Ravi Bala – Product and Business Model Development Technology Solutions for Older Adults

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Ravi Bala
Ravi Bala

Ravi Bala is an AgeTech Evangelist and a startup mentor in AgeTech and Remote Monitoring. He is a Co-Founder and former Board Member at HealthSignals, LLC, a leader in technology solutions for better senior living. An innovator and an expert in mobile health, conversational AI and digital strategy, he has a successful track record of creating and managing teams of independent thinkers. He has a tenacious dedication to compassion and dignity in the workplace. He is a teacher, a mentor, and a coach at heart and works with many startup ventures as an advisor.

He is currently Chair of the Capital for Good and board member for Girls First Fund – a global effort to end child marriage.  He was a Board Member of the Startup Corps and a member of the Drexel University AgeWell Collaboratory. He has taught courses in Digital Strategy in multiple MBA programs in Philadelphia. His latest passion is changing the model of eldercare with the aid of Conversational AI, Robotics and Passive Monitoring.

  • What do you envision for the future of the older adult experience?
  • What are some of the most promising technologies emerging for Aging at Home
  • General trends in healthcare and their impact on Eldercare / Aging at Home
  • What do you see as the biggest issue with eldercare today?
  • What promising care models do you see emerging in eldercare?

Hanh Brown: [00:00:00] Thank you so much for being with me today. And I’m eager to have this conversation about how technology can help improve our lives and lives of older adults and young baby boomers like you.

Ravi Bala: [00:01:39] welcome.

[00:01:40] Thank you so much time. I’ve listened to some of your past guests and you’ve had some amazing experts on the show, and I’m just hoping that I can measure up.

Hanh Brown: [00:01:48] Thank you so much for your time. So would you mind telling our audience where you’re from? Where you are now from a career standpoint and how you got here.

Ravi Bala: [00:01:59] I live in the Philadelphia area and I’ve been in senior living for about 10 years before that I’d spent a number of years working for IBM and, uh, as an entrepreneur doing software development out of India and I’ve done some. Interesting work in the area of contextual marketing and, uh, interactive technologies over the years, about 10 years ago, I was looking for some life-changing type of a, an environment where I started looking at opportunities to make a difference.

[00:02:27] And one of the areas that I was looking at was this whole new emerging thing called mobile health and mobile technologies. And I felt like you’re going to meet people that are going to take all of these technologies that are in different silos and put it together. So it actually makes a difference in what you do for the stakeholders.

[00:02:46] And that was the Genesis for this idea called health signals. So I got together with a friend of mine who owned a telecommunications company and our pitch to him. And we started this as a division of that company. To say, let’s see how we can go ahead and integrate mobile health technologies provide solutions for different organizations.

[00:03:04] We looked at different markets and we thought that senior living could really be an organized and industry that could benefit from this technology, this approach to bringing an integrated solution. That makes a difference for the residents, for the staff, for all of the investors and the stakeholders.

[00:03:21] So everybody that’s a stakeholder in the industry. It was a rude awakening about this was about 10 years ago. When we walked into the industry, one of the things that we discovered was there was no infrastructure. How do you take signals from your mobile technology edge points to somewhere where you can make a decision?

[00:03:39] If there is no good infrastructure? There was no wifi. There was no cellular connections across a lot of these senior living buildings, particularly those that are like 40, 50 years old were absolutely terrible. The disappointment for us that the infrastructure just didn’t exist and equally important. I don’t think at that time we had a lot of CPOs and CEO’s and senior living either.

[00:04:01] So even from a human resources perspective, it was a challenge to get the message across in terms of. Here’s how these types of technology changes can make a difference in the lives of your seniors, in the lives of your staff, and how do you sell it to the board? That was a really difficult challenge. So then we turned around and said, okay, this industry needs a solution.

[00:04:20] And the solution is you need infrastructure. Bruce Weintraub, who was the CEO of health signals was the chief architect polarize on fires. So with his background, we said, look, if that’s a problem that the industry is looking to solve, why don’t we just turn a business model around. And just go provide the solution, uh, community needs today.

[00:04:39] And that’s how we pivoted health signals into what I call. We became digital plumbers. We did campus-wide medical grade, Wi-Fi hosted voice over IP solutions, cellular backbone solutions, emergency response solutions. It’s just things that the industry really needed. And I did that for a decade and I think it was really, it was a worthwhile activity.

[00:05:01] I fell in love with the industry, primarily because of the people that were in the industry. A lot of the folks were so incredibly minded and I really got to imbibe this notion of servant leadership. I’d never really gotten exposed to that concept and the other corporate environments, I was a part of, but this really struck a chord with me.

[00:05:21] And I saw that with so many of these phenomenal leaders that I run across in the industry and in the decade, it was a wonderful experience. And. About two years ago, I started thinking about how is this industry going to change? Because there’s in the decades. We now have iPhones. We have wifi across the board in a lot of places and people are accepting technologies.

[00:05:44] They’re getting comfortable using it in their homes, in their offices, but our industry hasn’t changed that dramatically. And so I was trying to think about how is the business model of the industry going to change? Because I also do a lot of mentoring with startups. And so one of the first things that we look at is what’s the business model of your business for your startup.

[00:06:05] How is it going to fundamentally make a difference in terms of the before and the after. And it got me to thinking about this notion of will. This industry will the senior living industry get Amazon or Uber. A lot of other industries are getting Amazon to rubber and not this year, but last year at the leading edge leadership summit.

[00:06:27] I got to moderate a panel. I’d propose on it. I was able to get a, got some excellent panelists to talk about this notion of wills, eldercare, be Amazon or Uber. And that really got me on the journey to say, I want to get back to that. Doing the digital plumbing was phenomenal. It’s very routine at this point, but wouldn’t it be to do do is to get back to this notion of let’s take a look at the Amazon and the Uberization of our industry and see, what is it that’s going to happen to this industry and how can we start working on it?

[00:06:57] That’s where I am right now. I’m still working. I still mentor startups, which is great for me because it gives me a lot of fresh ideas on what’s happening on the forefront. And these are all aged tech startups. Primarily I’m looking at different opportunities to see where we can make, make an impact in terms of new models of senior living.

Hanh Brown: [00:07:14] It is much needed. There were already opportunities for improvement before COVID and since COVID, it has uncovered and then some, it just multiplied all the shortcomings. So I think there is an opportunity to improve and just make the next 10 to 20 years better for older adults. This is a great opportunity.

[00:07:35] So thank you for your experience, your passion and your just dry wanting to make a difference. That’s another reason. The driving force behind the boomer Linea podcast is that heading folks like yourself, just magnified, put yourself out there and amplify. There are great people, empathetic, compassionate, talented drivers, spearheading all these different efforts to make a positive impact on older adults.

[00:08:00] What do you see as the future of the older adult experience with technology? What do you see as the future of that?

Ravi Bala: [00:08:09] Earlier. I talked about looking at the business models in elder care. And one of the things that’s interesting is if you take a look at the number of seniors that actually live in what we call the traditional senior living campuses or environments like nursing homes, assisted living, independent, living snips, et cetera, that’s less than 10%.

[00:08:30] 90% of the seniors essentially live at home. And I see the future of senior living and the tremendous innovations that are happening, happening in the aging at home space.

Hanh Brown: [00:08:41] I think more and more folks prefer to be at home as long as they can. There needs to be an infrastructure to support that. And I think what you’re talking about just blinds right up in that living setting, there comes a point where perhaps safety might be in question for many people, they’re going to want to be at home as long as they can.

[00:09:01] So I, I think you’re right, aging in place is very much needed and we have to provide an infrastructure to allow people to live at home.

Ravi Bala: [00:09:08] Correct. I just make a statement when you talk about something about safety, which I think is really critical. If you take a look at the needs of a senior aging at home, you’re going to, you need the health aspects of it.

[00:09:22] You need the security aspects of it. I’ve got some notes in here on the side, you need the companionship aspect of it, which is really critical. And then. The part that I think we’re missing in a lot of senior living today is this notion of relevance. If you were to ask me today, how do I want to define aging or elder care or senior living?

[00:09:43] I really don’t care whether you call me a senior, an elder older adult. It makes no difference to me because if you change the terminology today, the baggage will come back in a decade. No matter what terminology you attribute to me. But what I want to do is to define that experience as engaged, active living with purpose and that purpose part of it, I think, is really missing in a lot of what we do in terms of senior living.

[00:10:06] I had an experience a while ago when. I was talking to a senior living executive and they were talking about going after the younger demographic market. And that’s always been the Holy grail, right? We want to get the seniors that are younger into the communities.

Hanh Brown: [00:10:22] so that they’ll stay on to the continuum of care, starting out with independent living and progressed to let’s say memory care, et cetera.

Ravi Bala: [00:10:31] We’re kind of do was to redefine the experience of senior living and saying, Hey, this is also relevant for people that are younger, and this works for you. My question to them was, do you have a service that a business office and your campus. I want incredible wifi. I want to incredible. I want your spare capacity in terms of office administrative people to be available to me, to be my personal assistant for the day.

[00:10:56] If I need to. Do you have that capability to create a rework type of an environment within, within your ceiling living communities? Or do you have an arrangement with somebody to do that? Because a lot of the people that if you want them to be moving in while they’re younger, they’re going to be. They what they’re going to want to be relevant in their living.

[00:11:12] They’re going to want to contribute to the communities. How do we make it easy? I happen to think that the most important job in elder care in the facilities, or even in a lot of the distributed settings that we might be evolving to is the resident activities director.

Hanh Brown: [00:11:29] It’s a huge role, the program director, because you have to take into account their physical, mental, and spiritual.

[00:11:37] And everyday there has to be some kind of activities to lend itself for them to thrive and to contribute and to have a purpose. Exactly what you’re saying. I’m very excited about that topic. Cause it’s, it’s just lines right up to honestly, to what you and I would want. So why would it be different if somebody is 65 or 75, they all want to have a sense of contribution and purpose.

[00:11:58] I personally believe when we talk about, they were talking about ourselves. Don’t you agree?

Ravi Bala: [00:12:03] Look, I am 64. I’m not ready to retire for another 10, 15 years. This is the demographic that people are talking about. And this again is another good insight that a lot of the industry is getting. Now that says, look, you could have a 55 year old that has cognitive impairment and you could have an 85 year old that can write poetry for you.

[00:12:22] So what you really want to do is to find a way to make this more personalized, the more individualized. And how do you cater services that are going to be relevant to those folks? I’ll come back to this notion of the activities directors role needs to change. It almost needs to become a director level, a C-level type of a role at this point.

[00:12:42] And it’s going to be distributed across. It’s not just one activities director. It is this activities director that’s got, that’s responsible for making sure that every department has a resident activities component associated with them.

Hanh Brown: [00:12:55] I’d like to see more of the activities that are engagement, wellness, and just anything that will lend itself for them to have a purpose because many of them.

[00:13:07] Because they’re moving into independent living. They’re still at one time engineers, investors, teachers, officers, accountant, physician, they contributed 30, 40 plus years of their lives. And I’m sure they want to continue to contribute. So I think it’s more important to provide that kind of setting one of which is making sure there’s an office space.

[00:13:27] We work type style and wifi and some kind of education, whether it’s online or just something to promote that kind of lifestyle.

Ravi Bala: [00:13:36] So I, I came up with a model for some of the things, for what I would want to do a policy in a community-based aging in place capability, pretty excited about this notion of the village to village network.

[00:13:48] I don’t know if you’re familiar with them, but the village concept started in Boston in 2001, and there are about 250 odd communities. And it’s a volunteer based organization where the community essentially takes care of elders within the community. I think with COVID, they’re finding it to be a bit of a challenge because as any volunteer based activity of service during a time, like COVID is falling apart in many cases, but there are other models that are evolving along those lines.

[00:14:18] So I was looking at some kind of a. Community-based care capability, but on the front end, one of the things you mentioned about safety, there’s a program called capable that evolved out of Johns Hopkins university, which I thought was really wonderful. They take an occupational therapist, a nurse, and a maintenance crew, and they’ll get over to a person’s home and then say, tell me how you live.

[00:14:40] What are some of the. Obstacles you have in your home, what would you like to do that you’re not able to do today? One example of that was they found that there was this lady that was in a wheelchair. She said, I really wish my son didn’t have to come over every week to wash my hair, but he has to, because I don’t have the ability to read the thing.

[00:14:58] So between the occupational therapist and the a, and the maintenance person, they were able to go ahead and create a low Laura is sink, where she could wash her hands hair on her own from the wheelchair. This extends the ability of that person. These kinds of changes, extend the ability of a person to live independently in their own home for a longer period of time.

[00:15:18] And they can do a safety concern, like the grab bars in the right places. And you can remove two of the doors that you don’t really need, so you can get the wheelchair through the place. And the nurse between the nurse and the, and the maintenance worker and the occupational therapist. This program has been run for about 10 years.

[00:15:34] And they’re looking to expand the program at this point in Philadelphia, as a matter of fact, habitat for humanity essentially took over the capable program for implementation the city of Philadelphia. I think that’s one part of it. Then the other part is the companionship. So you have organizations like silver nest that are evolving to go ahead and create companionship.

[00:15:52] And it also addressed those part of the economic equation. It’s a lot easier if you were to have three or four people living in the place and you can essentially then amortize the cost of living amongst all of those books. So addresses two of those things. On the other side, you’ve got organizations like Encore.

[00:16:09] That’s a, I can provide you with a purpose in life for the next act. So, if we were to do that, I think it addresses that. And you brought up something about learning and education and people are worried that seniors, a lot of seniors don’t have technology capability. And I think we see that we’re also seeing that reduce a little bit.

[00:16:28] There was an organization called cyber seniors, and I’m on the advisory board of this organization and they basically partner high school kids. And now with some college kids with seniors, so they can do technology transfer. And I’m going to assume that there is a wisdom transfer happening on the other end, which AIDS with the purpose part of the elders living.

[00:16:46] So if you take all of these existing programs that are in silos and integrate that into a program of offerings for aging in place, now you really got a model that could be sustainable.

Hanh Brown: [00:16:57] Post two separate entities right now. So we put it under one umbrella and offer that all encompassing service.

Ravi Bala: [00:17:04] That’s a great idea.

[00:17:05] Yeah, and this is not theoretical. There are two organizations that I know of that are actually working on these models. One is called care pods and operates out of North Carolina. And they’ve got a few care pods at this juncture in their model says we’re about $1,600 a month, approximately. We have 25 people homes and a care and a pod, there was one nurse allocated to them.

[00:17:30] And then there was regular phone calls, a pharmacist visits you once a year, they’ll do a video call with you on a regular basis to make sure your meds are all up to date. And you’re taking the right medications. And they also supply food like twice a week or three times a week. They’ll drop off food at your place.

[00:17:45] So that’s one organization then there’s a other organization called upside home is also doing something along those lines where they, they will do your E harmony match.com to find the right kind of roommates for you. And, uh, we’re also in the same ballpark to start off. It all depends on the geographies in terms of what the cost is, but the range is.

[00:18:06] 1500, $2,000 a bed. Basically, you’re now able to go provide that living at home experience that addresses these things of companionship, economics, safety, et cetera. And the youth are very technology based. Of course, you know, it’s interesting, I’m a technology geek, but in all of those conversations so far, I haven’t really brought up any technology because the more I’ve looked at the industry, we need to take a look at the fundamental.

[00:18:31] Modes of operation the business model of the industry, fix it. And then the technology is there to go ahead and make these things happen.

Hanh Brown: [00:18:39]Yeah. So are you suggesting that fixing hasn’t occurred yet, but once it is the technology to follow.

Ravi Bala: [00:18:45] It’s happening in tandem because the technology enabled some of the fixing.

[00:18:49] For example, with the guys that outside home, they couldn’t really implement the model unless they had the ability to do remote monitoring and remote monitoring has a bunch of different flavors. I’ve seen the first. Implementation of remote monitoring and senior living that I saw years ago, it was a purse.

[00:19:06] I mean, you’ve got the pendant that the seniors used to wear. And we also found that seniors would occasionally lose these pendants on purpose behind the sofa because it was gray and it was, it made them look old and feel old. And. I used to have arguments with a lot of the, a lot of the makers of these pendants to say, I want a swatch type capability, make it look like jewelry for me at the very least.

[00:19:32] So they’re not obligated to hide it or put it away or forget it, forget to charge it. So I think we need to make a, one of my favorite lines is from Steve jobs who says technology should either be beautiful or invisible, and we need to adopt that mantra within our industry. Let me design capabilities for remote monitoring.

[00:19:53] What I would really, I, I like the invisible part of the technology because we’re now starting to see an evolution of contactless monitoring technology capabilities. You have the, that essentially, and there was a company called IGT. Norway that, that I was mentoring that essentially is taking that and making it an industrial strength activity, monitoring pole detection capability for seniors.

[00:20:16] And they’ve got a pilot happening in one of the senior living communities in Florida. There’s a, there’s a company called bina.ai out of Israel. I’ve been I’m on the beta test program for them. And it really neat because just using my iPhone camera. I can do my SPO too. My heart rate, variability, my stress level, and they think they’re going to get blood pressure soon.

[00:20:36] So you can do all of that with the iPhone camera. And I wanted to test it on myself and my family, because I was wondering what the, with different skin tones, how does that work? And the, and we, my wife’s a cardiologist, so we have a couple of SBO to all Sox devices at home. So I had two Botox devices on my two fingers, and I had this device just to make sure that it was, that worked fine.

[00:20:59] And we did a couple of tests and it seems to function pretty well.

Hanh Brown: [00:21:03] That’s awesome. So I, I want to ask you some pertaining to conversational AI. I know you’re an expert in dead and it seems like a really cutting edge stuff. So can you explain how you foresee it impacting the senior care?

Ravi Bala: [00:21:18] Okay. First off, I’m not an expert in conversational AI, but I consume a lot of the information on conversationally.

[00:21:23] I’ve never done a project on it, so it’s difficult to consider myself an expert in it. I believe that voice is the most natural interaction that we have when we’ve grown up before writing, we had storytelling. And so we as human beings understand voice and how to use voice. And it’s the most natural interaction.

[00:21:44] And in 2015, when the first Alexa came out, Luckily, I turned mine off. My, the first Alexa came out, I bought the big device would be with the volume control knobs on the top and all of that, because I felt like this is exactly where we need to, this is how we need to implement technology in senior living.

[00:22:04] I want to be able to the typical, the 10 o’clock check-in call that we used to do. I’m sitting there going, why bother if I get up and move around, this thing really senses me moving around. So we should really be good with that. If I want to know what the menu and the dining room is, I shouldn’t have to make that phone call to the dining room to find out what the menu today is.

[00:22:26] I should just ask this voice device that this thing can go get it for me. If I’ve fallen down, even I can go ahead and tell it, help me or call nine 11. It should be able to do that. We just saw a really interesting announcement yesterday from Amazon called the care hub where I can link my Alexa device with my parents’ Alexa device.

[00:22:47] And I can, it can report to me respecting their privacy. Of course, once they say, okay, I can connect this. We get connected. And it’ll say things like mom was active this morning. I saw lights go on or there’s been no activity for four hours. So it takes a look at any deviation from the normal patterns and comes back and says, something’s not right.

[00:23:09] Check on them. I don’t know to tell you what’s right, or what’s not right. I just need to tell you something’s not right. Just check on them. I will tell you the echo show device has been a lifesaver for us during COVID. My parents live in a retirement community in India, and two years ago, when the echo show first came out, I bought two of those and I put one here.

[00:23:30] I took one to India, configured it, dropped it off in their home with wifi. And now every morning we do a five minute check-in. Basically it’s how are you doing? Is everything okay? And what’s amazing is when you see them face to face. They can’t lie to you and believe me, my parents, and they’ll all the other seniors lie to their kids about I’m feeling okay.

[00:23:52] Everything is good, no problems at all. And my in-laws who live about an hour and a half away. Also have one of these devices. My wife mentioned to you, she’s a cardiologist. She came in while we came back. Once talked to her dad on the phone and he’s feeling a little low energy at this point. What’s going on?

[00:24:08] He goes, well, my legs are a little swollen. Oh, wait a minute. Let me call you back on the show. And we call them the Alexa echo show. And she said, put your leg up. Let me see you put your thumb on the, on your leg. And the impression stayed. Blue accumulation. She basically told them, go to the ER right now I’m meeting you there.

[00:24:24] He got admitted for congestive heart failure of that night. Oh yeah. It’s not conversational AI, but it’s that whole communication capability, first of all. And then all these other things that basically say, you know, I can talk to something. It understands what I say. It interprets it, it goes ahead and finds the information, comes back and gives it to me.

[00:24:42] And that is incredibly important.

Hanh Brown: [00:24:44] Yes, it is. It is. We have something similar like that for my mom. It’s a camera and it’s audio visual and everything, so that all 10 of us can see her at any time. And there’s six of us that are near her. So we even with COVID, there’s one or two that still come by to check up on her.

[00:25:01] And I think it’s really important seeing it’s everything often they’ll tell you that they’re okay because they don’t want to burden you or, you know, worry about all this and seeing is everything. So thank you for sharing that. You mentioned that your latest passion is changing the model of eldercare with conversational AI and robotics and passive monitoring.

[00:25:24] So what change are you trying to achieve and how will this technology help you get there?

Ravi Bala: [00:25:29] The care model between things like capable and silver nest and Encore and all of that, all of this can essentially get enabled only if you have an underlying technology capability and that technology capability needs to have the ability to create communication, both audio and visual.

[00:25:49] It needs to create the ability for the senior to be independent. As much as possible. And the independence is enabled again by them being able to interact with the technology with nobody else helping them. And I’ve now started seeing the implementation of. Robots and a lot of senior living communities and they’re doing it primarily for monitoring what’s going on in the hallways.

[00:26:13] And some of them I’ve seen the Temi robots that connected health has been using. And they’ve essentially got things that they refitted that with sprays. So this, or COVID, it just goes through the hallways and sprays everything automatically. So it just avoids a person having to go through and do all of these things.

[00:26:30] So I think robotics. Will certainly become a, a significant part of care down the road in today’s world. It’s it isn’t quite there. I guess the best robot that I’ve seen is, is probably the new, again, Amazon announcement of this drone camera. That will essentially fly around the house and make sure that everybody’s okay and comes right back to it.

[00:26:51] So you need to have something that can function in today’s environments. You have staircases, you have landings obstacles on the floor, and when you get airborne, you avoid a lot of those. A lot of those obstacles, I mentioned that I mentor startups and there’s a, an organization called silver moonshots.

[00:27:09] John Warner runs it out of LA and it’s dedicated to H tech startups. One of the startups we had in our cohort was called Zeppy, which I thought was really interesting. And they also had this drone camera capability. It was basically a helium balloon on the top, and it was a drone on the bottom because the helium balloon allows it to float.

[00:27:30] You don’t need as much energy for this thing to fly around. And it would essentially, and the balloon also balloons front face also serve as a projection screen. So you can have almost a life-size space show up in front of people and particularly for people with dementia. This becomes really important because it is at the right level and it’s kind of life size.

[00:27:50] So you have the ability to recognize that as a face and initiate a communication, they’re still in prototype stages. They’re being sponsored through Televiv as a, you know, indoor drone and robotics program. I’m excited about technologies like that. That essentially say I can’t retrofit every home completely, but.

[00:28:10] I can overcome those obstacles by not worrying about the floor on the obstacles that can essentially go airborne and go ahead and make a deliver technology.

Hanh Brown: [00:28:18] I think there are so many just wonderful technology startup that’s in progress, or that maybe started during the COVID and we’re going to see many of them flourish in years to come.

[00:28:31] Now, what do you think are the biggest macro trends in healthcare today? How do you see these trends impact the elder care and people aging at home?

Ravi Bala: [00:28:41] That’s a great question. I’ve done a lot of thinking on, on this. And even before COVID, I’d heard the head of the Massachusetts hospital association say that.

[00:28:54] Twenty-five percent of the hospitals within Massachusetts were underwater. I didn’t realize it, but hospitals operate close to a supermarket in terms of the margins, one to 2%. And you can probably imagine what Cove has done to them. That’s completely decimated the financial statements. So even then they were talking about this notion of driving the hospital to the home.

[00:29:16] And they were saying that with the technology that is available now, we should be able to drive a lot of the functions to not just the outpatient centers, but actually drive it all the way to the home.

Hanh Brown: [00:29:28] Healthcare, like geriatric emergency care type. Is that what you’re discussing?

Ravi Bala: [00:29:34] it’s everything from, I can do 24 seven telemetry for you from home.

[00:29:39] Right. We’re talking about doing, for example, echos used to be only done in hospitals. Now you can essentially, I’ve got the butterfly IQ and ultrasounds, so you can essentially do that with your own. You got an iPhone, you attach the butterfly IQ and then you essentially can do ultrasounds.

[00:29:55] Echocardiograms used to be only done at home then. Yeah. Cardia that came up and said, we’ve got three versions of cardiac in our home that essentially give you EKG. And those EKG is get recorded on your phone and they can get sent right over to your cardiologist. And my wife loved it, especially the second iteration.

[00:30:13] Once she was able to use it and show it around the hospital, she absolutely loved the fact that you’re able to do that. And so a lot of the things that used to be only hospital-based are now being, you can essentially get them to be home-based and that’s been the history of technology, right. It used to be in the middle ages.

[00:30:31] If you had a headache, you had to have a physician come and visit you because you didn’t know what to do. And now you have a headache, you pop an Astra and you’re pretty much done. So we’re going to probably drive a lot of that stuff across the board. And let me just pull something out here, which is really cool.

[00:30:44] So this thing is called TytoCare. I don’t know if you’ve seen this before, but here’s, this is a device. That I bought at best buy it’s $299. And this device has various attachments, like an arthroscope and a stethoscope, all built right in. I can essentially take that device measure all of the things that I need to do and send it right out to a pediatrician, send it right out to my cardiologist.

[00:31:10] And so you’ve now got that whole examination capability. The triage function can get moved to the home. That’s not the only one we’ve now got MedWatch and a whole bunch of others. And we’re even migrating that to things like blood tests and urine tests can essentially be done at home now. There are things where you can essentially have your own.

[00:31:29] You essentially do a dipstick and you put it against a chromograph essentially, and send it over to your doctor and, or even an AI. That’ll tell you what the diagnostics.

Hanh Brown: [00:31:39] the integrity of, or credibility of the information that we get back to the hospital. So got to make sure that is we have to be concerned with the credibility and the integrity.

[00:31:53] Uh, the output, right. Technology is valuable, but there is something to be said that you do see folks, uh, to face-to-face because you can determine their status quo through their disposition, in how they communicate. Don’t get me wrong. I think technology can save us a lot of hospital visits, especially the older adults, but there’s still something to be said about.

[00:32:21] Um, determining the, the wellness of the person based on disposition and how they respond. So I think you’ll get where I’m going.

Ravi Bala: [00:32:30] I fully agree with you on, and my wife will definitely agree with you. We have. Discussions and spirited discussions about this. And it’s been interesting for me to watch this during COVID at the early stages of the game, they were trying to figure out what to do.

[00:32:45] And then they went to this televisits primarily and they call it tele-health, but it was really just televisits where you do a video call and you’re. Interacting with them with the patients. And that was almost 70, 80% of the call of the visits were all televisits and now it’s probably down to about 20% just because the offices were open.

[00:33:02] And my assumption is that over the course of the next few months, it’ll go right back up to another 50, 60% just because of explosion and the disease. I don’t believe that any of these technologies are an either or there is a continuum of services that we’re going to deliver. And this is healthcare and aging care.

[00:33:19] Aging care is such a huge part of healthcare. That in anything we talk about healthcare is you can attribute that to your aging at home agent care, et cetera. I think you need to combine. Remote monitoring. My heartbeats that come out of the watch are a lot of these devices that we’re talking about. You got to combine that with the face-to-face that you’re doing, even with the video, this is.

[00:33:42] This doesn’t replace, being able to see the patient. This is saying it’s a royalty paint to get out there in the winter, through the snow and get out to the doctors. I’m just not going to do it. Or COVID is there, I’m afraid of going there to the doctor. So for the next six months, I’m not going to see a doctor.

[00:33:57] I haven’t seen a doctor in six months or any, any of the ancillary services. So in this situation, that’s the one I got silver lining of COVID. Is this forced you to think about, you know, this is an alternative when the alternative is nothing. And you start off and that’s how all breakthrough innovation start like Clayton Christensen says really the disruptive innovations happen when it didn’t get successful.
[00:34:20] If you pilot them with the alternative is nothing very true.

Hanh Brown: [00:34:22] Wow. What a great insight that you have. I really appreciate this conversation. What do you think is, um, promising care models are emerging in the elder care right now? I know you mentioned several. Are there anything that really stand out that you believe will be very effective and successful?

Ravi Bala: [00:34:44] There are a whole bunch that are emerging. And the two that I mentioned between care pods and upside home, the smaller retail model at this point, but you also have folks like bill Thomas working on the greenhouse project and the pocket community model and kind of an emergence of a modified co-housing model.

[00:35:05] This journey has really exposed me to a lot of different efforts across the country that were not just aging oriented. Now the co-housing model was not an aging oriented model, but it’s a pretty large movement. I did not realize cohousing.org existed. And I didn’t realize that you can essentially go there and find out that there are co-housing projects in your area.

[00:35:25] And these are folks that essentially have a written into the contract. Some different models and some models have written into the contract three times a week. You’re all having meals together. There is a common area it’s designed for that. If you don’t want to do that, don’t move into this place. This is designed to be a quasi communal living type of a thing.

[00:35:44] And once a month that you cook, you’re part of the crew that cooks the meal for everybody, and you’re able to manage it. And this notion of it takes a village. That’s been the tradition in human history. I, I believe that this goes off of the aged care and senior living discussion primarily, but the whole concept of nuclear family is relatively modern for humans.

[00:36:07] That’d be bold. Bay’s been, yeah. Communal organizations, communal living and nuclear family started to happen as a result of some fundamental decision. That happened in the church. That’s another discussion for another day, but it really is a religious edict that essentially started this whole process of fractionalization off stick, kins on the tribes that would just help you evolve.

[00:36:28] So I like the co-housing model a lot, and I like the pocket communities where you’re essentially saying you’ve got a neighborhood and you got a bunch of small houses and we now have the ability to go ahead and create. A a community that cares for each other.

Hanh Brown: [00:36:41] What you’re saying, not everyone may want to move into a large community, 90 plus CCRC.

[00:36:50] So they’re still looking for something that’s local, communal generational green housing care pods. So something that’s small scale, but it serves all the purposes. I guess you can live in that type of setting to some extent, perhaps again, I keep going back to the safety factor, for instance, memory care.

[00:37:12] So I think there is a window that they can live in the setting that you and I described. I think that’s wonderful because you know, honestly, let’s say you and I are in our mid eighties, to be honest though, notion of something huge. Really glamorous and swimming pool and dining. That’s wonderful. I just don’t know.

[00:37:33] I really want that in my eighties. I want something more intimate. That’s small cozy homey near. Oh my God. This is probably for me mirror my loved ones. I am willing to move just to be near any one of my kids, my husband and I. So there’s so many components that come into. Making the decision where you want to live and how you want to be cared for.

[00:37:57] But before that, I want to be at home as long as I can. And then if I can’t do the day-to-day activities anymore, all the living arrangements that you described I’m with you, I would like to take that route.

Ravi Bala: [00:38:10] I think we used to talk about lifespan and then health span, right? Maybe we need to define an independent span or irrelevant span.

[00:38:19] And I want to increase that independence and relevance span as much as possible. And I think I agree with you. There is going to be a time where you’re going to need either a nursing home or a memory care home. I think all of us dream of saying, I want to go from a home to a hospice and that’s it.

[00:38:36] That’s my dream. And if we’re not fortunate enough to have that kind of an exit, then you know, you’ve got something intermediate and. The expectation, hopefully is that’s more of a sub one year type of a move as opposed to I’m there for seven or eight years. I mean, the statistics show that typical nursing home living, it’s not like a seven or eight year span.

[00:38:56] It’s like a one year span. If you go from an IOL L D AOL to a sniff it’s seven months, eight months, nine months a time horizon where you spend there. It certainly made me question after I visited a bunch of sniffs in terms of. How do I want that time to be? My dream is the day before I die. I want to have cause somebody to say, ha I never thought of it that way.

[00:39:20] And that’s what I’m hoping. If there is a way to get people to believe that they can do that and say, yup, you can have a purpose, you can do something. The fact that it’s the last day, you can call somebody to smile. And if we can give people that as part of their existence, And make it easy for them.

Hanh Brown: [00:39:41] It’s the best technology we can bring to bear hearing is relevant, purpose and options and independence, the ability to make decisions of what’s best for you, even for whatever window that you have.

[00:39:52] I agree. What do you think is your biggest strength that enables you to have a unique, impactful effect on older adults? Maybe something that’s not well known about you, perhaps something personal.

Ravi Bala: [00:40:03] I’m not afraid to be wrong. I’m okay. I’m okay with being wrong. I’ll think of ideas. I’ll talk to people about it.

[00:40:10] I, I don’t hold any of the ideas that I have close to me and I expose people to it because then they can tell me where I’m wrong at the end of the day. It’s about causing that aha moment, whether it’s today or tomorrow, I mentor startups because of that. I want to do futuristic things because of that, it’s stretching the bounds of how we think about something.

[00:40:31] And that’s what caused me to go back two years ago and look at the whole thing of, are we going to be Amazon to Ruber? Yeah, we’re going to be both Amazon and Uber. Now the question is how are we going to react?

Hanh Brown: [00:40:41] Wonderful. Wonderful. So now, how, and when did you find that senior living? Where’s your calling?

Ravi Bala: [00:40:47] I mentioned like 10 years ago when we were looking at mobile health systems integration, I think it was somewhat opportunistic that we ran into a senior living community and then we started working with them. And as I started to understand the industry, the thing that I was really drawn to. Was the leadership in the senior living communities that were so service-oriented knowers this concept of servant living that they brought to the table, I thought was the model we need to export across all industries.

[00:41:19] And it was basically that the people that work there cause we interacted with the seniors a little bit, but a lot more with the people that worked in the industry and it was the level of care and the compassion really drew me to them and was really amazing. It was one of the few experiences where somebody said, you guys are a startups, I’m just going to pay the bills early for you.

[00:41:39] It’s incredible.

Hanh Brown: [00:41:40] Yeah. The caregiving side of the senior living it’s like ministry work. The very compassionate, empathetic. You have to be. I mean, it’s not a job. It’s something that day to day you’ve touched physically touch someone you care and they interest in you. And that’s a big deal, especially in the later third or quarter of their lives, you know?

[00:42:02] And when they don’t see their family, perhaps as often, if they see the caregivers. So you are an extended family member, have you thought about your own aging journey? What have you done to prepare yourself as you are getting older?

Ravi Bala: [00:42:18] I have thought about it. What’s interesting is I’ve discovered it’s kind of interesting.

[00:42:23] Threw a curve ball into this whole equation. Initially, you used to say, well, when I’m old, I want to be close to family, my kids and all of that. And then I’d say, you know what? Kids are going to be busy and they could probably move after you moved to where they are. Friendships are really important. And I think we need to create a community of friends and see if there’s a way to congregate amongst them.

[00:42:44] And then COVID happened and I’m like, damn, I can’t really even see the family now because if it used to be, when I was with friends, I can always hop on a plane and go see the family, but now that’s not an option. So we’re going to confuse mode in terms of where does that draw between where my friends are and where my family is.

[00:43:00] I’d actually been talking to some potential developers to say, okay, if I were to get together 10 families. What is the option of creating a, kind of a congregate living environment that allows us to have small pods of living with a social area on one end and then a meditation area on the other end that is shareable.

[00:43:24] And how do you create those things with all the right technology underpinnings so that family can become part of this whole caregiving process for everybody. That’s one of the other elements that we hadn’t talked about is in a lot of the technology implementation. We’re now starting to evolve this notion of taking the family and making it easy for them to be involved.

[00:43:45] It’s just unfortunate that 84% of the caregiver giving hours in this country is volunteer caregiver, giving hours, and almost three quarters of them are women that do the caregiving. So that’s got to have a tremendous impact on their lives and how they want to progress in their careers and all of that.

[00:44:03] It’s unfair. What we need to do is to find a way to turn that ship around a little bit and making it easy. So we can liberate that intellectual force, the providers, a competitive advantage as a country. Yeah, on a macro scale, it has a lot of impact. So we’ve got to find a way to create this new washing machine on the dishwashers of the 21st century, which is how do you free up the three quarters of the caregivers are women by getting the rest of the family involved?

[00:44:33] How do you make sure that they don’t have to spend 20 hours a week, 30 hours a week essentially doing caregiving work? Can they do a more effective job with being there for the five hours that they’re really needed?

Hanh Brown: [00:44:44] Yeah. Out of this, maybe some of those caregivers are very entrepreneur, perhaps provide them the right needs, the right tools, the right direction.

[00:44:54] Because if they have been caregiving, whether it’s volunteered or paid, it sounds like most of it has been volunteered. They have some great ideas. So they’re the ones that we ought to be picking their brains to come up with innovative ideas in caring for older adults. I agree with that.

Ravi Bala: [00:45:09] Yeah, there was a really neat startup that in one of our cohorts at Silva, moonshots called a caregiver and they were approaching corporate businesses to say, you should really make this a corporate benefit because 70% of your workforce is caring for someone in one form or the other.

[00:45:26] And they’re not present in your offices, even though they’re physically there. Because they have caregiving burdens on their brain. And if you’re looking, we’re no longer in the piecework economy, we’re in the cognitive right presence economy in a war, your brain has to be present. Your heart has to be present.

[00:45:41] And you can’t do that. If you’ve got those caregiving burdens that are weighing on you. No matter how you try to measure people’s productivity. You’re not getting the best out of them. If you haven’t really alleviated those words. And even as a corporate business, it is incredibly important to make sure that we extend ourselves to say, what can I do to make sure your life is easy and kept caregiving as a burden?

[00:46:05] What do I do? And we need to make that an effective corporate back.

Hanh Brown: [00:46:08] Amen. I agree with that. I think every single one of us will become caregivers. Every single one of us does some capacity.

Ravi Bala: [00:46:16] Guard the statement that says there are only two types of people, caregivers, and those who will be.

Hanh Brown: [00:46:19] Wow. I really enjoyed this conversation.

[00:46:22] I really appreciate your time. Do you have any other thoughts that you would like to share?

Ravi Bala: [00:46:26] No, I think we’ve covered a lot of stuff. I think I’ve given you everything that I had. I’m just looking forward to getting back out of COVID and exploring how we can create model. Pocket communities and model small communities and what I’m really encouraged to see, for example, Lynne Katzmann Juniper communities in our area, when COVID happened, they essentially took their large community and sectioned it off into groups of 50 and pods of 50.

[00:46:54] And they said, these four people, then you, you’re not, you’re not alone, no longer have gonna have 20 people doing different specialized functions. Going through these, these pods, these four people are going to be the adult daughter and they’ll take care of everything. And you can section them. You can cohort them.

[00:47:07] You can isolate them. The original need was for isolation during COVID, but I think it may come up with an added benefit of, Hey, this is giving somebody a more holistic work environment. Cause I’m doing a lot of different things. I’m happier with it. And the person gets to know me. So there’s a companionship aspect that evolves from it.

[00:47:27] It used to be. I remember Volvo at one point used to have this model that says, we’re not this assembly model that everybody does this person. Doesn’t always just turn the screw. And that’s it. They’ll essentially take a crew of eight people and say, you assemble this car. And the quality of the car is one of them quite dramatically because they had pride of authorship in that.

[00:47:45] And I think this cohorting model may allow us to do that even in the larger communities as we age.

Hanh Brown: [00:47:49] And as we migrate into the years of retirement, I wholeheartedly believe that. The young baby boomers like you and I, we’re continuing to want to thrive and contribute and live vibrantly and have options to choose how we want to live as opposed to being mandated, to live in a circle way.

[00:48:11] Here’s the other thing that we haven’t touched on. I think it’s so important at any age. It’s so important that families have that conversation, how to budget and how they want to live and how they want their children in golf. So that when it’s time to make a decision, it’s not a crisis too often. It is a crisis.

[00:48:30] And if they already don’t know what those senior level options are, they might end up with the wrong one or they make a decision. It’s very rash. They miss not the best fit. So I think if you just rewind in time and just bottle this conversation in. Any of the other conversations I had in the podcast, it’s really educate, get the information that you need perhaps in your forties or fifties.

[00:48:55] Don’t wait until your parents that are in their seventies and eighties. I think that might be just a little bit too late living industry.

Ravi Bala: [00:49:01] The 10% has an image problem. If I were to talk to my in-laws about senior living, they visualize nursing homes with people in walkers and yeah, even though one of them was on a Walker.

[00:49:16] Don’t want to go live in that environment. And for them they’d much rather live in a house no matter what, but if you were to then say, Hey, what if I were to get half a dozen of your friends together? And we’ll go ahead and create this little pocket neighborhood for you guys. What I’m talking about doing for myself, it may take me 10 years to do this.

[00:49:32] Of course, I don’t need it for another 10 to 15 years at that point. I’ll have it ready. So I’m starting the conversation now, and that’s the kind of thing that we need to start doing with the elders is how would you like to live? Let’s figure it out here are the four different options and it’s not the nursing.

[00:49:48] All of it’s not theirs. It is. How do we create a new neighborhood for you?

Hanh Brown: [00:49:51] I like what you said. I think the two words that stood out little and friends, how do we get your friends together and live in this little pocket together? It’s intimate, it’s close and it’s friendship because you’re moving into people that, you know, you already know, or even making new friends too often.

[00:50:07] We say the worst day and I have to remind myself it isn’t day. They you and I we’re all in the same boat, right? Maybe a little, few years ahead, but it’s not what they want. It’s really, if you think about it, it’s what you and I want right now in the future. So I have to remind myself, I do use the word day in older adults and it all of us.

Ravi Bala: [00:50:30] Yeah. One other thing I’ll tell you. I don’t know if I mentioned this earlier in the conversation, the industry spends a lot of time trying to get away from the word senior. They will go from senior to older adults to elders do this. And I think it really makes no difference. We should own the word senior.

[00:50:48] And you basically say, you know what? This means. It means I have the freedom to engage in whatever I want to do. And it means I can let purpose drive my life and not be economic.

Hanh Brown: [00:50:59] Not the words dictate who I am. Do you know what I mean? So I’ll be honest with you. You can call me whatever you want. I don’t care what you call me because I know who I am when now.

[00:51:09] And when I’m 67 and eight, I don’t care what you call me. I mean, I keep thinking, why are we talking about how we ought to call these folks? What’s wrong with being a senior? Why is that? So derogatory. Call me a senior because I’m wise, I’m healthy. I’m strong. I want to contribute. Call me whatever you want.

Ravi Bala: [00:51:27] Yeah. And I always tell people I’m 64 and I’m tech support for my kids. It has nothing to do that number really varies for everybody. And when I’m 80, I’m still going to be tech support for a bunch of things.

Hanh Brown: [00:51:40] Yeah. And I would say to people, you know, I’m in my mid fifties, but I am feeling like I’m living my healthiest self, honestly, because I don’t have a little infants and tablets that I’m waking up in the middle of the night, but I’m feeling strong and healthy and free and even wanting to be more purposeful.

[00:51:58] So I’m a young baby boomer. But I’m going to tell you, I feel like it’s the best time of my life right now, even right in the midst of COVID. And you know why? Because I’m meeting folks like you, I do, I’m inspired by everything that you said so wonderful to hear someone kind of confirm what I was thinking.

[00:52:16] And then of course, adding to it. So many things that I didn’t know, and I want to be a part of that journey. So you can call me senior older adult aging, because I think all of that, it’s beautiful.

Ravi Bala: [00:52:27] Yep. I really enjoyed the conversation I want to, I’d like to do more just because off camera, it doesn’t really matter.

[00:52:33] I think it’s just being able to brainstorm on. What do you do? How do you take these conversations and put them into some kind of an action? And I want to see a pilot home that embodies a lot of these concepts and brings it together.

Hanh Brown: [00:52:47] This is an Uber. I’m glad that this is like our second conversation and it’ll be more public.

[00:52:53] But I’m always open for one-on-one conversation and let’s do that. Maybe we can think of some actionable items, a plan that we can move closer with days or months to come. I’m very open. Sure. Yeah.

Ravi Bala: [00:53:06] Excellent. All right. Thank you so much. Take care.

Hanh Brown: [00:53:11] Thank you so much.

Ravi’s LinkedIn Page: https://www.linkedin.com/in/ravibala/

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