CW Ep. 23: Innovations in Senior Care with Charles Turner
Charles Turner shares his eight principles for successful technology in senior care. Remember, technology is only a tool that enables innovation.
Over a decade ago, when we decided to launch into the senior care industry, I knew I wanted us to try to make a larger impact in this space. If you listened to my earlier episodes, you know, my background is not just in the senior care real estate and operations, but I have also worked for several large technology companies who don’t have any presence in our space. I wanted to bring some of my experiences from outside the industry, to this industry to try to make an impact in the lives of seniors that we serve. I thought if we did our research and found the best technologies, we could easily be the smartest guys and gals in the room, blowing away our competition with all of our many super cool innovations.
The first technology we identified as a game changer was this awesome tech that had specifically focused on memory care residents. It was, and excuse my language, pretty bad ass. It was a system. They came out of a major university with a ton of data supporting its effectiveness. It was a PC-based device that would sit in the residents room and you or a family member could pre-record your voice to give audio cues to our dementia residents to remind them of the next upcoming activity or to prep them that a caregiver would be coming in soon to give them a bath or numerous other things. It also allowed family members to help share photos for reminiscence therapy or music to help manage mood swings. It allowed the staff to pipe in content so that the residents would know about upcoming activities or allow the staff to secretly play the daughter’s voice through the device from a remote app, allowing the family to “be there” when they were not really there.
This thing was super cool. When perspective families came to tour, the things sold itself, hardly a tour would end without the prospect’s daughter crying of the arms of our sales director after a demo. It really helped alleviate the guilt of mom putting mom in a ”home,” there was also a ton of academic research that highlighted the efficacy of the system. It legitimately documented that it could reduce the number of agitated episodes by over 50% and significantly reduced the reliance of psychotropic meds for dementia patients. When we opened our first building under the leadership of our IT group, we put these devices in every room that leadership team loved them, the families loved the medical advisors, love them, academics from major universities, loved it. Heck even the press loved it. This system was the centerpiece of our big grand opening celebration, which brought in about 500 community leaders just to see it.
Sixty days later, when I returned for one of my typical site visits, I returned to a very different level of enthusiasm, almost every device if they were still in a resident room had been turned off. The rest were in the closet, collecting dust. My guess is a decade later, they’re still there in the closet collecting dust.
So what happened? In my ignorance, I violated what I now refer to as Charles Turner is eight principles for successful technology implementations in senior care. Had I known about Charles Turner’s eight principles for successful technology in senior care, I would have never purchased this system or at least I would have done it very, very differently.
I’m Charles Turner, CEO of Kare. Again, not his care with a K not to put too fine a point on it. If you are still paying a lot for overtime or using costly staffing agencies, you are doing it wrong. I know this because I have owned and operated multiple communities across the United States as well. And like the technology I have been describing the past few minutes, I also made many, many mistakes when it came to staffing. So if you want to know more, please go to, doyoukare.com again, Kare is spelled with a K.
If you listened to my previous episodes, we talked a lot about innovation, senior care, specifically, some of the behavioral biases and conditioning that prevents us from being more innovative. We specifically did not talk about technology because we often confuse innovation with technology. Innovation is the act of continuously improving. Technology is only a tool that enables innovation. You can be innovative with a big chief tablet and a number two pencil. You don’t need to be high tech. You just need the right behaviors to be innovative. Then you can go out and find the right tools.
This episode though will be a little different. In this episode, we’re going to be a little bit more tactical. We’re going to talk about the tools we’re actually going to talk about technology and what makes for a successful adoption in senior care. So without further ado, now, wait a second. Have you ever heard anyone say I’m going to more ado? What is ado anyway? Is it like a cranny? Why do we have nooks and crannies, but crannies are unable to exist without nooks, or could anyone ever just be combobulated? Why is it only discombobulated? I’m sorry. I just went off on a tangent. So forgive me. Or did I really just go off on more ado and not a tangent? Anyway, without further ado, I give you Charles Turner’s eight principles for successful technology in senior care.
Principle number one: stop trying to be cool. The first you need to dispel yourself off is that you will out cool your competition. We love our Apple watches, our Alexis and Google homes, our Uber apps and our Netflix streaming. Yep. They’re cool. But while these technologies may have a place in senior care, they should never be an end in and out of themselves, remember we are in the care business. If an Alexa helps you give better care than pursue an Alexa based strategy, but know that if you think you will drive census simply by sticking an Alexa in a resident’s room, you will find those Alexa’s gathering dust within three months, stop and posing a millennial worldview when an 84 year old widowed female. If you do not invest in the programming and processes necessary to deploy, train and support devices, you are wasting everyone as time and money. Seniors and senior care will rarely pick up a technology and use it. So don’t expect them to, I don’t care how simple it is to use. I know this sounds very cynical, but unfortunately it is the truth.
We know from research that seniors are very curious about the latest technology, but they also have a high degree of nervousness when approaching it. So expect a lot of handholding, but more importantly, ask yourself this question: If you do want to deploy the latest gadget into a senior care world, what do you want your results to be? How do you plan to use it to drive better care?
I firmly believe that if you start to shift your mindset from buying technologies that you think seniors and their families might find cool, and toward technologies that help you provide better care for your residents, you will start to invest your dollars in time, much more wisely.
Which brings me to principle two: Before you think about implementing any technology, start with your EHR selection. Every sophisticated business, and any industry always has at least three core systems, one a financial system to a customer or CRM solution and three, some sort of operational system that is specific for the industry that they are in. In our industry, that special system is an EHR or electronic healthcare records. Before you think about any other technology, you really need to decide on which EHR to use. Why? Because your EHR is the one system that houses all fundamental information about your residents. It is the system of truth. It is the one system that knows everything about Mrs. Jones, which room she lives in, what medication she takes, how much care she’s given and how her conditions have changed over time. Once you have an EHR, you can then start to look at other systems and technologies that can integrate with your EHR.
You could then potentially marry information up from your Apple watches or your bed sensors or your Alexa’s into that one record of truth. Otherwise you’ll have so many multiple systems that hold multiple pieces of information about Mrs. Jones, that the average senior care community gets overwhelmed with their information stored in these data silos, but be wanred. Not all EHR are created equally. I’m sure when you and your company are evaluating an EHR, you most likely look at it from a feature function perspective or which system most closely matches your current processes, or who do I have the best relationship with, or which system is easiest to use, or what is the price? These are all valuable criteria with which to evaluate software, but I would argue is a terribly short-sighted. It is 2020. We need to understand how well these systems play with other systems.
The question you must ask any of these technology vendors in this day and age is: do they have an open API architecture that allows them to integrate with other systems? Now, what did I just say? What is an API API stands for application programming interface simply stated it is a software intermediary tool that allows two applications to talk to each other.
The simple example is when you say register online for a conference and that website automatically integrates with your calendar application, there are several in our industry right now that don’t have open APIs. They don’t readily integrate with anything else. Sure. As customers, we may love the features and functions, but in order to, to future proof, our investment don’t limit yourself to these criteria. You may not have a specific plan to integrate your EHR data with any other system now, but I assure you, and then not too distant future, you will. And if you don’t, it will significantly limit your technology purchase options in the future.
Your ability to provide care relative to your competition will be significantly hindered by your ability to have an integrated view of Mrs. Jones because of principle number three: it’s all about the data.
Remember we are in the care business. As we’ve discussed in previous episodes, the days of opening up a pretty building and simply hiring a bunch of caregivers are coming to an end. The pendulum is throttling rapidly toward a model where care and care outcomes will be a differentiator. If you don’t believe me, look at what has become more critical during COVID, pink colors or infection rates. We’ve already talked about how senior care is running headlong into the acute and post-acute worlds. Medicare advantage is already looking to reimburse for some physical care. Doctors and hospitals want to care partners that will reduce their readmission rates, and which of us will win in the end? The one with the data will rule these potential partners, Medicare advantage, doctors, hospitals. Now, even families are looking for partners who can provide them proof of outcomes. Proof of outcomes requires measurement. Measurement requires data.
So if you have a limited technology budget, perhaps you should invest in whatever tools and systems provide you with the most data so that you can measure how well you are performing as an operator or how well your residents are improving or how well staff has performed. So while implementing an Amazon Alexa strategy may sound cool, if you can’t measure how it will improve resident satisfaction or engagement or increase staff productivity or better care, perhaps you may want to consider an investment strategy and technology that produces better quantified outcomes, but in the end, and data is not everything. If it does not go hand in hand with my fourth principle. Principle number four, it is also all about workflow and accountability.
Yes, we have to have the data without the data. Nothing else matters, but data for data sake, even in the most integrated world, can be limited. Case in point several years ago, we had been yes, and a wall based sensor system that measured thousands and thousands of data points about our residents. The point was not to spy on our residents, but rather to build up enough data on them so that we could then predict if say a fall was about to occur or where urinary tract infection was possibly going on. Or if there were more acute episodes of depression, the system was fantastic. It’s artificial intelligence for the time was unparalleled in the industry. And it really could predict changes in behavior that the naked eye could not always detect, but it had one major flaw. The designers of the system assumed that the data reports generated by the system would be sufficient to help intervene and improve care.
Unfortunately, this was a poor assumption. Every morning, each community stakeholder say a director of nursing or the care coordinator, or a say a memory care coordinator would receive these pretty red, yellow, green reports in their email highlighting the changes and conditions of all the residents, but red, yellow, and green reports don’t necessarily spur action. It did not enforce accountability. What it needed was a workflow engine that when the system detected that our resident was more prone to risky behavior, it should have automatically spat out tasks for a responsible employee to intervene on behalf of that resident, and then quickly report back. When the result of that action, then the administrator could then measure their performance of his or her staff based on how they responded to those recommended actions.
Unfortunately, this system had no way of creating action items for staff and therefore had no way of keeping staff accountable. So at the end of the day, the staff simply use it as a very expensive motion detecting system to detect falls. So make sure that when investing in any system, it doesn’t end with it’s pretty reports. Ask how it can be used to drive actionable behaviors, which drive better performance, and then better performance can drive better care outcomes. Also, if you operate multiple communities, don’t be afraid to allow your communities to see the performance of all your other communities. You may be surprised how a little competition between communities can drive better outcomes for your residence.
Okay. Let’s switch gears a little bit away from the technology itself and talk more about the human elements when selecting a technology solution. So principle number five, be very wary of asking a senior to behave in a way that they are not already doing now. Several years ago, I went to an aging technology conference attended by many of the best and brightest of Silicon Valley. One of the keynote speakers was one of the heads of design at Apple who preached that any technology hurdle can be overcome with good design and the senior care world, if a senior has not adopted a technology, he said it is because the technology was poorly designed while it was attitude is a wonderful example of Silicon puffery is extremely shortsighted. Let’s take Uber for example, I think the app is incredibly intuitive and easy to use. Without any training, if I had never used Uber before, I can easily pick it up and figure it out and be ordering or ride in a couple of minutes. But then let’s consider my 82 year old mother. For an 82 year old woman. I assure you, she has all of her faculties and is a sharp at 82 as she was at 42. Does she have a smartphone? Sure Does she have apps? Yeah. Has she taken it and an Uber before? No. Would she? Well not on her own.
The problem is not about the design and the problem is the concept. Can I convince her to use Uber, to train her, to use the app? Possibly. Well, that takes a lot more effort than it takes a typical say, 50 year old. Yes. And there in lies the problem possibly with a lot of effort and training, we can convince our residents to use a tool they have never used before, but do our organizations have the personnel, the patients and the institutional sticktuitiveness to see it through, oh, I’ll let you answer that question for yourself. Several years ago, we piloted a device that allows seniors to see family shared photos on their TV, in their room and reply with simple messages. The interface was extremely simple, extremely intuitive. Even with residents who had come had some sort of mild cognitive issue, they can easily figure it out, but the pilot failed despite our best efforts to see it succeed. Why? It was a problem with the concept. Our residents simply were not used to interacting with their TV that way to them. That is not what TV is despite our best efforts to explain otherwise.
This is why I’m a much bigger fan of wearables and sensors and other technologies that require residents to do something. Because at least with the residents in sensors, we were typically not asking our residents to do something or behave in a way that they’re not already doing?
So principle number six, training is overrated. Here’s where I get myself into a little trouble. If you read a lot of the industry, press specifically, as it pertains to technology implementations, most interviewees will always promote the idea that we need more and vigorous training to make a technology implementation successful. I kind of disagree and here’s why. Our industry faces a significant staff turnover crisis, depending on which statistic you look at, the typical senior care community turns over somewhere between 50% and 83% of its staff every year. So if you’re a typical 80 to 120 unit AL or skilled nursing facility has between 60 and 100 employees, this means you’re probably hiring somewhere between 30 and 80 employees every year. We can barely keep up with the hiring. How can we keep up with the training? I often feel bad for the technology vendors in our space. If they don’t want to lose adoptions, they constantly have to be selling the same product back into the same customer over and over again, just to keep up with the staff turnover. So that pessimistic attitude, what technologies should we invest in?
I think we should focus on three categories. The first category is fairly straightforward. We should invest in technologies that are generally ubiquitous across the industry. Almost all communities have a nurse call system and some form of electronic healthcare record system. So even if a new employee has never used your particular flavor before, they at least understand the concept, and that is what’s generally expected of them too. And the second category gory falls into what I call the simple stupid category. These are technologies that may not be ubiquitous, but are so intuitive and obvious that the ramp up requires a little to no training. Things like exercise, equipment, dining, and point of sale systems or digital checking kiosks like an AcuraShield or simple apps like Kare that are already being used by the rest of the staff anyway. So training is not that big of a ramp up. The final category should be reflection. What we’ve talked about earlier, it is something that produces a measurable results and, and something that the corporate office has measured every day, week, month and year.
If you do not feel you have a corporate staff to measure staff utilization and performance on a technology, don’t invest in it. We will talk a bit more about this in just a second, but you can invest in a technology that is continuously scalable in spite of employee turnover. Then you should second guess that strategy. For example, there are a ton of technologies that are extremely good at what they do. For instance, there are a lot of fall detection technologies out there that have significant clinical results showing massive reductions in their frequencies and severities of false. They are great. And when they launch in one of your communities, I almost guarantee you that you too will see a significant reduction in falls. Now, before invest in this technology, ask your vendor this question. If you go away and turn your phone off for 90 days, will I achieve the same results?
If you were worried that the answer may be no. And the solution you are looking to buy may not be as scalable as you thought. Which brings me to principle number seven. If your new technology initiative is going to be led by your IT department, turn in your resignation now. It will never work well unless you’re implementing a certain wifi or network or buying computers. Everything else is a waste of time and resources. I can’t believe that it is 2020, and many of the companies I talk with have their IT departments decide how and when to roll out technology. This is a mentality that was common when we had, we had to buy big mainframes or client server environments in the eighties and nineties, we don’t do this anymore. So cut it out. Take for instance, our Kare app, it is no different than the Uber app that you downloaded or log into a browser. It doesn’t require any additional hardware, costs nothing to get started and requires no training. When talking with a prospective customer a few weeks ago, she actually used these words. She said, wow, I really like what you guys at Kare are doing. I think it will help me out a lot, but you have to go through our IT department. They make decisions on all technology. My jaw hit the floor. Basically what this woman admitted to me was that somehow technology was something separate than the rest of what her business does. That they do both Kare and they also do technology folks. They are now one in the same. The business needs to drive their own technology decisions, not the IT department. That means if you were an executive with a senior care company, it is up to you to drive change. You can no longer afford to push it to your IT department.
Why? Because if no operational leader champions the change, then no one champions and change. The IT department is only there to support the business. They can’t make your nurse use that new staff scheduling application or that shiny new EHR. Stop it, cut it out. Which leads me to my next and mercifully final principle principle. Number eight: have a strategy. If you are a senior care leader, you can’t see direction to anyone else in your organization. Have a plan, have a strategy. Why? They will keep you anchored in your decision making. If you want to be the coolest hippest company in the senior care great. Be that, but, but put a plan in place that makes you focus on being that hip cool company. Maybe focus on the Alexas, the virtual reality projects, the products, the gaming systems. If you want to be known for outstanding care, then do that. Focus on your wearables, your sensors, your fitness equipment, your therapy solutions. If you want to be more of a, say a value provider, okay, that’s fine to spend your money wisely. But with one eye, always toward the future.
Remember it is not about the technology. Stop thinking that it is about the results. You should buy technology to drive some outcome, improve resident satisfaction, improve engagement, reduce falls, etc. So whatever the goal is, make sure you have the people and infrastructure in place to consistently measure the effectiveness and utilization of those investments. Otherwise your staff may not have the same strategic focus you do. So going back to the opening of this episode, you can now see why technology implementation fail can’t you? The tech itself was fantastic. The efficacy when used effectively was outstanding, but it still failed. Why? One, we focused on the cool factor, not what we really wanted, the results to be two, we had no underlying data or workflow strategy to make sure we could measure those results. And the system did not integrate with any of our other primary systems so we can manage the whole process better.
Three, we asked the seniors and their families to do something that they were not already used to doing. Four, we asked our staff to do something that they were not already used to doing. And the more we had to replace staff, the worst, the problem got. Five, we asked our IT company to roll it out. We didn’t take the lead. And finally it was disjointed from our overall technology strategy or more specifically, we had no technology strategy so we’re easily distracted by the next cool thing.
I’m Charles Turner and thanks for listening to this week’s BTG Contributor Wednesday. I hope you found this episode useful. I’m sure there are some things you may want to discuss or yell at me about, and that’s fine. So please connect with me at btgvoice.com.