The care economy has undergone significant historical shifts in recent years. From the acceleration of its prominence due to the Covid pandemic's impact on our society to shifts in Medicare and Medicaid policies, this economy is in a constant state of evolution. In just the past year alone, we have witnessed significant developments such as a care executive order, a surge in momentum for in-home care services, and the advent of AI ushering in new possibilities in the realm of caregiving.
This report dives into the 2023 trends within the various categories of care. Tailwinds indicate the growing momentum in different aspects—be it consumer behavior, policy changes, enterprise dynamics, or cultural narratives. On the other hand, headwinds signify the challenges and obstacles that continue to hinder the development of a modernized care system in the United States. Let’s dive in.
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Healthcare
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Professional caregivers
Disability care
The home is the key focal point for caregiving activities - from safety to recovery. Dive into the evolving patterns of household management and its role in the care economy.
The care workforce functions as the driving force of the care economy, even though they are often undervalued and overlooked. Let's examine the key factors influencing the landscape of professional caregiving.
Healthcare is expanding beyond the hospital with services like in-home and long-term care gaining traction, thanks to things like telemedicine. Take a closer look at the intersection of healthcare and caregiving to support the care needs of families.
Employers are increasingly recognizing that caregiving struggles affect their employee performance and have become an important payer of care in the form of care benefits. Explore the role of employers in this emerging area of care.
Society is aging and the older adult demographic is growing rapidly. This means increased care needs - from health, housing, nutrition, to monitoring, and so much more. Delve into one of the most important trends in care that is actively shaping our care economy.
With evolving family structures and increasing workforce participation, the landscape of child care has become a dynamic area, encompassing providers, policies, and care needs. Check out what factors are influencing the child care landscape today.
Disability care is facing a renaissance, in the the current era of increased awareness and advocacy. Discover the key driving forces that are shaping the landscape of disability care.
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Household management
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Household management
TAILWIND
Men are primed to become consumers of care.
While it is true that men on average spend less time than women on care, dynamics are changing. The Pew Research on Social and Demographic Trends reports that fathers more than doubled their time spent on housework (4 vs 10 hours/week) and child care (2.5 vs 7 hours/week) in the last 50 years. The Holding Co.’s consumer survey found that men self-report responsibility for over 70% of care purchases. Not only are they responsible for a significant portion of purchases, but men will also reportedly spend 55% more than women on the same products and services. This shift is also shown by companies like Cleo reporting that 50% of their users UrbanSitter reporting that 40% of their users are men.
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Household management
TAILWIND
Giving cash directly to families is proving impactful.
Although the expanded U.S. federal Child Tax Credit was only in effect for six months, the impact of the program was significant. It lifted 5.3 million people, including 2.9 million children out of poverty. It has been well-documented that cash policies are the most effective way of helping families who are struggling. According to an analysis of U.S. Census Bureau data by the Center on Budget and Policy Priorities, 91% of low-income families used their monthly benefits on their basic needs - food, clothing, shelter, and utilities — or education. While it’s unfortunate that the program was allowed to lapse at a federal level, guaranteed income projects are being created all over the country at a more local level.
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“91% of low-income families used their monthly benefits on their basic needs food, clothing, shelter, and utilities — or education.”
—Center on Budget & Policy Priorities1
Source: 1U.S. Census Bureau https://www.census.gov/library/working-papers/2022/demo/SEHSD-wp2022-24.html
Household management
TAILWIND
AI is transforming household management.
AI can help improve household management by providing personalized recommendations, automating solutions, enhancing home security, and developing smart appliances that adapt to the user's needs. Startups like Milo are leveraging generative AI tools like GPT-4 to enable a family to collectively outsource their to-do list onto a platform that keeps everything organized, including calendar invites , menu planning, and reminders.
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Household management
TAILWIND
Robotics could lighten our domestic labor load.
Robotics are poised to revolutionize domestic labor, easing the burden of household chores. Humanoid robots like Sanctuary AI's Phoenix and Tesla's Optimus are being designed to assess human needs and execute various tasks like meal planning and grocery shopping. In a recent study by University of Oxford and Japan's Ochanomizu University researchers, experts predict that robots will be able to do 39% of domestic chores by 2033.1 However, skepticism about such transformations persists due to the complexities of creating versatile robots.
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https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281282
Household management
TAILWIND
Smart home technology is integrating and improving.
The inability for smart home devices to communicate with one another has been a major barrier to widespread adoption. Large manufacturers have recognized �this reality and are actively adopting strategies to meet the consumer desire for interoperability. This is most evident with the recent launch of�Matter, an interoperability standard developed and run by the Connectivity Standards Alliance. Major players like Apple, Google, Amazon and Samsung are working with Matter to create a standard that allows smart devices from different manufacturers to work together. As they move beyond basic devices like light switches, thermostats and televisions and into smart security cameras, home security systems and more, interoperability will become even more crucial.
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Remote work has enabled some caregivers to balance work and family.
While women have historically had the majority of caregiving responsibilities, a recent study by Mother Honestly and Care.com found that 47% of men with a child under 15 felt they could spend more time with their kids due to remote work. The survey also found that 73% of caregivers use the time they save from working from home to care for their children, and 70% use it to spend more time with their partner or spouse. While remote work isn’t a magic bullet for care parity, it does allow caregivers the flexibility to stay in the labor force. The recent push to bring workers back to the office could ultimately upend this flexibility and employers should be cognizant of the knock-on effect of these policy changes.
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Household management
TAILWIND
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Venture-backed businesses aimed at making our homes easier to manage have struggled to be sustainable.
Scaling a business that’s addressing home management challenges has so far been a difficult task for any company. Many meal delivery companies, for example, have soared while propped up by venture capital and quickly fallen when the time comes to make it on their own. Household maintenance companies have also struggled to find sustainable business models, as with AAA shutting down their House Manager service in California earlier this year. The examples of solutions that are working, such as Rinse and Yumi, are specifically urban and often inaccessible due to a wide consumer basis because of high cost. As long as humans remain heavily involved in home management tasks, like delivering dry cleaning and cooking meals, the profit margins on these businesses will remain limited. Instead, the opportunity lies in using technology to make local businesses more efficient and effective in meeting their community’s needs, like what DoorDash continues to do with their new Packages service for picking up packages and delivering them to USPS, UPS, or FedEx.
HEADWIND
Household management
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Years of economic volatility have led families to be cautious about household spending.
Persistently high inflation over the last 2+ years has led households to feel squeezed by increased prices and cautious about spending. The Census Bureau’s Household Pulse Survey from December 2022 showed that 47% of respondents felt very stressed by inflation, and that at the margins, an extra child raises that stress by 4.2% points. IResearch with U.S. caregivers completed by The Holding Co. and McKinsey & Co. in June, 2023 found that 32% of survey respondents reported slightly higher or significantly higher spending on caregiving related expenses between June 2022 and 2023. Given these additional expenses for care, finding wallet share for purchasing household management products and services, will be exceedingly difficult for companies in this space. Additionally, an Executive from Honor reported that it’s common for families to stop spending money on in-home aids and other care services during times of hardship.
HEADWIND
Household management
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“When families need to tighten their belts, our network of franchisees often sees them reducing their hours of paid caregivers, taking on more of the work themselves.”
—Executive from Home Instead/Honor
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Professional Caregivers
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Professional Caregivers
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New talent models are connecting caregivers with care recipients.
Emerging sources of talent are paving the way for a more diverse and accessible labor force within the care sector. From parents helping parents out with child care, state government supporting apprenticeship models for child care and early childhood, EMTs and paramedics supporting home health outcomes, and family caregivers finally receiving compensation for their care work, these new sources of talent are making an impact.
Although they may not fully replace the formal caregiver workforce, they have undoubtedly alleviated the weight of care responsibilities, sparked innovative thinking, and offered relief to overworked and exhausted caregivers.
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Professional caregivers
TAILWIND
Public dialogue on our care workforce challenges has increased considerably.
The workforce of caregivers has long been an overlooked and undervalued sector. However, three years ago, the emergence of COVID-19 spotlighted the challenges and invaluable contributions of this essential workforce.
The pandemic ignited a wave of advocacy and awareness, from non-profit �organizations to the Build Back Better plan, that placed emphasis on job quality, �access expansion, and equitable pay for both professional and family caregivers. �The once invisible and underappreciated role of caregivers is now receiving the �attention and recognition it deserves.
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Professional caregivers
TAILWIND
Technology is being used to support care workers’ efficiency and effectiveness.
One of the most impactful ways to support the existing care workforce is by enabling them to work at the highest level of their expertise, focusing on tasks they excel at while outsourcing or streamlining other responsibilities. Innovative technological solutions, specifically AI and machine learning have demonstrated their ability to relieve care workers of repetitive tasks such as scheduling, tracking hours, and reminders. According to the American Hospital Association1, AI can already do 40% of the tasks done by non-clinical healthcare workers and 33% of the tasks done by clinical staff.
These solutions can also improve communication, and the digitization of data and information exchange, between care workers, families, providers, and care teams, ultimately saving time and enhancing knowledge transfer.
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“The biggest opportunity for technology [is] currently around making care providers as efficient and effective as possible.”
—Nevada Griffin, Chief Growth Officer, ConcertoCare
1https://www.aha.org/system/files/media/file/2019/09/Market_Insights_AI_Workforce_2.pdf
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Care workers are burned out and leaving the workforce.
The COVID-19 pandemic has highlighted the importance of care workers and their essential role in our society. However, the care workforce has been undervalued and undercompensated for far too long. Teachers, daycare workers, home health aides, nurses, and unpaid family caregivers have been pushed to their limits, causing many �to leave the workforce.
As a result, our economy and society are suffering, with 100,000 fewer child care workers, 300,000 fewer nurses, and 570,000 fewer educators in the US. This loss of care workers has created a devastating ripple effect, impacting the quality and accessibility of care across the board. It is critical that we recognize the value of the care workforce and invest in the recruitment, training, and retention of care workers to build a more resilient and equitable care infrastructure.
HEADWIND
Professional caregivers
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10M
More unpaid family caregivers have become a caregiver to a loved one, increasing from 43.5M (2015) to 53M (2020).
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Working conditions in long-term care are dire, enduring crisis after crisis.
The long-term care profession has struggled for years to attract, train, and retain new care workers due to subpar wages, dire working conditions, and difficult work. The average care worker - home health aides, residential care aides, nursing assistants - makes about $14.27 an hour.1 Median annual earnings for direct care workers are just $21,700 and 40% of direct care workers live in low-income households, with 43% relying on public assistance such as Medicaid and SNAP assistance.
Care facilities - assisted living facilities, skilled nursing homes, memory care facilities - were one of the hardest hit sectors during the pandemic due to a high risk population, making up at least 23% of all COVID deaths in the U.S. as of Jan 1, 2022. The current working conditions, deaths caused by the pandemic, worker shortages, and increasing demand for long-term care workers has made this nothing short of a snowballing crisis.
HEADWIND
Professional caregivers
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Certain policies have further fragmented the sector and impacted care workers.
There have been several well-intentioned but double edged policies that have �impacted the child care sector. The biggest of which is the movement towards �universal pre-k, where the unintended consequences of moving four-year-olds �out of a current system and into a new one has significant implications - for families, �care workers, and child care businesses.
Families are needing to reconfigure logistics and care workers lose continuity of care with toddlers. But most importantly, child care businesses, already operating on razor thin child-worker ratios, lose toddlers that help to balance out the time-intensive infants under their care. Other policies like D.C.’s requirement for workers to all have post-secondary credentials were made to improve the quality of care for the field, but the low pay makes pursuing further education challenging. Regulators and policymakers need to account for the impact on the system these policies have and ensure that it is a win-win on all fronts, rather than creating more unintended consequences for an already fragile sector.
HEADWIND
Professional caregivers
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Healthcare
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Healthcare
Care and healthcare are converging in the home.
The home is the next great frontier in care and healthcare. Home-based care innovation, ranging from preventative health to acute care, is booming. Some drivers include a tightening of healthcare facilities’ budget to expand infrastructure, resulting in providers pushing the experience to the home, to patient’s preferences to being treated in the comfort of their own home. A 2022 McKinsey survey estimates that up to $265B worth of care currently delivered in traditional facilities for Medicare FFS and MA beneficiaries could shift to the home, representing a 3 - 4x increase in the current spend at home.
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Acute Care
(Hospital in Home)
Activities of Daily Living
Post Discharge (Hospital in Home)
Preventative Health
Chronic Illness Management
Intermediate Activities of �Daily Living
TAILWIND
Importantly, this movement of home care comes with additional work and expectations on the informal caregiver to provide and care for the patient. Informal caregivers will need training and support if they are to pick up where the formal healthcare sector leaves off in this new hybrid healthcare climate.
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Healthcare
Non-traditional healthcare players are driving transformation in delivery.
Where and how consumers get their healthcare is being reimagined, not just because of technological advancement, but also because of unlikely collaborations. Amazon bought Pillpack and acquired One Medical. CVS purchased Oak Street Health. Humana acquired Kindred at Home. Apple is cozying up to insurers around the Apple Watch. And a sea of other activity.
When you look across the landscape, two key patterns emerge: non-care companies buying trusted care entry points (as is the case with Amazon and Pillpack/One Medical) or existing care companies deepening their relationship in the health ecosystem (as is the case with much of the retail pharmacy companies). Winning combinations and experiences still feel up for grabs, as is the role of the home as an anchor of these new experiences.
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TAILWIND
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Healthcare
Telemedicine hits an 80% adoption mark.
According to Rock Health’s 2022 Survey, telemedicine has hit the 80% adoption mark overall, becoming the preferred channel for prescription care and minor illness.1 What’s even more encouraging is that the survey reports notable adoption increases among groups that have long been underserved by the healthcare system - from older adults aged 55+, rural areas, women, Hispanics, and the uninsured.
However, the long-term adoption of telemedicine will be determined by policy changes, and while some of the flexibilities have been made permanent, some are still temporary through December 31, 2024, including key provisions such as Medicare patients being able to receive telehealth services in their home.
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Source: Rock Health Survey 2022
TAILWIND
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Healthcare
Evolving rules for Medicare Advantage allow reimbursement for new care benefits.
Before 2019, Medicare Advantage plans offering supplemental benefits were limited by a narrow definition of what counted as primarily health related. A reinterpretation of the rules by CMS has opened up a wider range of care related benefit options in Medicare Advantage plans.These changes acknowledge the importance of delivering both medical and non-medical services to enhance health outcomes and address the needs of Medicare beneficiaries. Notably, recent developments have allowed MA plans to offer tailored benefits that cater to specific diseases and conditions, including non-medical services such as transportation and meal delivery.
One example is the recent announcement of a new payment program for dementia care coordination services within the Medicare health plan called the Guiding an Improved Dementia Experience (GUIDE) Model. The program includes personalized assessments, care plans, and round-the-clock support for patients, all aimed at delaying the need for long-term nursing home care. The pilot program will test a per-patient per-month amount payment model for people who provide support services to patients with dementia. These improvements to Medicare come at a crucial time, providing valuable support for both patients and caregivers.
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TAILWIND
Healthcare
TAILWIND
Advancements in drug development could lighten caregiver burden.
The pharmaceutical and biotechnology industry play critical roles in care. Advancements in drug development, diagnostics, medication, and procedures can have significant impact on a caregiver’s responsibility.
An example of this would be in Alzheimer’s disease, where in Jan 2023, the FDA accelerated an approval for a drug, Lecanemab, shown in clinical trials to slow �cognitive decline in patients in the early stages of the disease. The impact on caregivers could be significant, as it means more adjustment time and fewer caregiving needs as symptoms would be slowed down.
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Consumers are only in the early stages of understanding privacy.
With the proliferation of data in the home, major questions have come up around privacy, data protection, sharing and ownership. Consumers seem to have general awareness and understanding of the cost and consequence of sharing their financial data, but this doesn’t necessarily translate to their way of thinking about sharing health and home data or monitoring how their children are using devices. According to a Global Consumer Insights Survey released by PWC earlier this year, when asked about their level of concern regarding personal data privacy, 32 percent of respondents said they are extremely or very concerned when engaging with consumer companies. Simultaneously, according to that same survey, 82 percent of respondents said they would be willing to share some kind of personal data in exchange for a better customer experience. This dichotomy highlights that consumer-facing companies, such as those in household management, have to actively protect consumer data while providing value with the data consumers do share.
HEADWIND
Household management
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Wearable technology hasn’t been effectively integrated into care contexts yet.
Consumer wearable technology has long held a promise of changing the nature of monitoring and assessment when it comes to health behaviors. While adoption has grown, ownership disparities persist among consumer communities that leaves out those who could benefit most from medical care management. Moreover, most wearables are purchased directly by consumers rather than being integrated into healthcare programs, limiting their use in managing medical conditions effectively. Other barriers include limited reimbursement pathways, challenges with EHR integration, and data overwhelm which impedes healthcare providers from encouraging wider adoption.
To overcome these challenges, partnerships between wearable manufacturers and healthcare providers, employers, payers, and clinical trial sponsors are crucial. Further, demonstrating the value of wearables in clinical applications is essential. Progress has been made, with some wearable makers identifying digital biomarkers for screening premature birth and monitoring Parkinson's symptoms. By bridging the gap between wearable technology and healthcare, care delivery can be revolutionized.
Healthcare
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“Health data sharing only moves at the speed of trust, and right now it’s slow-going.”
- Rock Health Survey, 2022
HEADWIND
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There is a continued lack of accountability as privatization of Medicare increases.
Medicare has been shifting from a government program to a public benefit provided through private companies, brought about by Medicare Advantage. This shift has significant implications for patients and payers. A Kaiser Family Foundation analysis found that insurers were making more money per patient in Medicare Advantage than with their individual or employer-sponsored plans. Furthermore, in November 2022, auditors uncovered millions of dollars in improper payments — citing overcharges of more than $1,000 per patient a year on average — by nearly two dozen health plans.
In another report by the NYTimes, it was found that the Medicare Advantage plans overbilled Medicare between $12B and $25B in 2020. While it’s popularity has grown significantly in recent years, the vision of curbing spending in healthcare has fallen to private plans taking advantage of a public program and exacerbating a care crisis.
Healthcare
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HEADWIND
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Increasing premiums are being pushed onto already cash-strapped consumers.
The impact of rising inflation is being felt across our economic system. In healthcare, inflation has created significant pressure on costs and is being felt by employers and providers of care especially in terms of profitability. In order to preserve bottom lines, providers have pushed the burden of costs to employers who, in turn, have pushed increasing premiums down to consumers, forcing care-related consequences and trade-offs. Employees are selecting plans with higher deductibles and therefore deferring a lot of care to consumers - which then becomes a care crisis. E.g., deferring diabetes treatment and then ending up being a caregiver challenge later on.
Rural America is facing especially dire circumstances, with a recent survey by The Commonwealth Fund’s 2020 International Health Policy group reporting that 36 percent of rural Americans did not get the care they needed due to costs and 25 percent of rural Americans reported serious problems with being able to pay their medical bills or not being able to pay them at all.
Healthcare
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Source: McKinsey, July 2022
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Employers
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Employers
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Employers are emerging as a significant payor of care.
The $648B care economy represents one of the largest annual consumer spending �items as a percentage of the U.S. GDP. One of the more interesting aspects underneath this significant number is who is doing the spending. Families aren’t the only ones contributing to this annual spending - other payors, such as employers, insurers, businesses, and the government, are key players in the market.
With the recognition that caregiving responsibilities have a direct correlation to productivity and employee retention, employers are increasingly prioritizing care benefits as a key offering that matters to top talent. As a result, the Future of Benefits 2022 report by care.com indicates that 57% of surveyed companies are placing greater emphasis on child care, while 51% are prioritizing senior care more in 2022 than they did in 2021.1 It is evident that care benefits are here to stay, and their prominence and importance will only continue to grow in the years to come.
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Source: The Future of Benefits 2022, care.com
Employers
TAILWIND
Hybrid healthcare and caregiving benefits are opening up more HR funding.
Solutions that blend healthcare and care benefits can provide a more cohesive benefits experience, attracting new buyers, and potentially open up more human resources budget. The Investor's Guide to the Care Economy found that only about 1% of overall employee benefit spend is on care-related benefits, compared to approximately 25% on healthcare benefits.
Innovations like Maven, Wellthy or Cleo, which offer access to healthcare and care coordination, can make the case for keeping healthcare costs low for employers while tapping into a bigger pool of funding.
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NEWS
Source: https://www.bls.gov/news.release/pdf/ecec.pdf
Employers
TAILWIND
Benefits are being fueled by a competitive labor market and government policy.
American employers are facing the reality that a lack of access to affordable child care could be blocking potential employment. Industries such as the airline industry have started offering financial support for child care or have plans to expand their on-site child care facilities to keep up with travel demands. And they’re not the only ones looking for solutions for families. Increasingly, economists are pointing to universal child care as a necessity for a prospective long-term labor shortage.1
Government policy is attempting to solve for this with actions like the Commerce Department announcing that any semiconductor manufacturer looking a slice of the $40B in federal subsidies will need to guarantee affordable, high-quality child care for the dependents of workers who build or operate a plant. Additionally, innovative state government programs like Michigan’s Tri-Share, equally splits the cost of an employee’s child care between the employer, employee and the state of Michigan.
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Commerce Secretary Gina Raimondo, center, with Gov. Kathy Hochul of New York, said that the child-care requirements should help companies hire mothers, easing a labor shortage.
Source: NYTimes, 2023
Source: https://www.axios.com/2023/08/04/us-labor-shortage-women-workforce
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Backup care benefits for hourly workers are slowly gaining momentum.
Hourly workers have historically been neglected when it comes to benefits, however, the tide seems to be turning. Competitive dynamics for hourly workers have spurred a growing recognition amongst employers of the importance of care benefits, resulting in several major employers offering backup care benefits to an overlooked population. For example, Target announced access to backup care and paid family leave, Best Buy offers backup care and Caregiving Pay to employees, JC Penny partnered with WeeCare to extend their child care benefits across their workforce, Walmart and Starbucks provide six weeks of paid family leave to their hourly workers.
COVID-19 has further pushed employers to view their hourly workers as a key part of their workforce, and to continue to invest in their needs. This is a start to a journey that would ideally provide more equity in the workforce in terms of benefits.
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Employers
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The economics of primary care benefits for hourly workers doesn’t add up.
While backup care has expanded to some major retailers in the U.S. (i.e., Target, Walmart), we have yet to see progress on full-time child care benefits for hourly workers - the demographic that needs child care support the most. The majority of employers report that they can’t make the business case of paying for care for their employees without burdening the consumer with a higher price point or taking the cost out of profit margins. The math simply doesn’t add up.
Employers
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“It’s very difficult for the employer to offer care to this workforce. It’s not tenable from a cost standpoint.”
—Priya Krishnan, Chief Experience Officer, Bright Horizons
HEADWIND
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There is a continued lack of clear and compelling ROI for care benefits.
The Return on Investment (ROI) has traditionally been a crucial factor in �evaluating the purchase of all benefits. Hard financial numbers on cost savings �and spend are often used to justify the addition of new benefits to an employer's repertoire. However, determining an ROI for care benefits can be more complex than �for other types of benefits.
Solutions need to consider intangible benefits such as productivity increases, retention, and improvements in overall wellness, which may be challenging to quantify. While the wellness benefits market provides the best proxy for the care benefits market–in terms of positioning and calculating ROI–more work is needed to demonstrate to employers the financial benefits that care can bring.
Employers
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“I think demonstrating an ROI on care benefits is very hard, because first of all, you’d have to determine the metric you want to measure. And second, there are so many other factors that could be influencing that metric.”
—Amanta Mazumdar, VP Total Benefits, Hilton
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Care benefits remain fragmented.
The proliferation of point solutions in the care market has led to friction for employer payers. There’s one solution for child care, one for backup child care, one for a care concierge, and the list goes on. Entering the market with a single point solution is understandably more feasible for startups and companies testing the waters in the space, but real value is created more efficiently for both the employee and the employer through a holistic solution.
Employers are increasingly looking for an aggregator of benefits through which they can manage all of their benefits. Startups like Cleo and Wellthy have reported that they’ve been hearing this from some of their biggest customers who are asking them to become a one-stop shop for care benefits, rather than providing just a couple of pieces of the puzzle. The investment to scale beyond a point solution is considerable for these start-ups and few in the industry have been able to raise the capital that would be necessary.
Employers
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NEWS
Growth in care benefits has slowed down due to macroeconomic conditions.
Due to uncertain macroeconomic conditions, growth in employers purchasing care benefits hasn’t grown as rapidly as it did during COVID. The pandemic pushed employers to purchase essential benefits that their employees were asking for. However, in a world where we are regressing to an eventual “return to normal,” employers do not have the same level of pressure as they did during the pandemic to make this decision.
Employee demand is still high for care benefits, as demonstrated in care.com’s Future of Benefits 2022 survey, but the jury is out in terms of the new normal for employers and their relationship to care benefits.
Employers
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"Employers stepped up during COVID and now we're seeing some of those very same employers reverse course. For example, Red Bull and Amazon are eliminating some of the back up care benefits.”
—Lynn Perkins, CEO, Urbansitter
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Older Adult Care
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Older Adult Care
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Older Adult Care
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Covid accelerated older adults’ adoption of technology.
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Outdated stereotypes of older adults fumbling with technology used to be everywhere. Older adults don’t want new tech. They can’t figure out how to use new tech. They won’t pay for it. The list goes on. But the reality is that, over the last decade, older adults have been increasingly adopting technology and the pandemic only accelerated the trend. The adoption of technology by older adults is also enabling the delivery of care in the home and creating the conditions for older adults to do things like accessing telehealth services and utilizing monitoring devices. Additionally, those aging into the 65+ bracket are increasingly tech-fluent and will create a large market opportunity for technology to support their aging.
Older adults with smartphones are using the following technologies on a daily basis:
Social Media Used
Internet Browsing
Instant Messaging
Video Calls Used
2016
2020
69%
(+60% increase from 2016)
81%
(+72% increase from 2016)
71%
(+58% increase from 2016)
38%
(+138% increase from 2016)
43%
47%
45%
16%
Source: The Investor’s Guide to the Care Economy, The Holding Co., July 2021
Tech and retail companies are seizing the opportunity to develop offers for older adult care.
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Best Buy is a best-in-class example of a retailer that has worked to become a care destination. They began their journey focused on senior health in 2018 with the acquisition of GreatCall, an emergency response product and service offering for �the aging (PERS devices, plus a scaled call center service). They’ve continued to parlay their brand recognition as a trusted purveyor of care products and services to deepen �their relationship with consumers around health. In the summer of 2023, they launched their revamped Lively program to provide older adults with tools and services that support their health, connectivity, and comfort in their homes, including access to medical and non-medical assistance, caregiver support, and emergency hotlines.
Apple has also been increasingly focused on developing health-related technologies and services, such as the Apple Watch and the Health app. These products have features like fall detection and heart rate monitoring that could be useful for older adults. Additionally, Apple has been working on developing features related to aging in place, such as the ability to control smart home devices through Siri. As more companies see the opportunity to serve older adults, the technology and services to enable independent living will continue to improve.
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More Americans are able to age in place thanks to new housing models.
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New models of housing are enabling seniors to age in place by providing them with safe, comfortable, and accessible living environments that support their well-being. These models range from purpose-built retirement villages to naturally occurring retirement communities, multi-generational co-housing, accessory dwelling units (ADU), and more. According to a study by the National Association of Home Builders, the demand for multi-generational housing is expected to grow by 50% in the next decade (after quadrupling to 59.7 million between 1971 and 2021 (Pew)). This growth is driven by a number of factors, including the rising cost of housing and an increasing aging population with care needs. ADUs are also increasing in popularity, as local governments become proponents and even incentive building more. They’re ideal for seniors who want to live independently, while still having a caregiver nearby. As of 2023, ten states and D.C., as well as many municipalities, have adopted or revised laws to encourage ADU construction and the AARP has also helped ADU legislation pass in 17 cities in the past two years alone
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Companies are jumping on the $151B opportunity to make homes safer for older adults.
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According to recent research done by AARP, 9 in 10 seniors want to age in place. But the desire far outpaces the reality: currently only 10% of the 115 million U.S. homes are ready to accommodate older residents with features like an accessible bathroom and few stairs. The National Association of Home Builders in collaboration with AARP and others developed a certification for aging in place specialists and Lowe’s and Home Depot have also jumped in with their own lines of aging-friendly products and services. Startups such as Rosarium Health and The Helper Bees have also popped up with solutions for payors and families to make aging at home safer. All of these initiatives are aimed at seizing the aging-in place and home-based care market, which we estimate to be upwards of $151 billion.
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Longevity investments continue to grow as some seek to delay aging.
Some predict that there will be more people over the age of 65 than those under the age of 18 as soon as 2034 in the U.S.; not all of those people are thrilled about growing older, and as such, there is big demand for innovation that will put off what was once thought of as inevitable. Longevity technology aims to improve quality of �life and promote longer life spans through discovery platforms, drugs, renewal therapies, gene therapies and more. The investment in this space is substantial. The Longevity Investment Report reported $5.2 billion of investment across 130 deals in 2022, up 77% from 2020.1
Pioneers like Jeff Bezos are seeing life extension technologies as ripe for investment as evidenced by his investment in Altos Labs, a biotech startup that aims to research the biology of aging and extend human lifespan. Economic data suggests that lowering mortality and frailty at every age and increasing life expectancy for US citizens is worth $700 billion annually.2 Individuals who have a higher quality of life for longer will be less likely to need care and more likely to live independently.
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“There is a common misconception in the general public that longevity means being frail and looking old for longer… Longevity therapies mean we will live longer and in better health.”
—Nathan Cheng and Sebastian Brunemeier of Healthspan Capital2
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A national strategy to support family caregivers has been adopted.
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Family caregivers are the backbone of the long-term care system in the U.S. Most of us will either be a family caregiver or need one at some point in our lives. With a limited supply of professional caregivers, the need for family caregivers is stronger than ever and will continue to grow as the number of available family caregivers shrinks relative to the number of older adults in need of care.
As an acknowledgment of the unique value that family caregivers provide and the urgent need to support them, the U.S. Department of Health and Human Services adopted a National Strategy to Support Family Caregivers in 2022. The primary goal of the strategy is to provide caregivers with training, support, and opportunities for rest and self-care. It highlights 350 actions that the federal government will take to provide family caregivers with much needed support, including respite services.
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Some states have stepped up to create innovative programs for elder care.
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Addressing Social Determinants of Health, such as nutritious food and safe housing, �can significantly improve health outcomes. For example, one study found a marginal increase in home-delivered meals for older adults was associated with a $109M �reduction in Medicaid costs, as well as a reduced likelihood of entering a nursing home. Since each state operates its own Medicaid system, it is up to each State as to how �much to cover social determinants of health. Excitingly, at least 33 states have chosen to include some form of SDOH related coverage for certain eligible populations through managed care contracts or the Section 1115 waiver.
Another state-level program that is attempting to provide additional aid to seniors is �the Washington Cares Fund, which is a first of its’ kind program in the U.S. Through �an established payroll tax of 0.58% on employee wages, the fund has been created to pay for long-term care services, the majority of which are not covered Medicare or private health insurance. This state-level support is giving elders much needed financial aid to cover expenses for care, renovation, and much more, and is an exemplary program for other states looking to support aging expenses.
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Innovations in financial caregiving are supporting older adults.
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As the number of older adults continues to grow, family members are taking on increasing responsibilities as caregivers to support their loved ones. While much attention is brought to physical care, a survey by Merrill Lynch and Age Wave found that 92% of caregivers said they provide financial caregiving versus the 64% who said they provide physical care. Fortunately, innovative companies like Carefull and Retireable are working to ease the burden of financial caregiving with financial products specifically tailored for older adults. These products aim to solve issues that are typical for this demographic and can cause their caregivers unnecessary stress. One example is financial scams, which are on the rise with >90,000 older victims reporting fraud in 2021, resulting in $1.7B in losses. Carefull’s services guard older adults’ money, credit, and identity from threats, thieves, and everyday money mistakes. Retirable is a financial services company that helps adults age 50 and up prepare for retirement and gain the financial stability they need to enjoy retirement. While startups like these continue to grow in the space, the opportunity to serve this demographic becomes increasingly obvious for larger financial institutions, as well.
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There is significant complexity in paying unpaid caregivers.
In the United States, there are an estimated 53 million individuals providing unpaid care to family members or friends. These individuals are doing critical work and are sacrificing their own personal and professional lives to do so, as well as often having to work less hours, if they can still work at all. According to an AARP study, three-quarters of family caregivers reported regularly spending their own money on caregiving expenses, averaging $7,242 annually, or 26% of their income. Despite the significant financial and temporal investment, these caregivers are not compensated for their efforts, and insurance coverage for products can only go so far. Some government programs have the ability to pay family caregivers, but they are complicated to navigate and difficult to access. Family caregivers need more resources and information to ensure that they are getting the funds available to them, and insurers and government need to find new solutions for providing financial compensation for the work unpaid caregivers are doing.
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“As a Medicare Advantage plan, I can only pay my members’ family caregivers less than $500 a year. That’s not nearly enough, but there’s no clear path right now to increasing that.”
—Executive at SCAN Plan
Source: https://www.washingtonpost.com/business/2021/10/29/high-cost-unpaid-caregivers/
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High quality, affordable professional care is hard to find and families struggle with the burden.
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Family caregivers often provide the most attentive care to their aging family members, but many have had little training to do all of the tasks that healthcare professionals would typically do. From medication management to assisting with activities of daily living, the responsibilities of caregiving can be both tiresome and complex. Additionally, the cost of lost income and the mental and emotional burden of caregiving for an aging family member can be significant; however, hiring a professional caregiver often presents its own issues. High quality paid care support is still hard to find, trust, and keep for too many Americans.
https://fred.stlouisfed.org/series/CEU6562300001
As people live longer, financial costs continue to compound.
As technology and advancements in healthcare enable people to live longer, the cost of these additional years of life add up. As the population ages, there becomes a greater need for healthcare services such as hospitalization, medication, and therapy, which can drive up costs for individuals, families, and governments. Additionally, older individuals may require long-term care, such as nursing home care or assisted living facilities, which can be expensive. The cost of these services is often borne by individuals or their families, and many people may struggle to afford them. According to a study by HealthView Services, a healthy 65-year-old woman who lives until 89 will incur about $175,000 more in lifetime healthcare costs than a same-age woman with Type 2 Diabetes who lives until 81, because of the additional monthly premiums and out of pocket charges over those eight years.
National health spending, which includes the federal government and households, is expected to grow at an annual rate of 5.1% between 2021 and 2030 according to the Centers for Medicare and Medicaid Services, however the annual cost of living adjustment to social security will average only 2.4% over that same time period, leaving a significant gap for those reliant on social security to cover their expenses as they age.1 In addition to the healthcare costs associated with an aging population, society will face other costs such as a decrease in the workforce population, which can impact economic growth and tax revenue.
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“A healthy 65-year-old woman who lives until 89 will incur about $175,000 more in lifetime healthcare costs than a same-age women with Type 2 Diabetes who lives until 81.”
—HealthView Services1
Source: 1https://hvsfinancial.com/white-papers/
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Inflation is causing aging to be more expensive than planned.
While inflation has led to struggles for many, it’s hitting those over 65 even harder because they typically live on a fixed income and are unable to increase their paychecks overtime or with bonuses. Millions of Social Security recipients received an 8.7% boost in their benefits at the end of last year, but prices remain stubbornly high and seniors are likely to see increased costs. Long-term providers will eventually seek to be compensated for the increased labor costs, supply chain issues and technical innovations that have all occurred during the previous contract term, which will continue to hit the wallets of seniors. Additionally, inflation can also impact the retirement income of seniors, which can make it more difficult for them to afford elder care services. If the cost of living increases faster than retirement income, seniors will find it difficult to pay for the care they need and may be put into difficult situations where they are choosing between receiving care and paying for it.
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Preventing loneliness and isolation among older adults continues to be challenging.
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“1 in 3 people between the ages of 50 and 80 say they sometimes or often still experience these feelings”
—University of Michigan’s National Poll on Healthy Aging1
Source: 1 https://record.umich.edu/articles/loneliness-isolation-down-but-still-high-among-older-adults/
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Loneliness has been labeled an epidemic by the U.S. Surgeon General and it plagues people of all ages, but it can be especially impactful for seniors. Older adults have long reported feelings of isolation and loneliness and those feelings were exacerbated by the COVID-19 pandemic when seniors were forced to pick between the very real risk of infection or the equally real risk of isolation. According to a study by the University of Michigan, feelings of loneliness, isolation and lacking social contact are finally subsiding three years into the pandemic; however, 1 in 3 people between the ages of 50 and 80 say they sometimes or often still experience these feelings.
The impact of chronic social isolation and loneliness extends beyond someone’s mental health and can have significant impact on their physical health and overall well-being. Research done by AARP shows that Medicare spends $6.7 billion per year caring for socially isolated older adults. Although the pandemic pushed more people into virtual communities, there is still much work to be done around how society can better engage with and become more inclusive for older adults.
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Child Care
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New systems are enabling parents to pay family caregivers.
Having access to money outside of one’s own income to pay a loved one for care is becoming increasingly normalized. This option has long existed with systems like Bright Horizons, but it’s never been widely known about or widely used. The pandemic opened up this option to employers with companies like UrbanSitter and Vivvi making it more accessible, and in turn, more widely adopted. It’s an exciting trend in helping to bring visibility and value to unpaid labor, though many employers have since dropped this option now that care needs are slightly less acute. There’s still much work to be done with employers in shifting the cultural perception of “free” care work from loved ones. States are also implementing new systems that are enabling payments to family caregivers. One example: the state of California has a Medicaid Waiver for freedom of choice that allows Californians to pay family caregivers directly through Medicaid.
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Child Care
American Rescue Plan dollars have pointed the way for how the system can evolve.
The American Rescue Plan allocated $39 billion in child care relief to states and providers, which was the largest child care allocation by the federal government ever in U.S. history. $15 billion of the total were discretionary funds, allowing flexibility for states to determine what was most pressing for their particular needs. The funds are still being allocated in innovative ways by some states, such as Minnesota where they created a task force to develop a 10-year plan for making child care more accessible for parents and sustainable for workers as a lifelong career. Another example is Harris County, Texas, which includes Houston, where they are using the funding on a community-centered approach to build quality networks. Although this money is temporary, those who are implementing wisely are gathering data from the initiatives to make a case for more in the future.
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“91% of low-income families used their monthly benefits on their basic needs food, clothing, shelter, and utilities — or education.”
—Center on Budget & Policy Priorities
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Some states are stepping up in the absence of consistent federal policy.
While lawmakers at the federal level continue to debate the cost and necessity of expanding access to child care across the country, states are filling the void in various ways. The COVID-19 pandemic highlighted an acute need for child care and advocates have been vocal that the need is pervasive for many families, which is leading �to new political motivation for solutions.
Governor JB Pritzker of Illinois for example, has proposed “Smart Start,” which would include $250 million in funding next year for child care providers and early childhood block grants, as well as early intervention programs. Governor Pritzker has set goals of adding �5,000 new preschool spots in the next year, 20,000 new spots over the next four years and offering universal preschool by 2027. Colorado passed a nicotine tax via ballot measure in 2020 to fund half-day preschool with widespread support across the state. New Mexico, California, Michigan, Vermont, and others are also making strides �towards expanding access to preschool or offering universal pre-K within the next �few years through various initiatives. Ultimately, there’s a significant opportunity for the states to implement policies that work for their local context and support both child development and working families.
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Tech advances have made it easier to ensure safety in child care settings.
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Safety is naturally a parent’s number one concern when considering who will care for their children. While the experience of finding a caregiver was previously based primarily on networking with neighbors and relationships developed with trust, technology has enabled parents to easily verify the background of those watching their children and to keep an eye on the kids while they’re away. TrustLine is a database of non-licensed in-home caregivers including nannies and babysitters in California and enables parents to quickly check the background of anyone watching their children. Care websites, like Urbansitter and Care.com, also utilize background checks for caregivers, providing consumers with a valuable stamp of approval prior to engaging. This also expands the pool of potential caregivers for parents who don’t have a close network for referrals.
Advances in other technologies such as the broad commercialization of �“nanny cameras” have also enabled parents to feel that their children are secure, �because they can easily see what’s going on in their homes at any given time and, simultaneously, create more accountability for the caregiver who knows they can �be observed. These tools are significant in providing parents with peace of mind �when they leave their children.
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Tech is creating needed efficiencies in the child care system.
Platforms like Winnie, Kinside, and Bridgecare are leading the way in developing technology to build a more efficient child care system. Whether it’s streamlining administrative tasks like billing, improving communication with parents or providing �a database of child care centers with available spots in a select vicinity, these tools �are all helping child care centers and the system to run more effectively. Adoption �of these tools by care providers can lead to less time on paperwork and more face �to face time with children. Additionally, these technological innovations are especially important in the face of a severe worker supply shortage, which is leaving providers short-staffed and overworked. Aggregating platforms, like Bridgecare, are also extraordinarily valuable in collecting data to build the case for new policy that addresses the dearth of child care in this country.
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President Biden signed executive order aimed at making child care more affordable and accessible.
President Biden's recent Executive Order (EO) aims to make child care more affordable and accessible with an array of over 50 actions spanning multiple federal agencies. Biden's directive revolves around two crucial aspects: the cost of child care for families and the compensation of care workers. The EO intends to address these by enacting new regulations and policies without requiring substantial additional public funding. The EO emphasizes collaboration among federal agencies, recognizing that child care touches a wide range of spheres, from workforce participation to family stability. It also includes initiatives such as improving compensation for Head Start staff, extending health insurance access to child care workers, and bolstering mental health support for them. The Department of Health and Human Services (HHS) and other agencies are set to examine ways to reduce child care expenses, eliminate eligibility barriers for subsidies and Head Start, and enhance child care affordability for military personnel. While the EO doesn't fulfill Biden's initial proposals for comprehensive child care coverage, it reflects an effort to take incremental steps towards more accessible and affordable child care
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Child Care
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Child Care
Affordability remains one of the biggest challenge facing families who need child care.
Families across the U.S. are struggling to find affordable child care and the problem seems to have no end in sight without significant investment from the federal or state governments. A study published late in 2022 by the Federal Reserve Bank of St. Louis estimated that families in the U.S. are spending on average 14% of their income on center-based care for a single child. This study also found that there’s a tradeoff between quality child care and affordability - states with lower child-to-staff ratios, which leads to more one-on-one attention, were less affordable overall. Another major driver of the cost of child care is wages, which account for a significant portion of operating expenses and, yet, are barely enough for the workers who are receiving them. Families are paying as much for one year of child care as they would pay for one year of public college, but they don’t have the same amount of time for planning and saving for child care as they do for college. This is forcing parents to leave the workforce to care for their children or to work at jobs where they can work less hours; this is especially true for women. The National Database of Child care Prices shows that in places where child care prices are high, mothers are less likely to be employed outside the home, even in locations with higher wages. Families deploy various patchwork solutions, including having older siblings or aging adults watch younger children, to enable parents to work; however, these can’t substantially fill the void in the way that government support could.
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Source: 1https://www.dol.gov/newsroom/releases/wb/wb20230124
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Child Care
The child care supply crisis is continuing to get worse.
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Child care providers are part of the backbone of the American economy, enabling �others to participate in the labor force. While their value to many is priceless and �the demand is high, the supply is low and hard to come by for many families. �The COVID-19 pandemic decimated a system that was already broken with estimates showing that nearly 90,000 workers left the child care industry between February �2020 and July 2022, and 16,000 child care programs closed, approximately 9% of �the industry’s licensed providers. The problem is pervasive, with a study by the Center �for American Progress showing that about half of the neighborhoods in the U.S. qualify �as “child care desserts,” which are defined as places where three children compete for each available spot at a licensed child care center. This is exacerbated in rural areas, where the number increases to 60% of families not having any access to child care at all. While the number of child care workers is slowly rebounding from its low point during the pandemic, there were still nearly 58,000 fewer child care workers in January 2023 than in February 2020. As wages rise in other industries, like fast food and retail, competition for these workers is real.
https://cscce.berkeley.edu/publications/brief/child-care-sector-jobs-bls-analysis/
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Total Care Industry Jobs, Nationwide, Monthly through February 2023
The industry continues to struggle to recover from sharp job losses it experienced early in the pandemic
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Child Care
All states need to evolve for universal Pre-K to thrive.
With good intentions, governors from New Mexico to Arkansas have been pushing for universal access to preschool or pre-kindergarten for three and four year olds. While this is good news for these children, there are significant ripple effects of implementing these programs. As older toddlers leave the child care setting for formal school, the cost of infant care goes up. Already strapped child care providers have an even harder time keeping their teacher-to-child ratio in compliance. One example of this is from when New York City expanded universal education to include all 4-year olds in 2014, causing child care programs that previously had toddler and infant spots to shift to serving the newly eligible pre-kindergarten students who would be paid for by the government.1 This ultimately led to a 15-20% reduction in the total availability for infant/toddler care (children under 2). It also affected the quality of care being provided with educators moving to the publicly funded programs that offered more competitive wages and better benefits. In order for universal pre-kindergarten to succeed without the knock-on effect to other age demographics, state plans need to also include financial incentives to programs offering infant and toddler care, pathways for salary growth, and parity across education and adequate resources and funding.
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“When New York City expanded its universal preschool program to include 4-year olds in 2014, it produced a shift that led to fewer seats available for children under age 2—about 2,700 fewer.”
—Jessica Brown, University of South Carolina1
Source: 1 https://www.edsurge.com/news/2021-05-10-the-unintended-consequences-of-universal-preschool
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Awareness around neurodiversity has increased.
There has been increasing cultural and workplace awareness around neurodivergence and how it shows up in different parts of society. Television shows like Everything’s Going to Be Okay are sharing the stories of people with neurodivergence in an accurate and relatable way, even casting Kayla Cromer, an actress with autism. Studies have also shown that parents of children with presentation of autism are more likely to seek a diagnosis for their child if they live near someone with a condition.
Policy change has played a role in increasing awareness where the American Academy of Pediatrics recommended screening for all children for autism during routine pediatrician visits at 18 - 24 months of age. Increased awareness has lead to innovations, like helping caregivers who have dependents with disabilities, therapy, and better education and community support.
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People with disabilities are increasingly employed and connected.
As the economy makes progress in recovering from the COVID-19 pandemic, �individuals with disabilities are returning to the workforce in larger numbers, �surpassing the pre-pandemic levels. This promising trend marks an improvement �in the longstanding and significant disparities between individuals with and �without disabilities in the workforce.
The pandemic-induced changes in business practices, such as increased flexibility in work schedules and remote work opportunities, have created more openings for individuals with disabilities who previously had limited access to these types of jobs and faced stigma when applying and interviewing in-person. In addition, flexibility in working and living has enabled people with disabilities to stay connected with different communities and support systems.
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ABLE account eligibility has expanded, potentially serving 8M more Americans.
ABLE accounts (Achieving a Better Life Experience accounts) are an investment and savings account for people with disabilities, similar to a 529 college savings account. The newly enacted ABLE age adjustment, which raised the age cut-off from 26 to 46 will expand the number of Americans with disabilities who can access this financial benefit, potentially serving 8M more Americans. This is especially beneficial to those who develop disabilities later on in life. It is also a huge support in terms of financial caregiving, helping individuals and families to maximize their hard earned dollars towards the care they deserve.
Additional ABLE reform is potentially on the horizon, with Senator Bob Casey’s recent proposal of the ABLE MATCH Act, which aims to remove financial barriers for low-income individuals with disabilities enrolling in the ABLE program, by allowing them to save beyond the $2,000 asset limit required by federal assistance programs. The act proposes a dollar-for-dollar federal match for new and existing ABLE accounts held by individuals earning $28,000 annually or less, encouraging savings for disability-related expenses and improving the financial well-being of those with lower incomes.
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Disability Care
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The pandemic increased awareness of disability and chronic illness.
The pandemic created a window into the true lives of families and how they deal with care. This public dialogue has given space to families and individuals with disabilities to advocate and share how they are coping and the needs that they have.
The prevalence of long covid has added to the awareness of people living with disabilities as 24 - 50 million Americans are struggling with chronic illness. Hopefully with increasing awareness, increased education, accomodations, advocacy, and allyship will follow for those who are living with or have a loved one with a disability.
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Tech is enabling people to find care providers for family members with disabilities.
Due to technology and connectivity, it has never been easier for people with disabilities to find the care that they need. This ranges from education, communities, treatments, caregivers - and this is especially helpful for specialty care.
Innovations like Sleuth and Joshin help families get connected to resources and caregivers ranging from ADHD to autism. Specialty care providers are now more �visible, as their practices become digitized with an online presence and families �can get the help that they deserve.
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Care worker shortages disproportionately affect people with disabilities.
The pandemic set off a surge of worker demand in healthcare settings (i.e., hospitals, clinics, front line workers), leaving families with in-home needs behind. In-home nurses who support children with special needs have become close to impossible to find and retain, from reports in the field. Even interventions to get family caregivers paid are narrow, like Respite for ME, which requires caregivers to be over 55 and the care recipient to be between 15 - 50 years old.
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Disability Care
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Disability support services remain profoundly fragmented and complex to navigate.
Families struggle to navigate the complexities of getting disability support, which is different in every state. In a 2012 report by the Government Accountability Office, officials from 34 programs collectively reported using at least 10 different definitions of disability, and 10 programs reported having no specific definition at all. In addition, the 45 programs reported at least 26 specific limitations to eligibility, such as limiting services to Native Americans or people who are blind.
In 2021 qualitative research conducted by The Holding Co., one of the top themes�that emerged from caregivers of children with disabilities is the fact that information and support is consistently hard to find and fragmented. On top of that, the �paperwork associated with obtaining benefits adds to caregiver burden and burnout.
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“The record keeping �and the paperwork is exasperating...f**ckin’ never-ending. It’s not hard, it’s just time-consuming.”
—Mother of 7 year old with cerebral palsy
“There is not one place to get all information. You don’t know what you don’t know.”
—Mother of 6 year old twins with Autism
User quotes source: The Holding Co. 2021
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Disability Care
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Product innovation in disability and care remains niche and underfunded, disproportionately benefiting already privileged families.
Innovation in the disability space has come a long way in the past few years. �Solutions like hearing aids, audio books, smart wheelchairs, adaptable clothing, high-tech prosthetics, and text-to-speech software has been tremendously �helpful in supporting people with disabilities.
However, these solutions come at a cost that often leaves out low-income �individuals and families. Product innovation needs to be more universal and �accessible in order to support the full range of people with disabilities, not �just those with financial resources.
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Disability Care
Infrastructure challenges and entrenched systems are thwarting innovation.
When it comes to new care-related products and services, it feels easier for entrepreneurs to go directly to consumers’ needs inside of their own homes. It requires less red tape and less integrating into mammoth healthcare systems that are notorious for being hard to navigate. And yet, meeting consumers’ needs inside of the home, and further asking them to pay for it, is only a small percentage of the overall market potential. Care entrepreneurs with ambition can look to unlock incentives-aligned payors, but they have to have stamina for compliance (e.g., HIPAA) and partnership dynamics (e.g., long sales cycles), neither of which are easy to deal with.
Healthcare
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Acute Care
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Activities of Daily Living
Post Discharge (Hospital in Home)
Preventative Health
Chronic Illness Management
Intermediate Activities of �Daily Living
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Further, consumers frequently share that the closer a solution gets to serving a health need, the more they believe that their insurer should pay for it (as opposed to paying for it themselves). A lot of emerging technology still has not demonstrated the unequivocal ROI case to payors (thereby oftentimes necessitating some way of gaining market traction and evidence of efficacy without them).
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The U.S. healthcare system is a machine that was designed to make money, not improve patient outcomes.
The American healthcare system needs a reform. At the heart of this, is the issue �that patient-doctor interactions are tainted by a profit motive instead of the patient’s best interest and care - sometimes called “the medical industry complex.” This collection of entities: the federal government, Medicare, Medicaid, hospitals, doctors, drug and device makers, and insurance companies are all competing and are beholden to each other, instead of to patients.
Any new entrants trying to innovate in this space will have to navigate �the complexity of competing interests and the existing stakeholders of the healthcare system. One emerging area that could change this dynamic is the decade-long movement of value-based care, which ties the amount health care providers earn to the results of the care they deliver to patients, and could correct the misaligned incentives of the U.S. fee-for-service system. There is reason to be hopeful; value-based care investment has quadrupled during the pandemic.
HEADWIND
Healthcare
4—TRENDS IN CARE
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