A move to a care facility may be the most disruptive and stressful event of a senior’s life. Senior health specialists say that the many changes a later-in-life move imposes on living and social engagement patterns can make such a move even more stressful overall than the death of a spouse.
And such stress, clearly takes its toll on mortality. According to the National Center for Assisted Living (US), the first-year mortality rate of those who move into a skilled nursing facility can be as high as 50% to 60%, and for those who move into an Alzheimer’s care unit, greater than 50%.
It is therefore essential for insurers focusing on the elder market to understand the relationship between mortality and social patterns, how changes in the degree of social engagement over time can affect longevity, and ultimately, how to provide the cover and services that can mitigate the stress and improve longevity.
Most older adults are determined to age in place – to live as independently as they can for as long as possible at their homes, near their families and where the care and services they need are affordable and accessible. A distinct and widening gap, however, has been emerging between what seniors need to age in place comfortably and what is available.
Many older people struggle with chronic illnesses associated with age as well as with age-related physical infirmities such as reduced vision, hearing, and tactile sensitivity. And although they might not yet be experiencing a reduction in their ability to perform the basic activities of daily living (ADLs), they may still need some help managing aspects of their daily lives.
In several major US and European cities, the determination of older people to stay near family, friends, and known environments and routines has resulted in what are known as naturally occurring retirement communities (NORCs).
Most NORCs – communities where at least 40% of the population is over age 60 – already have much of the basic infrastructures that can support ageing in place, including readily available public transportation, nearby pharmacies and supermarkets (and/or delivery services), and easily accessible venues for entertainment (movie theatres, concert halls, sports stadiums and the like).
For elders in Asian countries, ageing in place effectively will require far more than just money to pay for care: Seniors will also need ready access to targeted medical and non-medical services, including NORC-style services as well as integrated prescription and medication management, and specialised care services for specific needs such as wound care related to diabetes and cancer, eyesight care, physical therapists and/or fitness coaching and monitoring, biometric monitoring and tracking, and periodic cognitive assessments. Necessary non-medical services might include home retrofits to make it simpler for elders to continue to age in place.
The need also includes access to qualified and knowledgeable providers of senior health care – doctors, nurses, home health care aids and other health professionals who specialise in their needs. And currently, especially in Asia, the need is far outstripping supply.
Long-term care (LTC) policies currently available in Asia are geared primarily towards providing lump sums to pay for facility- or home-based care. Few insurers now provide such products, especially in rapidly ageing Japan, Korea and China, making LTC a cover with substantial market potential.
Still, what is becoming increasingly clear is that continuing to treat LTC policies as only a means to pay for facility- or home-based medical care is ignoring the potential to help many existing and emerging senior needs.
A growing number of companies throughout Asia are looking at how best to provide these services. A few have been building diabetes management solutions that can be bundled with policies. In Korea, for example, a group of companies piloted a non-insurance product for seniors consisting of bundled services intended for individuals age 60 or older (the oldest of the offspring of today’s seniors). Members of this generation continue to be the primary caregivers of their elders and do not always have time to research and source the many types of care needed.
In addition, companies looking at how technological interfaces can be optimised for the ageing. Older individuals ageing at home might be less able to engage fully in a physical manner in family life, they generally strongly wish to remain connected with its unique sensory familiarity in terms of colour, sound and tempo. Given that hearing, sight and touch capabilities deteriorate with age, an interface’s cognitive ergonomics must be sound – that is, they need to enable ease of information access and utilisation so that seniors can have a positive user experience.
Bundled products are also a natural fit for Asia’s ageing “sandwich” generation – the offspring of today’s seniors. These individuals are in their 40s and older, and are caring for their children and their parents (and sometimes even grandparents). Many of these individuals are approaching retirement age themselves and increasingly need to determine how their elders will be cared for, driven by filial piety (the virtue of respect for one’s parents, elders, and ancestors).
Several insurers as well as technology companies are already looking at how home health care management can be bundled, optimised, and integrated with insurance cover.
Some are investigating bundling not only coverage for biometric tracking apps but access to vetted service providers for everything from coaches for healthy eating and fitness needs to companies that can analyse and enhance a home’s technological capabilities. Several issues, including the adoption of technology and ways to assess risk for such product bundles, are being worked on.
In terms of technology, one interesting area of technology development that might favour elderly target populations is that of Internet of Things (IoT). IoT, put simply, is internet-based technology that enables interactive computing devices to be embedded in everyday objects and technologies.
Think, for example, of some of the newest refrigerators: those that are IoT-enabled can connect with a smartphone, track food contents and expiration dates, generate shopping lists, and even stream TV feeds. IoT technologies could also be utilised to not only help seniors to retain independence but also to help elders retain a satisfactory level of connectivity with their families and communities.
The real benefit for seniors who age in place with sufficient support is that their emotional quality of life can remain intact and secure. Moving to a nursing home or other care facility can make day-to-day life easier for seniors in certain ways, but it can also be highly isolating – a “comfortable loneliness” which can be deleterious to overall health and longevity.
Both mature and developing Asian insurance markets have high potential for such bundled solutions. Insurers should play a leadership role in the organising and structuring a solid infrastructure to provide the services and interfaces that will let various parties communicate with one another as they solve the problems of the ageing individual.
Re-imagining senior-focused living benefits products would require the development of broader platforms upon which customisable, integrated product and services bundles can be built, sold and administered. The bundles would enhance the overall policy, with features that would enable seniors to protect their independence and to care for themselves as they age.
Although the industry is at an early stage in this development trajectory, there is already a good amount of attention being focused on these needs, and the future promises to be challenging and exciting. Government support for the InsurTech that could enable such bundles and their underlying technologies to become a reality might bring a bright future even closer.
Ideally, a one-stop architecture can emerge, where insureds utilise a single interface to a platform that can provide the means to service, support, and pay for the needs. What will be crucial, going forward, will be the ability to offer a fully integrated and supportive infrastructure that will enable elders to age in place, with the dignity they desire and deserve.