Joseph Coughlin is the Director of the Massachusetts Institute of Technology AgeLab. He conducts research on the impact of global demographic change and technology trends on consumer behavior and business strategy, advising businesses in financial services, health care, leisure and travel, luxury goods, real estate, retail, technology and transportation.
Through the Vision Series, he shares an outlook for a health system that meets the patient or resident where they are and delivers both quality care and a quality experience. He talks about the challenges facing senior housing in meeting the needs of the modern-day consumer, and he explains what operators and providers can do to overcome these challenges. He also discusses how the work of MIT’s AgeLab plays into his vision for the health care system of tomorrow.
Describe your vision for a health care system truly equipped to serve the aging population in America.
Changes in the industry itself are happening in silos, but what’s pushing it all together is the seamless vision driven by consumers. They want a health system that provides choice, quality and experience — many of the same attributes [they look for] in consumer products and other consumer experiences. Senior housing and health care, in general, has hidden behind the story that we are different, that we are complex, that we offer care, that we are serving a critical need.
They are correct [assertions], they’re just incomplete. The consumer today is better educated and better equipped with information, and they are simply demanding more. They’re looking for some of the attributes that you would expect in other industries. They’re looking for ease of use and transparency of information. They don’t just want care, but convenience; they don’t just want connection, but community.
That’s driving senior housing in general to a new space. Some will succeed, many will not. But frankly, the new generation gap is about expectations. The older adult today is expecting far, far more than the older adult consumer yesterday.
If you could change one thing about the current experience most aging Americans face, what would it be?
Many of the questions and the services that we end up needing in old age are predictable; they are foreseeable. We need to take a new look at how we plan for our longevity. That means identifying service providers and brands even before we need them, so that we vet them while we’re still healthy and capable.
There needs to be a whole new profession of people who can navigate and sort through information to help us make smart choices … I’m talking about real advocates — people who get to know you personally. Indeed in health care, much like anywhere else, personal should be the new premium, not simply giving me a list of things that I can find on the web.
What do you see as some of the biggest opportunities for senior housing and care providers today?
They’re missing the power of technology big time. One application offered by a small company that can neither scale nor maintain systems will not cut it.
Senior housing and health in general needs to rethink where they serve the client. Right now, senior housing in particular believes that its value proposition is location-based. Anybody who wants to excite and delight the consumer should serve the consumer wherever they are. That might mean using technology to find ways to build pipelines into people’s homes, where people want to live. The whole hospital-at-home movement being pushed by insurance and many health care providers is an opportunity for all of them, but also an opportunity for senior housing.
Their brand should not stop at the property line. Their brand should extend into my home through technology, service providers and people I trust to go into the homes of people that I am caring for. If this change is not just about technology but the notion of service innovation, they are not going to do it all by themselves. They should now start thinking about partnerships — partnerships with other companies in the technology space that will help with home maintenance, transportation, food delivery and nutrition.
The idea here is to use technology to build the pipeline, wherever the client or customer may be, and to build partnerships that create an ecosystem delivering both quality care and quality experience.
What is the biggest hurdle to achieving your vision for a better system?
There are a handful. One of them is that it’s an entirely new story and an entirely new area evolving in real-time. It’s very difficult for any industry, not just senior housing, to realize that they may need to start doing something differently.
The second thing is the matter of capital. It’s going to require investment at a time when we’re recovering from the pandemic, and it’s making it difficult to allocate capital in innovative ways, let alone while trying to play catch up.
The third one is that the health industry, like senior housing, is also real estate-based. It’s about providing services at my hospital or providing care in residential services on my property or in my community. They need to think broader. They need to think about the consumer’s experience with every other part of their life and technology. That’s what [consumers] are expecting in health and in housing as well.
Do you see movement in the right direction with some of the new payment models, or do you think it’s going to take some bigger changes to get the capital to innovate?
We’re starting to see some innovations. For instance, I’m fond of a number of health care providers pushing hospital-at-home, providing better outcomes and happier wellbeing for patients.
In senior housing, we’re starting to see some real innovation in communities. They are no longer a happy place just because everyone of a similar age is together, they are a happy place because everyone of a similar age has a similar interest.
We’re starting to see communities like Enso Village by Kendal Corp. in California, around Zen living or a Zen community. We’re seeing 2Life Communities here in the Massachusetts area building affordable housing for people who want to be community organizers and politically active. We’re seeing true communities, which are not just people of a certain age, but more importantly, people of a certain interest.
Who do you think should oversee improving continuity of care?
At one end of the ecosystem, you might see services being brought to your home simply because it’s convenient. I don’t want to have to go food shopping, worry about my nutrition or deal with my transportation.
Then somewhere in between, it’s about being connected to the providers who are specialists in my health care — maybe a nutritionist or a cardiovascular care specialist. But ultimately, that same ecosystem will be at the very end of the service, which is providing care onsite. The transition is not a transition. Once you’re in the system, you’re in the system all the way. The example I’ll use is Apple. Once you’re in the Apple ecosystem, you’re there for good.
It’s scary because right now, it is very fragmented. We go from mom-and-pop shops to something perhaps larger, but in many ways, it’s because [the smaller providers] don’t have scale, they don’t have the reach, and don’t go from home to hospital and to care services seamlessly. They’re having a difficult time not just meeting the client or the customers’ needs, but more importantly to be truly innovative, which is about surprising and delighting and exciting. Because they don’t have scale, they’re having a difficult time doing that.
Do you think that insurance companies logically might be the ones to play that Apple role in the future for older adult health care?
I wouldn’t count them out. They certainly have the capital and IT infrastructure to do so, but they don’t necessarily have the knowledge of how to provide care service the way the boots on the ground people do.
I would argue that frankly, the way the ecosystem will emerge will not be one singular brand, but perhaps one brand that acts as your navigator and integrator of many other service providers together.
You can imagine several different companies but you trust that one integrator to be able to put it together for you, and right now that person does exist. We already know who she is. It’s what the caregiver does every single day. She’s the one who integrates and finds the provider for transportation, the doctor, the nutrition, the housing and everything else. What we need now is a company that has the capital, the IT, and cares to do the job the adult daughters and spouses have been doing for decades.
Talk a little bit about the work you’re currently doing at AgeLab.
We have one of the largest global panel studies on caregiving. We are recruiting caregivers from around the world to understand those micro-moments and tasks they do every day to provide care for loved ones — from health care to finance, to transportation, to housing, and the like. That project is called CareHive, and we’re working with many companies around the world on that.
We’re also working on something called C3 Home Logistics. I want you to imagine your home becoming a platform for the services we were just talking about. That the technology in your home not only facilitates the delivery of food and telemedicine and the like, but also begins to anticipate your needs.
If your walk or your gait has changed, it proactively notifies someone that a fall is likely to happen. Whether you have fallen and you can’t get up or your refrigerator is out of certain foods, the responses are automated. Maybe your home senses your mood and your well-being and helps you make a connection with either family or friends.
We have a vision for the home of the future going through five different stages, which will be about technology, partnership and service.
What are some words of advice for older adults and their families struggling to navigate the current system of senior housing and health care?
Start early. Sadly, most of us — and my family is included — don’t begin thinking of possibilities until someone falls and has an injury, or has a health event on Thursday, and by Monday morning, they need to move into a new site. These decisions are made in panic without time to do due diligence. As we are pushed every day to do our retirement planning, we should also be pushed to do our longevity planning.
Asking questions like, “How would I get around if I can no longer drive? Where would I live? Or what would be the characteristics of where I might live if I can no longer be in my home?” Having these conversations, not just on a financial level, not just on a consumer level, but with our family members and especially our adult children is critical. That way they understand our values so they can make the decision should they have to.
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