Laurie Orlov's blog

And in other news, CMS really wants older adults with dementia to remain in their homes.  The government agency seems to have given up on improving the quality or affordability of dementia care in senior living or nursing homes. The new GUIDE program will support caregivers and ‘enable people living with dementia to remain in their homes and communities.’ But is that the best setting for dementia care? No way to share meals with others, access staff-run activities, and build on the expertise of caring for people with dementia that the senior-related industries already established?  Never mind enabling caregivers to enter a robust job market away from their homes. Just asking. Here are the posts:

New progress for dementia care.  Home Care Magazine provided details about the just-announced Dementia Care policy changes, called the GUIDE Model, including care coordination services, support and payment to family caregivers to help keep care recipients out of nursing homes, as well as obtain respite help.  This is an 8-year program, and a part of the CMS Innovation initiatives. Notably, the GUIDE Model currently does not note or suggest any of the available technology, including home automation, that could improve dementia care. So here are five new technology offerings or update announcements, information from company websites or news media, that may help in the care of those with dementia:

Long ago 'aging in place' terminology emerged with a different meaning.  Forgotten now, it was briefly in Wikipedia to define the benefit of a continuing care retirement community where you did not have to leave the community if you required higher levels of care. And the term wandered over briefly to assisted living.  But it eventually stuck as remaining in your own home through thick and thin. And in 2013, it was promoted on the book circuit by former HUD director, Henry Cisneros about his 87-year-old mother – they were both insistent that she 'age in place.'  Which she did, until she died after a fall, isolated in her huge house after all her neighbors had died or moved away. 

The care continuum that serves older adults is an ignored reality.  The stove-piping of care-related services is a myth. It is perpetuated in associations, venture capital and public policy lobbying. Examples: Some believe family caregivers are a standalone entity that does not use care services. That committing to aging independently at home is a permanent decision. Or that home care a parallel universe to senior living. Or that workers in each of those do not also find work in nursing homes. Reality check: Family caregivers may hire home care services. Or they move loved ones to senior living. Senior living companies (and families) augment limited staff with home care workers. And depending on health, wealth or financial planning, many older adults will one day move to nursing homes, where the worker pool matches that in the other care services. Each part of the continuum wants to use technology to deliver better, more efficient, and health-aware care. Here are five– information drawn directly from the websites:

For too many years, high quality data about care of seniors has been elusive.  Lack of standardization of technology platforms – or lack of care platforms altogether – hobbled the care industries -- senior living, home care, home healthcare. Yet the merger and acquisition of companies in other industries ultimately results in consolidation of data. Platforms matter—they enable data standardization which in turn fuels growth. Consider Jet Blue’s interest in buying Spirit, getting planes and pilots(infrastructure) that match its current business. Consider Optum’s acquisition of Amedisys home health business. Note its 2015 $72.5 million write off of a failed in-house software deployment process. No doubt, Optum’s own data standardization business will help integrate Amedisys if the acquisition is improved.

Has anyone you know fallen and couldn’t get up?  If so, would you pick up the phone and call Life Alert, the purveyor of those miserable ads on TV?  This is not a fun company – read the reviews about working there. Philips launched its own Personal Emergency Response System (PERS) offering in 2005 through the acquisition of Lifeline Systems and gave up 16 years later, selling it to Connect America. Since then, Medical Guardian became a market leader ($100 million investment from WaterStreet), with Florence Henderson as spokesperson. And so some believe this is a viable (standalone?) market and believe that it has a low penetration rate into the potential market of worried older adults or their physicians and families.

Six mobility offerings from AARP AgeTech Collaborative. AARP’s AgeTech Collaborative launched in 2021 with a splash (and 50 startups) that has widened into an age wave, or a sort of Match.com for age-related companies to find others, including collaborators, sponsors, pilots, and more. Today’s collection includes 104 companies, many of whom have gone through the AgeTech Collaborative Accelerator process, including pitch competition, Accelerator program enabling entry into the AgeTech Collaborative program. The categories span Caregiving, FemTech, Health, Mobility, Savings & Planning, and Social Connections. Read more.

The cell phone – imagine a connected life without it. The story of that invention, particularly the context of an AT&T monopoly of the time period, is instructive about what it takes to get an innovation into the market – when many are involved, including government agencies; and obstacles, in-house and competitors, are all around.  According to interviews and his many anecdotes in his book, Cutting the Cord, Marty Cooper, aged 94, it was just one thing after the other to get the cellphone fully designed, manufactured, and into the marketplace as a mobile phone – when even his own company, Motorola, thought that the car phone market was the real opportunity.  Motorola’s own estimates of the cell phone market opportunity in the 1970’s was a wild underestimation, predicting that millions of devices sold.  Today the total number is closer to 18 billion phones worldwide. Many of those users in other countries own no other device.

Care workers – it’s not a shortage – it’s a crisis.  People who need care workers will tell you – the media will tell you, and the industry will tell you. From the national home care associations, a report in March: “The workforce shortage in home-based care has reached crisis proportions. Despite the best efforts of industry leadership and management, the gap between the numbers of patients and families seeking assistance and the availability of workers to provide that care is accelerating at an unsustainable pace. Home health care providers currently report turning away over 25% of referred patients due to staff shortages.” 

The past few weeks have brought broad-based wails of AI anxiety.  Last week in a meeting with some senior execs, there it was again – warning about scams, exploitation and worse. Then there is the AI laundry list of anxieties that keeps the media busy.  Note the hearings in Congress that raise questions and obtain carefully worded answers meant to allay widely shared fears. A regulatory framework has emerged (2 years ago) in Europe, with the purpose of helping Europe become a hub for AI innovation. The US government is interested in regulation, more for prevention, it seems, than to spawn innovation. But will it work? See social media.