Category : digest

Aging Gracefully: Graying Japan Tries to Embrace the Golden Years


Entrepreneurs are exploring robotics and other innovations to unleash the potential of the elderly

By Jacob M. Schlesinger & Alexander Martin | Nov 29, 2015 | This article originally appeared in The Wall Street Journal


Tomoyuki Ohashi, 72, is part of a group of senior citizens who work part-time at the Kohitsuji-en nursing home in Kashiwa City, helping fill a labor shortage. “I think I get a kind of advantage,” he says. “Maybe in the future, I’ll be allowed to live here.”

TOKYO—At an office-building construction site in the center of Japan’s capital, 67-year-old Kenichi Saito effortlessly stacks 44-pound boards with the ease of a man half his age.

His secret: a bendable exoskeleton hugging his waist and thighs, with sensors attached to his skin. The sensors detect when Mr. Saito’s muscles start to move and direct the machine to support his motion, cutting his load’s effective weight by 18 pounds.

“I can carry as much as I did 10 years ago,” says the hard-hatted Mr. Saito.

Mr. Saito is part of an experiment by Obayashi Corp. , the construction giant handling the building project, to confront one of the biggest problems facing the company and the country: a chronic labor shortage resulting from a rapidly aging population. The exoskeleton has allowed Mr. Saito to extend his working life—and Obayashi to keep building.

Conventional wisdom says a large elderly population undermines an economy, and that Japan’s unprecedented aging condemns the country to a bleak future. The logic: Old people are an unproductive drain, squandering resources on pensions and health care, while doing little for growth through working, earning, spending or paying taxes.

One in four Japanese is 65 or older, compared with 15% in the U.S. There are now just 1.6 working-age Japanese available to support each senior or child under 15.

That ratio is already considered unsustainably low. By 2050, there will be just one working-age Japanese for every senior or child. During the high-growth 1980s, Japan had more than two, about the same as the current U.S. level.

Pessimists say the only way to keep Japan from inexorably drifting into bankruptcy is radical change, like a sudden, sharp influx of immigrants—an unlikely prospect given Japan’s history as one of the world’s most homogeneous cultures.

But a growing number of Japanese executives, policy makers and academics challenge that proposition. They are exploring whether modest adaptations can ease the woes of an aging society, or even turn the burdens into benefits.

The optimists’ case starts with steering the growing number of healthy 60- and 70-year-olds from retirement into work. That makes them more productive members of society while helping staff jobs that otherwise would be impossible to fill as the population shrinks.

Japan’s ability to craft a successful aging strategy has global implications, since other nations will soon follow its path. The United Nations projects that by 2050, 32 countries will have a greater share of senior citizens than Japan does now.

Some Japanese see opportunity to cash in as aging front-runners, just as earlier generations exported world-beating cars and electronics honed first at home.

For now, though, Japan shows more strain than gain from its demographic shift.

A public works program launched by Prime Minister Shinzo Abe has been constrained by a shortage of young manual laborers. While Japan’s multinationals enjoy record profits—thanks to “Abenomics” policies of easy money and a sharply cheaper yen—they remain hesitant to invest earnings back home, sensing limited long-term growth due to a shrinking population. Looming over all of this are Japan’s heavy debt levels, bloated by pension costs.

Still, the dire predictions rely on a core assumption that may not fully prove true—that once people turn 65, they must lean on the rest of society. Japan is redefining “aging,” as its 60-, 70-, even 80-year-olds prove more vigorous, and less costly, than earlier generations.

While a falling birthrate is one reason for Japan’s graying, another is its remarkable advance in health through good diets, an emphasis on fit lifestyles and a national medical system which experts say saves costs by emphasizing preventive care.

They also point to new aging-related growth engines, including an automation spending boom to stretch Japan’s declining labor force, and a growing “silver market” of elderly consumers drawing down savings from a lifetime of hard work and thrift. Already Japan’s senior consumer market is worth more than ¥100 trillion a year (about $800 billion), and is expected to grow a trillion yen a year.

“We have to change our view from ‘antiaging’ to ‘smart aging,’ ” says business consultant Hiroyuki Murata, author of Japanese best-sellers like “The Business of Aging: 10 Successful Strategies for a Diverse Market.”

Japan’s life expectancy is 87 years for women, the world’s longest, and five years more than in the U.S. For men, it is 81—the third-longest in the world, and four years greater than in the U.S. Japan’s “healthy life expectancy”—an estimate of the age a person can reach and still live independently—is the world’s longest for both women (75) and men (71), according to a study published in the Lancet, a medical-research journal.

A Japanese mountaineer two years ago became the first octogenarian to scale Mount Everest, and Japanese athletes regularly dominate competitions for older athletes.

Japan currently spends 10% of its economy on health care, about average for advanced economies and well below America’s 17%, despite a population skewed toward the most medically expensive age group.

About one in five seniors work, nearly double the average for advanced economies in the Organization for Economic Cooperation and Development. More than half of Japanese men aged 65 to 69 hold jobs, up from about 40% a decade ago.

That, combined with more women workers, means the labor force has shrunk less than 1% over the past decade, even as the traditionally defined “working-age population” aged 15 to 64 dropped 8%, according to a June Barclay ’s report.

The temp agency Koreisha Corp.—a pun meaning both “aging people” and “aging company”—dispatches workers up to 75 years old. Some tasks are menial. An appliance company hires Koreisha temps to ride with repairmen and stay with the car, fending off tickets in parking-challenged Tokyo.

Construction companies added 60,000 senior hard-hats to payrolls over the past year. The transportation ministry in April lifted the airline pilot retirement age to 67.

Off a narrow winding road in Nagano Prefecture, a company called Ogawa No Sho turns to seniors to make dumplings. It used to have a retirement age of 78, but employees can now stay as long as they like.

One recent afternoon, an 85-year-old woman wrapped eggplants and miso paste in dough. Two men—one 76, the other 91—grabbed them with tongs and placed them on a large iron pan hanging from the ceiling, flipping them from time to time.

“Making dumplings only involves using your hands, so it’s easier on the body than farming,” says the woman, Fujiko Matsumoto, who works three days a week.

Elderly workers are also playing a crucial role filling Japan’s biggest labor shortage—nursing care for the still-older elderly. With unemployment already low, the labor ministry estimates one-seventh of Japan’s unfilled jobs are in the nursing-care sector, a gap that will swell as needs expand.

That void could be filled if more unemployed seniors step in. One-third of home-care workers are now over 60, up from one-fifth a decade ago.

Fumio Fujizuka, 73, joined Saint-Care Holding Corp. , a nursing care provider, after his rubber-products company went out of business. He comes to the office five days a week, sometimes as early as 7:30 a.m., then bicycles to nearby homes, bathing and dressing clients in their 80s and 90s.

Japan’s increasing reliance on a silver workforce is a mixed blessing. While many seniors say they happily seek work, others have no choice because of low pension payments or other economic hardships. Nearly one in four Japanese over 65 lives below the poverty line, about 40% higher than the overall population rate.

Employers see the elderly as cheap labor, sometimes hiring back retired full-timers as lower-paid temps. That is undercutting a government campaign to end a destructive decade of falling wages.

“Compared to younger people, we can curb their pay,” says Katsutoshi Sekine, who runs a farm cooperative in Chiba Prefecture and offers his nearly 20 senior fruit and vegetable pickers 80% of the going wage.

Elder workers can only go so far replacing the shrinking number of Japanese half their age. By choice or physical necessity, many put in just a few hours a week. At the Kohitsuji-en nursing home near Tokyo, its director estimates the 40 part-time senior workers there equal “three or four” full-time employees.

Other employers say they are wrestling with complexities such as how to deal with senior employees who suddenly forget vital information, such as numerical codes to enter their work facilities.

In some cases, the solution lies in technologies that help offset senior workers’ deficiencies, like the exoskeletons used by Obayashi at its construction site. The Fujisawa Aikoen nursing home about an hour outside Tokyo started leasing the “hybrid assistive limb,” or HAL, exoskeletons from maker Cyberdyne Inc. in June.

In Hokkaido, 60-year-old potato-pickers use rubber “smart suits” making it easier to bend over. Baggage handlers at Tokyo’s Haneda airport employ similar assistance.

In cases where older people simply can’t do the job or aren’t available, Japanese manufacturers are turning to robots, which help them keep costs down and continue growing.

Bank of Tokyo Mitsubishi UFJ, Japan’s largest bank, employs a small robot speaking 19 languages to greet customers, while a Nagasaki hotel staffed mainly by robots opened in July. Komatsu Ltd. is developing self-driving vehicles for construction sites, while industrial robot maker Fanuc Corp. is designing machines that repair each other.

Toyota Motor Corp. is testing in homes its “human support robot,” a videophone/remote-controlled android that allows family and friends to perform tasks for distant elderly people as if they were in the same home. In one demonstration, a young man uses a tablet to look around a bed-bound older man’s room, then directs the robot to open the curtains and bring the older man a drink.

SoftBank Group Corp. earlier this year drew global attention when it put on sale in Japan an automaton called Pepper, which it called the world’s first robot capable of understanding emotions. One of the earliest uses for the 4-foot-tall white humanoid is as a nursing helper.

In a Kanagawa Prefecture test, Pepper entertained a room of 30 80- to 90-year-olds for 40 minutes. He led them in light exercises and tested their ability to recognize colors and letters. Women patted his head like a grandchild.

Showing a video of Pepper with a dementia patient on another occasion, Shunji Iyama, one of the developers, says the robot may sometimes work better than people. “That man keeps repeating himself over and over again,” Mr. Iyama said. “If Pepper were human, he’d get fed up, but he just repeats the same reaction and doesn’t get tired.”

Mr. Iyama’s company, a three-employee startup aimed at the burgeoning elderly tech market, is called Fubright Communications, a contraction of “Future” and “Bright.” “Japan’s future is considered dark,” he says. “But if you change your viewpoint, this is the only place where we can test such technologies in such an aging environment.”

While new labor patterns and technologies alter the supply side of Japan’s economy, a parallel evolution is changing the demand side, with growth driven by an increasingly prominent “silver market.”

Still less than one-third of the population, Japan’s seniors control about 60% of the country’s $14 trillion in household assets and account for about half of consumer spending, with many no longer saving for anything.

Although consumer spending growth overall is weak in Japan, economists at UBS Securities there say they believe the expansion of the senior market could more than offset any declines that come from a shrinking population, at least for a time.

The elderly are already transforming aspects of Japan’s consumer market. When the government this year reviewed the basket of 588 items in the consumer-price index, it added hearing aids and knee supports, dropping school lunches and tennis-court fees.

Companies, meanwhile, are investing in new products and new marketing strategies to capitalize on senior spending.

Panasonic Corp. last fall launched the “J Concept” line of “easy-to use, light-in-weight” goods for senior consumers, with laundry machines and refrigerators designed to minimize body-bending and with easy-to-read control panels. Earlier this year, Japan’s No. 1 electronics maker said it aimed to expand its “age-free” unit’s workforce as much as tenfold, to 20,000 employees.

Ajinomoto Co. , a food and chemical company, launched in 2013 an “active senior project” with the slogan “successful aging,” with medical tests claiming early detection of ailments, as well as health supplements marketed as forestalling muscle and bone debilitation.

“The domestic market is likely to be shrinking, but we can still find a way to grow,” says president Takaaki Nishii.

The silver market has also sparked a boom in home reconstruction, to make residences easier for the elderly to live in.

Stores emphasize delivery more: 7-Eleven now takes meals to 730,000 homes, and sees the business doubling every year. Japan Post Holdings Co. , which runs the postal service, has teamed up with AppleInc. and International Business Machines Corp. on a “watch” service where mail carriers, for ¥1,000 a month, check on elderly customers, reporting back to family members via customized iPads.

Retailer Aeon Co. two years ago started overhauling shopping centers into “Grand Generation’s Malls” with grocery stores selling extra-small portions for low-appetite seniors living alone, like half-heads of broccoli. The malls have added classrooms for knitting and computer lessons, as well as a recording studio for amateur musicians, to help lure more seniors who want something to do.

Seniors now spend 50% more time in the store—and 40% more money.

There is even a potential market in dating services. For 16 years, Shizuka Koshikawa, a 72-year-old divorced man, has been running the Sanko (Three Happiness) Club matchmaking service for single Tokyo-area seniors as a kind of hobby and low-margin business. Next year he plans to expand to six cities around the country.

As awareness of the market grows, one of Japan’s hottest business buzzwords has become “shukatsu,” or “end of life,” referring to the explosion of products and services aimed at people preparing for their final years.

One September weekend, 50 companies and organizations from jewelers to travel agencies set up booths at Tokyo’s third annual “Shukatsu Festa” festival, as 3,400 customers streamed through. The event’s mascot—a feline-costumed figure dubbed “Shu-Cat-su” with a red headband urging “Be Alive!”—posed for photos.

The Asahi Shimbun newspaper was there explaining its new service helping people compile their life stories: ¥999,000 for a staff journalist to write it from scratch. A kimono maker peddled ¥100,000 garb for people to get cremated in.

A crowd listened to House Boat Club employees describe a cruise where passengers can scatter pretend ashes over Tokyo Bay to see if they would ultimately like to have their remains disposed that way. Nearby were representatives of two competing ash-scattering cruises. For ¥260,000, Balloon Memorial takes ashes into the sky on a brightly colored hot-air balloon.

Companies are pitching such products in part because a falling population has made it harder for families to tend traditional graves.

“Obviously, it’s better for society to have a large population of younger people,” says Yoriko Muto, founder and chief executive of the Shukatsu Association, speaking above the cacophony of hawkers.

“But in reality, Japan is already an aged society and we have to try not to think of this in a negative light…And there may be business chances in the process.”

Smartphone-connected Health Devices Top Healthcare Trends for 2016


According to PricewaterhouseCoopers annual Health Research Institute report, smartphone-connected health devices, behavioral health are top healthcare trends for 2016


By Aditi Pai | Dec 10, 2015 | This article originally appeared in MobiHealth News

Smartphone-connected device use, focus on behavioral health, and better databases for health information analysis, are within the top 10 trends in healthcare for 2016, according to PwC’s annual Health Research Institute report. HRI also released results from a survey of 1,000 US consumers.

“In 2016, millions of American consumers will have their first video consults, be prescribed their first health apps and use their smartphones as diagnostic tools for the first time,” the report reads. “These new experiences will begin to make real the dream of care anywhere, anytime, changing consumer expectations and fueling innovation.”

Health apps and connected medical devices were underutilized in 2015, according to PwC. But this will change next year, in part, because of the move away from fee-for-service care as well as advances in wireless technology. One of HRI’s main findings this year is that between 2013 and 2015, use of health-focused apps doubled. While in 2013, 16 percent of consumers said they had at least one health app on their device, in 2015, that number rose to 32 percent.

The adoption of these smartphone-connected health devices will be led by those using them for primary care and chronic disease management. These departments are already offering connected health devices, activity trackers, connected scales, health apps, and e-visits to their patients.

Cybersecurity concerns for smart health devices and apps will also be a big trend in 2016. Companies will have to take preemptive measures to maintain the trust of consumers. After a hacking incident, 51 percent of consumers said they would be hesitant to use any of the manufacturer’s devices, while a similar number of people, 50 percent, said they would be hesitant to use any connected health device.

Next year, employers will also prioritize behavioral health. According to PwC, mental health conditions cost US businesses more than $440 billion every year. These employers are focusing on issues like stigma and mental health awareness. The reach of behavioral health offerings will also increase. More primary care physicians will start using remote technology to connect with behavioral health specialists, which will ultimately help primary care teams manage routine behavioral health problems. And behavioral health doctors will use remote technology to connect directly with patients.

Patients are also on board with this trend. Some 72 percent of consumers between the ages of 18 and 44 said they would be willing to use video visits services to communicate with a mental health provider instead of going to an office visit. This number decreases to 43 percent with consumers who are 45 or older.

Another trend for 2016 will be the use of population health databases, which enable providers to identify more insights about patients. The survey found that 83 percent of patients are willing to share data with their provider if it helps providers diagnose and treat the patient and a smaller number, 73 percent, are also willing to share this data if it helps providers diagnose and treat other patients.

Doctors Underprepared for Onslaught of Very Sick Patients in US


By Leah Samuel | Dec 7, 2015 | This article originally appeared in STAT

Dementia and other degenerative illnesses are a challenge for primary care doctors in the US.
Photo Credit: (AP Photo/Charles Dharapak)

Nearly a quarter of primary care doctors in the United States say their practices are not well-prepared to manage patients with multiple chronic illnesses, according to an international survey.

The 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, released Monday, surveyed doctors in 10 countries, including the United States, Canada, Germany, Australia, and Sweden. Doctors in the United States and Canada felt least prepared among the countries surveyed to handle patients with multiple chronic conditions.

These patients are becoming more common. Aging populations mean more people suffering from degenerative conditions such as dementia and physical frailty. And medical advances have resulted in longer lifespans for people with chronic conditions such as diabetes and heart disease.

“This global phenomenon is the fruit of the success of improvements [in] medical technology and public health,” said Dr. Eric Schneider, the Commonwealth Fund’s senior vice president for policy and research, and one of the study’s authors.

American doctors’ confidence was especially low in dealing with mental health issues. Only 16 percent of US doctors felt prepared to treat patients with severe mental health problems.

“Primary health care physicians are simply overwhelmed,” said Schneider.

The survey authors highlight some efforts being made under the Affordable Care Act to improve care for these complicated cases. One promising model is the “primary care medical home,” which coordinates efforts between the primary care physician and other medical professionals to manage a patient’s various needs. The researchers also see promise in improved sharing of electronic medical records among health professionals, and in reforms of payment systems.

“We’re still in early days of the Affordable Care Act,” said Schneider. “But it’s designed to strengthen primary care and the treatment of chronic disease. This survey tells us there’s a lot of work to be done.”

Leah Samuel can be reached at
Follow Leah on Twitter @leah_samuel

ParkinsonNet: Improving the Lives of Parkinson’s Patients


More than 50.000 people in the Netherlands have Parkinson’s disease. Parkinson-specific and personalized healthcare is essential to improve the daily life of these patients. For over a decade now, ParkinsonNet strives to offer these patients the best possible care needed. ParkinsonNet, established by Dr. Bas Bloem and Marten Munneke in Nijmegen, The Netherlands in 2004, is a nationwide infrastructure consisting of 68 regional and multidisciplinary networks of specifically trained allied healthcare professionals who deliver integrated care to patients with Parkinson’s disease. Almost 3,000 healthcare professionals are part of this network.

ParkinsonNet’s goal: to make sure that every person around the world with some form of Parkinson’s disease receives the best care possible. ParkinsonNet accomplishes this goal by providing training, a yearly congress, developing guidelines, research and connecting patients and healthcare professionals. ParkinsonNet facilitates optimal collaboration between professionals and provides transparency about the quality and costs of healthcare. The result of the ParkinsonNet model is an increase in quality of care, greater efficiency, a reduction in disease complications (including a 50% reduction in hip fractures) and a marked reduction in costs. Because of these marked achievements, ParkinsonNet has received multiple national and international awards, including the prestigious Value Based Health Care Award 2015 by the renowned professor and health economist Michael J. Porter. Dr. Bas Bloem received this year’s Holst Memorial Lecture Award 2015 from Philips Research and Eindhoven University of Technology in recognition of his research and initiatives in Healthcare Innovation.

Financing Long-Term Services & Supports: Options Reflect Trade-Offs For Older Americans & Federal Spending


Over the past decade, purchases of private insurance for long-term services and supports have declined; a new study proposes three new options and estimates their costs and distributional effects.

Published Nov. 15, 2015 in Health Affairs
by Melissa M. Favreault, Howard Gleckman and Richard W. Johnson


About half of older Americans will need a high level of assistance with routine activities for a prolonged period of time. This help is commonly referred to as long-term services and supports (LTSS). Under current policies, these individuals will fund roughly half of their paid care out of pocket. Partly as a result of high costs and uncertainty, relatively few people purchase private long-term care insurance or save sufficiently to fully finance LTSS; many will eventually turn to Medicaid for help. To show how policy changes could expand insurance’s role in financing these needs, we modeled several new insurance options. Specifically, we looked at a front-end-only benefit that provides coverage relatively early in the period of disability but caps benefits, a back-end benefit with no lifetime limit, and a combined comprehensive benefit. We modeled mandatory and voluntary versions of each option, and subsidized and unsubsidized versions of each voluntary option. We identified important differences among the alternatives, highlighting relevant trade-offs that policy makers can consider in evaluating proposals. If the primary goal is to significantly increase insurance coverage, the mandatory options would be more successful than the voluntary versions. If the major aim is to reduce Medicaid costs, the comprehensive and back-end mandatory options would be most beneficial.

Many older Americans need long-term services and supports (LTSS) to help them with basic activities that they cannot complete on their own because of chronic illness or disability. In 2011, 7.7 million adults ages sixty-five and older received help with activities of daily living (ADLs), which include such tasks as bathing, dressing, eating, using the toilet, and getting out of bed. About 6 million adults in the same age group—nearly one-sixth of that population—have severe LTSS needs, requiring help with at least two ADLs for ninety or more days or having severe cognitive impairment.

LTSS needs will grow over time as the population ages. Urban Institute projections indicate that the number of older Americans with severe LTSS needs will increase 140 percent between 2015 and 2055, reaching 15.1 million. Over the same period, there will be an 80 percent increase in the US population ages sixty-five and older and a 190 percent increase in the population ages eighty-five and older.

The average American turning sixty-five today will incur about $138,100 in future lifetime expenses for severe long-term care needs, according to Urban Institute projections. These future expenses could be financed by investing $69,500 at age sixty-five, under the assumption that the investment earns average returns. This average spending estimate masks a large degree of uncertainty, which complicates retirement planning. Forty-eight percent of adults turning sixty-five today will likely never experience severe LTSS needs, while 15 percent will incur more than $250,000 in lifetime expenses. These estimates cover only those costs associated with severe LTSS needs and exclude the often substantial sums spent on coping with less severe disabilities.

Few Americans can protect themselves against this financial risk. Medicare does not provide coverage for extended LTSS. Medicaid does, but only for people who meet state-specific eligibility standards that limit benefits to those who have disabilities and very limited income and wealth. However, because people with LTSS needs may qualify for Medicaid after they deplete most of their resources, Urban Institute projections indicate that Medicaid will pay for about one-third of lifetime costs associated with severe LTSS needs for people turning sixty-five today.

Private insurance could help shield middle-income people from this financial risk. However, the market penetration of private long-term care insurance has been limited because of high premiums, the potential for Medicaid to crowd out demand for private coverage, and adverse selection—which limits the size of the market and drives up premiums. Indeed, sales of private long-term care policies and certificates declined from 528,000 in 2005 to 395,000 in 2012.

In addition, private carriers are no longer selling true catastrophic insurance, which helps protect consumers from financial risk. Instead, most of the carriers limit benefits to five years or less. As a result, private long-term care insurance pays less than a tenth of LTSS expenses for older people with severe needs.

Because private insurance is not widespread and public financing is available only for people who have few financial resources or who have already spent nearly all of their resources, older adults with severe LTSS needs will pay about half of their expenses out of pocket.These expenses impose financial burdens on many older adults with LTSS needs. In 2014, people ages sixty-five and older had median financial assets of only $76,000 and median home equity of only $80,000.

People who lack the resources for LTSS can receive poor or inappropriate care. This care gap can not only harm those who need assistance but also increase costs for Medicare, which pays for the hospitalizations and other medical treatments that often result from acute episodes caused by inadequate assistance.

Insufficient financial resources can also burden family caregivers, the primary support for most frail older adults. One in five family caregivers report high levels of emotional and financial stress, and more than three in five say that caregiving limits their ability to do paid work. The lifetime financial cost for a woman who leaves employment in her fifties to care for a parent may exceed $300,000, and she may be more likely as a result to fall into poverty than someone who did not leave employment to provide care.

Policy makers, advocates, and researchers have tried unsuccessfully for decades to create alternative LTSS financing mechanisms. In 1990, for example, the US Bipartisan Commission on Comprehensive Health Care—also known as the Pepper Commission after its first chair, Rep. Claude Pepper (D-FL)—proposed social insurance for home and community-based care and for the first three months of nursing home care for all Americans, regardless of income.The unsuccessful 1993 health reform plan of the administration of President Bill Clinton included a new state-run home care program for people with severe disabilities, with no restrictions on eligibility based on age or financial resources.

In the most recent attempt, Congress passed the Community Living Assistance Services and Supports (CLASS) Act as part of the Affordable Care Act in 2010, creating a national program of voluntary long-term care insurance. However, the law was never implemented by the administration of President Barack Obama and was repealed by Congress in 2013.

To better understand how policy changes could expand the role of insurance in the financing of long-term services and supports, we modeled several alternative programmatic options and compared likely outcomes under each to expected outcomes under current policies. Building on previous efforts to analyze LTSS financing policy options, we estimated overall costs and benefits and examined how they varied by multiple characteristics, including income. Our efforts represent the first look at some simplified options and highlight both the capabilities of our microsimulation model and its potential to inform the policy debate.

Read the full article here

McKesson Ventures Invests in ClearCare and its Digital Home Care Offering


By Aditi Pai  |  Nov 17, 2015  |  This article originally appeared in MobiHealth News

ClearCare has raised an undisclosed amount from McKesson Ventures for its cloud-based home care platform. The company has previously raised $15.5 million. ClearCare raised a seed round in November 2012.

Existing investors include Bessemer Venture Partners, Cambia Health Solutions, Voyager Capital, Qualcomm Ventures, and Harbor Pacific Capital.

“With the rapidly aging baby boomer generation entering retirement years, improving the quality of home care is more important than ever,” ClearCare CEO Geoffrey Nudd said in a statement. “We’re excited to be the bridge connecting home care to the larger healthcare system. With McKesson’s investment, our organizations can work together to achieve that vision.”

The company’s platform enables home care facilities to manage caregivers and patients. Features include matching clients with nearby caregivers and filling shifts if a caregiver cancels, texting and emailing caregivers reminding them of shift duties, and creating care plans for caregivers to use. The system also provides home care facilities with administrative features, like billing and payroll.

ClearCare works with four of the top five national home care enterprises, the company said. Facilities that use ClearCare manage 250,000 caregivers and 150,000 seniors. ClearCare is also currently working with Harvard on a three-year study to improve measurability of care outcomes.

“Given the shift toward value-based payments, it is more important than ever to cost-effectively support and monitor patients the 360 days they are outside the provider’s office,” McKesson Ventures SVP and Managing Director Tom Rodgers said in a statement. “We see a significant growth opportunity in finally connecting consumer-sponsored at-home care with the traditional healthcare delivery system for better patient coordination. We see ClearCare as the strongest and most broadly utilized platform on the market – for customers small or large – to enable high-quality services in the home and track clinical data on each individual’s health status.”

Earlier this year, McKesson Ventures invested in Carena’s $13.3 million round. Carena has developed a video visit offering, which they describe as a virtual clinic. The offering is designed to help extend health systems’ services. Patients can request physician visits via phone or the web. Visits typically last 20 minutes.

Where Seniors Go When Their Nursing Homes Close


By Carlyn Kolker  | 

When assisted-living facilities shut down, their elderly residents often have to scramble for a new home—and health and financial concerns can make it hard to find a fit.

When Emily Berger helped her mother, Mary Berger, move into the Prospect Park Residence, a long-term care facility in Brooklyn’s trendy Park Slope neighborhood, her mother settled quickly into the community of seniors, making friends among other residents and attending social events.

Mentally sharp but needing a walker to get around, Mary Berger couldn’t live independently any more. Her daughters thought the residence would be their mother’s last home before she died: Prospect Park Residence was just the kind of facility where children want their elderly parents to “age in place.” The average age of residents was 88; some residents had dementia or Alzheimer’s disease, and others used wheelchairs.

Jack Stock protesting the closure of Prospect Park Residence with his son-in-law, Geremy Schulick (Jennifer Stock)

But that all changed on March 5, 2014, when the home’s management abruptly told 130 senior residents and their families that it was closing. Entities related to the home’s landlord, Haysha Deitsch, planned to sell the building to an investor for $76.5 million, and the new owner would turn it into market-rate apartments. Residents had 90 days to move.

“It was just horrifying,” Emily Berger recalled of the meeting where residents learned of the closure. “People were so upset.”

Mary Berger joined a group of residents who sued Deitsch and New York State’s Department of Health to halt the closure. Berger and some of her peers vowed to stay in the home. But other residents began to scramble to find new places to live—places that could accommodate both their health needs and financial constraints.

As some residents left, staffing numbers dwindled and services diminished, Berger claims. Her mother, then 89, became addled and overwhelmed. “My mother got more and more anxious and depressed,” said Berger. “The services started to fall apart. She felt betrayed by the staff,” some of whom had known that the home would be shutting down but kept it secret from residents, she said.

Meanwhile, Berger said, she got no assistance from the New York State Department of Health. The Department of Health declined to comment on the home’s closure for this story, citing pending litigation.

Mary Berger moved to another assisted-living facility several miles away, but she soon fell ill and was in and out of hospitals and rehabilitation centers until her death in January 2015.

It is a chilling scenario: The place where you, or your parent, are supposed to live out your final years in peace is suddenly shuttered. It’s not just an issue in New York. In the suburbs of Washington, D.C., two assisted-living homes closed earlier this year (both “sit on valuable real estate,” a local news site noted). Last year in San Francisco, a private school moved to buy a 130-year-old assisted-living home for seniors of modest means, but a city supervisor stepped in, and another elder-care company ended up taking it over.

The question for the next generation of seniors in New York and other cities is not just where they will go when they age, but whether they’ll be able to stay there. What happens when aging in place turns into an eviction?

* * *

Advocates for seniors say that regulators and facility managers often don’t go far enough in safeguarding the wellbeing of seniors during closures of nursing and assisted-living homes. A resident’s closure experience may turn on what kind of home they are in, and what state they live in.

“Assisted-living and nursing homes are regulated in very, very different ways,” noted Toby Edelman of the Center for Medicare Advocacy. Nursing homes, almost all of which accept Medicare and Medicaid, are regulated by the federal government. In 2013, the federal government issued a new rule aimed at beefing up closure requirements, making nursing homes give residents 60 days’ notice before a closure and mandating that administrators of the closing facility “provide a plan for the transfer and adequate relocation of the residents.” State health departments are charged with overseeing the closures.

“I felt 90 days was so insultingly out of touch for someone with Alzheimer’s.”

Assisted-living facilities—such as Prospect Park Residence—are aimed at giving support to people in their day-to-day activities and are subject to state, rather than federal regulations on closure; those state regulations can vary widely.

Kevin Cremin, a lawyer with MFY Legal Services, one of the legal-aid groups suing over the closure of the Prospect Park Residence, said the state’s regulations do not offer enough protection to residents of assisted-living facilities. “In New York, the regulations on assisted living don’t provide adequate protections for residents, even those who have been there many years,” Cremin said.

New York State’s Department of Health rules forbid assisted-living facilities from disclosing to their residents that they are filing closure papers with the health department; indeed, Prospect Park Residence still accepted new residents before it announced it was shutting its doors, said Cremin.

Family members were livid about the 90 days’ closure notice that Prospect Park Residence gave—although it’s the state guideline for adult homes.

“I felt 90 days was so insultingly out of touch for someone with Alzheimer’s,” said Jennifer Stock, whose father, Jack, had mid-stage Alzheimer’s disease and was 89 when the closure was announced. “It’s very difficult for someone who has Alzheimer’s to find a good match.”

The Stocks needed a place that could accommodate Jack Stock’s financial and health needs. Stock had a full-time health-care aide, paid for by a special subset of Medicaid, but many of the well-appointed local assisted-living facilities in Brooklyn would not take patients with Medicaid. Traditional nursing homes that accepted Medicaid would not let a family choose a personal nurse, meaning Stock wouldn’t be able to move with the aide he’d been accustomed to.

“We couldn’t find a facility anywhere that would accept his combination,” said Stock. She said her father grew anxious as his peers moved out and his meals were served in a separate, smaller dining room.

“For someone with Alzheimer’s, it’s all about routine. There was no way to explain to him what was going on. He got restless and upset. The character of the place changed.”

Eventually, Stock and her husband found a private rental apartment where her father could live with his aide, but he fell ill with pneumonia in August 2014 and died the following month, before he moved into the apartment.

Today, seven residents remain in Prospect Park Residence. The judge overseeing the legal case has ordered Deitsch, the operator, to keep the facility open and provide basic services while he rules on the merits of the lawsuit challenging the closure process.

Joel Drucker, an attorney representing Deitsch, declined to comment on conditions at the residence, citing the pending litigation. He has appealed the decision letting the plaintiffs’ case go forward, saying the plaintiffs do not have a legal right to challenge the closure process.

“There’s another side of the coin. It’s a free country; people go into business and sell that business. How can someone be forced to remain in business?” Drucker said.

While Prospect Park Residence is closing for a lucrative sale, some care facilities close because they are forced to. So-called involuntary closures occur when health officials rule that homes have provided inadequate care, and Medicaid and Medicare cut off reimbursements. There were 106 terminations of nursing-home contracts in 2014, according to the federal Centers for Medicare and Medicaid Services (CMS).

“You are just placed somewhere else. No one knows where you went.”

Blossom South Nursing and Rehabilitation Center, a nursing home in Rochester, New York, lost its contract with CMS in January 2014 after it was placed on a watch list for low-performing homes because it was written up for deficiencies in safety, pest control, and record-keeping. The nursing home served mostly low-income residents.

The home was not in good shape when it was open, said Ken Traub, a co-chair of the Elder Justice Committee of Metro Justice, a Rochester-based advocacy group. But its closure wreaked havoc on residents. After the home announced it was shutting, about a third of the residents were sent to another home in Utica, New York—about 130 miles away.

“The nursing-home management didn’t have any real incentive to do a good job on placements of people, and these people were not easy to place,” said Traub. “This was a city nursing home; [the vast majority] of the residents were on Medicaid. Good nursing homes don’t like to take people who don’t have good private-pay money. Many [residents] had some health problems; some were smokers.”

After the home announced it was shutting, about a third of the residents were sent to another home in Utica, New York—about 130 miles away.

A year and a half after the closure, nearly all of the people who were sent to Utica have returned to the Rochester area, said Traub, but he maintains that the state Department of Health could have done a better job with their original placements.

The nursing home’s closure timetable was set by CMS and the state department of health complied with the federal guidelines, a spokesperson for the New York health department wrote in an email. “DOH has limited ability to force other nursing homes to accommodate the affected residents, but DOH does its best to ensure residents are relocated either within, or as close as possible to, their home county,” the spokesperson wrote.

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There are more than 15,000 nursing homes across the country. Even as the elderly population swells in coming years, with the aging of the Baby Boom generation, there will likely be more nursing-home closures, according to Cynthia Rudder, an advocate for the elderly. Medicare is covering more at-home and community-based services, she said, and individuals are trying to stay in their own homes.

Concern over how nursing homes shut their doors prompted Rudder to work with the National Consumer Voice for Quality Long-Term Care, a Washington-based advocacy group, to launch an online survey of residents, family members, nursing-home ombudsmen, and even staff of closed homes to find out about their experiences. She plans to use the survey results to develop models for best practices for future closures.

Closures may affect residents differently if they live in a rural environment or a major metropolis, said Eric Carlson, the directing attorney of Justice in Aging. Residents in lower-population areas can get transferred miles away. Big-city residents may get lost in the transfer system, as they are shuffled from one large urban facility to another.

“It’s the typical problem in the city—the anonymity,” said Carlson. “It almost makes it easier to do these really sloppy transfers; no one’s paying attention. You are just placed somewhere else; no one knows where you went.”

Regardless of geography, and whether it’s a nursing or assisted-living facility, being moved from one home to another can provoke “transfer trauma” in the elderly, a state of heightened stress and anxiety. Residents can feel hopeless if they are forced to find a new place to live.

“Facilities are supposed to do a whole number of things when they close,” such as help residents find new homes, Rudder said. “But sometimes it doesn’t happen. Even though there may be some good rules and regulations out there, we want to know: What’s actually happening?”



CARLYN KOLKER, a former reporter for Bloomberg News and Reuters, is a freelance journalist based in Brooklyn. She is at work on a book about speech and language development in young children, to be published by Amacom.

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