Grandma at the virtual Thanksgiving table this year. I heard two examples this week of Skype-ing an aging relative into last week's family meal; you probably know more examples. Pushy tech-sharp adult children make sure that Grandma is sitting in front of a camera for her meal (nursing home, assisted living or in her home) and able to chat during dinner, seeing the grandchildren, the dog, without having to make an exhausting and destabilizing (especially these days) trip to visit the long-distance family. In another call, I was told that everyone over the age of 75 who is going to go online is already there. Given the distance-collapsing nature of video, I just don't believe it -- every adult child who has children is going to find a way to get a video phone, a camera-enabled iPad, or a camera-enabled laptop into the home of an aging relative.
Two tin cans and a wire -- is that common sense? Over the hopping month of November, we learned that 500 million people will be using mHealth (mobile Health, sometimes also called wireless health and telehealth) by 2015. But wait -- not so fast. Then came the wet blanket study from Yale -- the NY Times article described the 'disappointing results' with remote monitoring efficacy. The article quoted Eric Dishman, who "noted that the monitoring system in the Yale study relied on the patients to phone in their daily results. Many failed to do so." So what the Yale study proved is that the use of technology with a bad process produces a disappointing result. No kidding. And because it was in the New England Journal of Medicine and written up in the NY Times, no doubt initiatives that are underway to extend deployment of remote monitoring of chronic disease will now be hobbled into re-justifying and explaining why their study is different, that their results (like the Veteran's Administration) are positive, blah, blah. That their forward motion is based on automatic transmission of results, automatic analysis of exceptions to baseline status, and a phone call TO the patient from a nurse. That after three months, more than 55% would still be participating because they received a benefit from being part of the study. Now that would show common sense.
Geriatric care managers are cautious and waiting. (Warning: rant on). Last week I spoke about technology for aging in place to a room full of New England geriatric care managers (and a few home care agencies and senior housing folks as well). When I talked about technology, particularly remote monitoring, filling the gap in hours covered by home care aides, they enthusiastically nodded in agreement. But when I ask if any are using this technology, I heard about interest, curiosity and upcoming pilot programs (no vendors picked yet), and the like. Ditto with the home care agencies represented in the exhibit area. What I didn't hear about -- confident or near-term likelihood of advocacy of a specific product.
The first boomers are about to turn senior. One might think that the excitement of the first boomer turning 65 in January would have waited a few weeks closer to January, but silly me. So one boomer will turn 65 every 8 seconds starting in January. Is it the beginning of one of society's great tragic periods -- too few jobs, dwindling public funds for safety nets, declining health, and a fundamental recasting of the societal dependency ratio (see WSJ article)? Or will it be the beginning of a long and joyous 'senior boomer' or 'booming senior' marketing marathon that rises and then slowly ebbs over 30 or 40 years when the 46-year-olds run out of money and steam? Your perspective may vary: it matters whether you make a product for an aging population but want to move the age downward and broaden the appeal (see GreatCall). Or whether the opposite is true and you're Toyota and want to create a vehicle that will tackle problems of aging head on (no pun in tended). Or whether you're in a complex senior-focused market, like MetLife and long-term care insurance, where the economics of longevity and the recession have both shrunk the target buying audience and made the cost of claims untenable.
Market indifference -- the mobility gap. You've seen the driver -- too short to see over the wheel, too timid to change lanes safely, maybe taking multiple chronic disease medications -- and still driving. In 15 years, 1 out of 5 drivers will be 65 or older. "The result is a 'mobility gap,' Joseph Coughlin, head of the Massachusetts Institute of Technology's AgeLab, which develops technologies aimed at keeping older people active" said in an interview. Cars can be made smarter, he says, to help save us. But as a society and marketplace, what are the solutions for today's older driver -- let's say just those 4 million above the age of 80? They can call the bus, take the RIDE, ask a friend, but as the current scenario stands -- to stop driving is, as he says, to be on 'house arrest'. Who would want to tell them to stop driving with this patchwork of transportation alternatives, especially in the suburbs where most live?
Kinect-ion mania. This was an interesting week -- aside from the mid-term elections, which were as riveting a score-keeping experience as I've watched since the days before the 2004 World Series. But immediately after the election came the arrival and quick store departure of Microsoft's Kinect sensor units: the Target near my home sold out in one (brief) day. After reading the various near-rhapsodic reviews in the NY Times -- and this June's hopeful speculation about boomer-senior Kinect benefits from the Senior Director, Worldwide Health at Microsoft -- you have to wonder. Says Dr. Crounse: "How about home physical therapy or medical rehabilitation with expert avatars or live health professionals guiding me? What about supervised exercise programs for weight control? How about applications for people with cognitive disorders or neuromuscular challenges?" Yes -- how about all of that?
So you want to launch a boomer/senior, home health tech, etc product or service. It's getting to be that time of year for launches and the press that accompanies them. This year, as always there are many vendors that have or will have new products and services or enhanced capabilities -- and want to get attention, prowling the vast aisles of the Consumer Electronics Show (CES) in Las Vegas in search of possible channel partners, media attention and a list of who is in their space. In conjunction with that event, perhaps they will 'officially' launch. Or perhaps an existing company will officially launch a new product or service. Here is a checklist as derived from recent encounters and discussions:
MetLife today reminds us why aging in place, like long term care rates, will trend upward. With MetLife's new study just out that updated nursing home, assisted living and home care rates -- it is no wonder that seniors will, whether or not it is appropriate for them, increasingly age outside the nursing home and assisted living realms. On average across the US, nursing home rates have risen 4.6% to $83,585 per year; assisted living is up 5.2% to $39,516 per year and home care aides now cost on average $21/hour. Home care, in particular, is untenable as 24x7 coverage -- multiplying out to an impossible $183,960/year. Nursing homes have closed, assisted living facilities are not full. Given rising life expectancy, especially for women, combined with rising rates of diabetes and other chronic diseases, we seem to be approaching a conundrum of longer life and poorer choices and options. This represents both an opportunity and a dilemma for today's vendors: the opportunity -- filling in care gaps of every type with remote monitoring, health and fitness tools, video, and wearable technology. The dilemma -- recognition that those who will benefit most may be least able to pay for it as currently marketed and priced -- and until adoption is greater, price reductions and bundling into broader solutions is unlikely.
Tangential to the talk: technology for an aging population. Looking through the agenda of the Connected Health Symposium in Boston, it's apparent in an agenda so densely packed with doctors (not to mention the attendees, with 26 just from Mass General Hospital) that this is not a conference about technology and aging (duh!). And that is despite the fact that the biggest patient dilemma for both the businesses and providers packing the rooms remains the aging and very old patients who fill their offices and hospital beds and run up the largest bills at end of life. Among the sponsors and exhibitors, these vendors stood out for me as important for serving an aging population. In alphabetical order:
Different year, same dream, more hope.Connected Health Symposium in Boston sponsored by Partners Health Care had more than 1000 attendees and an optimistic tone following this past year's congressional investments in health care reform pilot programs that may include the use of telehealth-type technologies. If you were a new attendee with a pesky chronic condition, perhaps you would have been alarmed at the continuing (from previous years) discussions about what to do about you: 'nudge' via incentives or penalties toward healthier behaviors, overcome your underwhelming (10%) nationwide sign-up for personal health records, devise new ways to 'amp up' your compliance with doctor-prescribed regimens, argue whether your favorite social networks will get you to do what the doctor can't -- and above all, get your active participation in harnessing the ballooning cost of care. Lots of talk about payment reform from today's transactional and confounding fee for service to (deep breath): 'outcome-driven, quality-based, global payments through accountable care organizations.' I think that means charge less, pay less, get less of what today costs too much for too little in the way of results:
