Tell HN: your next idea should focus on aged care

130 points by thornjm 1 year ago | 137 comments

I’m a nobody in a medicine role but with a previous career in engineering.

I’ve just had a poorly thought out mild epiphany realizing what’s been staring me (and I’m sure everyone else) in the face: There is a huge burden of simple care tasks assisting people with transferring, mobility, dressing, showering, feeding, memory, medications etc.

Individually: The carer role is hard, physical, foul, violent, confronting, and worst of all 24/7.

Systemically: Half of the health system is clogged full of people admitted for social / care issues rather than medical issues. The population is aging and people are living longer with more severe deficits. There is a huge volume of exploited laborers keeping the system afloat.

It’s almost certainly a technical impossibility to solve a fraction of these problems and a large proportion of them likely need socially acceptable and safe human-robot interactions. However, a brilliant / affordable solution to getting grandpa out of bed or wiping his butt or engaging his mind could dramatically improve care timeliness, quality, safety, frequency, etc. and revolutionize parts of industries.

If you’re an entrepreneur looking for ripe territory consider literally any problem in aged / disability / nursing care.

TL;DR less hype / investment in self driving cars and AI that can solve esoteric BAR exams and more focus on helping grandpa safely stand and walk to the bathroom.

</rant>

binary132 1 year ago |

The reality of elder care is that (especially) infirm old folks really need a lot of hard, difficult, unpleasant care that our economic system has made basically impossible for their children and extended families to perform, as would have probably been done in the past. This requirement isn’t going to go away. There will be no cheap, safe, efficient butt-wiping robot, and unmotivated, uninvolved third parties are going to keep doing lousy jobs and getting old folks hurt. Technology is not going to make much of a dent in this one.

octopoc 1 year ago | |

This is true for most cases. However in my family we have special circumstances: because my grandfather is a veteran, my father is paid to take care of him. It is an absolutely phenomenal experience for our family and has brought us all together. If we could enable this again for everyone that would be good for everyone in terms of mental health.

binary132 1 year ago | | |

I think it would be great if states offered support to people who were willing to be caregivers to their elders and children. These are essential roles that cannot really be replaced.

antiatheist 1 year ago | | |

This is available to anyone in Australia, although ~$500-600 a week isn't enough to support the carer and the one they care for in most personal circumstances. https://www.servicesaustralia.gov.au/carer-payment

hiAndrewQuinn 1 year ago | |

Perhaps I'm missing something here. Why wouldn't an elderly care home invest in such a robot, considering this is one of the most common and time consuming tasks their orderlies need to perform on a daily basis? It seems like it would free up a lot of bandwidth to take in yet more elderly folks, which would be more profit to the care home.

malfist 1 year ago | |

> Technology is not going to make much of a dent in this one.

I'm sure people said the same thing many times before. Agriculture is probably a good example of it, even if you ignore anything before modern times. Do you think after we developed tractors that we would have went on to make automated tractors that run by GPS and can plant, weed and harvest?

Technology can, and does, solve hard problems.

ensocode 1 year ago | |

This, on the other hand also younger people are getting old. Future old people might be much more tech-averse

RecycledEle 1 year ago | |

The butt wiping robot may be called a bidet combined with air drying.

nopmat 1 year ago | | |

Or have a self-cleaning, self-sanitized shower van with lifts and adaptive equipment make the rounds like an ice-cream truck.

shrimp_emoji 1 year ago | |

> care that our economic system has made basically impossible for their children and extended families to perform

I don't wanna take care of my parents; I blame society.

I don't wanna have kids; I blame society.

We really can't keep letting society get away with all this.

llamaimperative 1 year ago | | |

This is just a snarky way of saying “incentives drive behavior” which, of course, is actually true and when incentives yield bad outcomes we should interrogate the system that produces them.

linotype 1 year ago | | |

Even if I did want to have kids, I wouldn’t have them to take care of me in old age. What if they move to Japan? Should I have them move back to the US to take care of me?

Nah, we should build a society that can and does take care of its elderly.

binary132 1 year ago | | |

The reality is that right now, most people need to work full-time-plus just to get by.

My wife and I have a bunch of kids. We are also the only ones who will be meaningfully sorting out care for our parents. I am fortunate to be able to provide enough support to make it work. I also don’t feel confident that when we’re also responsible for caring for all four of our parents, there’s going to be enough of our time and energy to manage it along with my work, especially if there are more little ones or medical issues at that time. It’s important to be realistic.

And again, I’m an outlier. Most people have fewer resources to devote to it.

bzmrgonz 1 year ago | | |

Establish UBI and then we can blame families for not wanting to care for their elders, but until capitalism demands dual-income to sustain the nuclear family... we can't unfold that blame blanket you're proposing.

silverquiet 1 year ago | | |

I can’t have kids; I’m single.

bigbassroller 1 year ago | |

Just brand a bidit with a lifting mechanisms

k310 1 year ago |

Agree. Simple stuff that people really need is missing. I mean really simple. I can't read product labels even with serious myopia and a magnifying lens. Only Trader Joe's makes readable shelf signage. Use-by dates take 30 seconds to even find. And there are tons more things. I made a list ...

It's getting longer. Thanks for posting this.

SkyPuncher 1 year ago |

I actually ran a health tech startup in this space within the past decade.

It’s basically a no go market. Patients don’t have the funds themselves. Those that do simply hire a dedicated, private staff.

Children don’t want to pay for it since they view it as there parent’s expense.

Everyone views it as a cost that the healthcare system should cover - even though there isn’t money for it.

hn_throwaway_99 1 year ago | |

Your response makes sense to me, but it also highlights why I've become so disillusioned with "tech" generally over the course of my 25 year career.

My optimism about tech used to be because I saw tech as solving humanities most pressing needs (even if it usually has unintended consequences like pollution, etc.) But now I see tech (most of the time, obviously I'm speaking in broad generalities) as not even bothering with pressing problems because you can make more money hijacking dopamine pathways to sell ads.

I mean, when I think of tech that would actually improve my life I think about things like a clothes-folding machine, not a program that writes mediocre poetry.

dingnuts 1 year ago | | |

> think of tech that would actually improve my life I think about things like a clothes-folding machine,

I think about this constantly, and it's a funny example because apparently the math involved for figuring out how to fold clothes is basically an unsolved problem. As I understand it the robotics -- also a very hard unsolved problem -- are the easy part, which should emphasize how horribly hard this problem is.

Several other things: 1) I recently saw a LinkedIn lunatic claim laundry was already automated, because laundry machines exist (way to out yourself as someone who never helps with laundry)

> mediocre poetry

2) I refuse to call language models "intelligence" until they can at least meaningfully contribute to the design of novel devices like the robots we are discussing. If it can't invent, it's not intelligent! Intelligent things are capable of novelty, not only regurgitating existing witnessed patterns.

lolinder 1 year ago |

> or wiping his butt

Slightly weird take: bidets have this field fully covered and the only thing stopping them from being widely used (especially in this domain!) is user resistance to an unfamiliar solution to a very personal problem.

We don't need new tech for this, we just need a marketing breakthrough.

makeset 1 year ago | |

To be clear, the original "bidet" fixture as found in some older European bathrooms, a second toilet bowl to squat over and manually wash, is far from useful for anyone, let alone the elderly. If people are horrified to hear the word, that's probably what they are picturing. There's also the shower hose dog wash thing which is almost as bad. To avoid confusion, the toilet seat spray feature (which is great) is often termed "bidet seat" or "washlet".

hn_throwaway_99 1 year ago | |

> bidets have this field fully covered

No, they don't. This "let them use a bidet!" stuff is an asinine response that is literally the equivalent of "let them eat cake."

Elderly people who need someone to wipe for them are usually either completely physically immobile where they're not exactly strolling to the toilet in any case, or they're wearing diapers, or they're so mentally declined they basically forget what they're supposed to do.

Plus, as the owner of a bidet who uses it every time I take a poop, you still need to wipe. What, you're going to just drip dry in your underwear - gross! My bidet even comes with a drying fan but it's in no way sufficient, you still need to wipe.

carlosjobim 1 year ago | | |

So you have to sacrifice one of two people. Either the old who cannot take care of himself, or the caretaker who has to waste their life taking care of the old.

Duanemclemore 1 year ago | |

Having worked in high end residential, I can tell ya the LAST person who's going to want to use a bidet is ironically also the hypothetical "grandpa" who's not rich enough to hire someone to wipe his a$$.

000ooo000 1 year ago |

You've got it all wrong. Entrepreneurs aren't short on ideas; they're short on ideas that will make them rich. Why/Who's paying for a robot to wipe grandpa's butt when "there's a huge volume of exploited laborers keeping the system afloat"?

6510 1 year ago | |

You could advertise the robot then send and exploited laborer to do the robot job as a success story, could have robot operators in far away lands and for select elderly a robot suit would be sufficient.

warkdarrior 1 year ago | | |

Is that going to be cheaper than actual immigrant labor?

chillingeffect 1 year ago |

Yep. Spend an hour with an elderly person trying to do things like change a password, unsub from a mailing list, connect a Roku, look at a digital photo album, etc. Will blow your mind wide open. We basically need an entire tier of easy internet for the elderly.

bzmrgonz 1 year ago |

I think improvements to the electric-exo-skeleton contraption can keep the elderly mobile for an additional 10 years.. There comes a time when an elderly person cannot take a flight of 2 or 3 step stairs and that's when they stop moving, so if the exoskeleton can get them to the track or a flat area where they can walk, I think it can help tremendously. Additionally, I think those 2 circle zero gravity contraptions might help with circulation. As for the butt wiping, that's a tough one, but only because of the stigma associated with wearing anything on the sphincter, I can see a 12v electric sphincter dilating aparatus being very efficient in controlling bowel movement, but I don't see our childish society accepting them with a straight face.

Rinum 1 year ago |

Big barriers to entry: regulation, liability, and reimbursement/payment

Duanemclemore 1 year ago |

Architect here. (the building kind.) "Aging in Place" and "Universal Design" are two of the most transformative, difficult, subtle, and important problems facing us today. Other countries are building social structures to address the systemic issues associated with aging.

But because of the nature of our healthcare and bureaucratic systems, we have a unique need for interventions in physical conditions - be it small-scale building modifications or assistive technologies. So, especially if you want to innovate making -stuff- I concur wholeheartedly.

That said - it looks like the comments until now on this are mostly looking at software-based assistive technologies. Which is ALSO a spot-freaking-on approach.

aio2 1 year ago |

Not about your point to develop a new project, but is the population aging? I know in certain areas, yes, they are, but a quick look at one of those population pyramids shows places like the US, with a more even population age group, meaning the population as a whole isn't generally getting older.

Please enlighten me though, I know almost nothing of this field.

dukeyukey 1 year ago | |

The US doesn't have an even population pyramid, there's a bulge of late baby boomers and late millennials, but none for Gen Z.

aio2 1 year ago | | |

This is my source: https://www.populationpyramid.net/united-states-of-america/2...

As you can see, the percentages for each age group are close to each other, meaning it's more even.

badpun 1 year ago |

The Japanese have been supposedly working on robots to support their aging population for a couple of decades now. It sure seems to be extremely difficult to make progress in this field (and in robotics in general).

Also, as you noted, half the picture are people whose problems are self-inflicted, mostly due to bad lifestyles. Right now, companies profit off bad lifestyles (first by selling them and them by helping to manage consequences). No comercial entity will profit from population keeping itself healthy and balanced, as mostly involves substraction (NOT doing some things) and not addition (doing/buying). It's a awareness and policy issue, and can only be fixed through either campaigns promoting good living, and through policies which enable it (more vacation time for workers, healthier food in stores, less stress due to economic pressures etc.).

written-beyond 1 year ago |

We've actually built something in this line and are in the process of open sourcing it in a few weeks. Very small underfunded team, which makes us a little slower.

greentxt 1 year ago |

Inflation and fiscal irresponsibility are central to this issue. It just takes a really selfish generation and a political system that rewards myopic policy to create this sort of gerontocratic inequity. The fix is fiscal responsibility and fostering a culture of personal responsibility rather than a culture of "the government owes it to me" which is pretty obviously not sustainable. The sins of the father... There is no money here, only debts, both monitary and moral.

lcabral 1 year ago |

I think this is some already being looked at in some aging societies. Look at Japan and even China where they have a lack of nursing personnel. They are looking at the humanoid robot hype with a keen eye for supporting people in the future. And there are likely many other research being done with emphasis on these societies that could show us problems that need solutions.

ggm 1 year ago |

Where i live in an apartment complex the ground floor retail outlets struggle. They'd make awesome podiatry, physio, optical, aged care, you name it. With increasing trend to care in the home, and with apartment living common for the elderly, these kinds of service tenancy seem like a no brainer: your clientele is all around you.

Mathnerd314 1 year ago |

I'm working on a fitness app, I was mostly thinking about myself but as soon as I looked at best-selling fitness books it was clear that the market was pretty much all seniors. Although it could just be that seniors like books more, I also found similar trends in other media.

instagib 1 year ago |

The exploited laborers part is true and you never know how the care is going.

Someone noticed rashes showing up on an elderly person and installed an in bathroom hidden camera. They were leaving them in the bathroom for hours and exiting/re-entering through the window.

cynicalsecurity 1 year ago |

There is no money in this business to make. Someone who didn't think of their old age in advance definitely hasn't got any money now. Sure, you can try to milk the government, but this is not really a sustainable business.

donw 1 year ago | |

Retirement homes are basically in the business of funneling the life savings of elderly residents into their own coffers.

For a fully mobile senior requiring no additional care, you're looking at a minimum of USD $3500/month at an assisted living facility. Add in any nursing needs, and that number will quickly go north of $5k/month. Once you start heading towards your late 80s, that number again quickly doubles.

Note that this does not include medical care, diapers, clothing, a phone, etc.

And this is the bottom of the market. A higher-end home will run double if not more.

In Japan, there are homes for every income tier, from "nothing more than a government pension" on up. Sure, the lower-end homes aren't great, but they beat homelessness by a wide margin. And these are private businesses, not government-run facilities.

thornjm 1 year ago | |

Many staff in different roles, 3+ shifts a day, 365 days a year is a lot of labour costs. Replacing even a fraction of labour is likely $100K a year of potential investment. More so in expensive labour countries.

altdataseller 1 year ago |

If you think its such a huge obvious problem, i guess the obvious Q is why don’t you put your money where your mouth is and why aren’t you pursuing it? (Assuming you aren’t)

czbond 1 year ago |

Yes - but it is so hard to find persistence and passion for such problems (at least for me).

Duanemclemore 1 year ago | |

I know where you're coming from, 100%. But I want to share something that's stayed with me to this day.

When I was in graduate school for architecture fifteen years ago I saw a lecture by an architect I already respected greatly named Niall McLaughlin. He taught at the school (still does I think) so on four consecutive Wednesdays he gave these astounding two hour lectures. And he would take questions after until every question was answered. These events sometimes lasted 3 - 4 hours. The themes were "Architecture and ..." The two I remember without going back into my notes were "Architecture and Tools" and "Architecture and Memory."

This whole shaggy dog story is because "Architecture and Memory" started at the philosophical level but by the end tied in to his own work on memory care facilities. He's a famous architect. Has since won the Sterling Prize, the biggest prize awarded by RIBA. A. Big. Deal. And I don't even know if he publishes his memory care facilities.

But he got into that market - he shared with us - because he had a close family member who needed that care. Flash forward ten years and I'm spending time in a memory care facility with a very close family member. Thinking back to his experience, knowing how it felt. Realizing his personal empathy drove him to pursue a whole area of practice that most would never consider. I doubt he lost money doing these facilities but I can assure you he wasn't doing it for the high profit margins.

I'm absolutely not knocking your statement. The exact opposite sentiment is coming through I hope. If it's an area you're interested in exploring how to delve into and develop ideas within - find a reason to care. What I mean is - if you're interested in developing solutions in the area find a way to identify a real world problem worth solving in it. Volunteer a little at a nursing home or community center with senior programs, meet people facing the issues that come with aging.

Not to say you'd be doing it to be opportunist, but if you're looking for a "product market fit," start by observing the real and present every day challenges of the market. Use it to build the product story. I don't want to sound ghoulish in my biz-speak, but it's real - I think we all have personal experiences where knowing someone going through something gave us a reason to care about that issue in a broader sense.

Good luck - it's an area that is flush with problems worth solving, and I think could be rewarding to explore.

rramadass 1 year ago |

I have been looking at this domain for a while now and thinking about how one might become a "Social Entrepreneur" in this domain. As an example, India has now included all senior citizens over 70 under its Universal Health Coverage umbrella (https://nha.gov.in/PM-JAY) and hence the need for these services/organizations have become more pressing. In developed countries with a large aging population the situation is even more dire.

The main issues i can think of are;

1) Regulations - Govt. mandated laws on access to health records, personal liability etc.

2) Insurance - Can these services be charged under govt./private insurance schemes/claims?

3) Personnel Training - All employees must be trained in aspects of Nursing and People management, there must be on-call Doctors etc.

4) Wellness Centers - Places where the elderly can be brought in for regular companionship and prophylactic exercises.

5) Transport - A fleet of vehicles to transport the elderly to and from their homes.

6) Supplies - Medicines and everything else as needed.

There are three main models that i can think of;

a) The "standard" elder care homes which take care of everything for a fee.

b) A live-in nurse/maid/caretaker employed through a agency (popular in developing countries) where the person lives with the family taking care of the elder. You pay a monthly fee to the agency and they pay the caretaker's salary after taking their cut.

c) A on-demand comprehensive health services company. This can be a non-profit/for-profit organization offering various services (medical/support/companionship etc.) to the elderly who live alone or have nobody to look after them. Services could be offered based on the needs and on a yearly/monthly contracts or as needed per call. Think of it as Uber/Wework for Healthcare. I think this is the need of the hour since there is a huge population above 50 worldwide living alone. Just helping them maintain their health will go a long way towards easing the pressure on the healthcare system leaving the hospitals free to serve those who need it most.

To drive the point home, watch this 3-part documentary series on "Living and Dying Alone in Singapore" to get an idea of what awaits many senior citizens - https://www.youtube.com/watch?v=d499mlwXWfk

The organization mentioned in the above documentary and from which we can learn is here - https://chenghongwelfare.org

antwerp1 1 year ago |

…and let us know before your company goes public

r_singh 1 year ago |

Capitalism or things you can buy are only good for things that can be measured but there are lots of things that need to be and are done in the world everyday that cannot be measured especially coming to self care, child care and elderly care

guilhas 1 year ago |

Loneliness is a big one, maybe boomerMeetup.com

Day centers for old people used to be very popular

But I would say there should be better health lifestyle guidelines for everyone to avoid being incapacitated. How in rural Europe and Africa you still see 80 and 90 year olds still digging land, saw an 100 year old lady, in Africa, still doing accounting for local businesses

Maybe is the lack of sleep, unhealthy food, too much coffee, alcohol excess, too many pills... but people should watch out the bill will come

snapplebobapple 1 year ago |

The corrollary of this is you need to hustle now because there is maybe 15 years left before the majority of boomers cease to be customers due to dieing and the next generation is much smaller. You need to capture yoyr market share now then weather 20 years of less exciting before the millenials ramp up demand hard again

kjkjadksj 1 year ago | |

Just have n64s and phish cover bands in your nursing home and you will capture more of the aging gen x population than you will know what to do with.

abhiyerra 1 year ago |

In about 5 years the baby boomers will have all hit retirement age. With social security and Medicare there will likely be a significant amount spent on healthcare taking care of this generation.

bradgranath 1 year ago |

"There is a huge volume of exploited laborers keeping the system afloat."

This is the problem that needs fixing.

And not with fuckin' robots with butt lasers.

atemerev 1 year ago | |

Err, how? They are doing it voluntarily. They want these jobs. They can work at other jobs too, but that would be an education startup opportunity.

silverquiet 1 year ago | | |

Voluntarily? As in they could just stop working and they'd be fine?