An entirely different business platform will develop over the next five to 10 years that will beat out traditional providers in serving the growing numbers of frail older adults and their families. Current modes of long-term care service delivery, such as assisted living, nursing home and private duty home care providers, will lose unless they begin to innovate a patient-centered, setting-agnostic platform that meets a much broader array of family needs.
Mismatched Needs and Services
For quite some time, we have noted the impending aging of the baby boom population. But now it is here – in five years, the rate of growth in the over age 85 population will begin to match that of the 65- to 75-year-olds. This is when the growth in frailty among the population will start to climb at exactly the same time that the number of non-elderly will decline in proportion.
Current trends suggest that the vast majority of even the frailest older adults will live in a conventional, single-family dwelling. But, so far the market has largely failed to deliver services in a manner that meets the needs of frail elderly living at home. In fact, evidence suggests that it is dangerous to live at home if you are a frail older adult.
Members of this group are more likely to be the highest users of healthcare than their counterparts in nursing homes and assisted living. And, even among those who hire paid help, 60% report having an adverse consequence related to unmet need, compared to 30% of those living in supportive housing. In recent interviews with family care managers, I am astonished at the gap between what is available and what people want to buy – even for families with significant income and assets.
Adult daughters and sons who want to and can pay someone to care for their parent at home report huge challenges. These adult children consistently tell me that their choices are unclear — services available do not match their specific need, and they feel utterly unprepared and unskilled for the professional-level responsibilities they have for medical management of their parents.
The New Solution
With the changing demographics, a new platform will emerge to meet these needs. It will likely be a business model that supports a hub-like connector. The “connector” acts like a concierge, curating and recommending services that consumers do not even realize they need but that are essential for staying at home. Items that span the medical and non-medical, such as medication management, home modification, grocery shopping and food preparation, or Uber for older adults that can transport them to activities and bring activities to them. When supportive housing becomes a necessity, the new platform will be there to connect the family with good options and help with the transition — a service that is very often unavailable in our silo-based system.
Preparing to Lead
There are two customers for the future platform: older adults with fewer and fewer unpaid caregiver resources available, and healthcare systems whose Medicare payments will depend increasingly on their ability to manage the full spectrum of biopsychosocial needs of the most expensive beneficiaries — those with frailty in old age.
Many SNF and ALF/IL managers and operators I know are doing a good job preparing for the future post-acute care delivery system and investing to be among the best in their markets at what they do so that they can be part of the new hospital networks. However, facility-based providers should consider innovations that will allow them to fill the unmet need that exists for services in the community. They do not need a home care platform to do it.
Facility-based providers who want to be among those who offer solutions rather than buildings will need to innovate. But, innovation does not usually happen after a long planning process and a laborious business plan are completed. It happens rapidly and often spontaneously. Here are three ways to create spontaneous innovation that will make your organization more hub-like for the future.
- Connect with Customers Up and Downstream. The most important thing a provider organization can do is to develop solutions for its customer base before it gets to the facility. An organization can create upstream value through outreach to the community hubs that are already trying to serve older adults at home — the area agencies on aging, churches, for example. These organizations may suggest an opportunity for a provider organization to extend its expertise and/or services. At the same time, when a family is in crisis during post-acute care, the SNF is in a good position to offer services and support that can help the family and older adult transition home and set up day-to-day help.
- Invest in an Innovation Culture. The nurses and aides who work in facilities have great ideas. But it can be hard to leverage their expertise and turn it into a minimally viable product. I know of two large SNF companies that listened when therapists and nurses pitched programs to improve care transitions and reduce rehospitalizations, before those ideas were as relevant as they are today. Now those companies are beautifully positioned and the employees are very satisfied. There is a substantial literature on implementing innovation systems and one good list is provided in the December 2014 Harvard Business Review article, “Build an Innovation Engine in 90 Days.”
- Connect to Tech. There is a new and exciting innovation movement to bring technology platforms to aging services. These technology providers are not looking to replace hands-on care but to improve it. These tech entrepreneurs are looking to connect with providers. Review the companies in the Aging 2.0 portfolio and look for synergies with your offerings, specifically with an eye towards extending beyond the facility. These tech companies are new and open to partnerships.
Right now, families believe they have to do everything themselves as much as possible. That belief is hard to overcome if the market lacks products they would actually want. Traditional providers have an opportunity now to lead innovation and change to create a new and better market for everyone.