How One Technology Startup is Driving Improvements in Outcomes for Dementia Patients

Imagine a little dog appearing on the screen of a small tablet computer talking to an elderly lady about her grandchildren. Sounds like some sort of science fiction movie? Well, in fact, it is a new elder care remote assistance service offered by tech startup GeriJoy, which offers a team of expertly-trained, 24x7 caregivers via a special tablet app, all for about the cost of a Starbucks coffee every day.

All this month, we are looking at how technologies and clever innovations are changing elder care. In this post, we spotlight one particular technology that has a huge potential impact on the way that elder care is currently performed.

GeriJoy is the result of an insight that Victor Wang, a MIT grad, had while considering the condition of his aging grandmother, who lived alone back in his birth country of Taiwan. Her children and grandchildren lived far away. Wang could see the effects of the social isolation on her mood and overall mental health. Eventually, Wang’s mother left her job to return home to Taiwan to be with his grandmother, even though she could still care for herself at that point.

Wang decided to apply his graduate studies in human-machine interaction and 3D rendering to build a solution. He saw an opportunity to create a new type of business with a social purpose. Wang’s vision included addressing the coming crisis in elder care due the shortage of trained caregivers. Currently, 5 million Americans have Alzheimer’s, requiring 16 million people to care for them.

Dementia is stressful for both caregiver and elder. Life’s little changes can be a difficult and confusing moment for a senior who is facing short term memory challenges. Even the end of a shift for one home caregiver can confuse the elder who might not be able to understand.

Meanwhile, on January 1, 2015, the US Labor Department will change the worker protection rules requiring the home care industry to pay minimum wage and overtime when a caregiver’s hours extend beyond 40 in a given week. Home care agencies are responding with a higher number of shift changes rather than pay overtime. Wang’s GeriJoy works with these home care agencies helping them to smooth the increased number of caregiver shift transitions.

However, the benefits that have been shown for the elder are not limited to just better caregiver shift changes. Because GeriJoy uses real people to interact with the elders through the animated application, it avoids the current limitations associated with artificial intelligence. Wang knew that the solution had to offer a meaningful human connection. Only another human could do this emotionally sensitive job for seniors.

At first the idea of a virtual 3D pet on a tablet computer appeared to be an unlikely solution. However, unlikely solutions are sometimes the best. For the elder, recent research has shown the importance of pets in their lives. For various reasons, though, a real pet can be problematic in a care environment or at an elder’s home. Allergies, regular walks, and litter boxes pose challenges for an elder, while a pet cannot provide the type and quality of intellectual and emotional support that helps to stimulate a senior’s mind.

Wang was surprised at just how effective his solution turned out to be. GeriJoy offers elders an increased sense of autonomy. Elders who may refuse care from a stranger because of pride could be more open to GeriJoy’s digital presence.

Some might have concerns about the possibility of this type of technology for reducing the time we spend with seniors. However, Wang explains that GeriJoy is not able to replace the physical elements of care giving. Instead, GeriJoy offers a much needed supplement to physical interaction. Often, the GeriJoy service has helped to slow the mental decline of the elder, while helping to assist the human caregiver with hydration, food, and medication reminders for the elder.

As we look five years ahead in the elder care market, products like GeriJoy will have an increasingly important role to play. Current trends towards more elders aging in place and the average age of residents in assisted living continuing to rise, there will be an increasing need to facilitate their care. Technologies like GeriJoy are part of the coming set of solutions towards improving both the quality and reducing the cost of long term care.


For more on how technologies can help with elder care, see this page.

Future of Home Care: Technology for Aging in Place

Normally our organization does not focus on the future. The vast majority of families we help have immediate challenges with, or questions about, the financial side of aging care. They want solutions and answers that are relevant and available right now to address their pressing needs. In this post, we depart a little from a focus on the here and now and peer five years into the future. What will non-medical, home care look like? What elder care services will be available? What aging

The Honda Walking Assist Device

technologies will exist?

What Will Change in Home Elder Care?

One can think of non-medical home care that allows individuals to age-in-place as serving three distinct needs.

1. Monitoring and Supervision: prevents self-injury, wandering and ensures medication regiments are followed.
2. Physical Assistance: help with the activities of daily living such as transferring, mobility, eating and personal hygiene.
3. Companionship: social interactions, conversation and observance of mood.

Technologies will provide change in all three areas but to varying degrees.

The area of monitoring and supervision will be most dramatically affected by new technology. In this area, the need for human assistance in the home will all but be eliminated. Wearable GPS devices will track location and alert responsible parties immediately when required. Web-enabled medication management system will do the same, track consumption and alert individuals when deviation has occurred. A whole new suite of personal data and actions will be monitoring and reported. These will include blood pressure, temperature, weight, movement within the home, falls, bathroom usage and even the opening and closing of cabinets, refrigerators and oven doors. As human based monitoring in the home will decrease, there will be an increased need for remote human monitoring of all the new data that is generated, as well as for immediate, non-emergency, on-call assistance.

The need for physical assistance in the home will also diminish as a result of new technology by not nearly at the pace or magnitude of monitoring. The past ten years have seen a slow but steady increase in equipment and devices that aid elderly individuals in maintaining their independence, think of walk-in tubs, stair-lifts, elevating chairs and toilet seats. The near future will see self-stabilizing utensils that enable persons with tremors to feed themselves. Driverless cars will create affordable out-of-home transportation options. Wearable stride management / walking assist devices will help the elderly with in-home mobility, short distance movements outside and decrease falls.

Paradoxically, as in-home technologies reduce the need for in-home care, they create an increased demand for companion care. Less visits at home from caregivers leads to an increasingly isolated life for the elderly living at home with limited mobility. Enter virtual companionship, this concept will play out several ways. Already we are seeing increased family communication with social media savvy seniors. Coming soon are simplified devices with persistent video channels open to family members. These programs are really just user-friendly, home versions of workplace video-conferencing software. Then there is a category of paid companionship for when family members are not available. Gerijoy, a new startup out of the Massachusetts Institute of Technology, offers virtual caregivers and companionship through tablet computers.

What Will Stay the Same?

Technology will delay the need for care. It will help the elderly stay in their homes longer. Still as physical needs become too much, as seniors can no longer help each other, as decreased cognitive ability prevents home life, the need for residential care in the form of assisted living and nursing homes will continue. Economic realities will result in increased usage of adult day care in place of full time home care and we will continue to see a relative decline in nursing home placements in favor of more cost effective assisted living.

Now to bring this article back to our area of expertise, the greatest thing that will not change and the area of aging that is most in need of innovation remains the issue of how to pay for care. Technology will reduce the care hours required, but still one must pay for the technology. Currently, the pace of new aging technology well exceeds the pace of developing innovate ways to pay for it.

Tell us what technology or innovative ways of caring for the elderly are you most excited about.

Financial Planning for Later Life

Photo by Zuerichs Strassen

The Washington Post ran an article recently about how hard financial planning for later life stages can be. Even when families are relatively well prepared, the process can be complicated and the landscape ever changing. If that was not enough, some people who present themselves as elder care planners might actually be working on commission. The unintended effect is to recommend unnecessary financial products or services for families who are trying to make the best decisions for the long term care of their loved one.

While the complexity and possible conflicts of interest may be reasons that some of us do not choose to plan for the cost of care for the later years in life, this is certainly a shame because of the many benefits of planning. People who plan ahead for elder care costs and long term care costs often report feeling an increased sense of control and reduced anxiety about the future. Further, planning and professional assistance can often help a family save on care and improve the quality of life for the elder.

This post describes the range of elder care financial planning services, from simple self-serve options to the variety of specialists who help with specific cases, and everything in between. We share this with the hope that it leads you to find the most appropriate assistance to start the process with your loved one. As with all planning, it is always better to start early.

Resource Locator Tool

First, our organization maintains the Resource Locator Tool, which can be found online at payingforseniorcare.com. The free, self-service tool consists of a simple questionnaire that helps identify programs and services that are available to the elder. It searches over 400 regional, state, federal and private programs. While this can be a fast and simple first step, families will need to take the program information and make their own plan. Click here to use the Resource Locator Tool.

State Social Service Agencies

Throughout the country, there are local Area Agencies on Aging that have offices where families can come in and talk to a support person about their situation. Because of the role and familiarity with the local networks, they are great advisors on which assistance programs are available. Some are not as familiar with national, private or Veterans Administration assistance. Of. Because the popularity of these free services, there can be wait times for an appointment. Find your local agency here.

Elder Care Resource Planners

A step up from free services would be to work with an Elder Care Resource Planner. They help elders and their families to identify all options and build a plan to fit the elder’s evolving needs for care. Their approach is comprehensive in that they will review all of the national, state and private programs to find the highest level of support. Elder Care Resource Planners are not as expensive as other types of professionals with prices that range from $500 to $1,500 per engagement. It should be noted, though, that while the Planner develops the plan families must take responsibility for the implementation. Learn more about Elder Care Resource Planners.

Medicaid Planners

Many seniors may have to rely on Medicaid at some point. The Bipartisan Policy Center reported that Medicaid pays for two-thirds of the costs of long term care in this country. A specialist Medicaid Planner can help families learn how to qualify for this program. In this area, it is often helpful to have guidance because of the complexity of the rules and the financial products that exist to help families qualify. This service can greatly improve the likelihood of an elder being accepted into a state Medicaid program. Fees range from $2,000 for a simple case to as much as $5,000. Learn more about Medicaid Planning.

Geriatric Care Managers

While Geriatric Care Managers typically oversee the care of an elder, some also assist with some of the financial aspects. Because of the depth of their knowledge of the health needs of seniors, they offer a valuable service that helps families anticipate the changing needs of the loved one. They can also be quite knowledgeable about local prices and providers. They are usually educated as nurses or social workers and may not have a financial planning background. Their services will typically be hourly and range from $50 to $200. Search for geriatric care managers.

Veterans Benefits Advisors

The Veteran’s Administration accredits advisors to help vets learn about their benefits and apply. These specialist advisors can help vets and their families save time and improve the chances that they will receive their full benefits. They are required not to charge for actually preparing an application, but they do charge for their other time helping clients. Prices range from free to about $2500. See a list of Veterans Benefits Advisors.

Financial Planners

Finally, financial planners received specialized education and accreditation as professionals to advise families on their finances, retirement, and preparing for long term care. They typically work with middle and upper income level individuals and may not have much specific knowledge of local aging programs and services for low income families. They focus on a range of financial products to preserve wealth and can be pretty expensive. They will charge either by the hour or based on the size of the client’s net wealth.

Planning for later life stages can be challenging but the benefits are clear for families. We hope that this list of the common types of resources available to help you plan will enable you get started. Please feel to let us know about your experiences or any types of planners that we missed in the comments.

12 Most Popular Articles on Financial Options for Elder Care

Many people discover our website through search. We are very happy to be there when people need more information about financial options for caring for an elderly loved one. Over the six years that we have been providing information services for programs and support for caring for seniors, we have learned a lot about what people are looking to learn more about. Here is the list of our most popular articles:

1. Home Care Financial Assistance and Payment Options – Article

Home care is increasing in popularity and it is easy to see why this information rich article tops our list. In this article, we take a closer look at the costs that are involved in home care, define the most important terms, and explain how the major long term care programs will and will not help cover the costs of home care.

2. Financial Assistance and Funding Options for Assisted Living – Article

Assisted living is an attractive and very diverse set of services. For families who are new to elder care, this informative article will serve as an excellent primer on topic. We review the costs and financial options for paying for assisted living. A wide variety of options are discussed from creative uses of home equity to clarifying which types of services Medicare will cover.

3. Medicaid's Assisted Living Benefits: Availability and Eligibility – Article

Medicaid has expanded, state by state, towards offering more assisted living benefits for eligible seniors. In this article, we dive into the topic on how, when, and where Medicaid can be used to cover assisted living expenses. Readers, no doubt, appreciate the comprehensive table of all state Medicaid assisted living benefits.

4. Receive Payment as a Caregiver: Cash and Counseling and Other Options – Article

From its debut as a pilot program, Medicaid’s Cash and Counseling options have been extremely popular. The programs have grown significantly over the years and the appeal is not hard to see. These flexible programs are often used to help pay family caregivers. Readers likely value our factual approach and well linked articles.

5. Costs of Senior Care – Article

As the title suggests, this article introduces the reader to many of the costs, fees, and less known expenses associated with caring for an elderly loved one. Updated annually, readers learn what average costs are and how they vary by geography and other factors.

6. Medicaid and Long Term Care for the Elderly – Article

Continuing with our friendly and helpful tone, this article seeks to assist the reader with gaining a basic understanding of how Medicaid functions. We address some of the common misunderstandings, clarify the various names that the programs are called, and explain the eligibility requirements. This is an invaluable crash course on using Medicaid for long term care.

7. Medicaid's Home Care Benefits: Eligibility, Waivers & Application Information – Article

Addressing another popular topic, this article seeks to make sense out of Medicaid’s benefits for home care. While a federal program, Medicaid is implemented by the states. The policy is made quite complex by all the state variations. Readers save not just money but their time spent researching Medicaid.

8. Making and Paying for Home Modifications to Enable Aging in Place – Article

Anyone who has had to care for an elderly loved one in their home will understand how daily life can be made extremely difficult by common architectural features. Readers will learn how to receive assistance to pay for modifications to allow a senior to continue living in their home and community.

9. Medicaid Planning: When it is Necessary and Finding Assistance – Article

While our informative site provides a lot of knowledge for family caregivers looking after an elderly loved one, a professional Medicaid planner can apply their specialized knowledge to their particular senior’s situation to help the family save money. This article will help a family decide whether to work with a Medicaid planning professional.

10. How to Pay for Nursing Home Care – Article

Skilled nursing might be necessary for some seniors. In this article, we dive deeply into this topic and how to make sure that the reader gets the information that they need to provide for an elderly loved one. From Veteran’s benefits to Medicare, this article reviews all of the programs and explains how they can be used. We also included a table on home nursing daily rates in all 50 states.

11. Paying for Walk-in Tubs: Medicare's Benefits and Other Financial Help – Article

Somewhat surprisingly, we discovered that this article’s focus on one particular home modification was very popular with readers. Walk-in tubs are sometimes a key feature that allow an elderly person to continue to live in the home where they are most comfortable. Medicare can be sometimes used to help offset the costs of walk-in tubs.

12. Types of Senior Care: Definitions and Comparisons – Article

Rounding out our review of the top 12 pages on our site is another great introduction for readers new to elder care. The field has many specific terms that can confuse someone. Often these particular terms make the difference whether one is eligible or not. Readers learn essential information that helps them throughout their care giving journey.

Getting Paid for Caring for an Elderly Loved One with Medicaid

Update Sept. 2015 - Our organization has released a Paid Caregiver Program Locator which allows families to search for programs that can be used to pay them as caregivers.  Start here. 


There are a variety of ways to help bridge the financial gap when caring for an elderly loved one. One of the most attractive approaches is to be paid as a family caregiver. For many families, this option offers two distinct advantages: receiving a new source of income while also ensuring the quality of care that your loved one receives.

In this post, we explain how Medicaid can provide this type of funding. If you are interested in the other, non-Medicaid based programs to get paid for care giving, please see this blog post (“Five Ways to Pay Family Members as Caregivers”).

Photo by the Abbeyfield Kent Society.

Overview

Medicaid, a federal program that is administered by the states, operates a series of programs referred to generally as ‘Cash & Counseling.’ The National Resource Center for Participant-Directed Services oversees the states’ Cash and Counseling programs. Other names include as Consumer Direction, Participant Direction and Self Directed Care. Most states have these programs under their own Medicaid waiver programs. They exist with a variety of names, such as Colorado HCBS Waiver for the Elderly, Blind, and Disabled and the New Jersey Personal Preference Program. See the full list here.

Program Description

At their most basic level, these programs provide cash to the participant and allow them the choice as to how best to spend it on their care. Participants can select their own home care agency, which may be someone from their own family. This means that the adult children and, in some cases, the spouse of the recipient could be hired as a caregiver.

When an individual is already enrolled in Medicaid or eligible, the agency will begin with a visit to the home of the senior to understand their needs. They will also contact the recipient’s caregivers and doctors. Once the agency has made a decision how much care is needed, a specific funding benefit is made based on the need and the regional cost of care. The benefit amount can change as the recipient’s needs change.

Most programs consider the situation where the care recipient needs a ‘surrogate’ to help them make care provider decisions. In these situations to avoid conflicts of interest, the care decision maker should be different from the individual who is employed as a caregiver.

Because the caregiver will actually become an employee of the senior, in some states, a third party organization might be required in order to make sure that payroll taxes are filed if those payments are above a minimum level where taxes are due.

Eligibility

• The care recipient must be enrolled in a Medicaid consumer directed waiver. Sometimes Medicaid waivers are oversubscribed and individuals will be placed on a waiting list.  

• In most states, individuals must be 65 and/or disabled. Participants with Alzheimer’s, who require nursing, or who require assistance with the activities of daily living are medically eligible.  
• Participants must be a resident in one of the states where these programs are available. See our list of the state programs for detailed information on your state program.

Understandably, getting paid to provide the care that many family members are already providing is an attractive option for families. However, the programs can be complicated. For people who are considering applying to Medicaid for the first time, a Medicaid planning professional can help. 

Learn More

Individuals wishing to learn more about how these programs can be accessed for your situation should visit our website for the full article on the Cash and Counseling programs and to find out more the program in their state.

Many Options to Help with Aging in Place

Photo by Ben Sutherland

Many options exist to help when elders and loved ones want to age in place and are looking for financial assistance. In this blog, we summarize several of the different articles we maintain that relate to helping elders and their families pay for the expenses related to aging in place.

Home Modifications

Home modifications are the changes that one makes to their home to make it easier for them to live independently and with the most amount of safety. Support to help pay for these modifications comes from many programs and in many forms. Medicaid, the VA, several state programs and a many community organizations provide support and assistance for home modifications.

Visit the Home Modification article on the payingforseniorcare.com website for a complete review of these programs.

Cost saving technologies

A wide range of products are marketed as aging in place technology. In this article, we focus on current technology that helps to reduces costs. With personal safety monitoring technologies, family members benefit from knowing their loved one is safe. For individuals who spend significant time alone, online companions can help keep elders company without the travel costs. Medication Management technologies help seniors who take multiple medications on an ongoing basis and are challenged to remember to take which pills to take when.

Visit the Cost Saving Technologies article on payingforseniorcare.com for more complete coverage of the technology options that available in 2014 and help cut costs.

Durable medical equipment

Americans who are aging at home instead of in a skilled nursing facility increasingly need to purchase home or durable medical equipment. Durable Medical Equipment can be understood as different from Home Medical Supplies. Normally, multiple sources of payment exist for any single item of durable medical equipment. Seniors and their family caregivers should be aware of all the possible sources of funds that may be available in order to increase their possible benefit.

Visit the Durable Medical Equipment article on payingforseniorcare.com for more complete coverage of the financial options.

Walk in tubs

Bathroom injuries are common for seniors trying to steady themselves on shower doors, towel racks and other fixtures while getting in and out of the tub. Medicare does not consider walk in bathtubs ‘durable medical equipment.’ Medicare will not cover the expenses associated with a walk-in tub. Medicaid, however, does have options that are likely to assist in the procurement and installation of a walk in tub.

Learn more Medicaid Waivers and other programs that can help with buying and installing a walk-in tub on payingforseniorcare.com.

Stair lifts

Medicaid will likely reimburse for medically required stair lifts as long as they enable elders to continue living in at home and avoid a nursing home. Options exist for elderly veterans and their spouses who are not able to climb stairs for reasons unrelated to their military service. Because a stair life is a type of home modification, various state-specific programs provide financial assistance for them.

Visit the Stair Lifts article on payingforseniorcare.com for more complete coverage of the programs to help pay for them.

Home care supplies

Home care supplies are generally disposable and usage is intended for one person. Individual expenses associated with home care supplies vary greatly. When used for medical purposes, prescriptions might be obtained but are generally not required. However, insurance policies will more likely reimburse for the supplies when the elder has a prescription or a statement of medical need from an accredited medical provider.

Visit the Home Care Supplies article on payingforseniorcare.com for more complete coverage of the financial programs to help pay for them.

5 Ways to Pay Family Members as Caregivers

Update Sept. 2015 - Our organization has released a Paid Caregiver Program Locator which allows families to search for programs that can be used to pay them as caregivers.  Start here.

Without question, the most common question our organization is asked is: "Can I get paid to provide care for my parents (or spouse)?"  On own website, we maintain a list of programs that offer that option to family caregivers, but as some new options have become available, we thought a blog post overview of all five different ways family members can be paid as caregivers of their elderly loved ones was in order. 

1) Medicaid Waivers

This is the most common and well known option.  Many states have Medicaid Waivers that allow participants to receive care at home instead of in a nursing home.  Some of these waivers allow for self-direction of care services.  This means the participant is free to select their care providers.  They can "hire" their adult children, other relatives or a few states, their spouses to provide them with personal care.  Relatives are paid the Medicaid hourly rate for home care.  Medicaid Waivers have enrollment caps, so only a limited number of individuals can participate through this option.

The exclusion of spouses in many states from being paid has led to an unintended consequence of some divorces.  While there are rules prohibiting spouses from being paid, there are no rules that prohibit former spouses.

See our website for a state by state guide of the Medicaid programs. 

2) Medicaid Personal Care Services (PCS)

Approximately 50 percent of states allow for personal care services in their Medicaid State Plans.  As with Medicaid Waivers, some of these programs allow for consumer direction of personal care providers enabling participants to hire friends and family members to provide them with personal care. 

These PCS programs differ from Medicaid Waivers in two key ways.  First, typically Medicaid Waivers have less restrictive financial eligibility requirements than PCS programs.  It is not uncommon for the monthly income limit for a Waiver to be approximately $2,130, while Medicaid PCS programs might be closer to $800 - $1,000 / month.  Second, because these programs are offered through the Medicaid State Plans, they are entitlements, unlike Medicaid Waivers which are not. 

3) State Based Non-Medicaid Programs

There are also non-Medicaid consumer directed care programs.  Unfortunately, a much fewer number of states offer these programs.  During our most recent survey, we found 12 states offer consumer direction in their non-Medicaid assistance programs for the elderly. 

4) Veterans Directed Home and Community Based Services

The 4th option is for veterans and their spouses only.  Similar to Medicaid Home and Community Based Services Waivers, there are Veterans Directed Home and Community Based Services.  Under these programs veterans, especially those living in rural areas, are given the flexibility to select what cares services they require and whom shall provide them.  Family members and friends can be hired to provide personal care.

5) Medicaid Life Settlements

Also referred to as Life Care Funding Plans, this is the newest way family members can receive payment for caregiving.  The approach is for holders of life insurance policies who require ongoing care and are considering Medicaid as a long term solution. 

Medicaid counts life insurance policies as assets and generally persons with these policies cannot qualify.  A Medicaid Life Settlement allows the individual to convert their life insurance policy into a dollar amount of care services.  That money is put into an account and used to pay for care for the policyholder.  It can be used for any type of care such as home care, assisted living or to make home modifications that help seniors maintain their independence (walk-in tubs, wheelchair ramps, stairglides etc.). 

It can also be used to pay family members for the care they provide.  For example, a spouse with Alzheimer's may require 24 hour supervision.  They might go to adult day care for 8 hours on weekdays and be looked after by their spouse for the remaining time.  The spouse could be paid the hourly Medicaid rate for the caregiving. 

The account that holds the money is a Medicaid qualified spend down, so when the funds are exhausted the individual is in a very strong position to qualify for Medicaid.

To learn more about each of this option and discover other sources of funding please explore our website.