The Business of Informal Caring
Big ideas are little ideas that no one killed too soon.~ Seth Godin
Aging in Place
I’ve got an idea…
For years I’ve been using the acronym TNT, which stands for TRENDS, NEEDS, TECHNOLOGY. I once heard it on a Nightingale Conant tape quoted from some very successful entrepreneur. I forgot his name but, the concept has never left me. I’d like to employ it as scaffolding for a business idea that could very well be an unfair competitive advantage for companies thriving (not just surviving) during these times of megatrends and accelerated change. Let’s unpack this…The more beautiful question is this, Where’s the TREND, Where’s the NEED, and Where’s TECHNOLOGY headed?
TREND
The Demographic Transition
In 2020, there are an estimated 727 million persons aged 65 years or over worldwide. This number is projected to more than double by 2050, reaching over 1.5 billion persons. The share of older persons in the global population is expected to increase from 9.3 percent in 2020 to 16.0 percent in 2050(source: World Population Ageing 2020 Highlights – the United Nations). Further, the number of Americans ages 65 and older will more than double over the next 40 years, reaching 80 million in 2040. The number of adults ages 85 and older, the group most often needing help with basic personal care, will nearly quadruple between 2000 and 2040 (source: urban.org).
The key point in the statistics is the bold line forecasting the 85 and older(“oldest-old”) group quadrupling between 2000 and 2040. We know that only 4.5 percent (about 1.5 million) of older adults live in nursing homes and 2 percent (1 million) in assisted living facilities. Most older adults (93.5 percent, or 33.4 million) live in the community (source: ncbi.nlm.nih.gov). This essentially means living in a community and aging in place will require labor and resource-intensive care for a growing number of older adults. They require the most “informal care” and we are now smack dab in the middle of those years. This brings us to the next element of the TNT model.
NEED
What is “Informal Care?”
“Informal” caregivers, also called family caregivers, are people who give care to family or friends usually without payment. A caregiver gives care, generally in the home environment, for an aging parent, spouse, another relative, or unrelated person, or for an ill, or disabled person (source: hopkinsmedicine.org).
Informal Care Giver Profile
Caregiver.org reports the average age of an informal caregiver is 49.2 years old. 48% of caregivers are 18-49 years old. Upwards of 75% of all caregivers are female and may spend as much as 50% more time providing care than males (Institute on Aging. (2016). Read How IOA Views Aging in America). According to the National Alliance for Caregiving and AARP, in 2015 approximately 43.5 million caregivers have provided unpaid care to an adult or child while about 34.2 million Americans have provided unpaid care to an adult age 50 or older. The value of services provided by informal caregivers is more than $470 billion annually – almost as much as Walmart makes in a year (source: simplefill.com)
The 2020 update reveals an increase in the number of family caregivers in the United States of 9.5 million from 2015 to 2020. Family caregivers now encompass more than one in five Americans. The study also reveals that family caregivers are in worse health compared to five years ago (source: caregiving.org)
The economic effects of family caregiving can result in financial strain with substantial financial consequences. One in 5 caregivers reports high financial strain as a result of caregiving (18 percent). Four in 10 have experienced at least one financial impact as a result of their caregiving (45 percent). Most commonly, 3 in 10 have stopped saving (28 percent) and 1 in 4 have taken on more debt (23 percent), both of which could have longer-term repercussions on caregivers’ financial security into the future, especially if the caregiving situation lasts a long time. Caregivers of adults find themselves providing care for 4.5 years, on average, and an increasing proportion have been providing care for 5 years or longer (29 percent, up from 24 percent in 2015). In fact, caregivers’ savings are eroding, with 22 percent who used up personal short-term savings and 12 percent who used up long-term savings (for things like retirement or education).Two in 10 have left bills unpaid or paid them late (19 percent), while another 15 percent borrowed money from family or friends. One in 10 have been unable to afford basic expenses like food (11 percent). Six in 10 caregivers report working while caregiving (61 percent) and the majority have experienced at least one work-related impact (61 percent).
As in 2015, most working caregivers report going in late, leaving early, or taking time off to accommodate care (53 percent). One in 10 working caregivers have had to give up work entirely or retire early (10 percent). When this happens, caregivers more often face financial impacts (2.9 on average) and are twice as likely to report high financial strain (35 percent). Employers appear to be taking note of the challenges facing caregivers in the workforce. Caregivers more often report having workplace benefits such as paid family leave (39 percent, up from 32 percent) and paid sick days (58 percent, up from 52 percent) than in 2015, likely an effect of a greater number of large employers and state and local governments taking action on paid leave. Despite this progress, most caregivers (61 percent) still report having no paid family leave at their workplace.
~ 2020 Report Caregiving in the U.S. aarp.org
KEY POINT #1: The estimated economic value of the services provided by informal caregivers in the United States has grown rapidly from $50 billion in 2009 to $470 billion in 2017. These caregivers not only give their time to caring for loved ones but often face financial repercussions, due to out-of-pocket costs, as well as reduced income and retirement savings (source: weforum.org)
KEY POINT #2: According to a 2018 AARP report, an estimated 10 million millennials care for an aging loved one – about one in four family caregivers.
KEY POINT #3: For unpaid caregivers, burnout comes from the combination of performing physically and mentally exhausting work, coordinating care and medications, managing their own jobs and families, and navigating the bureaucracies of care and finance. Compassion fatigue and secondary traumatic stress, with symptoms ranging from depression to insomnia to substance abuse, are widespread and largely undiagnosed. Just as with so many parents who operate without societal support, life becomes a matter of sheer endurance. But at some point, as care needs become even more acute, no amount of endurance or will or grit can make the situation tenable. There are no solutions and no real relief, other than eventual death, shaded with the peculiar mix of relief and regret. “Watching people you love suffering is debilitating, but you have to keep going,” Laura said. “That’s just another thing you tamp down. You have to stuff away anything you’re feeling because there isn’t time for that. You have too much to do” (source: The staggering, exhausting, invisible costs of caring for America’s elderly, by Anne Helen Petersen).
BOTTOM LINE: As millions “age in place,” millions more must figure out how to provide their loved ones with increasingly complex care.
TECHNOLOGY
We anticipate a growing appetite for solutions that enable older adults to age in place. The US home care market is expected to grow from $100B in 2016 to $225B by 2024. The trend is driven by Baby Boomers, who overwhelmingly prefer to age in place. But, while 77% of people aged 55 and older want to age in place, only 50% think they will. As investors, we see a unique opportunity for technology to close the gap. As COVID-19 has surfaced new fears associated with long-term care facilities, the desire for aging in place has accelerated. Long-term care facilities, which are often underfunded and understaffed, are finding themselves under increased scrutiny. Families have grown fearful and, as a result, senior housing occupancy has hit a 15-year low. In addition, COVID-19 has accelerated technology adoption, as telemedicine services among seniors increased 300% during the pandemic. More healthcare visits are happening virtually and–particularly for older adults–the trend is anticipated to persist. We anticipate COVID has dramatically increased older adults’ comfort with technology–a shift that will accelerate their adoption of digital health tools (source: rockhealth.com).
Source: homehealthcarenews.com
Aging in place – which includes daily essential activities, health and safety awareness, care coordination, transition support, and home-based care – is a $151 billion market. That’s according to a new report from The Holding Co. and Pivotal Ventures. “The [market growth] is driven from older adults themselves,” Jocelyn Ling Malan, business design partner at The Holding Co., told Home Health Care News. “The use of technology is important because it really unlocks a whole new wave of types of products and services that you can use to reach older adults,” she said. “I think a really huge myth is that older adults don’t know how to use technology at all – and that is a myth that we are trying to debunk.” Source: homehealthcarenews.com article by Joyce Famakinwa (subscribe to their service for more valuable content and writing like this, I depend on it).
KEY POINT: A recent AARP study found that older adults are adopting technology more than ever before. Internet, smartphones, tablet, wearables, and even smart TVs and speakers, are being used by an increasingly growing number of older adults. … According to estimates, the Age Tech market is expected to reach $2 trillion (source: thegerontechnologist.com)
Summary, so Far
The excellent resources cited above can be summarized in a few bullet points.
- The population is getting older
- They desire for aging in place
- Someone will have to do the heavy lifting to make this happen
- That someone will be predominately women in the workforce (boomers, GenXers, and Millennials)
- Technology helps but it is not the total solution, it’s complimentary to hands-on
- This will come (already has) at a great cost to “Informal Caregivers” AND THE COMPANIES/BUSINESS that employ them
We have solid evidence that large U.S. companies are getting into the aging in place/homecare business. Best Buy, Amazon, and even Walmart are focused on the TNT model. In the article, ‘We Want to Support People Being in Their Home’: Walmart, Amazon Outline Health Care Strategies‘ by Andrew Donlan | August 30, 2021, the author, quotes a Walmart executive from MATTER’s recent “Healthcare 2040: Changing Care Delivery Models” virtual event, “We want to support people being in their home and aging in place,” Walmart Health Senior Vice President Marcus Osborne said during the event. “We also want to address social isolation and … how technology is playing a role there.” According to the piece, Amazon is also deeply invested.
Wonderful, market forces are certainly at work here and the opportunities are TITANIC. I’m encouraged the Walmart Health Senior VP is supporting aging in place as a market ripe for innovation and solutions–it’s about time. However, are they considering who will be doing the heavy lifting? Or how that might affect their bottom line? Given all that I’ve laid out in the TNT model, the TREND is here, the TECHNOLOGY is evolving rapidly, and building a better-mouse-trap market force is working as it should…What concerns me is the NEED aspect of the Informal Caregiver-Worker. According to a recent article on healthaffairs.org, there are work related opportunity costs.
KEY POINT: According to benefitspro.com, indirect caregiving costs to employers can add up to $10,098 per employee.
Here’s where I’ve got an idea…
The RAND Corporation reported in 2014 that the Cost of Informal Caregiving for the U.S. Elderly Is $522 Billion Annually, it has only gone up since. Wouldn’t it make sense for the private sector to stop the hemorrhaging and come up with some win-win solutions? Informal caregiving raises the odds workers will stop working (COVID proved that to be true), reduce hours, change jobs, or accept lower-paying jobs. One study cited women ages 51-70 work 3-10 hours less a week while caregiving and another found women ages 57-67 lost 174 hours annually when caring for parents. These are all detrimental to businesses large and small. Not to mention mental and physical health issues related to the stressors of informal caregiving and what that does to workplace culture.
One of my favorite sayings is “Poke any saint deep enough and you’ll find self-interest.” Why not have businesses offer “perks” through HR departments like other benefits offered that address the challenges that their employees are no doubt experiencing?
Suggestions
Have on staff as a part of Human Resources the following geriatric specialists and resources:
2). Occupational Therapy CAPS certified Home Inspector
4). Senior Real estate Specialists
5). Resource List
6). Employee discounts for *aging in place Technology Products (ie Best Buy)
7). Offer Support groups for employees who are informal caregivers to network
8). Flex time schedules and work from home
9). Eldercare Referral Services / Contract with companies like Homeinstead.com
*OR DEVELOP THE AGING IN PLACE TECHNOLOGY THAT WILL DO ALL OF THE ABOVE AND SELL THE PACKAGE TO COMPANIES AS AN EMPLOYEE BENEFIT. This is a huge opportunity to do well while doing good.
Make these an integral part of your company/business culture. The time, energy, and human suffering saved by having guides available could be beneficial in very tangible ways!
PROS
Increased Productivity from workers (PEACE OF MIND/POM factor, )
Decreased Downtime/Sick time
Pro-Aging Work Culture
Female Supportive Workplace
Unfair Competitive Advantage
Employee Retention (Stay for the Perks)
Right Employee (Caregivers are responsible)
Be Viewed as a Progressive Company to Work for
Healthy Bottom line
This is a BIG Idea…Don’t Kill it.
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