The Geriatric Care market – A worldwide trend equals a vast world of business opportunities (Part 2)

Following Part 1 of the Geriatric Care Market analysis, where we focused on the growth figures of our ageing population, and the immense market values of service and medtech device sectors that supply the geriatric care market, in this article we will explore the market trends, and its opportunities such as market consolidations, shifts in care models (from medication to prevention, carer roles, preference for home-based care, value-based payments, etc.) and highlight some innovative community-based solutions to the challenge of caring for our rising numbers of elderly citizens.

Market Trends – New solutions, care models, and improvements on existing approaches

Across the geriatric market, from care facilities to medical devices and pharmaceutical care, there are developments and technical/structural evolutions, as well as drastic new approaches and innovations.

Be aware of these changes, and tap into those markets and methods that represent sustainable and long-term opportunities, in order to achieve long-lasting and durable profits.

The following approaches are being implemented and or under discussion for application/expansion, shaping the geriatric care market now and in the future:

Market consolidation
  • Large corporations are growing in the geriatric service market due foremostly to consolidations rather than just creating new capacity. Large corporations are dominating larger shares of the nursing sector by owning and running multiple facilities. Nonetheless, some larger-scale homes have also been built in recent years.
  • Private owners operating various small-scale residential/nursing homes. Private owners show a preference for residential rather than nursing homes. (The difference between the two being that residential provides minimal assistance for daily living, and a nursing home is continuously available for supporting daily activities and tasks.)
  • In 2015, in the UK, around 63% of all elderly homes were owned privately.
  • Merger and acquisitions, such as Genesis Healthcare acquiring Sun Healthcare Group in 2012, further consolidate the market. This merger created the largest skilled nursing provider in the USA.
Preference of patients to receive home care
  • Home care is deemed safer, more personalized, cheaper, more dignified and better for the social fabric and families.
    • More than 20% of the elderly hospitalized (in developed nations/ medium-to-high hospital qualitative conditions) obtain an infection or develop other complications whilst in the hospital.
  • Home care markets are expected to see rapid growth; the patient as the client/consumer ultimately, voices a clear preference to sustain independent living as long as possible.
  • Home care markets are highly technology-dependent and a huge opportunity for medtech manufacturers/designers.
    • Approximately 74% of the geriatric population (60 years +) in Europe lives at home. This is equal to a potential client base of 130 m.
    • In North America, the estimate is around 75%, equal to a potential client base of 55 m.
    • Asia, housing the largest geriatric population by far, however only 27% of elderly live independently, equal to around 144 m.
      • There are great deficits of elderly residential and care homes throughout Asia, in part due to ongoing hc-system developments as well as the remainders of the traditional reliance on community/family-based support rather than institutionalized care. With the changing social structures, i.e. more women working and geographical distances between generations, there is a market gap and high market potential for all sorts of elderly care.
    • Post-surgery, long-term and chronic conditions are the most demanding/urgent home-care issues.
Moving away from medication to prevention
  • There is a systemic focus to invest into preventing physical and mental ailments, in order to lessen financial burdens of handling elderly conditions later down the line.
  • Though perhaps a less favorable turn of events for pharma who have large revenues from elderly medications, this is a fresh opportunity for preventative care providers, who can seek businesses in the form of physical and mental training services, activity-programs for the elderly such as daycare centers, commercial senior group activities/trips, etc.
  • This prevention approach/market is open to any other type of services yet to be invented, that stimulate community living, integration, mental and physical well-being, and relative individual autonomy for the elderly.
Payment approach switches from FFS to value
  • Public reimbursements across various HC systems are transferring traditional payment schemes from Fee-for-Service unit payments to outcome/performance-based, and quality-focused indicator schemes.
  • Forming partnerships across care types that reduce duplications of services, minimize unnecessary costs, where value is central.
  • Offering palliative and chronic care in home and community-based services; integrating care paths.
Voluntary work
  • The previous example of Hogeweyk works with voluntaries, and so do various elderly homes across the world, requesting support from voluntaries to help with social activities and excursions, etc.
  • The non-profit initiative Cycling Without Age, originating from Norway, organizes voluntary workers to drive elderly from nursing homes around on bicyles.
  • The NGO Amigos de Los Mayores (“friends of the elderly”) unites voluntaries with lonely, socially excluded elderly, who often suffer a slight physical incapacity aggravating their exclusion.
Innovative solutions, new care models
  • Robots for emotional and physical support
    • Conversational robots are already on the market, to promote speech and mental stimulation for elderly patients.
    • Robots are also programmed to encourage physical movements and mobility, instructing the elderly patient to perform certain exercises.
  • Hogewey/Hogeweyk nursing village in the Netherlands
    • An entire village-like living space where elderly patients suffering from forms of dementia are cared for in a community setting, where nursing staff are dressed like peer civilians, and the normality of daily life and independent living is fostered maximally.
    • Currently around 150 patients live here, and 250 employees work there.
    • The private group owning Hogewey is Vivium, with a 5% market share, obtaining a large share of their financing from public healthcare funds. They also work with volunteers and through donations.
  • Global Care Bank Schemes – earning and cashing “care credits”.
    • Time banking is a scheme were members can earn credits by helping elderly citizens. These credits can be given to elderly (care recipients) known to the member, or used for their own elderly care later on when they need it.
    • It combines voluntary work, self-help and community support.
  • Teaming up young and old populations :
    • Shared living spaces, where the younger counterpart extends some basic support to the elderly such as domestic chores, in exchange for cheap accommodation.
    • Via online teaching programs where recently retired, and or 60+ elderly, provide online teaching and education to younger generations, often from vulnerable situations.
In-demand sectors and trend drivers

The WHO has selected the following categories, in respect of the various areas where innovations are occurring, and trends are being generated, in regards to the challenges of our ageing population:

  • Community and home-based care
  • Fall prevention and mobility
  • Sensory impairment
  • Mitigating cognitive decline
  • e-Health and robotics
  • m-Health
  • Elder-friendly medicines
  • Social innovation for ageing and health
  • Tools for decision-making
  • Changing family structures

Market constraints

  • Affordability
  • Reimbursements/eligibility criteria to qualify for public and or private insurance funding.
    • Insurance coverage can limit the selection of reimbursed medication, reducing the extent of giving personalized drug therapies and restricting physicians from prescribing medication that is not covered by insurers.
  • A lack of reliable public information for nursing homes/residencies, and a fear of moving into a permanent residency and giving up the freedoms of independent living, hinder some elderly from moving to institutionalized care settings.
  • Stigmas around mental illness delay or halt elderly from seeking mental healthcare.

Opportunities

Other conditions, less frequently mentioned in geriatric market discussions, that are widely prevalent amongst elderly populations, such as depression, obesity, substance abuse (1/5 elderly estimated to suffer from substance abuse, particularly prominent are alcohol and tobacco), poverty and oral HC, also present areas where specialized attention is needed and gaps in healthcare markets are evident.

More opportunities include:

  • Medical devices – Creating valuable products for carers and patients
    • The following specialisms are growing the fastest and forecasted to have the highest medtech demand:
      • Neurology
      • Orthopedics
      • Cardiovascular
      • Pulmonology/respiratory diseases
      • Rehabilitation and post-surgery
      • Assistive devices
    • Furniture sensitive for elderly needs
      • A US study published 2017 reveals that over 20,000 nursing home residents throughout the US suffer serious facial injuries due to falling and hitting hard surfaces. Preventing these injuries through countermeasures, particularly in elderly-sensitive furnishings and room-layouts, is an immediate opportunity for designers. Complete post-fall recovery for an elderly person is often impossible, and lingering disabilities are common, presenting a further care burden and financial cost.
    • Devices that extent the quality of life, promote independent living, are user-friendly, etc.
  • Pharmaceutical sector – Elderly-appropriate formats and the complexity of multiple morbidities
    • The most common elderly ailments, such heart conditions, dementia, arthritis, cancers, respiratory diseases, osteoporosis, diabetes, influenza and pneumonia, along with other chronic diseases, tend to have a first line pharmaceutical treatment.
    • Providers catering to these conditions must be conscientious of elderly-specific pharma-related challenges, such as the patient’s capacity to adhere to prescribed dosages and the frequency of intake. Furthermore, there are elevated risks when handling multiple morbidities simultaneously. Of course, affordability of the medicine is another factor to consider.
      • A study dating 2015 revealed that 40% of medication-taking elderly in a Belgian nursing home needed to have their medication pulverized, as they were unable to swallow the pill-format that the medication originally came in. The staff took such steps without consulting the pharmacy or other pharmacologists.
      • Another study dating 2014, reports that within a sample population of elderly aged 70 years and older, 95% experienced one or more practical problem consuming their medication. (Problems range from the inner/outer packaging of the medication, to reading and understanding labels, preparing medication appropriately prior to consumption, etc.).
    • Pharmaceutical manufacturers focusing on geriatric markets can positively differentiate themselves by producing particularly elderly-friendly packaging and formats.
  • Robotics – For mental wellbeing and mobility
    • Robot markets for elderly care and assistance are forecasted to experience a massive boom in the coming years.
    • Robots/robotic purposes can be categorized in 5 wide segments:
      • Personal/engaging: for emotional and cognitive wellbeing, and to stimulate movement.
      • Physically supportive robots, strengthening limbs for example, for mobility.
      • Support for carers and practical issues: to relocate elderly, lift them into vehicles, upstairs, into bed, etc.
      • Robotic arms for surgical interventions and diagnostic devices
  • Collaboration with public and private insurers/market players – Qualify for reimbursement
    • With ever rising costs to maintain and continuously improve/upgrade facilities and care processes, paired with the fact that elderly’s pension plans are often insufficient to afford the care they desire (whether in nursing homes, or domestic care), it is crucial to have an understanding of the insurance situations for various types of care.
    • Either jump onto the well-insured programs, or lobby in the sector to obtain improved coverage for services that prove beneficial to healthcare’s affordability overall.
  • Shift to value-based – Who will supply the tools to achieve this?
    • Value-based payments use metrics and statistics/data collection to facilitate the identification of quality in care. Providers of IT solutions to serve such ends, that can consolidate and evaluate data based on where quality/value is generated, will be of great benefit and in high demand for performance-based payers.
      • Various states in the USA are rapidly gearing toward value-payments; e.g. New York, is aiming to base 85% of its Medicaid payments in long-term care on value by 2020.
  • Labour market – High demand for trained nurses
    • Worldwide nurse personnel growth has stagnated and there is a shortage of trained nurses to cater to growing elderly population, in all the settings where elderly are cared for (from home settings to institutional and or hospital care)
    • Nurse demographics are also ageing, and a wave of impending retirees will drive the demand for skilled nurses even higher in the next 3-7 years.
    • A survey dating 2014 in the US, reports that 25% of the sampled hospitals reported a nurse-position vacancy rate of 10% or higher.
    • Nurses are learning a wider range of medical skills, as physician/primary care shortages are also becoming more prevalent and nurses are often used to compensate for gaps in care.
    • There is a clear correlation between high nurse to patient ratios and improved health outcomes.

The message to be taken away from these articles is that the geriatric market is very large, dynamic, and dependent upon a wide diversity of services and medical support; solutions and opportunities are arising across all types of sectors, and payers are open for new ideas that create value and secure qualitative care for the elderly. Be conscientious of all the developments and demands of this rising care market, and optimize your solutions to address the challenges.

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About Laura Weynants

Performs primary and secondary market research to create Country Deep Dive Reports at TforG. Interviews KOLs and medical sector professionals to build on TforG’s healthcare market expertise and competence networks. Complementing five years of sustainability policy and CSR communication, she now focuses on grasping key medical market trends, structures and opportunities in medical sectors worldwide. Coming from an international background of living in Germany, Spain, USA, UK and Belgium, she has gained a keen insight in international organizations and language skills to perform first hand investigations. She graduated from Sussex University Brighton, UK with a BA English Literature and Sociology and achieved a Master Degree in Sustainability and Corporate Social Responsibility in EOI Business School in Madrid, Spain.