Understanding Eldercare in the Digital Age
The Impact of Technology on Aging-in-Place Solutions for Seniors
I met Dave for the first time in June this year. We had just moved into the apartment above his. My car was parked across from Dave’s patio and every time he happened to be outside, he’d roll his wheelchair forward and strike up a conversation, his furry friend Beta by his side.
Dave, a graphic designer and amazing artist, once told me that he moved to Tennessee from Florida in hopes of better healthcare. He sounded optimistic about his upcoming robotic double bypass surgery and had complete faith in his surgeon. Dave and I shared an appreciation of artisan coffee, so I promised to take him to one of my favorite coffee hangouts upon his return.
31 days after the surgery, Dave texted to let me know that he was in a rehab center nearby undergoing physical and occupational therapies to regulate his breathing - a side effect possibly from the anesthesia. He missed spending time with Beta and was also craving Aloo Vindaloo. My wife and I talked about treating Dave to some home cooked Indian delicacies upon his return.
I met Dave for the last time when I visited him at the rehab facility. With an oxygen tank attached to his wheelchair and a breathing tube running up his face, he said he was getting stronger and was hopeful of going home in a week's time. We discussed the high cost of rehab, how his insurance had run out, and how he was awaiting approval for a 5-day extension.
Dave was 74-years-old when he passed away on day 51 of this recovery at the assisted living facility that he was transferred to. His final text to me said:
Hi Raj and Vee, welcome to my day 47. I’m waiting for a transfer to assisted living section, but I have blisters on my feet from surgery and assisted-living does not have capability to nurse the blisters. Breathing is still not right but I’m getting stronger from the therapies. I hope you guys are well. Take care. I will see you soon if I’m not here the entire millennium.👍
Dave is the reason I am writing this article. I can’t help but wonder if the outcome would have been any different had he been able to afford more time at the rehab center, or if he had been able to receive at-home care with Beta by his side. I may never know the answer. On record, he died of a cardiac event caused by a pulmonary embolism or other blockages. May his soul rest in peace.
The Trouble with Eldercare
In 2022, the WHO reported that the global population of people older than 60-years of age is expected to double, from 900 million in 2015 to 2 billion in 2050. They predict that abuse of this aging population is likely to increase as well. 1
In the United States, it is estimated that all baby boomers will be older than 65 by 2030, expanding the size of the older population, and 1 in 5 Americans are projected to reach retirement age.2
Rebecca Love, Chief Clinical Officer at IntelyCare, highlights the challenges America is facing with the growing population of elders, in a recent Forbes article. The lack of affordable housing and the challenges of availing long-term care services plagues this aging population, leading to cases of physical and emotional trauma. Rebecca points out that the House Republican plan to hand Medicaid to insurance companies, slash Medicare and allow Social Security to wither, will compound this problem. 3
Meanwhile, nursing homes and assisted senior living facilities are crippled by staffing shortages, high operating expenses, and a lack of funding.
According to the June 2022 survey released by the American Health Care Association (AHCA), which represents over 14,000 nursing homes and long-term care facilities in the United States, 60% of nursing homes reported a worsening situation with meeting their workforce hiring needs. 71% reported their inability to find interested or qualified staff, leading to the hire of temporary contract staff in addition to requiring their staff to work overtime. 61% are denying new admissions, and 73% reported concerns about permanent shutdown. 4
The Technology for Eldercare
My parents live alone in South India and use Alexa to play their favorite devotional songs. Alexa is not a new concept to them, but they are slowly starting to realize how smart devices can help them with their everyday needs.
From wearables to connected devices that send diagnostic data to the cloud for families and healthcare professionals to monitor, there are several use cases for using the Internet of Things (IoT) in supporting health and wellbeing for senior care.
For example, disease management is an area that will significantly benefit from the use of connected HealthTech, according to COGNITEQ.5
For Diabetes, using connected blood sugar monitors can send an emergency alert when the patient’s blood sugar level is low.
For Arthritis, using smart devices smart lighting systems, smart door locks, etc. for seniors who experience joint pain and difficulties with movement, or for easing pain using wearable devices that stimulate nerves.
For Heart diseases, using special wearables for continuous monitoring of heart rates as seniors move about and carry on with their normal lives.
For Parkinson's disease, using special IoT sensors to collect data about severity of symptom changes and send them to the doctors.
For Special needs, apps that would help seniors with vision or hearing impairments to help translate text into Braille or solutions that decrease background noise and direct wanted sound into the ear canal.
Some of these are part of the Internet of Medical Things (IoMT)6 segment, which had a growth of USD 144.23 billion in 2022 and is expected to grow at a compound annual growth rate (CAGR) of 20.4% from 2023 to 2030.7
According to HealthTech Magazine8,
Voice interactive technologies aren’t beneficial just for patients and residents, they are also useful to senior and post-acute care staff.
Optimized communication options for overworked staff at nursing homes, unified smart home experience for remote care, virtual reality training to help caregivers step into the shoes of the elderly, are some innovative ways technology can alleviate the issues of staffing.
DUOS, founded by Karl Ulfers in 2020, seems to be a promising solution for at-home care. Backed by Optum Ventures, the startup works with Medicare and Medicaid plans and aims to tackle the Social Determinants of Health (SDOH) by using AI-based technology to match aging Americans to expert caregivers for everyday care. 9
According to the August 2023 Zion Market Research findings, the global elderly care services market is slated to grow from $1,100 billion in 2022 to $1,800 billion by 2030. The Home Care segment is expected to see the most growth compared to Adult Day Care and Institution Care segments.
While new technology is poised to disrupt our traditional approach to providing care of elders, these innovative solutions should not overlook the need to prevent elder abuse in our communities and care facilities.
The Desperation to Solve Eldercare
Papa Inc, a startup launched in 2018 valued at $1.4 billion, claims they can provide companionship, care, and support to the elderly using the gig economy business model. In one sentence, I would describe Papa as a well funded US-based health care startup which employs strangers to pick up caregiver-like gigs for on-demand jobs using an Uber-like app.
Fierce Healthcare has a Papa-friendly definition.
The company matches seniors with younger caregivers, called Papa Pals, who socialize and help out with in-home tasks as well as shopping, transportation and assistance with prescriptions. Papa works with Medicare Advantage and Medicaid health plans, and a number of large employer-sponsored programs also offer it as an eldercare benefit.
Bloomberg Businessweek described them in more laymen terms.
It’s a gig economy version of home assistance, a family-on-demand TaskRabbit for seniors. Customers hire contractors from Papa’s network to come to their homes, hang out and chat, do household chores, chauffeur them to doctor appointments—basically anything shy of the most intimate work done by a traditional caregiver, such as bathing people or helping them use the bathroom. Customers are called “papas,” the contractors “pals.”
According to the Papa website, Founder and CEO Andrew Parker’s idea sprouted from his experiences, when his family struggled to “balance the daily demands of life with supporting his grandfather”.
I get it. With our demanding jobs and competitive lifestyles, it’s unfathomable to provide care to our elders these days. We’d rather spend time scrolling social media. My sarcasm is not aimed at Andrew, though. It comes from my guilt of not being able to take care of the daily needs of my aging parents in person.
Papa has earned a lot of industry recognition, and for good reason. Their growth trajectory is commendable, and it justifies their $240 million VC funding to date. Papa claims they have reduced loneliness by 69%, decreased hospital readmission by 11%, and flaunts a good deal of health plan partnerships. Their warm-and-fuzzy website showcases a wealth of information with case studies and industry reports. The intuitive app for Papas and Pals to connect and communicate looks top-notch.
Everything looks too good to be true. This seems to be THE GIG that would win us all the karma points we require that would offset all the questionable choices we have made in our lives. But then I read the Bloomberg Businessweek expose.
The Dark Side of Eldercare
A 70-year-old elderly woman with mobility issues who lived alone in Duluth, MN was recommended by her social worker to try out Papa for her additional care services. On Jan 30th 2023, Martin Jermaine Billue Sr., a 51-year-old man with an arrest record for several drug convictions in the late 90s and 2000, was paired as her “Pal” to help her with shopping and household chores. Three days later, she reported an alleged assault.
According to the Duluth News Tribune, Billue was charged “with first-degree criminal sexual conduct, kidnapping and second-degree assault with a dangerous weapon for allegedly brandishing the knife while sexually assaulting the 70-year-old woman”.
Billue was arrested on a $200,000 bond and later tried by the state. The investigation revealed that the accused, who claimed that the sex was consensual, was found to be “cryptic” and dodgy during police interviews about what had really happened. On June 30th, the state dismissed the criminal charges against Billue due to exculpatory evidence, citing “the interest of justice”.10
The Bloomberg Businessweek article11 was the first to bring public awareness to this case. Out of the 1200 confidential complaints they reviewed, the Duluth case was the most disturbing among dozens of other sexual harassment and assault allegations logged by Papa. Incidents that spanned over a 4-year period included complaints of unlawful imprisonment, indecent exposure, groping, and theft reported not only by Papa’s elderly insurer-certified clients but also its contractor Pals.
How Papa Inc. failed to uncover Martin’s previous criminal record during their background investigations is anybody’s guess. Why Papa Inc. employs any stranger off the street instead of professional and certified caregivers is blatantly evident in the fact they value growth over care.
Since this incident, the CEO promised to add a second level of scrutiny to vet their Pals. It is unclear if they have taken measures with their health care part to vet the Papas as well. The solution cannot be one-sided, and any measures taken must not be reactive.
The gig economy is very appealing to a many entrepreneurs. Our dependance on apps has made it easier for on-demand services to reach our doorstep or enter our homes. Startups like Papa Inc. seem to want to mimic Uber-like success with millions of VC dollars spent heavily on sales, marketing, and technology. In their rush to capture and disrupt their niche, they seem to also adopt Uber-like mistakes by compromising on security and privacy. I would like to see founders like Andrew Parker flip the narrative and focus on building trust with quality of service, instead of growing their brand with market expansion. For that, we also need more investors who value cause above returns.
Elder Abuse, a Global Epidemic
The Nursing Home Abuse Justice Team12, which was founded to shed light on the epidemic of abuse and neglect in nursing homes and assisted living facilities, reports that staffing shortages crisis surveyed at 30% in 2022 has continued in 2023 across the nation. The lack of appropriate staffing and funding at nursing homes leads to increasing cases of abuse and neglect for its residents.
The issue is not isolated to the United States. The most luxurious and expensive nursing homes in the UK made the news recently. Hidden cameras revealed 88-year-old resident, Ann King, a former nurse living with dementia, being taunted, shouted at, and rough-handled by the staff of Signature Senior Living in Surrey. 13
The Crime Survey for England and Wales (CSEW) estimated that 210,000 adults aged 60-74 experienced domestic abuse in the year ending March 2018.
A survey commissioned by the charity Hourglass in 2020 revealed 1 in 5 UK residents have personal experience of abuse as an older person or know someone who has been abused.
If it weren’t for the footage captured by the cameras secretly installed by Ann’s son, the abuse would have gone unnoticed. “Data on the extent of elder abuse is limited, and reported rates are likely to be an underestimation.”, according to the UK Criminal injuries Hotline.
The effectiveness of preventive and intervening efforts are largely unknown due to the lack of data. When developed countries in the west are struggling to deal with the problem, it is only fair to assume that the situation in developing countries is nothing less than dire.
Preventive measures are reactive at best. The healthcare and social welfare sectors need to partner with the private sector to combat elder abuse and improve elder care.
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According to The WHO, “The abuse of older people, also known as elder abuse, is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.”
According to Census.gov, Demographic Turning Points for the United States: Population Projections for 2020 to 2060
According to the Forbes article, “We must shift our cultural view of aging to ensure that our senior citizens are welcomed and integrated into the fabric of community life, not shut away, out of sight.”
American Health Care Association (AHCA) published a 2022 report documenting the State of the Nursing Home Industry: Survey of 759 nursing home providers show industry still facing major staffing and economic crisis
COGNITEQ notes, “IoT for elderly care is one of the most promising developments for ensuring secure independent living for seniors. The value of such solutions enriched with IoT devices for elderly shouldn’t be underestimated, not only for seniors but also for families who worry about them but don’t have the ability to stay with them 24/7.”
According to Deloitte, MedTech will allow “devices to generate, collect, analyze and transmit data, creating the Internet of Medical Things (IoMT)— the connected infrastructure of health systems and services.”
A new research about next generation technologies notes that the “advancements in sensor technology, miniaturization, and connectivity solutions are enabling the development of more sophisticated and affordable medical devices, making IoMT more accessible to healthcare providers and patients, which is driving market growth.”
Nursing Home Abuse Justice advocates for change to protect residents from abuse and neglect, and believes everyone deserves dignified care. If someone you love has experienced nursing home abuse or negligence, the team at Nursing Home Abuse Justice can help you. Call (855) 602-3678 to learn more.
So sorry about your friend, Dave. Healthcare especially in this country is frustrating at best.
Am sorry to hear about your friend, Dave. I like your summary review of caregiving companies, and failing to do deeper background checks is a worrisome aspect.