Home Care

Nursing home avoidance continues for both investors and care recipients. You might have read about investors cutting back on nursing home investment within ‘healthcare’ REITS.  CMS and Medicare are reimbursing less for ever-shorter nursing home stays, ending their multi-year ‘billion dollar pie eating’ wave of investment.  Note that the biggest chains of skilled nursing facilities (SNFs) like Signature Health Care (which has a web URL signaling LTC -- LongTerm Care) Revolution) – what might that revolution be?  Consider the consumer’s first encounter with the industries for health care, long-term care (LTC), skilled nursing facility (SNF), nursing home, or post-acute facility. This terminology morass mirrors the reimbursement patterns of government agencies, which, in turn, drive investment language, behavior and labeling.

Some industries remain the same for 30 years – and then POW!  Think back to travel agencies, bank branches, bookstores, hardware stores.  Each of these ultimately were traumatized into consolidation and transformation by new entrants. Smaller players in every segment went out of business.  The consumer was willing and eager to change. Online promotion of new capabilities helped them see what the existing players could not. Consider that in 2011, there were a very few indicators of the utility of tech-enabled home care. Naysayers about home care’s future in those days included some of the most entrenched.

Tech-enabled home care isn’t really there – yet.  Okay, there are smart phone apps that reveal a caregiver has arrived. There are back-office offerings like CareTree or ClearCare – in a way, these are the ERP (enterprise resource planning) systems for home care agencies.  And then there are the new entrants, scooping up more money, presumably planning to take over the home care universe with…apps. So what is the device of choice for these folks?  A portal or app that can be accessed through a smartphone or perhaps an iPad.   These are big leaps forward from the no-transparency, telephone-only days of yore, true. But what if there was a multi-purpose device in the home that could enhance the quality of life of the care recipient – and also assist with information flow between the participants, including professional caregiver, agency management, family members?  

Who expects that most seniors will move to assisted living? Not that many. Our clues: # 1) one of the long-time thought leader consultants in senior housing, Ryan Frederick, is now involved in multi-generational housing development.  Or Clue # 2) Occupancy is unchanged in senior housing – still at 89% for the past three years. And don’t you just love the phrase 'inventory has outpaced absorption'? Or the next big challenge for senior housing – serving the middle class? And the profile of the resident in assisted living?  Clue # 3) The typical resident is an 87-year-old woman who remains for an average of 22 months.   Clue # 4) The net worth for folks aged 75+, presumably the feeder group for assisted living, inclusive of home equity, is $155,714.

Finding new findings is slowing down in these last days of August.  First we learn that older people are happier. Whew. And we also learn that seniors don’t seem to take to digital health tools, according to a JAMA-published National Health and Aging Trends Study, a project out of the school of public health at Johns Hopkins University. “Notably, the seniors in the NHATS were willing to get on a computer to respond to this annual, in-home, computer-assisted, longitudinal nationally representative survey of community-dwelling Medicare beneficiaries 65 years and older.” Okay – hence it must be valid.  Says study author Dr. Levine: "Little is known about how this population actually uses technology." Well, actually quite a bit is known -- and published during the study years of 2011 – 2014.  For one, consider the 2011 Linkage survey of individuals age 65-100.  Then there are the numerous surveys from Pew, for example, this one from 2014 on older adults and technology adoption.  Or from Nielsen.