among older adults is clearly increasing. The growth has been tracked most recently in survey samples that compared the most recent with prior time periods: AARP surveyed 2063 and Pew Research surveyed 1502 adults. And Linkage Connect surveys the oldest, with a sizable sample of 2398 older adults. For all three, broadband access and smartphone ownership and use is growing. But what if tech adoption came from a sample size of 2.9 million households pulled from the 5-year census (American Community Survey/ACS) data? That was posted in November of 2021, with surveying ending in 2020 (just before Covid-19) and was made available within the last month. Good news -- seventy-six percent of the 65+ population as of 2020 has access to broadband -- and tech adoption has clearly risen since 2015. One might assume that post-Covid census data will be even more significant.

Staffing issues continue to plague senior care organizations. The news articles pile up – assisted living and nursing home staffing shortages; stranding older adults without home health care; keeping patients in hospitals longer because of lack of care; nursing home staffing crisis; Medicaid paying family members to provide care, low wages and low unemployment worsen care situation, and on and on. And the shortage of care workers is mirrored in other industries – signs are posted everywhere seeking workers in the midst of the ‘great resignation.’