Laurie Orlov's blog

No understatement, these are very difficult times for nursing homes. First off, thousands of residents have died, and news media organizations are now obsessed with counting and re-counting, totaling up the numbers (more than 10,000 as of today) and then counting some more. So many of the 1.5 million residents of nursing homes were already very frail people, needing help with 3 or more ADLs. 72% of residents are women, most are age 85+, and as noted, 'many also have only a small group of family and friends for support.' Yet there are people who should know better lined up to bash their performance at managing this virus: "If there was any type of senior-care facility that should have been most equipped to manage the COVID crisis, it should have been skilled nursing facilities," said Brian Lee, a former Florida long-term care ombudsman who currently is a member of an advocacy group called Families for Better Care." Right.

Seniors and technology – change is in the airwaves. In ways that could not have been anticipated six months ago, the technology marketplace (sellers and buyers) for older adults is accelerating in interest level and adoption. And that is likely an understatement. Following the reimbursement changes after in-person visits disappeared and numbers of visits exploded, firms with telehealth tech are finding a one-year-pipeline compressed into one month. The odds are, not confirmed yet, that Wi-Fi deployment, donation of tablets and online video tools, are all accelerating in the time of Covid-19, which will be confirmed in a future survey. Consider six intriguing examples – please send or comment with others if you have them:

Saving seniors from Covid-19 means worsening isolation. In an article in the NY Times, Paula Span’s title said it all: Just What Older People Didn’t Need: More Isolation. The article attempts a number of references to mitigation, including the use of GrandPad in two Pace programs. These are compelling, but the overall story is about the oldest on the wrong side of the Digital Divide, which is notable and particularly pitiful in settings like nursing homes, Note in the Johns Hopkins Covid-19 guidance about nursing homes, at the very end, authors acknowledge the risk of social isolation and make a few (lame) recommendations. These do not include, unfortunately, providing usable technologies to connect isolated seniors with families. What might they be to help with loneliness? Here are six that businesses and non-profits serving older adults should provide for each of their constituents. Please nominate another six -- especially consider those with dementia.

The older adult coronavirus statistics skew toward oldest. There are more than 69 million people aged 60+ in the US. The oldest adults that appear to be at greatest risk dying from Covid-19 are not those of a specific age, but those in the oldest age ranges, particularly with 'underlying conditions.' From the CDC released April 8: Rates of hospitalization (4.6 per 100,000 of population) during the month of March indicated 13.5% of those hospitalized were aged 65+. And 90% of hospitalized patients identified through COVID-NET had one or more underlying conditions, the most common being obesity, hypertension, chronic lung disease, diabetes mellitus, and cardiovascular disease. The US statistics do what nearly all US data analysis does – 'older adult' equals 65+. But look at South Korea (in an article intended to make millennials nervous), the death rate in Covid-19 patients ages 80 and over was 10.4%, compared to 5.35% in 70-somethings, 1.51% in patients 60 to 69, 0.37% in 50-somethings.

Note the wave of announcements of 'free' tech services and sea changes. A number of companies popped into my inbox in the past week with announcements of a period of free access to remote care/engagement technologies – including and in alphabetical order CareCentrix, CareTree, Ergo, Eversound, Outpatient, Ready Responders, NurseCaller, Touchtown, StaySmartCare, See You Link and VitalTech. If your firm is in the remote care/caregiving space (health, telehealth, engagement), please comment or email and I will add to this list. And our family doctor’s staff initiated an offer of a Facetime (or Skype or Hangouts or other choice) for a follow-up visit instead of going into the office. Note the other ‘temporary’ change of reimbursement for remote (even telephone) visits, now fitting into the concept of telehealth. The ‘tipping point’ of telehealth is here – and tipping with a suddenness that is unnerving for overstretched vendors and most notably, difficult for providers who may lack the equipment and/or processes to deal with patients remotely, despite the risks to themselves with in-person interaction.

The world is spinning from the events of March 2020. At the beginning of the month, it made sense to publish a Market Overview about tech for older adults that did not link all tech to Covid-19, and by the end of the month every single news item, announced business initiative, investor prediction, startup messaging, university project, and technology topic was only about Covid-19. It’s almost quaint to look at where the month began since publishing the 2020 Market Overview of Technology for Aging on March 5. The technologies noted are as relevant today as they were on March 5 – however, their application as the list of press releases notes, may be different. Telehealth is suddenly as critical as it always should have been. Smart home (and enablement of remote interactions matters more than it ever has.) From the month:

This past week offers updates to services, policy, and practice. Expect more announcements moving forward, but matching reimbursement for telehealth with in-person visits was a big deal. Many other changes have been put in place, eliminating co-pays, adding coverage for telehealth for those without insurance, and many others many of them state-by-state (see Florida and California, for example). Senior living companies are readying telehealth services (see Holiday Retirement) and no doubt more will follow.

The coronavirus pandemic has prompted instant behavior and tech changes.  And not just about hand washing and social distancing.  For the past two days, it’s apparent that the seemingly forever slow growth of telehealth adoption has entered a new, “When can I have that? Yesterday?” phase.   This applies to caring for and treating the 2.5 million in senior living communities, including nursing homes. Some senior living providers have been ahead of the game for some time with telehealth, like Asbury Communities and Holiday Retirement -- offering services for residents at times when physicians cannot be on site. But the interest and use of telehealth in senior living has been accelerating since April 2019, when Medicare Advantage plans began covering it. And further, when senior living companies were enabled to provide their own Medicare advantage plans, that piqued more interest in telehealth.  All that's left is to install the connectivity to make it effective.

Consider the directives aimed at senior living communities. Rant on. The Washington State nursing home deaths and the virus presence in multiple nursing homes have an immediate result. Nursing home visits are now restricted nationwide – and it appears, despite lack of clarity, that also means assisted living – the combination spanning 2.5 million nationally. Most people look at the lock-downs as completely sensible, preventing the spread of the virus to such a vulnerable population.  And worker shortages already plaguing this industry are expected to worsen as workers call in sick, out of fear for themselves or their families. 

​HIMSS was canceled – but the briefings went on to shed a light on what’s new.  When a conference of the scale of the largest annual health IT event HIMSS (possible attendance of 45,000 compared to 2019) is canceled, it sends shudders through the world of the entrepreneurs and providers they wanted to meet, solving thorny care delivery problems, finding customers and partners, gaining visibility to unusual and compelling solutions. And it created a big challenge for the multiple PR firms engaged to help create that visibility to innovation in care. Following cancellation, phone calls replaced nearly all 10 scheduled in-person meetings. In addition, HIMSS is in the process of arranging a digital version of HIMSS. In the meantime, Here are some of their updates, in alphabetical order: