Kramer: Covid-19’s ‘Creative Destruction’ of Senior Living Requires New Tech-Driven Models

The ongoing Covid-19 pandemic is dismantling a long-held notion among some senior living providers that health care is not their domain.

That doesn’t mean senior living providers need to abandon hospitality-driven models altogether. But it does likely mean they need to rethink how they coordinate care within their communities, according to Nexus Insights Founder and National Investment Center for Seniors Housing & Care (NIC) Co-Founder Bob Kramer.

“[The pandemic is causing] what you might call the creative destruction of some of what has been the paradigm to senior housing and care,” Kramer said during a panel at the 2020 Collaborative Care HIT Summit Thursday. “The senior housing and care model that we don’t do health care, and that we ship out our residents for health care services, I just don’t think that model will survive.”


In just the past six months, older adults have learned to fear the hospital, the emergency room and the doctor’s office, as these are places now associated with a deadly pandemic, Kramer explained. But at the same time, many have also felt the effects of social isolation like perhaps never before. This creates opportunities for senior living providers to fill the gap by coordinating health care services within their communities, while providing the social programming and engagement that senior living is known for.

This doesn’t mean senior living providers must provide health care services themselves, as they can forge partnerships with other health care providers. But it does mean that providers will have to more actively manage the chronic and underlying health conditions of their residents in the future.

“The health and safety of your residents and staff is what you’re going to be judged on,” Kramer said. “And if they’re failing, in a pandemic or in a flu season, you’re going to be judged and held accountable for that.”


Through certain technologies, such as telehealth, artificial intelligence and remote monitoring, senior living providers have an opportunity to achieve that, and to “triage on site” to determine whether a resident really needs to leave the community.

One big question is how payers will help drive that trend. But that’s not to say payers aren’t trying to solve that problem, too, according to Andy McMahon, vice president of health and human services policy at UnitedHealthcare Community & State.

“From where we sit, there’s an enormous opportunity, if we can deploy a remote care management system in a much broader way, that we could dramatically expand the access and reach that we have for our members,” McMahon said during the panel.

During the pandemic, UnitedHealthcare has noted telehealth “skyrocketing” with a 20-fold increase in usage among its long-term care population earlier this year before leveling off.

One challenge to using technology to coordinate care is the data itself. Care providers, including those in senior living, have learned much more about data collection in recent years — but that doesn’t mean the data is always useful outside the places where it’s collected, according to Susheel Ladwa, CEO of healthcare technology firm Onyx.

“Health care does not have a data problem, it really has an interoperability problem,” Ladwa said. “The silos of data were created because of regulations that mandated that providers implement [electronic medical records].”

But Ladwa believes there is a policy change coming down the pike that could help overhaul how data is shared from one health care provider to another. The Interoperability and Patient Access final rule from the Centers for Medicare & Medicaid Services (CMS) will require all health plans to make their data available as an application programming interface by July 1, 2021. This, in turn, will give developers access to more general health care data, and therefore help solve the interoperability problem as they work on new technology products.

“This particular mandate, I think, is driving big change,” Ladwa explained. “I see this as a Tesla moment for health care: It is essentially going from gasoline to electric.”

Moderator Majd Alwan, senior vice president of technology and business strategy, and executive director of the LeadingAge Center for Aging Services Technologies, offered his own view of the trend. He believes that health care and aging services were data-poor prior to electronic health records and documentation. Then, with the advent of electronic records, they became data-rich — but it was too overwhelming to digest. Now, the industry is entering a third phase, where it can potentially solve for interoperability.

“It’s a must to have the right visualization tools, data analytic tools, predictive modeling, AI, machine learning and deep learning to turn the data into knowledge,” Alwan said. “And then layer the experience of the providers and the payers and the professionals right on top.”

What that might look like in the future is unclear. But Kramer used the example of recent pilots where Meals on Wheels volunteers enter a senior’s home and observe their surroundings for signs that more assistance is needed, such as moldy food in the refrigerator or a house in disarray. Normally, these observations might just stay with that volunteer and whoever they report to. But if there was a way to record, share and analyze these observations using technology, that could prove a powerful tool in keeping older adults well.

“The challenge is making sure they have the means to upload their observations that are then screened by an algorithm searching for red flags, and are instantly shared with those responsible for the delivery and care for that individual,” Kramer told SHN in an email exchange.

In another example, senior living residents may choose to voluntarily share some health data with their doctors remotely. And in fact, this may be what the baby boomers ultimately want as they age, he said during Thursday’s panel.

“I do think that this is the role of tech, in enabling boomers to self-direct and self-manage their own health and their own lifestyle, and to get constant feedback,” he said. “This is a planner’s dream. We know all people aren’t planners, but I think this is going to nudge boomers much more in that direction.”

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