What Are Old People For?

There’s a lot of discussion these days in the homecare industry about how innovation and technology can make lives better—especially for older Americans who overwhelmingly prefer to age safely at home. But how can it really happen on a large scale? That’s what organizers of the SAGE/2019 Conference, hosted in Los Angeles last month by the homecare company Honor, hoped to ask. They brought together policy makers, entrepreneurs, health system managers, home health agency owners, representatives of global companies, a Google vice president and more to tackle the topic. Seth Sternberg, Honor’s co-founder and CEO, asked participants to consider three overarching questions:

• What can be done to solve the caregiver shortage?
• How can homecare interface with the health care system in order to fundamentally improve people’s health?
• How can innovation impact caring for the elderly?

In his opening talk, titled “What Are Old People For?,”eldercare expert Dr. Bill Thomas challenged participants to reconsider not just the work they do but also their understanding of the people they work with. “We either stumbled, fell into or chose the greatest work on earth and it’s the greatest blessing in our professional lives,” he said. “The source of our difficulties can all be traced to a foundational misunderstanding of aging in American culture.” That misunderstanding, he said, is that elders are somehow different from the rest of us—or that they should be required to abandon their independence in exchange for being cared for. Throughout the day, panelists tackled topics like “Who Will Pay for Care?” and “Better Care Integration and Outcomes.” Here are some of the top quotes from the speakers and panelists.

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I have found that the best work with elders takes place when we stop doing things for them and we start doing things with them. There’s a pernicious idea in American society that older people are deserving of care and support if they surrender autonomy and dignity. So: I will help you but I get to call you dearie … I will support you in your own home, but that means you’re no longer independent. Older people understand what’s at stake. It’s not the money, it’s what you have to sacrifice on the altar of dependency that is so terrifying. And it is why otherwise sound-minded prudent people say, “No, I don’t want someone coming to the house.”… In our beloved field we must work to eradicate the act of subtracting dignity as part of our payment. And we can do this.

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Q: How do we as a society, or as an industry, take advantage of technology while being mindful of the ethical issues and of dignity? A: I think technology can’t and shouldn’t move too fast because of those issues … My belief, because I definitely don’t want a technology- or data-first approach, it has to be that the driver is that actual person—the elderly person—who has to decide what level of privacy they want to keep. And it has to be up to them. It cannot be up to the family, it cannot be up to the caregivers. And if they have no capacity to do that then it’s a very, very complicated issue.

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Q: What role should palliative care play? A: It’s really important with dementia to take care of pain. A lot of behaviors come from pain. And pain is unrecognized. This is before palliative care, too; this is early stage. We specialize in taking care of very difficult-to-take-care-of people, the ones nobody else wants to take care of, [who are] in and out of behavioral health three, four, five, sometimes eight times … People don’t recognize the pain they’re in … Palliative medicine is thought of more towards the end of life, and it is, but there’s a palliative piece to dementia [care] that’s the earlier piece.

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Q: What comes to mind as the single most important area to address as we help seniors age? A: Listening to people and what they need. People with dementia are people, too, and I think there’s stigma associated with that, and so just having that understanding and connection for them. And being able to provide those different options like adult daycare does enable people to stay at home longer. It’s affordable, it’s $11.88 an hour, it gives people a chance to socialize and transition … And maybe it looks totally different than that, but making sure we have all the different opportunities for people so they can do that and not just be feeling like they’re stuck at home and there’s nothing they can do.

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Q: What is the friction point in this sector that’s keeping innovation from happening? A: How health care is paid for is a fundamental issue. There’s been some reform, right? But it’s slow. I think Medicare with the bundle experiments and all the other experiments has started to show that if we start to pay folks so that we care about the overall health care and not just the episodic successes, we’ll do better… but I think we’re all going to have to take a leadership role. We get people at the sickest of the sick, in a very short period of their life, but we spend most of the money, in a hospital. And right now we know we get paid every time a patient comes through our doors, right? … Instead of spending 28% of health care dollars in the last year of people’s lives, in very complex ICUs and doing crazy therapies to keep people alive, and we spent some of that in preventative care and helping them stay healthy at home and understanding their goals of care, we’d be better off. But it’s going to take everybody coming to the table.

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Q: How can people in homecare take advantage of the tailwinds that are coming around palliative care? A: How many of you do direct clinical care on some level or have in the past? How many of you are palliative care providers? The same hands in theory would stay up, right? Because what you’re doing in homecare is unlikely to be curative, and that really is the distinction with palliative care. In my opinion, palliative care is quality care. What palliative care offers to the community or to patients or families or those that we love is a multidisciplinary approach to the multidimensional aspects of suffering. So being able to recognize it’s not the liver in 206 that’s the problem, it’s the person who has a liver who happens to be in 206 … Person-centered care is what this is all about.

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Q: Care isn’t affordable for many—how do we address it? A: The single greatest service I think we can provide older people and their families is to have strategy discussions and strategy conversations. This looks like what we traditionally call care coordination … The first thing is that we are all going to live a whole lot longer than we think. Think about the savings vehicles people have access to and consider that while people want to leave something for their children, they also don’t want to be a burden.

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A look into the future

The SAGE conference showcased tech-driven products from five startup companies, offering insight into how robotics, artificial intellengence (AI), virtual reality and machine learning are being used to advance in-home care. Tombot: Tombot makes robotic emotional support animals to improve quality of life for people who cannot safely or practically care for a live pet. Originally designed to meet the medical needs of seniors with dementia, Tombot Puppies are also used to help children with autism, adults with major depressive disorder, anxiety or PTSD, and for long inpatient stays and arduous outpatient treatments at hospitals. www.tombot.com Cherry Home: Cherry Home is a remote monitoring solution to support older adults living at home, developed by startup Cherry Labs. The wall-mounted devices use AI to recognize people, learn their behavior patterns, monitor their movement and activities, and alert caregivers to unusual behavior such as a fall, changes in gait or lack of movement for an extended time. www.cherryhome.ai Mentia: Created as an outcome of the founder’s Ph.D. dissertation on dementia therapy, Mentia provides frontline staff with the missing piece in non-medical home support: cognitive care. The company’s signature product, Deva World, is a game-like digital environment for touchscreen tablets that embeds over 20 psychosocial interventions. www.mentia.me Golden: Golden’s Financial Care App alerts family members to pay bills, monitors and protects against senior fraud, automatically finds government benefits, reduces expenses to make money last and helps family members figure out how to pay for homecare. The How to Pay for Mom’s Care program partners with homecare, hospitals, senior services and Medicare Advantage plans. www.joingolden.com Electronic Caregiver: Electronic Caregiver is a growing monitored technology provider, and one of only a handful of nationwide service providers. The company has invested more than $50 million in clinical research and development to create Addison Care, a comprehensive, connected home virtual caregiving system. www.electroniccaregiver.com