Aging in Place is the ability to live in one's own home - wherever that might be - for as long, as confidently and comfortably possible. Livability can be extended through the incorporation of universal design principles, telehealth, mhealth and other assistive technologies.
Voice First is changing health and wellness offerings today. Already the predicted capability to speak a request or instruction without having to type or tap on a device – known as Voice First – has transformed how we interact with technology. If we can speak a command to play music, control the lights, or open the shades – benefits can accrue to the elderly living alone, to individuals who are blind or have macular degeneration, and those with disabilities. And AARP and Optum have initiated pilots to determine if this technology can help mitigate social isolation among the elderly and improve health outcomes. But there are experiments and pilots for using Voice First technologies for health and wellness applications. So what’s intriguing?
Answers to some questions are obvious -- or obviously missing. Health tech and service providers want to speak – at least a little. Alexa has the answer to ‘Where’s the Nearest Hospital” but sends you to WebMD for how to treat a sunburn. Consumer healthcare literacy concerns (“what’s a formulary?”) led insurer Cigna in March 2018 to launch Answers by Cigna. Need first aid guidance about dealing with a fever? There’s Mayo Clinic First Aid Skill. Ask questions to Google Assistant -- much like Apple’s Siri, shows both the promise and weakness of current offerings. The dilemma - to provide an answer to a question that exceeds (Google’s) 29-word brevity for the software’s spoken response. One of the critiques of WebMD’s Alexa skill – it didn’t understand drug names.
Healthcare systems offer voice-enabled interfaces – as experiments. KidsMD, launched in 2016, has been a pioneer in use of Voice First health offerings – offering ‘trusted pediatric content.’ For other providers, asking where the nearest urgent care facility is – especially if you’re out of town – may make some sense. But see Independent Health’s Alexa skill – does asking about your deductible make any sense? Your particular cost to visit an ER? As some have said repeatedly, Voice First does not mean Voice only – and a 29-word response, well, for some questions, the less said, the better.
What newcomers have entered the market? Besides ‘longevity market new media’ like Stria (former Next Avenue) that provided a splash of cold water for startups and investors in the older adult space. Although there is little evidence that any investors are bullish about the general older adult market – despite AARP documentation and various books to the contrary, innovators continue to create new offerings to help older adults live better lives. Here are five recent and soon-launching offerings to help – content is from the websites of the firms or articles about them:
CareAcademy. "Empower caregivers to learn how to deliver the best care to older adults with the support, guidance, and compassion needed to improve their quality of life. We would then make it easy for caregivers to “upskill” and continue their education over time so they could better serve clients as needs changed and advance their careers. The result is a better caregiver, a better home care agency and a better way to care. Today CareAcademy provides home care agencies with a best in class online education platform.” Learn more at CareAcademy.
CogniZance. "CogniZance was established to provide a cognitive enhancement service for older adults. Building on top of neuroplasticity findings, the service includes daily exercises that take place in the real world and that are meant to train users’ working memory, attention, creative thinking and more. Join CogniZance today and start training your brain on a daily basis using our new integration with Facebook Messenger.” Learn more at CogniZance.
JoinPapa. "Papa uses technology to simplify and speed up the process of finding qualified assistance for your loved one at a moment’s notice. Maybe your loved one just needs help with a few household tasks this afternoon. No problem, connect to local Papa Pals instantly, select one that meets your needs and they’ll be there in under an hour, for as little or as long as you or your loved one need them. Traditional agencies require minimum hour commitments (daily and weekly), many days to find a qualified caregiver to even come to meet you.” Florida only at this time. Learn more at JoinPapa.com.
Kinto. "When your family needs to keep an extra eye on mom, coordinate her care, manage her meds, make sure things are in order or just keep everyone in the loop, Kinto has you covered. Whether it's managing medications, keeping track of important documents or simply keeping a list of everything there is to do. Connect with other Kinto families to exchange support, wisdom and knowledge.” Learn more at KintoCare.
PeoplePower. "The Home Occupancy Status Microservice is also capable of knowing when people are asleep to deliver advanced automation, senior care and wellness solutions from understanding a person’s natural sleep patterns. Able to put a home to sleep or wake it up gently to better prepare residents for the day, improvements to a person’s circadian rhythm are possible through sleep predictions to intelligently adjust home temperature and lighting conditions appropriate for the time of day, the day itself, and even the season. Senior care solutions become more intelligent and supportive by understanding away, at home, asleep or awake states of older adults." Learn more at PeoplePower.
The business model of the Internet is crushing us. Rant on. We could start with Twitter, which is deleting millions of bots, trolls, and other fake accounts (often with automated software generating hundreds of tweets per day). This is raising concerns over the company's growth and true number of monthly users. But not raising concern about the business and social value of Twitter. Has anyone looked at the age distribution of Twitter users? Only 8% are 65+, and the biggest block is aged 18-29. Consider that its share price and profit of $61 million in Q1 2018 are tied to growth in ‘legitimate human users -- the only ones capable of responding to the advertising that is the main source of revenue for the company.” Translate: capable of responding because they are human 18-29 year olds, not because they have money to spend. And then there are:
Websites – as quantity of edited text declines, the user experience is crushing us. The Wall Street Journal is not a junk website, but because I used Chrome on a big display screen to search for closet built-ins, the first-displayed ad for one of those companies ate up the upper one-third of the screen real estate. I did not search for BMWs – nor do I own one, but the NY Times website equivalent has BMW videos to warn me that there are only a few weeks left of summer. Of course, your results will, as goes the web, vary greatly and with each visit. Look for a topic presented in a Google Alert, for example, telehealth. First click ‘No’ on whether to subscribe to a site for home health agencies, then study the ring of event ads. Or car rentals – where a website popup called ‘Advertiser Disclosure’ admits that it prioritizes rental agencies that compensate it.
Technology Designed for All. A long time ago (7 years this month) in a tech world far, far away, a report sponsored by AARP predicted that technology change would deliver a new user experience. The concept was referred to as "Technology Design for All" -- defined as 'User experiences that appeal to all age groups, persisting across versions and devices.' According to the report Connected Living for Social Aging, which was published 7 years ago this month, the future was predicted. It is worth a look back -- note that it did happen just as described. Consider smart speakers (the Echo was launched in 2014), IoT boxes, phones, tablets, PCs, Macs and all cloud-based software. These work without the need to download and upgrade on Patch Tuesday, though fixing privacy is the next big technology hurdle.
Are we really ready for self-driving cars?In a taxi in DC – the driver wends his way around buses and pedestrians. It’s the day after the self-driving car killed a pedestrian. The next day, you can find scores of link references to a police comment that the car was likely not at fault though no investigation has completed – or even been started. In another tech publication (“Big Think – your daily micro-dose of genius”), you can read that in over 1.5 million miles of testing, one year ago was the first time the car had been at fault when it crashed with a bus. Really? How does the writer know this? Because Google says it was a ‘misunderstanding in the car’s software and from now on, the car will understand that large vehicles and buses will be less likely to yield.’
In a short month, heard lots about caregiving and hearing. You have 'conversed' with an older person who cannot hear well without hearing aids but owns an expensive pair which are highly adjustable. But they don't put them in, or lost one of them and not replaced it, even though the VA will pay for it. These individuals may ask you a question, but they don’t wait for an answer they can’t hear well. And so they go on – talking about themselves and assuming that’s fine at your end of the 'dialogue' They have families who become irritated with them; they spend a great deal of time alone. Then one day, they become part of an equation – those with hearing loss are at greater risk of developing dementia. Sigh. Here are four blog posts from June:
Narrowing the price gap between hearing aids and PSAPs. The hearing aid industry offers pricey hearing aids for people with ‘defined’ hearing loss. The FDA wants you to understand that it regulates hearing aids – which it defines as helping the medical condition of hearing loss. The FDA then observes that Personal Sound Amplification Products (PSAPs) are “sound amplifiers for consumers with no hearing loss who want to make environmental sounds louder for recreational use.“ Recreational? Hearing aids that they do regulate are now made by a small number of companies and are sold with audiologist services for $1000 up to $4000 per device – most people need two – they have a lifespan of up to 7 years. That price includes a hearing test, fitting, initial batteries and more.
Ten Technologies from the Silicon Valley Boomer Venture Summit. Two competitions, both sets of presentations in one day. The first five are finalists in the 2018 Silicon Valley Boomer Venture Summit Business Plan competition. The Business Plan Competition features companies pitching their ideas to a diverse panel of judges for feedback, funding and a $10,000 prize. The second five are finalists in the AARP Innovation Labs Pitch Competition for companies focused on providing peace of mind to family caregivers through the use of VR, AI and other disruptive technologies. The winning team will go on to the AARP Innovation Pitch Event in Washington, DC, in October of 2018.
The market is changing – and older adults can and should benefit. At some point, family members and professionals may notice an individual’s hearing loss and may express concern. Especially now that hearing loss has been linked to an increased risk of dementia (ref Lin and Lancet), the baby boomer population may be open to corrective possibilities before age-related hearing loss worsens and isolates them from peers and family. Experts also see the trend in self-care for all types of health concerns now includes hearing loss. Today there are numerous options for evaluating hearing loss, pricing and purchasing devices that should be part of organization and family approaches.
Recognizing this, retailers – in store and online – see a business opportunity. Audiologists recognize that their focus may have evolved to provide hearing tests as a process step for fitting an individual with appropriate hearing aids – and perhaps less on providing lower cost options such as teaching coping strategies that may be no cost or low cost. In addition, more recently the hearing aid vendors have been pressured to lower prices or offer lower-cost alternatives. Already making their way, these offerings are in the Canadian market. For consumers and professionals, consider the role of:
Amplified TV Sound, amplified phones, and visual indicators. Consumer Reports recently updated its recommendations for improving TV sound, for those with some hearing loss. These can include stethosets (wireless hearing headsets), headphones, and soundbar speakers among other options. Amplified phones are designed for people with hearing loss and may be with cords or cordless, wall-mounted or table mounted – and may include large buttons and/or pictures of frequently dialed contacts. They may be appropriate for individuals who have difficulty hearing a phone ring or hearing parts of conversations that may include higher frequencies. They may have visual indicators (like flashing lights) as a way to alert an individual to a phone call or an emergency.
Training people on tactics after self-administered hearing tests. Anyone can give self-testing a try in the privacy of their own home. A self-administered online test like this Speech-to-Noise variant can help individuals or caregivers with an assessment of their ability to understand others in potentially noisy environments. There is even a guide to multiple online hearing tests – from calibrated pure-tone tests to uncalibrated tests, including Speech-to-Noise. With appropriate guidance, individuals can be offered further suggestions about the differences between Personal Sound Amplification Products (PSAPs) and whether they are an appropriate next step.
PSAPs – limited research, but possible benefits noted. In 2017, Consumer Reports published test results of 18 of these amplification offerings for “individuals with mild to moderate hearing loss”, ranging in price up to $500 each, noting that prescription hearing aids generally start around $1650, inclusive of audiologist fees. One 2017 JAMA-published study compared the capability of several PSAPs to hearing aids and noted comparable benefit for at least one of them. Another research study in 2017 examined the utility of direct-to-consumer offerings, including direct mail hearing aids, and concluded that there was benefit – but noting that research has been limited. Guides to PSAPs are regularly updated, including 2018 lists from Everyday Hearing and The Wirecutter. Also consider commentary about category, which for some, are in the ‘ears’ of the wearer.
FDA – Making the definitional matter worse. The widely quoted definition of hearing aids comes from the US Food and Drug Administration: “Any wearable instrument or device designed for, offered for the purpose of, or represented as aiding persons with or compensating for, impaired hearing…only available from licensed providers.” The FDA provides a guide which has no doubt worsened market confusion about PSAPs, defining their purpose “to increase environmental sounds for non-hearing impaired consumers. Examples of situations when these products would be used include hunting (listening for prey), bird watching, listening to a lecture with a distant speaker, and listening to soft sounds that would be difficult for normal hearing individuals to hear...”
Along came hearables – wireless earbuds and other variants. Sometimes referred to as ‘smart headphones,’ these can be placed in-ear as earbuds or as headphones, to ‘enhance’ the listening experience and also have a 2018 ‘complete guide’ on Everyday Hearing, a prediction that these are the next big wearable platform, or this set of ‘best’ from a site called “Wareable” – tech for your connected self. In reality, the hearables market appears to be the one focused on the ‘recreational’ use the FDA has applied to PSAPs.
Two sets of pitches, ten finalists across the competitions. The first five are finalists in the 2018 Silicon Valley Boomer Venture Summit Business Plan competition. The Business Plan Competition features companies pitching their ideas to a diverse panel of judges for feedback, funding and a $10,000 prize. The second five are finalists in the AARP Innovation Labs Pitch Competition for companies focused on providing peace of mind to family caregivers through the use of VR, AI and other disruptive technologies. The winning team will go on to the AARP Innovation Pitch Event in Washington, DC, in October of 2018.
Kytera. Behavior monitoring for aging-at-home, allowing better care services, improved emergency detection and predictive analytics. Companion offers System is based on Contextual Activity Analysis technology and it consists of a wristband and easy-to-install sensors. Learn more at KyteraTech.
LifePod. Virtual caregiving, providing peace of mind to caregivers and improving the quality of life of their loved ones with voice-initiated, intelligent and connected services to support the elderly as they age-in-place. Learn more at LifePod.
Tomeah Health. On-Demand platform for agencies to drive greater efficiencies and improved transparency in the delivery of care. Learn more at Tomeah Health.
Raivan. More accurate lung cancer diagnosis by enabling live visualization of the airways. More when there is more.
Wavelet Health. Implantable stroke monitor for high risk atrial fibrillation to reduce time to treatment after an ischemic stroke. Learn more at Wavelet Health. Winner of the Venture Summit $10K prize.
Evolution Devices. A sleeve that uses electrical stimulation to regenerate muscles and prevent falls for the elderly. Learn more soon at Evolution Devices.
Loop. A family communication device for the home that allows you to seamlessly share video, photos, and video chat. Pre-order. Learn more at JoinLoop.
Embodied Labs. The intersection of healthcare training and virtual reality storytelling to provide a culture shift solution that empowers every member of the care team to share their expertise and value one another. Learn more at EmbodiedLabs. Winner of the AARP Innovation Labs Competition.
MyndVR. MyndVR is a national health and wellness company providing Virtual Reality solutions to Assisted Living, CCRCs, Veterans homes, 55+ living communities and home-health care providers. Learn more at MyndVR.
Ohmni Robot. Designed specifically for seniors to enable them to continue their independent living in a comfortable and worry-free environment. Learn more from OhmniLabs.
The more things change… Life expectancy is long – tech attention span from investors and innovators can be short. Reviewing the past 10 years of blog posts (from 2008 until 2018), in the beginning, consider the categories and innovations. To mitigate social isolation, for example, note the video phone and the printing mailbox. The objective was to communicate with grandma or grandpa, who might be bereft of email – or for that matter, WiFi, Skype, tablet, smartphone, PC or MAC. Imagine the blissful simplicity or those times -- for the grandparents. Largely forgotten now -- Mailbug, BigKeys – and printing mailboxes Presto and fax-machine based MyCelery. But the PERS market, around since 1975 in the US, has repeatedly been predicted to be obsolete and about to be replaced with something else.
As time passed, how to categorize? Way back, optimistic offerings from innovators took shape into problem-opportunity clusters – mapped out in the first Market Overview in the spring of 2009 (attached to this blog post). There has been plenty of forward motion in the past decade towards the objective of improving or maintaining quality of life. And the sub-topics of categories -- Communication & Engagement, Safety & Security, Health & Wellness, Learning & Contribution – remain as the collective elements of a framework that can make it so.
The hearing aid industry offers pricey hearing aids for people with ‘defined’ hearing loss. The FDA wants you to understand that it regulates hearing aids – which it defines as helping the medical condition of hearing loss. The FDA then observes that Personal Sound Amplification Products (PSAPs) are “sound amplifiers for consumers with no hearing loss who want to make environmental sounds louder for recreational use.“ Recreational? Hearing aids that they do regulate are now made by a small number of companies and are sold with audiologist services for $1000 up to $4000 per device – most people need two – they have a lifespan of up to 7 years. That price includes a hearing test, fitting, initial batteries and more.
As hearing aid prices are disrupted, the PSAP and other hearables disrupt the industry. If Costco is pushing the hearing aid industry price down, at some point that price meets the upper end of the PSAP market of $500/pair of PSAP maker like Clarity, SoundWorld Solutions or Tweak Focus. The underlying technology in hearing aids and that of Personal Sound Amplification Products (PSAPs) is not different. The go-to-market channels, however, are quite different. Retail stores, online websites offer PSAPs for buyers who adjust the device themselves – the which the FDA calls the ‘audio version of reading glasses.’ And Consumer Reports calls them ‘hearing helpers.’ But are they really? Or are they hearing aids in disguise because the FDA does not currently regulate them? Maybe they are hearing aids that you adjust yourself? How do theysync up with the more recently introduced 'hearables' which encompass a plethora of firms?
Cut to the chase – the FDA should get out of the consumer’s way. Regardless of what it is called and how defensive the government agencies are, improving ability to hear among older adults is a health and quality-of-life positive, and could be related to lowering healthcare costs. The companies in this industry (Hearing Aid and PSAP) need to help the FDA help the older consumer who lacks either device. Decouple the product from the services, allow consumers to make their own choice of where to buy and with what service they need, and track price and competition – and measure the numbers of people who report improvement in quality of life, health status, and social engagement.
Let’s Talk – What’s Happening With Voice First Adoption? Smart speakers – they seem to be the new, new thing. According to eMarketer’s new report , 40.7 million people will use a ‘smart speaker’ at least once in any given month. Because there is competition now, primarily from Google, the market share projection for Amazon (which ‘shipped tens of millions of devices at Christmas’) will drop from 66.6% to 60.8% share by then – and Google Home-related will rise to 30%. Other than Amazon and Google – “Other” will grow from 8.3% to 14%, which presumably includes Sonos, JBL, Harmon Kardon and other entrants. Does this matter? The split is less important than the growth in overall adoption, not because this is the coolest of new gadgetry, but because the user interface is finally improving and matching the way we think -- after many years of deteriorating screen-based UIs that, on a good day, are just plain annoying.
Too much road noise, no self-driving information. So how safe are self-driving cars for us, those pesky consumers who are also the victims of this tech for tech's sake? Ask yourself – how would you know? Even the NTSB doesn’t want you to know details of accidents involving Tesla’s Autopilot. Let’s remember the so-called problem being hustled into the market -- to reduce deaths from auto accidents. They are astonishingly low already, according to a Rand study, at 1 per 100 million miles traveled. According to the Wall Street Journal article, Tesla promised to release safety data on its self-driving tech regularly starting next quarter, though they have not said what sort of data and what could be gleaned from it -- perhaps in advance of another series (see link) of crashes.
For a Chief Medical Officer, what role does technology play? Recently there was an opportunity to query executives in senior care, including Dr. Arif Nazir, Chief Medical Officer, Signature HealthCARE, who was asked about the technology impact on long-term care jobs. The insights quoted here could be generalized, not just to Skilled Nursing Facilities, but to all types of care delivery – and are particularly notable in the context of last week’s New York Times article: "How Tech Can Turn Doctors into Clerical Workers.” As Dr. Nazir notes, it’s not just doctors who can be frustrated by over-emphasis on technology. Here are the questions and few observations about the work and the workers.
Skip the tech – listen to the experts interviewed – first robots. The good news – this week’s Health Care Technology supplement transcended the limits of doctors and hospitals – and dabbled in the dilemmas of elder care – included technology to assist those with dementia and mitigate loneliness. The bad news -- another in a long line of ‘robots and chatbots look after the elderly,’ with promotions of those oft-promoted Care.coach and ElliQ, adding Catalia Health’s cute Mabu. These are worthy experiments – and not wanting to be left behind, there are always health organizations eager to see what the fuss is about. Says USC researcher, Maja Mataric: "Robots give patients the illusion of having a physical companion…it isn’t actually very hard to project empathy (Mabu)...Empathy is what you do, not what you feel." Really? How comforting.