Look more closely at the 65+ age range. Not a trivial group — 39 million last year, a mere 13% of the US population today, but surging forward with bulging baby boomer segment additions. Of the current 39 million, 5.8 million are 85+, representing the fastest-growing age cohort in the US. What do the 85+ have in common with the 65-75-year-olds? Aside from being lumped by NPD and media into one bucket, that is. Survival, for one thing — if you live to be 65 in the United States, the odds are good that you’ll make it to at least 83.5 — for those who reach age 85, women will live another 6.8 years, men between 5 and 7 more years. Oops. The spread between 65 and 90+ is looming a bit large — a 90-year-old may very well have children who are 65 to 70.  Surely, these two ends of an age spectrum need different products, but more to the point, so many in the range of 65-and-beyond will need to care for and help those with long life expectancies, not to simply survive, but to live as well as possible (seeHuffington Post and Silver Planet for some inspiration about living those extra years).

Reading about the crisis in Japan, let’s not abandon the real elderly. Left behind in retirement facilities, nursing homes, perhaps making up a disproportionate percentage of those who are counted among lives lost, one has to wonder. Consider those in the US — in senior housing, retirement communities, and condominium complexes throughout places like Arizona and Florida, where the adult children may be unlikely to reside; where hurricanes, tornados, flooding, sudden cold, or failing air conditioning are crisis conditions for the elderly. Does everyone who knows someone living alone and away from their family also know what the escape or support plan is to help them in the event of a disaster? What are the top ways to monitor and stay connected to them?

Hearing, monitoring, seeing, connecting. These are key tasks that matter as life span lengthens and maybe even marketers get wise to sub-segmentation of the oldest age ranges — the upper end of the 65+. So usable telephones (land and cell) top the list, usable for those with arthritis and Parkinson’s, able to persist on battery, with multiple and easily charged mobile batteries. Captioned telephones for the hearing-impaired — many of whom do not wear hearing aids until long past the point of enjoying phone conversations. Then add magnification and Internet-enabled cameras — I was pleased to see that the latest Humana/Care Innovations pilot of Intel’s Health Guide includes a camera — hopefully the pilot in Tampa will include a sizable number of the real elderly. But then add computers and Internet service for the real elderly so that they can see and be seen on webcams — what’s it mean when a Google search of ‘Help seniors access Internet’ returns three Australian web addresses in the first seven results? Or check out SeniorNet (targeting the 50+? Huh?) when there is no listed Florida Learning Center and only 2 in Arizona? When (Pew Research) reports that only 30% of those age 75 and older go online and only 20% have home broadband (eliminating the usefulness of Skype and clear images of family members). When AARP lumps the real elderly into the 50+ Digital Divide and, unfortunately, appears these days to set survey (and enrollment) sights set on the 45+?

If you think the Internet doesn’t matter for the real elderly, think again. I am also reminded of one of the big disasters in the US — 9/11 — and how cell phones and land-lines services that day became useless as networks clogged under the weight of worry. But as I recall, AOL Instant Messenger was up and accessible by dispersed family members throughout a very long day. And I think about Facebook messages from Americans in Japan alerting their families when they became unreachable by phone. And I wonder how many of the real elderly were reachable through an Internet connection during either crisis?

Our new report, “Generation Alzheimer’s: The Defining Disease of the Baby Boomers,” sheds light on a crisis that is no longer emerging – but here.

Many baby boomers will spend their retirement years either with Alzheimer’s or caring for someone who has it.

An estimated 10 million baby boomers will develop Alzheimer’s.

Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer’s – a devastating, costly, heartbreaking disease. Increasingly for these baby boomers, it will no longer be their grandparents and parents who have Alzheimer’s – it will be them.

“Alzheimer’s is a tragic epidemic that has no survivors. Not a single one,” said Harry Johns, president and CEO of the Alzheimer’s Association. “It is as much a thief as a killer. Alzheimer’s will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now.”

According to the new Alzheimer’s Association report, “Generation Alzheimer’s,” it is expected that 10 million baby boomers will either die with or from Alzheimer’s, the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression. But, while Alzheimer’s kills, it does so only after taking everything away, slowly stripping an individual’s autonomy and independence. Even beyond the cruel impact Alzheimer’s has on the individuals with the disease, Generation Alzheimer’s also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.

“Most people survive an average of four to six years after a diagnosis of Alzheimer’s disease, but many can live as long as 20 years with the disease. As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities,” said Beth Kallmyer, senior director of Constituent Relations for the Alzheimer’s Association. “This long duration often places increasingly intensive care demands on the nearly 15 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security.”

In addition to the human toll, over the next 40 years Alzheimer’s will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America.

And while every 69 seconds someone in America develops Alzheimer’s disease today, by 2050 someone will develop the disease every 33 seconds – unless the federal government commits to changing the Alzheimer’s trajectory.

“Alzheimer’s – with its broad ranging impact on individuals, families, Medicare and Medicaid – has the power to bring the country to its financial knees,” said Robert J. Egge, vice president of Public Policy of the Alzheimer’s Association. “But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation – there has been great success. In order to see the day where Alzheimer’s is no longer a death sentence, we need to see that type of commitment with Alzheimer’s.” The full text of the Alzheimer’s Association’s “Generation Alzheimer’s” report can be viewed at www.alz.org/boomers.

Editor’s Note: For those looking to help their retirement community, senior center, or fitness center members diminish the effects of Alzheimer’s/dementia, I highly recommend Super Noggin, an extraordinary brain fitness lifestyle program based on the famous Nun Study and The Anti-Alzheimer’s Prescription. Full disclosure: Super Noggin is a client of TR Mann Consulting.

(photo http://www.classicmoviegab.com)

“A mother can take care of 5 children yet 5 children can’t take care of one mother.”

-unknown

I came across the film Make Way For Tomorrow (1937) by Leo McCarey. The movie is about an elderly couple, Barkley (Victor Moore) and Lucy (Beulah Bondi) Cooper, who are forced to separate when they lose their house to foreclosure; and none of their five children is willing to take both parents in.

Barkley is not able to find work due to his advanced years and with foreclosure eminent the elderly couple summons the adult children to break the news. A temporary solution is for the parents to split up and live with different family members; which proves to be untenable for all parties.

As Barkley continues to search for work so he and his wife can live independently, the scenario predictably deteriorates into a human tragedy:

When Lucy continues to speak optimistically of the day that he will find work, her teenage granddaughter bluntly advises her to “face facts”; that it will never happen because of his age. Lucy’s sad reply is to say that “facing facts” is easy for a carefree 17-year old girl, but that at Lucy’s age, the only fun left is “Pretending that there ain’t any facts to face…so would you mind if I just kind of went on pretending?”

-Wikipedia

Although the film ran over 70 years ago the topic is more relevant than ever as the aging population and the economic down-turn spell CRISIS for many seniors and their families.

Elderly Foreclosure

The global economic depression has hit boomers hard—as over 684,000 homeowners age 50 and over were delinquent, in foreclosure, or lost their homes last year. This is especially troublesome for the older adults who are on fixed income and limited time horizons for recovery. Not to mention the coming tough times for federal assistance programs for seniors; as pressure on aging services to poor and frail ramps up.

3 Stories: The Faces of Foreclosure

For a growing number of Americans the “Golden Years” are a fanciful dream that died with a personal loss or economic fates; never to be realized despite years of working and planning. Here are three stories to put a human face on the hardship faced by older adults:

Patricia 5 years in her home

Cole 28 years in his home

Andree 20 years in her home

These stories are heart-breaking, increasingly common place, and in need of solutions.

Saying Goodbye to Aging in Place?

We can discuss aging-in-place remodeling and elegant universal design options, but unless individuals like these have a “place” to age in–it does little good as they are evicted from homes where their dreams once resided.

In a review of Make Way For Tomorrow, Jamie S. Rich finds the film more hopeful because it shows us two people who can make the best of the worst times, who are resolute, and who never let go of what matters, even if they have to say goodbye to it.

Which many will have to do…

Watch the Film Make Way For Tomorrow

http://www.youtube.com/watch?v=V_MrZojHUdQ (10 parts)

See

One Away: Seniors in Trouble

911-Foreclosure Update

Foreclosure Threatens Elder-Care Homes

More Families Move in Together During the Housing Crisis

How to Cope with Elderly parents moving in

Equal Justice Works: Elderly Hard Hit by the Mortgage Crisis

How to Live With Needful Aging Parents

Lessons Learned By Moving an Elderly Parent Into A Boomer’s Home

How to Prepare When Elderly Parents Move In With Adult Children

Help

NRMLA: ReverseMortgage.org

HUD Reverse Mortgage Frequently Asked Questions

Reverse Mortgage as a Foreclosure Intervention Tool

Legal Aide for the Elderly

The Elder-Care Team

Support Our Seniors

I can’t die. It would ruin my image.
- Jack Lalanne

A man’s health can be judged by which he takes two at a time – pills or stairs.
~Joan Welsh

I read an article online from SmartMoney titled; Hanging On at Home. The piece begins with the jugular question: Where will people live as they grow old?

The author goes on to describe a summary of the social forces that have shaped the living conditions of seniors prior to WWII, up to the present. He then provides five suggestions for “cutting through the clutter” of aging-in-place information on the web.

Not to cloudy the waters further, but I’d like to add a sixth suggestion…

Jack Was Right

Many of the targeted audience for the SM article grew up watching black and white images of a sincere, high-energy-buffed-guy in a tight-fitting jump suit, giving motivational chats, leading invigorating workouts, encouraging deep breathing and healthy living; all accompanied by lively organ music.

The sets were simple (a steel office chair and a poster board) but the concepts were not—and they still ring true today.

Jack Lalane was right; he knew that many people’s lives were just suicide on the installment plan. Jack recognized our changing disease states which have gone from acute (i.e., pneumonia which was once called “the old man’s friend”), to chronic (i.e., diabetes which isn’t cured only managed over long periods); and many were due simply to neglect.

Functional Aging

Aging in place requires more than just making a few simple changes such as replacing doorknobs with pull handles or installing ramps and no-step thresholds. These strategies are important, but functional aging is a key element in extending independence.

Lalanne described “functional aging” in his The Hands of Time episode. The goal was to die “young,” as late in life as possible…which is really the difference between extending life vs. extending health; they are not the same thing.

Much attention has been paid lately to the biomarkers of aging and how they can be affected by lifestyle. One key biomarker (measurable physiological factor related to aging) is aerobic capacity.

Aerobic capacity (age and weight specific) is how exercise physiologist measure uptake and utilization of oxygen by the body; the term used is VO2max. This is an essential factor for aging in place, because if you have a VO2max of less than 10ml/kg/min you can’t live independently at home because of the inability to do activities of daily living (ADLs).

The Bad News

As we age, under normal conditions (meaning no underlying diseases like lung cancer) our VO2max after age 30 decreases by 1% each year. So a 70 year old has a 40% decrease in VO2max.

The Good News

Exercise can decrease that 1% yearly decline in VO2max after age 30, by half. So a 70 year old may only experience a 20% decrease in VO2max.

The Sixth Suggestion

So, while you’re doing that elder-friendly home evaluation, embracing the concept of universal design, emphasizing fall prevention, comparison shopping-remodelers, and staying aware of public trends…PLEASE don’t over look taking care of yourself physically (and mentally).

As Jack might say; you know students, your body needs to be available to you…

See:

Time to Remodel that “House”
(photo soloflex.com)

Residents of The Heritage of Green Hills participate in a Super Noggin class.

Non-Profit Dedicated To The Cognitive Health of Boomers and Seniors Is Worth Talking About

It’s a beautiful thing when your work and your passion collide. Remarkably, I’ve had this good fortune several times throughout my career.

A couple of years ago, I was speaking at the International Council on Active Aging’s Conference (ICAA) when I was greeted by one of the most spectacular humans I have ever met. The ICAA conference seems to bring out extraordinary, caring people (a couple of years prior, I also met Maestro David Dworkin, the founder of Conductorcise). On this day, I met Bruce Findley.

Bruce’s story was fascinating. He was a VERY successful business man; a resident of Shell Point Retirement Community; and the founder of LEAF Ltd., a private foundation and 501(c)3 nonprofit organization dedicated to promoting intellectual wellness for boomers and seniors. Bruce has gifted millions of dollars of his personal wealth to LEAF with his only goal of improving the lives of others.

He asked if TR Mann Consulting could help his team market an innovative brain wellness lifestyle program, which we later named Super Noggin. For me, it was an easy answer as my Mom had battled with Alzheimer’s before passing away.

So, what’s so innovative about Super Noggin?

If you’ve been paying attention to the brain fitness arena, there is a plethora of cognitive fitness computer programs. And many of them are very good. However, as a resident of a retirement community, one of the things Mr. Findley and his staff noticed was that boomers and seniors prefer to learn in a social setting. So his team set to work on creating something they’d enjoy — something they could envision maintaining. Just like fitness is a lifestyle change, creating healthy brain habits is a LIFESTYLE change.

So the team set to work. Based on the world-famous Nun Study and other current neuroscience research findings, Super Noggin is a comprehensive program offering a multi-pronged approach to LEARN and PRACTICE brain-healthy habits and to TRACK progress. The components of the program promote cognitive challenges, physical exercise, good nutrition, social interaction, stress reduction, and personal reflection.  And, as fitting to where we first met, Super Noggin is compatible with the wellness model of the ICAA.

One thing that makes Super Noggin different is that it is led by Certified Super Noggin Instructors through a network of participating locations such as wellness centers, gyms, YMCAs, retirement communities, JCCs, senior centers, community centers, and other facilities.

In Fayetteville, Arkansas, energetic 68-year-old Billie Jean Harvey is a perfect example of the type of person taking advantage of Super Noggin. She is healthy, active and engaged — and she’s looking to stay that way.

She was recently interviewed by NWA Online about her interest in the program.

“Sometimes, I just get lost in time,” the Fayetteville resident said. “I get tied up with what I’m doing and completely forget my schedule.”

Harvey said she and her husband worry about losing their memory because both of their mothers were diagnosed with Alzheimer’s. She said she works to keep her mind sharp by doing puzzles and volunteering, but is concerned that her husband, 69-year-old Charles “Winston” Harvey, is stuck in a routine.

Harvey said she and her husband learned about Super Noggin while volunteering at the Fayetteville Senior Center. She said she was relieved when her husband agreed to participate in the program.

“I want to do whatever it takes to keep my brain sharp,” she said.

Chris Romick, a retirement community Sales Director in Reading, Pennsylvania agrees that the proactive approach is in line with his residents needs, “At The Heritage of Green Hills, which is a full-service retirement community for people 55 and up, our residents believe in prevention through a healthy lifestyle… rather than reactive health care. Our residents want to STAY healthy! This is why Super Noggin was such a perfect fit for our community. I can tell you this much, people have told us that one of the attractions for moving to The Heritage was the availability of Super Noggin.”

Expanding the program

Now that program is already serving hundreds of boomers and seniors, I’m actively looking to partner Super Noggin up with some progressive companies. I’m getting ready to knock on the doors of some major companies such as big pharma and long-term care companies.

Why? Because it makes sense for them. Let’s take long-term care providers as an example.

Why would Super Noggin make a useful marketing tool for long-term care providers?

Super Noggin provides a NO RISK opportunity to:

1. Lower marketing costs
2. Endear current prospects and potential clients
3. Lower your actual coverage expenses
4. Generate positive press

Super Noggin is modeled after the widely successful SilverSneakers program. The preventive health principals at work in the SilverSneakers program are similar to what we’d expect for Super Noggin. While SilverSneakers is focused on the physical body, Super Noggin is a cognitive lead fitness program.

The SilverSneakers Fitness Program has been a vital component of several major health plans’ acquisitions and retention strategies. These companies include AARP Medicare Supplement, SecureHorizons (AARP Medicare Complete), Humana, Health Spring, several Blue Cross Blue Shield plans, Kaiser Permanete, Bravo Health, and Highmark, just to name a few.

Voluntary disenrollment results in lost premiums as well as acquisition costs to replace members; programs like SilverSneakers and Super Noggin can help. In studies of health plan retention among SilverSneakers clients, voluntary disenrollment rates among program participants were substantially lower than among those not enrolled in the program. Depending on the size of the health plan’s membership, this difference can mean the retention of a significant number of members.

Responses from 8,400 SilverSneakers enrollees who completed the 2008 annual member survey support these findings. Based upon their experience with SilverSneakers:

•          61% said the likelihood of their remaining with their current health plan had improved or greatly improved.

•         71% said the likelihood of their recommending their health plan to friends or family had improved or greatly improved.

•         83% rated their health plan an 8, 9, or 10 on a scale of 1-10, with 10 being the best.

•         58% said they were likely to choose another health plan offering SilverSneakers if it were no longer available through their current plan.

63 percent of SilverSneakers members said the benefit was an important consideration in deciding to join their health plan.

Lowering Coverage Costs

Insurance and health care companies are always seeking new ways to reduce direct and indirect health care costs. For companies that offer long-term care insurance, brain fitness is a key component to fighting rising health care costs. Some insurance companies like Penn Treaty American reported a reduction in claims after offering brain fitness exercises to their long-term-care insurance customers. Providing your members with important brain fitness knowledge enables them to live healthier, more independent lives.

The tools Super Noggin utilizes have been clinically proven to enhance cognitive abilities, reduce insurance claims, and improve lives:

• 5-year predicted reduction of medical expenditures by 3-4% (Wolinsky, 2009)
• Improves performance on activities of daily living (Edwards, 2002)
• Reduces risk of onset of depressive symptoms  by 38% (Wolinsky, 2009)
• On average an improvement of memory scores equivalent to approximately 10 years. (Smith, 2009)

(Source:  The business case for wellness programs in retirement communities and seniors housing, a white paper from the International Council on Active Aging).

A proactive cognitive health program can give policyholders the tools they need to actively address their concerns of developing dementia. Such a program may also reduce the frequency and length of future cognitive claims.

In recently published studies, participants practicing brain fitness showed statistically and clinically significant gains on standard cognitive batteries, while participants in control groups showed minimal or no gains. The gains are equivalent to 10 or more years of improved cognitive function (such as ability to remember and faster processing speed) among populations over age 60.

The Super Noggin could revolutionize the long-term care insurance industry … give a major PR boast to pharmaceutical companies … lift the profile of commerce giants like Wal-Mart … or alter the future of a country that faces a dementia crisis. The possibilities are endless!

Call To Action

So, who’s ready? Any and all contact suggestions would be greatly appreciated. I am driven by the generosity and vision of my good friend, Mr. Findley, and his goal of improving the aging process. His charitable group has created something definitely worth sharing!

Tom Mann, 410-292-4333

• Remote home monitoring got buzz and investment. Venture capitalists stepped up for remote monitoring: Healthsense received venture funding, as did WellAWARE. Numerous news outlets pointed a consumer flashlight onto GrandCare Systems and this still fairly narrow market, now blurred further this year with remote health monitoring (aka telehealth, wireless health) — now in some cases reimbursed due to vital sign monitoring during post-hospital rehab stays.

PREDICTION: 2011 will further blur the distinction between remote health monitoring and passive activity monitoring. Given the fertile health technology marketplace of grants for trial projects among non-profit organizations, my take is that vendors would do well to add device enablement (like blood pressure and weight scale), seek FDA approval and throw in the towel on preserving a standalone category.

• The PERS market got a Philips auto alert boost. In January, Philips launched Lifeline with Auto Alert for automatic fall-detecting PERS devices, likely at the expense of its own Lifeline device sales. By creating market awareness (yuk, that home page is still bleak, bleak, bleak!) about passive fall detection and notification, Philips offered help for competitors Wellcore, Halo Monitoring and others with fall detection capability. Meanwhile, mobile PERS with GPS location identification continued its move (pun intended) forward and outside the home — striving to appeal to a younger and more out-and-about population.

PREDICTION: In 2008, PERS market growth was predicted to be flat — Parks Associates asserted a $600 million flat line, supplanted by a corresponding growth in passive remote monitoring. Not so, it turns out. Today PERS is approximately a $1 billion market — and while there are a number of new remote monitoring entrants, passive remote monitoring is still below the adoption radar. What’s next? I am waiting (and may have to wait well past 2011) for elder-focused applications and trained carrier call centers that leverage the built-in accelerometers, GPS trackability, and (ha, ha!) ease of use of cell and smart phones. In the meantime, PERS sales will grow, not as fast, but steadily as the population ages into frailty — remembering that 85+ is the fastest growing segment, that PERS contracts typically last only for two years.

• Games got gestures — someday seniors will benefit. With the launch of Microsoft’s Kinect interface, teens got a chance to jump higher while playing group Xbox games, including the ability to play group games simultaneously from separate locations.  But speaking instructions and using hand gestures is an important user interface change that can transform the accessibility of apps — check out this MIT Kinect browser navigation accomplishment posted just minutes (it seemed) after Kinect sold out at Target.

PREDICTION: Hand gestures, recognizable features, and spoken commands — app vendors, go forth and create! At least 5 vendors focused on the older adult market will offer a Kinect-enabled application by end of 2011. Throw in specific health and chronic disease management — many times five. Design-for-all apps, lots and lots.

• The iPad marginalized the need for an annoying PC operating system computer. In January, the iPad announcement looked pretty impressive… and the screen looked very pretty.  Well, doubt no more about boomers — these things are everywhere, boomers seem to love them and they (or their many, many imitators) are migrating into the homes and lives of older people — someone besides Apple will tell us how many.  These types of devices will, over time, make us forget that we used to need simplification software to overlay on top of complex and consumer-hostile devices.

PREDICTION: In our near-term lifetime, older adults depending on your children or Best Buy to upgrade Windows patches may become a distant memory. The same Microsoft that brought this brilliant Kinect interface into the market will hobble out its own tablet next week at CES. Maybe it will be foisted on enterprises through IT mandate, but among an older population for home use, forget it. Even though folks may have told AARP they won’t buy one, they just didn’t know what they were saying — AARP surveyed too early (June) about a product that had just began shipping (late March).  Newer products from other vendors will also make the concept of an operating system upgrade either quaint or invisible.

• eReaders eliminated the need for reading glasses. Meanwhile, as you can plainly see in airports, planes, trains, and TV commercials, the eReader (Nook, Shmook, etc.) is taking a big chunk out of physical books. As my husband has noted with his free Kindle reader for Blackberry, if you like to read, eReaders mean never having to search for your reading glasses.

PREDICTION: We are in a silly ‘i-this’ and ‘e-that’ phase right now — vendors may fight to the death to keep it that way, maybe even giving eReader devices away with a purchase of 10 or more books? But in the end, it’s pointless — eReader software will be on all tablets, game controllers, portable and phone-like devices.

• Caregiving software — is this really a standalone market? Along with initiatives to help caregivers, caregiving applications sprouted in 2010, but is this a category? With software as a service, these apps really seem to be functionality that is part of a larger caregiver portal, possibly white-labeled by a service or healthcare insurer/provider (like Kaiser Permanente) or offered by a home care agency as part of a solution that includes devices — including home health monitoring and/or web cameras.

PREDICTION: For those caregiving applications that are part of the professional caregiver services toolkit, 2011 will be the year in which the largest home care agencies (family/companion and health) expand their tech reach. They will include standard caregiving functionality that updates and includes family participation. They will consider Skype (or its equivalent) to be a core competence of Geriatric Care Managers — as with SeniorBridge. They will replace the requisite post-visit telephone call tag with the kind of simultaneously-viewable update that families can create with a portal like CaringBridge.

• Dementia undermines aging in place. All remote, health, and gadgety tech notwithstanding, let’s consider Alzheimer’s and the CDC’s statement that “nearly half of those age 85 and older may have the disease.” (Feel free to spend some time online trying to nail down that definition, the percentage, and/or its source, but I digress…) Wander prevention technology presumes a willing and available responder to receive those close-by alerts or forming a relationship with the local police to find the missing. It presumes someone is wearing a tag, device, necklace or bracelet. But we’re better at locating prisoners and dogs than we are at preventing people from wandering to the point of danger.

PREDICTION: During 2011, more vendors will emerge with unobtrusive tracking devices linked to smart notification software that incorporates a hierarchy of responders and a multiplicity of ways to reach them. Hey, maybe we’ll even see that GPS shoe (as of today predicted by Foot.com to ship in early February 2011). If there’s no associated service, though, the shoe will be absolutely useless.

• Vendors of age-related products and services still struggle to address the market properly. The pathway to sales is littered with the simultaneous obstacles of poor economic climate, limited funding, few solutions-versus-products, long sales cycles in many cases, complex decision-making relationships (adult child? senior? professional caregiver? who?) and new management learning curves. To tackle some of these obstacles and promote sharing of lessons learned, last year’s Silvers Summit spawned an AgeTek Alliance of vendors and supportive organizations, which will this year will hold training and networking sessions at CES.

PREDICTION: 2011 will (hopefully) see more coherent and reusable channel cultivation, more multi-vendor product bundling, growth in training of service providers and resellers, and greater awareness of appropriate tech among referrers like doctors, GCMs, and senior housing organizations. In 2009, I speculated about certification of service providers in technology for aging in place — in 2010, NAHB’s CAPS — Certified Aging in Place Specialist) program wisely split into two parts — Marketing and Communication Strategies for Aging and Accessibility (CAPS I) and Design/Build Solutions for Aging and Accessibility (CAPS II) — the latter includes an assessment of needs which will, hopefully, include tech communication requirements. In 2011, there will also be forward movement that exposes minimum product requirements — like usability, ease of installation, and ease of operation — through ever-greater exposure of actual user experiences. Although it makes sense to consolidate objectives and outcomes among age-related consortia and groups, that is highly unlikely in the near term. Finally, for those of you considering entrance into this market, please follow these Ten Tips.

• Bad prescription — hospitals and the elderly. Maybe you missed it a few days ago — more than 1 in 5 of those admitted to hospitals (2008) were over the age of 75. And those aged 85+ were 2.5 times as likely to need nursing care upon discharge as those age 65-74. Interestingly, Microsoft’s HealthVault Community Connect, “a portal solution that helps connect healthcare institutions to their referring communities and patients,” according to Microsoft’s Luisa Monge, is just beginning to be deployed as part of hospital admission — where discharge planning must begin if it is ever to function properly.

HOPE: To get to the hospital, someone has to call 911 (or drive in the car). My dream is that whoever does the calling or driving has the ability to produce a list of current medications on a sheet of paper that has all identifying information, including the name of the doctor, next of kin and contact info. This is so low-tech — if the very old can’t stay out of hospitals, can they at least arrive armed with their own data?

• Design for all or design for aging? Finally, let’s tackle the thorny issue of whether there is such a thing as ‘tech for seniors’ or should all tech incorporate certain core principles — in effect, ‘design-for-all?’  How about devices with good lighting, adjustable font, audible display options, color adjustments? And as Dr. Joseph Coughlin noted, shouldn’t tech be more FUN to use, not just utilitarian?

HOPE: In 2011, let’s hope that marketing senior-related products doesn’t have to be fear-focused to effectively reach the consumer.  Let’s hope that it becomes less and less important to design tech exclusively for the use of older adults. Let’s hope that everything we use is wonderfully easy to figure out, that the buttons on our new TV remotes are bigger, that configuring web-enabled television can be done in fewer than 5 perilous steps (this requirement was comfirmed by Best Buy), that the user manual is only a nice-to-have that comes with our phones, readers, tablets, and games. Let’s hope that if we want the full-featured, heavy-duty sophisticated options — or we want tech to be friendlier in the event that our dexterity, vision, or hearing declines ever so slightly — that even though you can’t always get (exactly) what you want, you can usually get what you need.

Editor’s Note: If you haven’t visited Laurie Orlov’s blog, Aging In Place Technology Watch, you should. When it comes to understanding technology as it relates to aging, there is NO better source of information.

I (Tom Mann of Love and Company) recently presented “Improving Marketing and Sales for your Retirement Community, CCRC, Assisted Living, or Skilled Nursing Care Facility” at the LifeSpans educational seminar. Here’s the PowerPoint I presented with transcriptions!

On the horizon is a DVD player so he can watch M*A*S*H reruns and other programs and movies he so enjoys.  And he’s on the waiting list for “Honor Flight” next year, a program that transports World War II veterans to see their memorial in Washington, D.C.

From coffee shops to clothing, the mature market is willing to use their disposable income.

How do you attract seniors to your town, city, or state? And what’s their value to the local economy? Late last year, I was asked to speak at the National Active Retirement Association (NARA) Conference on this topic. State representatives from across the country where in attendance, as was NARA’s founder Dan Owens, who has been harping on this overlooked fact for some time now. The beauty of attracting retirees to your town, is that essentially, the drivers are similar to what drives tourism. And, once you start that trickle of retiree money, it builds momentum like a fly-wheel, i.e., one restaurant attracts another … then an art gallery … then a museum …

Plus, attracting retirees costs less than it does to try to attract major manufacturers. And the return to the local tax base is a whole lot more! Think about how major companies hold small economies hostage (unless you do this, this, and that, we’re leaving). In addition, companies can and do go out of business. Seniors with their social security checks stabilize economies and diversify risk.

Shortly after this presentation, our team was invited to talk to several of the representatives of Opelika, Alabama (Opelika and Auburn are adjacent to each other and have grown to form one fantastic destination). Amazingly, the bulk of their marketing has been done with the young professional in mind. When I showed them the stats favoring boomers and beyond and their spending patterns, they were floored. Next, we reviewed some of their marketing materials, the type faces and fonts where so small and so dense, I couldn’t read it (at least not without getting a headache). Truthfully, they just hadn’t thought about how their marketing materials appealed to retirees. Fortunately, they quickly understood what I was saying. These folks get it! And, they are blessed with fantastic southern weather; a world-class university; charming, walkable towns; some of the kindest people on the planet; and an incredible value proposition from a real estate perspective — not a bad starting point!

Towns and cities all across America are aspiring to be on U.S. News & World Reports’ Best Places to Retire list. The reason -  many urban planners believe that the mature market will bring economic stimulus with them in various forms, such as job creation, a boom in real estate, retirement communities and senior housing sales, an import of savings and reliable incomes. Other advantages of attracting boomers/seniors/retirees include economic and social stability, an increase in the tax base and volunteerism. Compared to wooing industry, retirees are a bargain. But as the massive generation of baby boomers grow older, communities must also be prepared for a growing strain on local health care systems and infrastructure. To read more on the pros and cons of enticing the 65+ demographic to a local economy Master_Retiree_Attraction_FINAL_Report.

Also, here’s a great article about how one Florida town discovered that retirees, not NASA are the economic drivers for their economy.

Mature Market Experts: more boomer, senior, and mature market news and stats you can use – Shared Housing – The Next Senior Trend? Many baby boomers find themselves rattling around in a big, empty house, alone and overwhelmed by the upkeep and financial drain. But they may wish to age in place rather than move on to assisted living. Other folks’ finances simply will not allow them to buy a home. So why not match these two groups up, and perhaps they can help each other out? That is exactly what the Shared Housing movement is advocating. The National Shared Housing Resource Center lists organizations attempting to get participants connected, either in a match-up program (which helps find a compatible boarder who either rents or offers services to the homeowner) or a shared living residence (where a group of unrelated people share a large  home). Taking this desire for symbiotic living a step further is the Co-Housing movement, where a community is planned and built around the concept of common living spaces, cooperative decision making, and shared work. If a senior needs some physical assistance, a willing house member or neighbor may reduce or eliminate the need for a health care aid. Both Shared Housing and Co-Housing are naturals for mature populations who may have lost a partner and are lonely, or would enjoy sharing a ride in return for babysitting. Maybe it takes a village to raise a child, but it is good for the 65+ age group too.

For more information on Co-Housing click here.

To read further on Co-Housing read this.

To read further on Shared Housing read this.

The caveats and conundrums qualify each rendering of buzz. The Hilary Stout article cited several of the almost clichéd concerns expressed by various University research experts: worries about privacy (‘big brother is watching you’), false alerting (70-year-old mom was painting the sun room, not having a heart attack), parental resistance to the tech (being bothered by it, or being bothered by their children who want them to use it.)  Meanwhile, the Leland article raised cautions about price and lack of reimbursement, whether the technology monitoring would let adult children off the hook for visiting their parents. And in September 2009, Business Week quoted IDC’s Scott Lundstrom, vice-president for research at IDC Health Insights: “Right now this is a niche market made up of affluent people who want to monitor their parents. The technology is going nowhere without a reimbursement model that supports it.” Yeah, yeah, yeah, but why?

So let’s swat our way through the thicket of buzz and caveats.  What will make the market for technologies for aging in place, or the inverse, technology to help with caregiving of aging parents, or the market’s largely overlapping segment, telehealth, become mainstream enough to be a given, expected to be available, and NOT newsworthy as a ‘new’ category? 

1.  Wanted, a viable channel strategy.  While it is possible that family members may hop onto the Internet and search for a remote monitoring system for their aging parents, more likely a member of the senior value chain (the industry) finds families like those in the Times article through local activities and local contact.  Systems need to be installed; high quality service must be provided; products must be leasable and returnable; pricing must enable revenue sharing; products must have easy-to-integrate interfaces — see more of this very important list provided on this blog by contributing integrator, Susan Estrada from Happy Home.

2.  Wanted, insurance reimbursement or viable pricing.  Studies continue to launch here there and everywhere to re-prove yet again the benefits of telehealth and remote monitoring of all types.  Because insurance companies and government agencies are not yet convinced, even with FCC and FDA enthusiasm, technologies that include or integrate with chronic disease monitoring fall into (or are placed there by vendors, actually) into health, disease management categories that health professionals must quantify financial benefits again and again to convince those who may be perpetually doubtful, possibly due to lack of endorsement.  As one research interviewee told me once: a dollar saved in the healthcare industry is a dollar lost by someone.”  In the absence of this elusive reimbursement, pricing must fit into the budgets of families or those who provide services in order to become mainstream.

3.  Wanted, a tech-smart senior value chain.  Hopefully some of the buzz from the Times caught the ear of what I refer to as the ‘senior value chain’ – the multiple and diverse organizations and people who really want to help support aging seniors. These include: caregivers, geriatric care managers, social workers, discharge planners, home care agencies, independent and assisted living providers. Do all members of this chain view staying current and knowledgeable about technology tools as part of their job? Even as aging in place (aka not moving) becomes a near-national mantra among families and seniors, even as home care agency businesses grow at the expense of nursing homes and assisted living, the technology categories described in the Times articles (past and present) are not mainstream among home care agency providers, for example. So families mull over what will be happening in this largely tech-free world on the off-days, and off-hours when aides are not present or don’t appear.

4.  Wanted, the ‘right’ products and services.  So let’s say the above 3 issues were all non-issues. We still have no really clear expectations of what we (the senior value chain) want from the products and services themselves.  We have phones with no GPS, we have GPS tracking without phones, we have PERS devices that are mobile without fall detection, we have products with fall detection that not mobile-enabled. We have remote monitoring devices that cost hundreds and remote monitoring devices that cost thousands of dollars. We have HIPAA-compliant and FDA-approved, and we have no-and-no to either. We are targeting markets of the still-well-enough to drive, or is it the frail-enough to be home bound? Products can be marketed direct to consumers, or no, should vendors seek distribution? Vendors must decide, channels must be recruited, manufacturing decisions must be made, but this is an industry of uncertainty about the correct strategy — because the market expectations are not yet ‘mainstream’.

The technology isn’t really new, but a mature market isn’t really here, either.  I love buzz — it is energizing, exciting, and validating for what those who are working hard in this industry — and it energizes me as well. But a few (how many?) years from now, it would be great to read stories about how adoption of all of the technology categories discussed in the two Times articles last week grew by leaps and bounds, practices are standardized, training of professionals incorporates those practices, senior well-being is clearly better in the study groups versus the control groups, and the young engineering talent of the world recognizes the opportunity to enter this well-established and mainstream market.

photo toddnoordyk.com)

It’s a world of laughter
- A world of tears
It’s a world of hopes
- And a world of fears
There’s so much that we share
- That it’s time we’re aware
It’s a small world after all …
-Written by Richard M. Sherman and Robert B. Sherman

BMI (body mass index): A ratio of weight to height (weight in kilograms divided by height in meters squared) BMI = kg/m2

The other day I was working with a gastroenterologist (GI doctor) who was sporting a smart looking Mickey Mouse watch. She had acquired it on a recent family vacation to Disneyland. This sparked some conversation about the land of enchantment and some of the rides they experienced. Of course I had to ask about the Small World ride.

The line: It’s a small world after all (sorry now that it’s stuck in a circular loop in your head), has been the subject of many jokes and comments throughout the years; but what followed was a new twist to me. Seems the ride had been out of commission for repairs and the reason…

Well, there is some controversy surrounding the reason the ride was shut down in 2008. The ride has been around some 45 years and the original flume and fleet of boats made their maiden voyage during the 1964-65 New York World’s fair. The sturdy little pastel boats have been doing yeoman’s work ever since. No doubt that kind of run would even cause Cal Ripken to pit stop for some refurbishments.

According to MiceAge the Imagineers of the 1960’s designed the ride to accommodate the average man (175lb) and woman (135lb) of the era; not the adult of today who can often weigh more than 200lbs. The boats ride lower in the water and tend to “bottom out,” causing the whole contraption to stop in its tracks. The solution (prior to redesign) was to limit passengers or escort embarrassed patrons off the ride.

Several stories including one in the New York Times call on readers to draw their own conclusions. The subject is somewhat taboo and Disney denies any connection between redesign and weight of the riders.

Whether the connection is valid or not the fact remains Americans are getting heavier on average. According to the U.S. National Institutes of Health, approximately two-thirds of adults age 20 or older are overweight or obese with BMIs greater than 25, and nearly one-third have BMIs greater than 30. Less than one-third are at a healthy weight with a BMI of 18.5 to 24.9.

In my own experience as a nurse I’ve witnessed hospitals having to equip ceilings with steel I-beams to support mechanical lift systems to get obese patients in/out of bed. A recent staff development in many care settings are the “Lift teams.” These are designated staff whose sole job is working the lifts and turning patients—in order to save nurses from back injuries.

Kaiser Permanente purchased a fleet of love-seat sized wheel chairs years ago to accommodate the increased girth of its members. I once took one of these devices to a presentation at Nike World Head Quarters…they couldn’t believe their eyes as I rolled it in the room.

At issue are not just the obvious effects of BMI on health and longevity but control of one’s own experience and for this discussion that means aging in place.

It’s About Control (but not what you might think)

In an article from Newsweek (Feb/23/2009): Stress Could Save Your Life, author Mary Carmichael writes about the connection between control and stress. Carmichael notes a classic study where scientists put two rats in a cage, each locked to a running wheel. The first rat could exercise whenever he liked. The second was yoked to the first and forced to run when his cage-mate did.

The exercise that usually decreases stress and encourages neuron growth in the brain did just the opposite in the second rat—the reason…control. Psychologists know that one of the biggest factors in how we process stressful events is how much control we have over our lives. A body rendered un-available due to high BMI can place limits on personal control (mobility and independence). Much of the appeal of aging in place is about choice—to make the issue relevant is to frame it as matter of control.

Research has shown that by avoiding a further increase from 28 kg/m² to 32 kg/m², a typical person in early middle age would gain about 2 years of life expectancy. Two years of extra life down the road might not sound all that compelling to some, but the issue is really more one of extending health—not extending life.

Inactivity doesn’t necessarily shorten the life-span…it most definitely shortens the health-span. –Dr. Rosenburg, Tufts University

Extending the health-span can equate to maintaining mobility and independence; ultimately leading to a higher degree of control (& decreased stress) over one’s life experience. And that’s what aging in place is all about.

See:

Calculate: Your BMI
Research on life expectancy
Middle aged women and stroke
It’s a small world video

Heritage of Green Hills Serves As Prototype For Super Noggin

Over the next 18 years the baby boomer tidal wave will reach the shores of retirement.  Add to that the fact that people over 85 are now the fastest-growing segment of the population, and the result is that by 2050, the number of Americans 85 years and older will quadruple.

Total healthcare costs are more than three times higher for people with Alzheimer’s Disease and other dementias than for other people age 65 and older, according to the 2010 Alzheimer’s Disease Facts and Figures, published by the Alzheimer’s Association.

According the Facts and Figures report, in 2006:

• Medicare beneficiaries with diabetes plus Alzheimer’s or another dementia had 64 percent more hospital stays than those with diabetes and no Alzheimer’s, and their average per person Medicare costs were $20,655 compared to $12,979 for beneficiaries with diabetes but no Alzheimer’s or dementia.

• Medicare beneficiaries with coronary heart disease and Alzheimer’s disease or another dementia had 42 percent more hospital stays than those with coronary heart disease and no Alzheimer’s or dementia, and their average per person Medicare costs were $20,780 compared to $14,640 for beneficiaries with coronary heart disease but no Alzheimer’s or dementia.

• With family members providing care at home for about 70 percent of people with Alzheimer’s disease, the ripple effects of the disease can be felt throughout the entire family. According to Facts and Figures, in 2008, nearly 10 million Alzheimer caregivers in the U.S. provided 8.5 billion hours of unpaid care valued at $94 billion. In addition to the unpaid care families contribute, the report also reveals that Alzheimer’s creates high out-of-pocket health and long-term care expenses for families.

• Out-of-pocket costs that are not covered by Medicare, Medicaid or other sources of insurance are 28 percent higher for Medicare beneficiaries with Alzheimer’s than those without. Individuals with Alzheimer’s and other dementia living in nursing homes or assisted living facilities incurred the highest out-of-pocket costs – an average of $16,689 a year.
 
Growing prevalence of Alzheimer’s Disease and dementia 

• There are 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer’s Disease. By mid-century someone will develop Alzheimer’s every 33 seconds. By 2050 there will be nearly a million new cases per year.

• Alzheimer’s is the sixth leading cause of death in the country, surpassing diabetes; it is the fifth leading cause of death among individuals 65 and older.
From 2000 to 2006, while deaths from other major diseases dropped -

> heart disease (-11.5 percent),
> breast cancer (-.6 percent),
> prostate cancer (-14.3 percent) and
> stroke (-18.1 percent) -
deaths from Alzheimer’s disease rose 47.1 percent.
 
Two innovative organizations fight back 

The Heritage of Green Hills, a stunning full-service retirement community for retirees 55 and up, has made a name for itself by pushing preventive health care, rather than reactive health care. “Our residents are some of the most active, independent people you will ever meet. We aim to keep it that way! ” says The Heritage’s Executive Director, Chris Romick. “Currently, we are a country that reacts to health care problems rather than practicing preventive health care. As part of our Well By Design program we’ve teamed up with the not-for-profit LEAF Ltd. Foundation. LEAF has developed an innovative new program called Super Noggin.”

The Heritage of Green Hills.

Super Noggin is a brain fitness program for those who want to stay mentally sharp throughout life.  It is designed to maintain and even improve brain fitness, but following the program also contributes to good physical health – a bonus! It’s the first cognitive fitness program to integrate live classes, advice on computer programs, and behavioral changes (namely sleep and diet) to promote healthier brain fitness.
 
The components of the program promote cognitive challenges, physical exercise, good nutrition, social interaction, stress reduction, and personal reflection.  Super Noggin is compatible with the wellness model of the ICAA (International Council on Active Aging).
 
“We’re honored to be the first retirement community in the country offering Super Noggin,” exclaims Chris, “we know it will make a huge difference in the quality of the lives of our residents. Our Well By Design staff members are among the first in the nation to be Certified … and now they can lead groups in maximizing their brain fitness throughout the year. That’s exciting! ”

Super Noggin Class An Overwhelming Success

On July 1st  the Super Noggin team led a packed room of more than 70 Heritage residents, ages 55 to 88, in a Super Noggin class titled, “Ten Steps To Brain Fitness.” But Super Noggin is more than just classes; it’s about making lifestyle changes that can dramatically improve life.
 
Super Noggin is a comprehensive brain fitness program offering a multi-pronged approach to LEARN and PRACTICE brain-healthy habits and to TRACK progress.
Super Noggin includes:
 
• educational and motivational workshops
• brain exercises to stimulate cognitive functions
• a year-long schedule of individual and group activities to keep your brain fit individual tracking of progress toward a healthier lifestyle

Registered Nurse and resident of The Heritage, Bonnie Ebling likes what she sees in Super Noggin, “We keep active physically. We need to keep active mentally too! When you go to a Super Noggin session, it reinforces things you already knew but you also tend to have a lot of ‘Ah ha’ moments.”  Executive Director Chris Romick agrees, “At The Heritage, our residents believe in prevention through a healthy lifestyle… rather than reactive health care. Our residents want to STAY healthy! Which is why Super Noggin was such a perfect fit for our community. I can tell you this much, people have told us that one of the attractions for moving to The Heritage was the availability of Super Noggin.” 
  

Full Disclosure: Both The Heritage of Green Hills and Super Noggin are clients of TR Mann Consulting.

Line up to learn your longevity likelihood.  Aren’t you just loving the opportunity we will soon have to download that free genetic marker test kit, the one that with 77% accuracy will tell whether we will live past 100? Boston University scientists have ‘no plans to profit’ from the results, but they will make the kit available later this summer. (Warning: analysis of the results will be costly.) I am so struck by how the law of unintended consequences could play out, especially in areas of insurance — as with a home test kit for Alzheimer’s, people might be more likely to purchase long-term care insurance. With a longevity test on the market, how long will the term need to be in term insurance? Taking it a step further, should insurance companies offer free kits as a marketing device? Should your doctor know that you’ve taken such a test? Should a health insurer know? What happens to rates, deductibles and lifetime caps? What kind of housing and support systems would we want if we knew we could live to 100 or more (or if we knew we would suffer from Alzheimer’s)? What would our families do with that information?

Which brings me to home care — what we want. So let’s just imagine that many more of us are going to make it to 100, that we fear nursing homes and obsessively want to stay in our own dangerous-but-familiar houses. Of course, we will want to be there all alone in our later years, visited only by home health or companion aides from the growing home care industry (hopefully they won’t visit us too often, though, and draw attention from the SEC). Hopefully the aides are background-vetted, well-paid, well-trained, dedicated and conversational, and are the low-turnover folks. Hopefully they will take us out to events and social activities, make sure that we are well-monitored and Skype-connected to our far-flung relatives, if not in the home then by driving us to places like this just-opening and Skype-enabled Clearwater Aging Well Center.  Hmm. Do you believe this?

We have the time to craft a better experience. Let’s face it, the lonely boomer at home at 100 is unlikely: our mis-managed bodies may not permit it — even if the above scenario was realistic. That doesn’t mean we aren’t going to live far beyond ye olde expectations. If we knew how long we might live, we also need to imagine and advocate for lower-cost, longevity-friendly housing for those ‘middle’ decades of the 70′s and 80′s, but that will house us when we’re 95 and low on money. We need a rethink of nursing homes, blending them into services for seniors in a community — so that they move past the current shrinking anathema status. That might mean more consolidation, along with blending of skilled services first into communities, and then those services into group housing that will match our budgets and interest profiles. 

Care we want — can we get it? Where we’ll be living, the aides are kind to us: they form friendships and support each other and are well-supported by management. They enable us to find friends and continue to do activities we like — with others, not alone. Where we’ll be living, monitoring our well-being will be welcome and standard; enabling our tech-connectedness will be understood and supported by management and staff. When we move in, we won’t need to take our tech gadgetry with us — they’ll be part of the residence, with Kindles and Nooks in the library, wireless in our home, and appropriate use of video. Maybe useful and friendly robots (not just Paro-fluffy-friendly) will free up the repetitive and low-skilled labor, doing so at a low cost, freeing up staff to focus on higher-skilled tasks. This has happened in every single other industry in the past 50 years — why not this one?

We are in a crisis of mistaken expectation — thus tech opportunity.  In today’s economically challenged world, we suffer from a lack of product and service marketer realism (see Tom Mann’s Mature Market blog about senior housing developers) all along the continuum of care to the consumer. Everyone wants things the way they were (as in the above senior housing example) or they don’t know what they want but are shocked at what they actually get, whether it is with the doctor, the hospital, or the home care agency. Those who are creating and selling tech-enabled products and services have an opportunity to sell into the gap — whether it is in cost-reduction, family expectation management, or enabling standardized back office consolidations for service providers — who want to enable a better longevity experience at a lower cost.

Work — what they (sort of) mostly do and expect to retire at 66.  Now here’s where things get interesting: 8% work part-time, 6% are self-employed, 5% are looking for work, 7% are on disability, and 8% are fully retired.  Let’s turn that around and see it for what it is:  only 60% work full time for companies! Somewhat ironically, they expect to retire at 66, although 50% plan to either take their social security benefits earlier (before they are eligible for full benefits) at age 65 or get the partial benefit at age 62. Delusionally-speaking, 69% have set the date for taking social security as exactly the same as they said it was two years ago — despite declining value of their assets and the state of the economy, not to mention their level of employment.

What, me worry?  Here’s where the delusional part really begins in earnest. Sixty-six percent of them have one or both living parents. Half of them have children still living at home. But what are they concerned with — despite these two arguably significant future care-related issues? Twenty-five percent worry about affordability of their own health care, and only 18% of the respondants worry about remaining useful. Only 15% imagine they will want to or have to work part-time in their retirement years; only 13% of them worry about funding long-term care needs, and only 12% of them are concerned with outliving their money.

Middle boomers — read the older boomer tea leaves. In another MetLife report from October, the real world of older boomers is explored in the pleasantly-titled Buddy Can you Spare A Job? Three-quarters of today’s older boomer workers expect to work for pay after retirement, but fewer than 35% report actually making it happen.  Meanwhile, turns out that working in retirement correlates with better health. From this, we can conclude that older boomers need the money. Middle boomers will need the money too, and not just for their own health care costs. And it doesn’t hurt that working can be engaging, that it provides you with a purpose, and that it keeps your mind from rotting.

Mature Market Experts: stats and news you can use on boomers, seniors and the mature market – 5 Important Trends for The Ages - Ever since I wrote Death of the Continuing Care Retirement Community on our Mature Market Experts blog, people have been asking me what the future holds for our aging population. Here are some trends I see that will change the lives of aging baby boomers and seniors:

1. Virtual communities – With the help of technology, organizations such as the Village to Village Network are successfully changing how seniors age in place. By offering a wide variety of services – from in-home preferred vendor lists, cultural and social events and member-to-member volunteer opportunities … to health and wellness programs, educational and special interest programs and community service – all accessible via phone or computer – organizations such as these are making it easier for people to successfully age in place.  Beacon Hill Village in Boston, founded in 2001, is a great example of this, as is the newer Mill City Commons.

Please note, that I said, “successfully” age in place. Adding elements such as common dining tables and happy hours at local partnering dining establishments, along with the transportation to get there, adds an important social element that was previously missing from this sort of offering.

Baltimore/Washington has become a hotbed for these villages. According to a recent Washington Post article, there are six in Washington, DC, at least two in Fairfax County and eight others in various stages of development in Montgomery County. I expect the rest of the country will soon follow important trend.

2. New Urbanism – This “new” trend was supposed to happen a long time ago. I think a couple of things are finally conspiring to make it more likely to happen now:

a. Urban land values have dramatically dropped, allowing creative developers to take advantage of better pricing

b. Towns and cities have become desperate for tax revenue making them more amenable to developers’ designs

c. The recent recession has altered the “bigger is better” mindset that had taken over housing … which means the more modest square footage available in urban living is becoming more acceptable (that being said, I wouldn’t build anything less than 2 bedroom floor plans if at all possible)

d. Boomers don’t want to move to a “retirement” community and understand the benefits of urban life

Again, smart retirement community developers will understand these trends and meld them into their plans. A perfect example of this is the The Cardinal at North Hills, which is a full-service retirement community being built in the heart of North Hills, a newly revitalized part of Raleigh, North Carolina. North Hills’ wonderful array of new shops, restaurants, and entertainment venues become tangible amenities of The Cardinal and a key component in their marketing.

3. Technology – The key to executing excellent ideas like virtual communities is efficiencies. Technology provides the efficiencies that allow models like this to work for the very first time. Just as important, the technology now allows for the monitoring of a senior’s vitals (and non-vitals). According to a recent report, Caregiving in the US of 50+:
• 23% of caregivers reported utilizing an electronic organizer/calendar
• 16% use an emergency response system
• 12% utilize electronic information with their doctor or care manager,
• 10% reported using electronic sensors to detect safety problems
• 7% said they use website/software for health records

Again, just as important is the use of technology for social contact, for example email and Facebook. Recently, my children introduced visual Skype to their grandparents. It is advances like these that mitigate some of the risks associated with social isolation.

Look for investors to continue to pour money into health care/social issue technology.

4. Mini-retirements/lifelong employment – Boomers tell us they’re going to work far beyond age 65, for two reasons; necessity and fulfillment. Yes, boomers and seniors have been hit extremely hard by the recent recession … but I also believe that people are beginning to understand that life “engagement” is essential to good health (this is particularly important for the brain). As a result, I believe many boomers who would have previously turned to retirement will turn to “mini-retirements,” meaning vacations of one month or more. These longer vacations allow for the opportunity to invigorate the mind and soul in a more meaningful way than the traditional vacation (this concept was first espoused by Tim Ferriss, who wrote an interesting book called the 4-Hour Work Week).

Today, it’s a lot easier to slip between the world of work and play, thanks to technology. It’s now just as easy to get most work done from the sunny Caribbean as it is from DC, New York, Chicago, or LA. I predict that we’ll see this as a growing trend … longer careers dotted with mini-retirements.

If you operate a retirement community with monthly service fees, make sure you offer an adjustment for these long lapses in their occupancy. Otherwise, you might be scaring off some of your younger residents who like to travel. In addition, make sure that your community offers administrative services, that working residents can utilize at a cost. Making it easier to maintain their business, will make it easier to choose your community.

5. Health care plans will begin to pay for prevention – as I discussed in the point above, research is beginning to show us that if you don’t use it, you lose it! Health care companies will begin to focus on preventive health care rather than reactive health care. Expect to see more health plans adopt programs like Silver Sneakers. Why? Because it saves the plan money, helps with new member recruitment, while at the same time assisting in member retention.

Brain fitness will be a key component of this plan, as the costs of Alzheimer’s and dementia threaten to ravage the US health care system (there are now nearly a half million new cases of Alzheimer’s each year; and by 2050, it is expected that there will be nearly a million new cases per year).

Developers of retirement communities and active 55s would be wise to partner up with these preventative programs, as they will become an increasingly important marketing “amenity” in your community. Note: I recommend reading The Anti-Alzheimer’s Prescription.

Remember, when it comes to building housing for seniors, it’s all about control. A senior who is tackling the aging process is looking to remain in control of their life. That’s hard to do, when your body is letting you down. Anything you can do as a developer/operator that enables them to maintain that goal gets you closer to a sale.

About the author: Tom Mann is the Vice President of Strategic Marketing Services for Love and Company, a marketing/advertising firm that specializes in marketing to boomers and beyond.  In the last ten years, he has helped sell over 7 billion worth of retirement communities. He is also the co-founder of Mature Market Experts.

Mature Market Experts: more news and stats you can use on boomers, seniors and the mature market – Here comes “Nana Technology.” Andrew Carle, assistant professor at George Mason University in Fairfax, VA, uses the term, nana technology (as opposed to nanotechnology), to describe the technology being developed to assist baby boomers as they age. We’ve all heard of life line pendants, that can send an alert when an elderly or disabled person needs assistance. Carle and Russell Bodoff of the Center for Aging Services Technologies (CAST) relate how future technology will offer many other forms of help to seniors. Several companies are creating intelligent phones that could help those with memory loss by showing a picture of the caller, their relationship to them, and notes on their last conversation. Smart walking aids will be able to avoid obstacles, come when summoned and perhaps even detect irregularities in gait (that may predict a fall), along with a locator beeper so the device can be found if misplaced. In as soon as two to three years, robotic “nurses” may be available to help lift a patient. Shoes that aid balance, trackers for Alzheimer’s patients, smart pill dispensers and medicine cabinets are all in development. To read more in an  click here.

It will be interesting to see how these products are marketed.

Mature Market Experts: more mature market news and stats more often – Seniors Keep on Working. Many seniors are are choosing to work into their 70′s and 80′s for various reasons. Due to financial concerns in the recent economy, countless baby boomers are no longer secure that they have the funds to sustain a retirement that could now last more than thirty years due to the increase in life expectancy. Others simply wish to remain busy and active while they are healthy.  The Bureau of Labor Statistics reports that about seven percent of those over 70, or 1.1 million people over 74,  remain in the work force at least part time. The ideal of a retirement filled will leisure and travel has hit up against the harsh reality of decreasing retirement funds and drastically escalating health care costs. “Policy changes like the elimination of mandatory retirement laws and the Social Security earnings penalty for workers who are full retirement age have also made it easier to remain employed later in life, both in full-time and part-time jobs.” says Carole Fleck in the AARP Bulletin. The Center for Retirement Research at Boston College estimates that of those born between 1948 and 1954, 52 percent may be unable to maintain their lifestyle in retirement. Of those born between 1955 and 1964, 64 percent may be unable to retire with ease. To learn more click here.

Walking for health

Mature Market Experts: more news and stats you can use on boomers, seniors, and the mature market – AARP/Blue Zones Vitality Project. This innovative project strives to replicate the  longevity and health discovered in “Blue Zones”.  Scientists have studied the habits and practices of these unusually long lived populations from around the globe. Now, many residents of Albert Lea, Minnesota have joined together to incorporate these advantageous practices into their lives.  Already, they are discovering unexpected benefits. To read more about this fascinating story click here.

Should the old get out of the way to make more planet room? Dr. Rich observed that by 2030, 84% of those 65+ will have completed high school and 24% will have a bachelor’s degree, compared with 15% with a college degree today. She noted that tomorrow’s centernarians will be very comfortable with smart phones, Internet, and whatever else is around to enable them to access any information resources — including being very demanding healthcare consumers. She worried that the planet cannot accomodate all of what she terms ‘Geezerdom’ and that perhaps it would make sense for the old to voluntarily ‘get out of the way’ to make room for everyone else.

Evercare’s ‘healthy and articulate’ 100-year-olds are engaged in life now. Who would have thought that half of centenarians are familiar with Ninetendo’s Wii Fit, 21 percent go online, with 10 percent using e-mail weekly, 5 percent watching TV shows, 4 percent downloading music, 3 percent use Twitter, and 2 percent would want an iPod if stranded on a desert island.  Half are walking and hiking, more than half watch quiz shows, and 77% read to stimulate their minds. Both the centernarians and college seniors talk to friends and family to manage stress. Somewhat worrisome for our future, 63% of 100-year-olds said they ‘do something to help others’ as a secondary stress reliever, while 78% of college seniors report that they resort to ‘me time’ to manage stress.

The Judith Rich column includes advice for extending your life span. She quotes a laundry list of widely publicized advice on how to increase your lifespan (15 minutes a day laughing, not smoking, and having a positive outlook add more years). But that list doesn’t include staying connected to community, doing something to help others, staying on top of current news and world events, or using a computer to stay connected to family. Let us remember that the Evercare interviewees are already 100 years old — and this is what a surprising number of them do. Maybe if we want to live to 100, we should emulate them. This being a tech blog — here’s my twist:

Own a computer. I am still hearing that tired line from vendors who make proprietary (non-PC) products that 65+ customers are baffled by computers — that’s why their product isn’t built on a PC. It’s especially ironic to me that telehealth vendors send technically knowledgeable people into the home of 65+ to install monitoring units, will train them on the use of those products, but the PC is just too overwhelming a platform. Enough already. Ignoring the communication needs of your ‘patients’ by giving them single-purpose devices is, politely put, insensitive. Telehealth nurses tell me that patients appreciate monitoring because it shows that someone cares. Imagine their enthusiasm if someone showed them how to use a touch screen for email, sent them some e-mail and showed them how to join an online community for PatientsLikeMe?

Stay informed — news and new ideas. Despite my fondness for them, we probably won’t be reading paper newspapers too much longer — too hard to distribute, too expensive to buy, and tough to get rid of when you’re done reading. But even if you’re still buying them, you can still set automatic e-mail feeds from newspaper companies, set Google Alerts for topics that interest you, and keep up on what’s what in the world of trends and ideas.

Get exercise — physical and brain.  It doesn’t really matter what you do as long as you propel yourself out and about, get your heart going, and give your bones enough stress to keep them from thinning. If where you live means Wii Fit, so be it. And give your brain a workout while you’re at it — anything that involves stimulating, including training your brain to keep your driving skills, or learning something. See stay informed.

Buy smart phones – and keep them charged. No point in getting lost on our way to age 100 — might as well get a BlackBerry or iPhone that gives you portable e-mail access, but where you can also be guided with directions, find a restaurant or gas station, chat with your grandchildren, and even use the phone to call 911 in an emergency. They’re useless when the battery runs out, so manage a charging lifestyle habit early — required for the computer too. See own a computer.

Find like-minded communities. The ‘Lifespan’ advice in Dr. Rich’s column said that going to church regularly adds 3 years to life expectancy.  If we broaden that advice to suggest finding like-minded people — in person, online, on the phone — engagement with others is the key. If we are like 50% of those over 65 today, we will have 2 chronic diseases — even more important to find others who have figured out how best to manage them. See stay informed, buy a smart phone, own a computer.

Consider online medical services. As we near 100, there will be no reason to feel trapped in the house, unable to access medical advice. We can subscribe to online services (phone, e-mail, virtual visits) from companies like TelaDoc or American Well, or LiveNurse on a Jitterbug phone.

My thought — being 100 in this scenario overcomes some of the physical isolation that can result from physical frailty (and losing your nearby friends and family). To me, that looks like a better deal than Dr. Rich’s idea of checking out in order to free up space.

Nursing homes may be the most cost effective, unless… First of all, even though today we seem to be in a ‘no nursing home, no way’ mindset — it may be at some point in the future that the pendulum will swing back to nursing homes as the more economical place to be when 24-hour Medicare-certified care is needed. Once Medicare coverage expires we are going to be abandoned to our own devices…

…Remember that technology has lowered the cost of every other industry. If, as we seem to insist, we want to be in our own homes, then what can drive down the cost of that home care? Will it be telehealth diagnostic technologies for chronic conditions as validated by the VA (see our Trends page)? Will it be smarter in-home monitoring of our well-being — including safety and medication adherance? Will it be comprehensive transportation services like SilverRide that bring us to where we can interact with others? Or will it be virtual interactions — using cheap cameras that connect us to doctors?

To learn more, I guess you’ll just have to watch this space.

Guess I was right: Wireless and web-based education are in the sightlines of senior housing executives. This just in — a McKnight’s survey done last fall and now summarized confirms they were anxious and worried about their future. Will they have the ability to compete with staying put, especially as they stare down a future of high-expectation baby boomers?

2013: time to differentiate with services. Execs tidat are struggling to balance and fill their capacity — in a time when seniors can’t sell their homes and afford to move in. That’s also how I read words and behaviors at the recent ALFA conference in Philadelphia. According to this Mather LifeWays Institute on Aging survey representing 435 senior living communities around the country, 22% of communities now offer Web-based education (life-long learning) for residents, but 69% will do so in 4 years. And the percentage of ‘smart homes’, aka those with wireless networks, will grow from 8% to 39% in that same period. This is all part of programs to ‘promote quality of life as residents age in place.’

The future is — well, in the future. The reality is that survey responses are not an obligation to change behaviors or environments and actually make purchases — they simply confirm a non-committed and no- -money-down distant future ‘intent’. So let’s look at the vendor exhibit hall participants at the recent ALFA event in Philadelphia — because if there was ever an indication of intent or even possibility, it is the presence of vendors who want to make a sale — either now or cultivating potential.

Where’s the tech for residents today? I walked up and down the aisles and noticed 3 vendors (out of 300) at the May event who were presenting technology aimed directly residents’ quality of life. IN2L (It’s Never Too Late), MyWay Village, and PointerWare. If we add Personal Emergency Response, Emergency call systems, and resident monitoring, we add a few more. However, I put these in the category of staying alive, not quality of life. The rest of the technology vendors were all over the problem of running the facility operations: marketing, payroll, finances, billing, etc.

Residents need access now. I have been through many facilities – from small ALFs to the big and stylish CCRC, from nursing homes for the upscale to those occupied by the very poor. With a few exceptions, I see little technology for the use of residents, even though it could grab their minds and break up a day that is too often largely punctuated by meals and naps. Ironically, the more immobilized the resident, the more they would benefit from Internet surfing with Big Screen Live or listening music delivered through a kiosk by Linked Senior.

Put small money where your survey responses say you’re going. While at ALFA, I spoke with a number of executives to test their interest in a future panel on tech for residents. What I surveyed: eyes glazed, most assured me that they were not the right contact, that someone in their organization would be a better contact. Anecdotal information, for sure, not demonstrating their clearly surveyed intent to do something by 2013.

Mature Market Experts: more mature market news and stats more often – Why healthcare information technology should matter to you (part 2) - In my last article I discussed the benefits that health information technology could offer in relation to home health and, in particular, the experiences I had with my father when he was alive. Continuing on that theme, I would like to take some examples from my experience and demonstrate how certain key innovations could have made management of chronic ailments much easier for my father and for the family in general.

One of the chronic ailments that my father suffered from was the wet (or neovascular) form of macular degeneration. Neovascular macular degeneration affects about 10% of those patients who suffer from macular degeneration in general[1]. While there currently is no means of stopping or reversing the effects of macular degeneration, certain therapies (laser photocoagulation) can stem the bleeding associated with the wet form of the disease.

The effects on my father were heartbreaking in many ways. In my father’s working life he was a writer and editor for a number of industries, including the New York Medical Society, Ford Truck Times Magazine, and he was an advertising executive back in the 60s at J. Walter Thompson advertising as well as having his own advertising agency in the 1950s. In summary, my father’s sight was key to his livelihood. This was a man who used to read the New York Times cover to cover almost daily. In the last 5 years of his life, as a result of this ailment and the stroke he eventually suffered, he was left sightless and unable to enjoy the one thing that truly gave him pleasure.

I’m certain that many of us have equally poignant stories. During the 5 year period of both chronic and continuing medical care my father required I spent a great deal of time running him from specialist to surgeon to primary care physician to therapy and back again. I recall very vividly having to run him into Philadelphia from his home in the suburbs—about a 60-70 minute drive—for the purpose of having his eye surgeon review his progress. I remember how stressful the situation used to be: it was a fairly major production getting him out of the house and driving him down and back as he required assistance due to limited mobility. Oftentimes the visits were merely checkups of no more than 5-10 minutes duration. It was at these times that I used to ponder whether having a remote video and picture taking capability could have accomplished precisely the same thing: if his surgeon had the ability to review a photo remotely, my father could sit in the comfort of his home and have a retinal camera that I or another care giver could use to take a picture of his retina which could then be transmitted and reviewed by the surgeon remotely. Then, the visit could have been accomplished through a telecommunication session, in which the surgeon could speak with him directly over the telephone while reviewing the image. This would provide context for the imagery as well as provide for a much less stressful environment for my father.

Recently, Healthcare IT News reported “remote monitoring not only saves unnecessary trips to the emergency department, but prevents readmissions to the hospital.”[2] Unfortunately, the same article reports “healthcare payers are resistant to providing reimbursement for remote patient monitoring.” A chief reason for this seems to be the fact that the payer-provider reimbursement model is not adequately structured to take advantage of the benefit.

It would seem to me that the use of the technology would reimburse itself. Ignoring the time spent in traveling to and from the surgeon’s office, consider the fact that the visit itself could be shortened and accommodated on a schedule that could make most effective and efficient use of both parties: patient and provider. For example, a virtual office visit could be held at any time during the day (not just during “normal” office hours) and could even be managed from the provider’s home office. Of course, key to this would be the availability of a patient record in which information could be securely uploaded (e.g.: retinal imagery). A personal health record could have served this purpose. Furthermore, the relaxed setting of the patient’s home would have enabled a much more relaxed environment for the patient.

While the scenario I have described is not unique, it serves to illustrate a broader need and provides a compelling motive for telehealth and telecommunication. By linking healthcare information technology with existing means for communicating over telephone lines it is possible to achieve ends that will ultimately benefit chronically and elderly patients. In the next installment, I will address the benefits for other diseases, including stroke and glucose, and how the case for healthcare information technology has real benefits for the home-bound or chronically ill patient.

[2] Bernie Monegain, “Remote patient monitoring improves outcomes for chronically ill, study shows.” Healthcare IT News. March 24^th, 2009.

We are all familiar with visiting a physician office for the first time. You know the routine: you are handed a clipboard containing half-a-dozen pages or so in which you must disclose every torrid aspect of your life. You must hand over your insurance card so a copy can be made and you must list every medication, every tablet, every vitamin you take in quantity, type, label so that THIS physician has a clear picture of who you are and what has ailed you. Some people are more organized: they make copies of this information and merely re-copy onto the forms so that they do not have to make up their stories out of whole cloth. Others are not so organized. Regardless, this information is normally maintained by your primary care physician (PCP) and is seldom shared unless you explicitly ask for records or, perhaps, your PCP is one of the more “progressive” types using an in-house electronic medical record system. Alas, currently only a relatively small number of U.S. physicians make use of health information technology. The estimate is that 17 percent of U.S. physicians and between 8 and 10 percent of U.S. hospitals employ health information systems in the form of electronic medical records for capturing and maintaining patient medical data (David Blumenthal, 2009).

However, consider having to repeat this process for each physician you visit. This takes me back to the story of my father. My father, who passed away last August, had a stroke in 2003 at the age of 85. I’ll save the experience of the basic medical challenges for another article, but I will relate that the treatment process involved half a dozen specialists and allied health professionals. All of these individuals required similar information regarding his health and history. Each one of them required the information in a format similar to the method described above with clipboard and pen.

Let’s consider for a moment an alternate method for the requisite “data transfer” experience described above. Suppose that my father’s history, medications, allergies, treatments, etc. were all contained on a single “device,” such as something having the form factor and function of a Universal Serial Bus (USB), or memory, stick. Then, if each physician and specialty practice had the capability of reading such information from this device into an electronic record that employed common interfacing and formatting so that the information could be populated in a way that would be visible and accessible to each physician, a number of benefits would have resulted. First of all, the mere physical act of copying the same information over and over would not have been required. Secondly, the likelihood of inaccurately entering information could have been avoided. Given the fact that I was the primary source for data entry, I can attest to the fact that I am error-prone! Thirdly, having a complete and accurate list of his medications, his treatment plans, clinical notes, and orders all available would have provided to each specialist a comprehensive understanding of his history. This would have enabled each of them to communicate more effectively to determine how best to treat him without having to ask redundant questions of both him and me during the visit—more time could have actually been spent in treatment!

The capability and benefits described above are not out of our reach. The technologies exist to enable the scenarios described above. The benefit to patients is obvious, as can be discerned from even this simple telling. Improving healthcare delivery can be achieved without bringing rocket science to the practice—we can begin simply by doing what we currently do more efficiently and by bringing some good sense to the practice. We as citizens think nothing about going to a store and using a credit card to pay for goods and services. Yet, we have nothing equivalent in standard practice that allows us to treat the most precious good: our bodies. In the coming weeks I hope to expand upon this theme and raise awareness on the benefits of information technology and its benefits to healthcare.