Technology assist: the LTC market's cutting-edge demand.

It is no secret that our nation's aging population is experiencing unprecedented growth as the baby boomers approach retirement. In less than 50 years the number of elderly will double. Just as the baby boomers have transformed every facet of life--from the growth of suburbia to the role of information and technology in day-to-day activities--it's a safe bet that they will continue to create waves of change in the way we retire, spend leisure time and, importantly, in the way we age and support aging.

As the boomers retire, the nation's social and healthcare support systems will feel increasing strain that will be relieved only when new products and technologies emerge from the collaborative efforts of government, industry, community-based aging service providers, and academia. As empowered consumers, the boomers will seek out alternatives to "get the job done," and those alternatives will surely include new and innovative uses for technology.

The Center for Aging Services Technologies (CAST) is a nonprofit program established in 2003 through the aegis of the American Association of Homes and Services for the Aging. CAST's mission is to help unleash the potential of technology for innovative development that will reduce our nation's escalating healthcare costs. CAST uniquely blends providers of aging services, academic researchers, and industry representatives--all interested in advancing the role of technology as one way to address critical issues in eldercare.

CAST believes that we are fast approaching a tipping point in the development of home-based, consumer-centric healthcare technologies that will transform healthcare and social services delivery. The iPod's rapid growth and acceptance is one example of an older technology transformed and repackaged into a highly successful and easy-to-use consumer product with a robust support infrastructure. Similarly, CAST believes that once consumers accept the idea that healthcare services can be delivered in innovative and cost-effective ways, we will see many iPod-like success stories emerging to fill the inevitable demand of a very large market.

This is the market with which long-term care providers will be dealing. In fact, it already is, as boomers' parents enter CCRCs, assisted living facilities, and nursing homes. Success in meeting new marketplace demands will determine the survival of many long-term care organizations. Because baby boomers, as tomorrow's seniors, will be the early adopters of new technologies and products, CAST wanted to hear their interests and opinions.

CAST commissioned a comprehensive literature review that only partially answered our questions, so we decided to launch a nationwide focus group effort, led by aging-services providers, to explore such questions as: How willing are boomers and "border retirees" (those nearing retirement) to use technology as aids in caring for their aged loved ones? Do boomers see a role for technology to help manage their own health and wellness? How can CAST and, in general, the long-term care marketplace help tap into the potential of technologic solutions?

To provide the broadest possible national results, CAST recruited border retirees from five cities in different geographic regions: Minneapolis, Dallas, Jacksonville, Seattle, and Hartford, Connecticut. We conducted ten focus groups with a total of 80 participants over a 19-day period during March 2005. Respondents were between 50 and 65 years old, with current experiences in assisting an older family member or other elder at home, and as users of one form of technology, typically a cell phone or personal computer. All participants completed a brief questionnaire to help us better understand their backgrounds and experiences. Questions focused on demographic information, current caregiving experiences (for example, offering elders help with paying bills or grocery shopping), and technology experiences (for example, using e-mail).

The session moderators explored the boomers' views of:

* their concerns about aging;

* as caregivers, what they see as the problem areas of aging;

* how they plan to maintain their health as they age, and what they view as the long-term benefits from doing so; and

* their willingness to share in the cost for new and innovative home-based technologies.

The moderators introduced a short video story depicting one family's use of technology to support an elderly relative. Some of these technologies focused on home safety by monitoring movement to detect falls, some provided reminders to take medication and to help avoid medication mishaps, other technologies provided tools to assist with activities of daily living, and some helped to combat isolation and improve quality of life. This vision-of-the-future video stimulated group discussion, creative thinking, and speculation about various in-home technologies that could ease current and future caregiving responsibilities. Three major concerns emerged from the groups:

1. How and where to get information to be successful as a caregiver. The lack of preplanning for this type of event, often without prior experiences to draw upon, causes adult children to find themselves in the middle of their own crisis. Because many of the border retirees are currently employed and may be raising their own families, adding this additional responsibility puts tremendous stress on the adult child and the family. Participants shared their experiences of the elder parent trying to hide his or her current condition to avoid worrying the adult child, who has now become the caregiver. This is compounded by the elder's fear of interfacing with technology and becoming frustrated, which is a regular occurrence with these families. How do the boomers best cope?

* Many simply did not know where to find information and resources they felt they needed to care for their aging parents. Until they viewed the vision video, they could not comprehend the technologic solutions that are or would soon be available to assist them or their parents.

* Participants described a driving desire to be empowered in managing their personal health, as well as managing the health of their loved ones.

* Another concern was learning how to find transportation solutions to help their elder parents maintain social connections, and finding ways to connect (and stay connected) with their elder parents to ensure they are safe and well. Many families are geographically dispersed, which creates an unmet need to understand the status of their loved one's health and safety on a real-time basis. Families are attempting to bridge the distance gap with today's technologies, such as the phone or e-mail, but both sides find that these methods aren't always sufficient.

2. What the boomers want from technology. Once the group saw the vision-of-the-future video, they understood how technology could be integrated to effectively address their most pressing needs. The excitement level in the room was palpable after they viewed the technologic possibilities, which led to a very animated discussion around what boomers want from technology, i.e., ways to reduce the stress and burden of caring for aging loved ones.

* Many participants discussed their expectation that technology would be available to solve many of the problems they face today when they have the need for assistance in their aging process.

* Another popular request was for solutions that would compensate for the geographic distance between boomers and their loved ones.

* Boomers were looking for a menu-type approach, allowing some customization by being able to pick and choose features that are most relevant to a specific condition or situation.

* Getting a handle on medication management and managing doctor's visits were also mentioned. Telehealth technologies were seen as a preventive tool for those who know that a certain disease state preexists within the family.

* Almost everyone expressed an interest in having a portable, accessible medical record. They thought it was very important to have personal control over access to this, but wanted it to be available to them when needed.

3. Boomers are willing to pay for technologic solutions when they perceive value. Many participants mentioned their desire to not burden their own children with the types of experiences they were going through with their own parent. This was a strong motivator for many participants to take action and investigate or purchase potential solutions.

* Many participants asked when they could purchase the solutions they saw in the vision video.

* Income level did not seem to be the determining factor for willingness to pay.

* Border retirees, who were most willing to pay for a technology, were those who reported spending more than two hours per day caring for their loved ones. They appeared almost desperate to find solutions to assist in the care of their loved ones.

* Lower-income participants talked about their willingness to "pay a lot" for a technologic solution that could minimize their time spent on eldercare. These participants were the ones who could least afford to miss time from work to care for an elder relative. Most importantly, these participants were looking for solutions that would deliver peace of mind and real-time information about their loved ones' current condition.

* More than 50% of the participants were willing to pay more than $100 per month for some combination of the solutions depicted in the video. There was frequent comparison to the inevitability of phone bills and Internet or cable bills during the payment discussion.

* All of the participants saw great value in paying for a flexible service that allowed them to choose the elements that were of most importance or need to them. The basic theme we heard was the willingness to pay for security and peace of mind.

Implications

The results of our review of existing literature of the technologic needs of seniors and of our focus group research have far-reaching implications for a variety of entities that affect the future of aging, from the perspective of both the senior and the caregiver.

1. Collaboration is essential--no one can do this alone. Often reported in the past was the basic fear that "too much technology can be a bad thing." It is a bad thing if it is helpful but not equitably available to all, is cost-prohibitive for those in most need, or does not serve its purpose or complete the job promised. Technophobia is alive and well when it comes to the idea that developments in technology might increase efficiency but at the same time replace the human connection of healthcare. With regards to the possibilities of technology improving health and quality of life, however, perhaps even the technophobes can be persuaded to embrace it. Commitment and vision need to encompass all levels--from government to academia to corporate America, as well as physicians, health systems, and community-based aging-services providers (e.g., the assisted living, skilled nursing, home care, and independent senior housing environments that will inevitably interface with these boomers).

2. The market of potential consumers is very large. There is a tremendous potential market for technologies to help caregivers and seniors as they age in place, as well as a well spring of public-policy recommendations aimed at ensuring that innovations reach consumers in need. Our findings imply, however, that today's technology is not far-reaching, accessible, prudent, or solution-focused enough to meet the needs of today's and tomorrow's diverse seniors. Much more is needed, and much more can and will be provided.

3. Technology will transform the way healthcare is delivered. Current long-term care facilities will not disappear, and there will never be enough facilities, staff, or dollars to provide this level of care to the numbers of aging adults we anticipate. Current aging-services providers, with their knowledge base and skill sets, have an excellent opportunity to lead in providing new care options through technology. New partnerships between technology companies and aging-services providers offer an opportunity to derive more successful and beneficial results from technologic applications. Care facilities will become excellent test sites and possible early adopters of these technologies.

Conclusion

Visions such as these do not need to remain dreams. They can translate into reality as increased portability of client information, more effective distance caregiving, improved accountability of monitoring systems and devices, more opportunities to age in place, and decreased demands for long-term care placement. According to our research results, consumers are light-years ahead of the professionals. They are willing to share in the cost for such advancements. They are hungry for and eagerly awaiting the ability to use the technologies designed to support their caregiving.

From the CAST Needs Research Task Group: Helen Higgins (cochair) is Business Development Manager for Hewlett-Packard Co., Corvallis, Oregon; Kari Miner-Olson (cochair) is Chief Information Officer for Front Porch, Burbank, California; Leo Asen is Administrative Director of Housing and Senior Centers for Selfhelp Community Services, New York City; Sandra Elliott is Director of Aging & Senior Services Development, Meridian Health Systems, Neptune, New Jersey; Judy Girouard is Vice-President of Clinical Program Development, Hebrew Senior Life, Boston; and Jeanne Mattern, PhD, LSW, CCRP, is Senior Research Associate for Menorah Park for Senior Living/Myers Research Institute, Beachwood, Ohio. For further information about CAST and its initiatives, visit www.agingtech.org. To send your comments to the authors and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].

Helen Higgins, Kari Miner-Olson, Leo Asen, Sandra Elliott, Judy Girouard, and Jeanne Mattern, PhD, LSW, CCRP, provide a special report from a Center for Aging Services Technologies study of multicity focus groups.