Laurie Orlov's blog

Covid-19 sharpens the benefits of teleaudiology. Half of those aged 75+ and one-third of the 65+ have hearing loss. During the pandemic, telehealth use grew sharply in the care of older adults, enabled by CMS reimbursement changes that likely will be permanent.  It’s also likely that teleaudiology (the utilization of telehealth to provide audiological services) will gain additional importance when face-to-face visits are worrisome, even impossible in some locations. As with other market segments, the hearing health market saw the opportunity to promote their teleaudiology (or tele-audiology) services for those who already own telehealth-capable hearing aids that may need adjustment. Some may require a smartphone app and in-office guidance from the audiologist to get started with it, or at the least, read an explainer about "merging face time with FaceTime." Here are five examples – content is from the vendors:

June -- it was the worst of times.  Who can comprehend that 43% of Covid-19 deaths are linked to nursing homes? Who could have imagined the economic impact of job loss and (almost all) business shutdown?  Who could have speculated that senior living organizations would have occupancy levels nationwide below 88%? Who would have thought that telehealth definitions would include phone calls and Facetime?  Most importantly, as so many families were reminded, their aging relatives had not adopted any of the devices and software that would enable face-to-face communication. Or that high speed internet would not be available in nursing homes or the dementia care units in assisted living where their relatives now lived. Let’s hope July is better! Here are the five blog posts from June 2020:

Reading about big tech controversies can make you sigh.  Rant on. You may remember when the browser arrived.  Maybe you knew about Mosaic in 1993 or Netscape Navigator in 1994.  But you probably did not try them unless you were a geek -- because there wasn’t much to look at then on the so-called World-wide-Web.  Apple’s Safari did not appear until 2003 and Google Chrome in 2008 – eventually these dominated the browser market, though three cheers for the existence of privacy-oriented browser Brave (2016) and search tool DuckDuckGo (2008). No doubt both will disappear into acquisitions. As for social media, things really got going with AOL Instant Messenger in 1993 -- then all was pretty quiet until 2003-4, when LinkedIn, MySpace, Skype, and Facebook all arrived. 

You see PERS news releases on occasion. PERS -- Personal Emergency Response System -- is a long-time market dominated by pendants worn around the neck. Recently Parks Associates sized the PERS market to be $1.1 billion by 2024 -- others think it is a $3.1 billion market today. Also early in the year, Vidapoint was announced as a 'global' low cost offering. LifeStation announced Mobile LTE, small and fast, a pendant linked to a sizable 24-hour call center.  Then in April, Verizon does it again, launches a PERS, this time a smart watch offering, called the Care Smart Watch for seniors.   Let us remember Verizon’s last short attention span for this space. Its Sureresponse™ PERS pendant was new in this research conducted in 2012. The quotes are from executive Jonathan Hinds who departed in 2014, not coincidentally when Verizon stopped selling it. Sureresponse was mostly erased from the Internet by 2016, except for user documentation,  online reviews, some not so hot.   

https://locatemotion.com/remote-patient-monitoring/Telehealth – the genie is out of the bottle.  In March, the government announced expansion of telehealth access, noting that it would raise the reimbursement rate for telehealth visits during the Covid-19 pandemic to match the doctor’s rate for in person visits, as Seema Verma, the head of CMS noted: ‘the genie was let out of the bottle’ and won’t likely be put back in. The regulatory change enabled "the use of smartphones, video conferencing platforms such as Zoom, and messaging services like WhatsApp; and the ability to provide care across state lines in 48 states."

The articles are beginning to appear here and there.  In the time of Covid-19 lockdowns, some are talking about an increasing use of technology in their nursing homes. Others are discussing the race to enable ‘televisits’ -- noting outreach from AARP to CMS to boost the requirement for enabling technology in nursing homes.  And numerous other articles have appeared that showed nursing homes receiving donations of technology. The State of Florida gave tablets to 150 nursing homes. The attorney general of Massachusetts supplied 750 tablets to nursing home residents. And Texas provided $3000 per Texas nursing home for tablets, webcams, and headphones. The pictures associated with some of these introductions of technology were bleak. Fortunately, some states are now allowing families to visit residents in designated areas outside.

Will results change when older adults are surveyed later this year? So we know that ‘remote care’ and ‘caring’ in its various forms, including telehealth, seem to be heating up as a priority, whether for senior living organizations, families, healthcare provider organizations, and putting more emphasis on the need for home healthcare and home care, especially in times in which the care workers hesitate to enter a home and which families are locked down and not visiting.  Here is where we were on technology adoption at the start of the pandemic, and the wave of telehealth interest heated up.  As one tech company told me, a one-year-pipeline compressed into a month of demand.  And a plethora of companies raised their hands to offer their engagement technology for free.  So if this is the baseline of adoption, what’s next when the surveys come around again?

May was an unmerry month of angst and abject failure. All around, we have been locked down beginning in March. We have been incredulous, watching older adults die alone in a nursing home, and then dying in many nursing homes. Then half of the 30 million small businesses shut down temporarily. Then hospitals limited admissions in anticipation of an onslaught – and limiting their revenue-generating business – and some shut down completely. And on and on. In May came the trickling of re-openings and beginning of renewed life, though very different from that previous life.  We wait and watch to see what will be different, especially for older adults and their access to technology, moving forward. Here are six blog posts from a May unlike any previous:

Technology usage has climbed sharply during Covid-19. Pew Research notes 53% of responders in April consider the Internet as ‘Essential’– although, no surprise, the oldest did not. And Nielsen observed that the pandemic was a catalyst for the rise of tech use for working at home and shopping, among other uses. In addition, telehealth usage has skyrocketed, with virtual doctor visits expected by Forrester Research to top 1 billion by years end. The spike has been attributed to a) the declaration of a state of emergency in March; b) introduction of Medicare/Medicaid coverage matching in-person visits; and c) encouragement from hospitals and medical practitioners.

Try staring at the NY Times list and its murky map.  The NY Times decided that tracking down and mapping the list of nursing home deaths nationwide required more than 30 contributing writers for the story. The ‘Nursing Homes in Crisis’ collection is about Covid-19 in 2020. Actually in each recent year, the New York Times has looked at nursing homes and found them to be a problem in 2017, wanting for a great deal in 2018, just a bit in 2019, then an onslaught of investigation most recently.  Amid the outcry, the negative comments about bad management, bad physical design of the buildings, bad for-profit ownership, bad Covid-19 testing, etc., etc. -- very little deep thought about why people live there and what change is likely.