There is a lot going on with Evernest that I want to share with you.
 
We are blown away and humbled by the number of you that have told us “Evernest is exactly what I have been looking for!” We are working harder than ever to bring Evernest to you as soon as possible. Here are some updates on our progress.
 
Design Progress and Request for Suggestions
 
We are finalizing the details of Evernest’s design and construction in order to meet our target of beginning production this summer. While our design and construction team has over one hundred combined years of experience designing healthcare and housing environments, we are always interested in feedback from customers and potential customers. Please send me an email or give me a call if there is a specific design element or functionality that would help make Evernest as perfect for you as possible.
 
Most of the customer feedback we have received so far has to do with caring for family members with Alzheimer’s or another form of dementia. This makes sense since more than 50% of individuals in long term care institutions like assisted living or nursing homes are living with dementia, and multiple studies indicate that individuals with moderate dementia experience higher quality of life scores and slower progression of the disease when they live in their own home as opposed to in an institution like a nursing home. The John A Hartford Foundation, a nonprofit dedicated to supporting family caregivers, surveyed people living with dementia and the respondents listed “supports to live independently” as one of their top needs. You can see the Foundation’s video of a “Living Well With Dementia” symposium on the Evernest Facebook page here:
 
https://www.facebook.com/MyEvernest/posts/2052616884958074
 
The practice among so-called “memory care” facilities of inappropriately prescribing psychotropic drugs to residents with dementia has increasingly come under fire of late, so there is increased interest in adopting industry best-practices for non-pharmacological interventions in dementia care. Some of the best practices that will be incorporated into Evernest include:

• Rights of the Resident: Allow residents to express their preferences by providing increased independence properly balanced with caregiver support.
• Appropriate Environment: Provide an uncluttered, quiet, safe environment with “context cues” as to what the behavior in the environment should be.
• Community Connection: Leverage Evernest’s placement in a real community to facilitate connection and interaction between resident and community-based resources.
• Caregiver Support: Use technology to provide caregiver supports that reduce reliance, fatigue, and isolation.
• Support Animals: Real and simulated support animals have a demonstrated positive effect on individuals with dementia, and Evernest is pet friendly!

 
Target Pricing
 
A top question among potential customers is “How much will Evernest Cost?”
 
In order to provide the safest, most flexible senior living solution possible we have designed Evernest with the same quality of construction that you would find in a licensed healthcare setting or custom home. Beyond ensuring that our residents are as safe and comfortable as possible, this quality of construction means that Evernest can be permitted and placed in areas that other “trailer-based” products like mobile homes are not allowed. Our unique design and construction method allows us to offer various size options as well.
 
Even with the additional cost of our high-quality construction, we are striving to strike the perfect balance between amenities and affordability. While we haven’t finalized pricing just yet, we have set price targets for two pricing options. We welcome your feedback on pricing, and if there is any way we can accommodate your budget while maintaining the level of safety and quality you expect and deserve we’ll make every effort to do so.
 

1. Purchase – Our target purchase price is $90,000. This price will include transportation and installation within a specified radius of our headquarters in Dallas, Texas. Our remote monitoring and communication service will be available on a tiered subscription plan. Additional features such as care concierge services and other specialized programs and applications will be available separately.
2. Rental – Our target monthly rental rate is $1,800 per month. This rental rate will include our remote monitoring and communication service as well as transportation and installation within a specified radius of our headquarters in Dallas, Texas. Additional features such as care concierge services and other specialized programs and applications will be available separately.

 
Evernest is designed to be easily transported nation-wide without special accommodations or exorbitant cost. If you are outside our free delivery area, contact us with your location and we can provide a customized transportation quote. 
 
Accessories like decks and ramps will be customized based on your specific needs and priced accordingly. Furniture can be provided at an additional cost as well.
 
As a reminder, we will handle all of the details of working with your local city, code enforcement, and contractors for permitting and installing Evernest. If you want to be sure that your city will allow Evernest, please let us know and we’ll research that for you for free.
 
Evernest Waiting List
 
We have not yet started accepting deposits or assigning delivery slots, but because of the volume of interest we have received we are starting to keep track of people who are telling us they are ready to “get in line”. If our production timing matches your need and you’d like us to put your name on the waiting list, please let us know so that we can plan production accordingly.
 
Exciting Medical Plan Changes
 
While Evernest is certainly an innovative idea in long-term care, the tide in the industry is continuing to make innovations like Evernest easier and more accessible.
 
Contrary to widely-held misconceptions, Medicare does not pay for long-term care. This means that your options for paying for help with non-medical daily living needs were your own pocket, long-term care insurance, or Medicaid if you’re in a nursing home.
 
Medicare recently announced exciting changes to its rules for the supplemental benefits that Medicare Advantage plans can pay for. Starting in 2019, Medicare Advantage plans will be able to pay for some non-medical in-home care as a supplemental benefit. These changes could make it less expensive for Medicare Advantage beneficiaries to stay at home longer with appropriate in-home care. 
 
There is already widespread recognition that providing supports that allow seniors to stay in a home of their own results in better health and lower costs for plans like Medicare and Medicaid. Lawmakers are increasingly acknowledging this fact and giving seniors more options to pay for care at home. Evernest is proud to be a leading innovator in helping seniors stay in a safe and supportive home near family rather than resorting to expensive institutional care.
 
Parting Thought
 
According to Dr. Alan Greene who looked at statistical safety records for hospitals, you are 47 times safer skydiving out of an airplane than being admitted to a hospital! I’m sure you skydivers out there take comfort in knowing this!

Ever Yours,

​Greg

“Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).”
-Medicare.gov

There are many reasons healthcare at home is just as effective as institutional care: a mobile workforce of skilled caregivers, advanced telehealth and remote caregiving technology supporting the caregivers, and happy patients receiving care where they most prefer to be. The primary reason that care at home is less expensive than institutional care is also its greatest opportunity: it’s an otherwise idle healthcare asset. The home can be furnished with the same caregivers, technology, and capabilities as specialized healthcare settings without the added cost of a separate, dedicated setting.
 
Much like sharing economy innovators Airbnb and Uber have leveraged technology to extract value from assets that would otherwise be sitting idle, mobile health technology is transforming everything from our watches to our workplaces to our homes into productive healthcare assets. Our homes have the unique opportunity to “disrupt” our entire healthcare system provided that they can accommodate an increasing level of caregiving and technology within. If they can, homes will necessarily become the healthcare settings of the future.

The term “disruption” gets widely invoked these days when any upstart company shakes up a market traditionally controlled by longstanding incumbents. The key to the principle of disruptive innovation however, according to the guys who coined it, is the transcendence from mere disruption to a sustainable innovation.
 
Our advanced healthcare institutions and their services exist to accommodate the most intensive needs of their most medically complex (sickest) customers. However, because the number of these customers is small, the cost of maintaining those resources must be spread across all customers. In other words, the majority of dollars spent on providing healthcare are invested in very expensive people, places, and tools that most of us seldom utilize but pay to maintain nonetheless. The commonly quoted figure from the Kaiser Family Foundation is that 51% of total national healthcare expenditure is spent on the sickest 5% of the population.
 
By prioritizing the needs of their few most medically complex customers, traditional healthcare institutions have left the door open to competitors who are able to offer a substitute product for less demanding customers at a lower cost. Healthcare innovators are capitalizing on this opportunity by offering a basic healthcare product at a low price (e.g. Minute Clinic at CVS), and then gradually moving upmarket to capture all of the market share that the incumbent provider leaves available to them (freestanding emergency departments). A more visible example is the evolution of Lexus versus Mercedes, which is the brand Lexus was designed to compete with head-to-head. The flagship Lexus LS sedan was half the price of the comparable Mercedes when it was introduced in 1989… today Lexus controls approximately the same percentage of the US luxury car market as Mercedes.
 
This is the “disruptive innovation” scenario, as originally defined by Joseph Bower and Clayton Christensen, which describes how tomorrow’s homes will capture increasing market share from our institution-based healthcare system. While care provided in the home today is largely a less expensive substitute for lower acuity post-acute and long-term care, the migration of care to the home will ultimately extend farther up the acuity spectrum. One Johns Hopkins study determined that 1/3 of seniors admitted to their hospital could have been treated just as effectively at home with fewer complications, lower rates of hospital-acquired infection, higher patient satisfaction, and at a cost savings exceeding 20%.

“The hospital as we know it will be on its way out.”
-World Economic Forum, 8 Predictions for the World in 2030

The healthcare industry’s response to the potential of in-home care can be seen in moves like Humana’s purchase of a 40% stake in Kindred Healthcare’s home healthcare business, CVS’ purchase of Aetna, and Walmart’s talks of a merger with Humana. Vertical integration of payors, providers, and retailers of consumer goods lets us know where those payors think the best value for their dollar will be in the future. Federal payors are getting on-board as well. Healthcare services delivered in the home and community now comprise the majority of all Medicaid long-term care spending, and home healthcare will be the fastest-growing category of Medicare spending by 2020. 
 
This makes sense when you consider that three times as many seniors get professional healthcare and supportive services at home as receive care in institutions like nursing homes and assisted living facilities. Another 20 million seniors receive some form of long-term care at home from unpaid providers like friends and family, and four million seniors live in the same home with family members who provide care. As the number of individuals requiring long-term care more than doubles to 60 million by 2050, the home will increasingly be forced to do double duty as a care setting.
 
Several healthcare industry verticals that support care at home are already experiencing tremendous increases in market share, but rapid growth comes with growing pains. Over the next five years the home healthcare industry is projected to have the highest compound annual growth rate of any industry individually tracked by the US Bureau of Labor and Statistics, but it is challenged by a shortage of care providers (a deficit of 335,000 by 2040 according to MIT). The remote patient monitoring sector is expected to reach over 36 million patients by 2020 as in-home care providers increasingly turn to technology to leverage their limited human workforce, but more than half of providers acknowledge that they are underinvesting in the technologies they will need to keep up with demand.
 
Professional at-home caregivers and aging-in-place technology providers alike acknowledge that their ability to operate effectively and scale efficiently is hindered by the variability and dangers of the home environments they operate in. Twelve million seniors are living alone in a home that is unmanageable and unsafe, and 90% of them reside in a different city than their nearest child. The all-too-frequent response to a family’s concerns about their loved one’s safety at home is a move to institutional care close by.

“The Medicaid system currently steers people toward nursing home care. Far more people can be covered in [home] care programs for significantly less.”
-Ed Rendell, Former Governor of Pennsylvania

While long-term care institutions like assisted living facilities are striving to integrate additional healthcare capabilities into their housing offerings, fewer than ten percent of seniors receive long-term care in institutional settings. As the entire healthcare industry pivots to person-centered care, the next advancement in care delivery is to bring institutional capabilities to individuals where they want to be (and most already are): at home.
 
The traditional housing industry has attempted to accommodate escalating demand for healthcare accommodations at home on several fronts. An estimated $30 billion annually is spent on home modifications for healthcare, including everything from grab bars and wheelchair ramps to complete ADA-accessible renovations. Developers are also converting multifamily communities and single-room-occupancy buildings into informal “village” healthcare models and seniors-oriented co-housing.
 
Other innovators are recognizing the economic and quality of life advantages associated with family participation in care and creating homes that accommodate multigenerational living on the same lot. A 2016 poll by the Scan Foundation determined that family caregivers preferred to provide care in their own homes to any other location, and a separate study found that 44% of surveyed homebuyers are willing to house their parents in their homes. Lennar homes, the largest homebuilder in the United States by revenue, has an entire line of homes that include a separate but attached dwelling unit that is universally designed to accommodate both families and aging residents in multigenerational households. These NextGen homes have seen near 100% annual sales growth since their introduction in 2011. 
 
Another innovation that delivers the advantages of family-supported care but with the added flexibility and independence of separate living spaces is the Temporary Healthcare Structure (THS). Temporary Healthcare Structures are standalone dwelling units that are placed at the home of a caregiver providing care for a family member. Occasionally deridingly called Granny Pods, THSs are much more than just a cute cottage for aging parents. They offer several benefits beyond the convenience and cost savings that come from having family next door.
 
The THS’s greatest economic advantage is in avoiding unnecessary institutionalization. Up to 100,000 seniors are unwillingly moved into expensive institutional care every year simply to ease the minds of family members. THSs are outfitted with features like activity and vital signs monitors, telehealth technologies that facilitate remote diagnostics and care coordination, and ambient ADL supports that reduce caregiver load around activities like bathing, scheduling and medication management. This technology promotes the independence of the resident while keeping families and caregivers continually updated with actionable health information that reduces unnecessary worry.

“Sick people, particularly those with serious conditions, greatly prefer the company of their friends and family to residence in a hospital or nursing home.”
-David Mixner, Healthcare Activist

A second benefit unique to Temporary Healthcare Structures is their ability to rapidly deploy almost anywhere. A frequent topic of discussion around addressing the social determinants of health is access to care and the “care deserts” in rural areas of our country. As rural healthcare providers struggle to survive, the 16% of our country that is 30 miles or more from institutional healthcare needs a care solution that is both economical and flexible. THSs leverage the close family networks that commonly exist in rural areas and deliver the advanced monitoring and diagnostic tools that are lacking. As the cost of care interventions increases with distance, the value of accurate predictive analytics leading to effective care interventions is multiplied many times.
 
Perhaps more important than improving access and affordability, another extraordinary benefit of Temporary Healthcare Structures is the demonstrated health benefits of the self-reliance they foster in residents. By allowing residents to maintain for a while longer the independent lifestyle they prefer, the residents don’t exhibit the mental and physical degradation that too commonly occurs with institutional care. Proximity to family is also demonstrated to have a profound positive effect on health outcomes. Older adults who have frequent contact with family have markedly lower rates of unnecessary institutionalization and hospital admission, and post-acute patients discharged to a home where they live alone have a 50% higher 90-day readmission rate than patients who live with family. Residents in THSs do not suffer from the same levels of institution-acquired infections, insomnia, malnourishment and dementia associated with institutional care. 90% of older adults prefer a home-like setting to institutional care, and THSs give them the social and technological support they need to live where they want and enjoy improved heath at the same time.
 
Recognizing that facilitating person-centered care in low-cost settings is good for patients, families and payors like state-funded Medicaid waiver programs, five states have passed laws that compel cities and local jurisdictions to allow Temporary Healthcare Structures and to expedite approval of compliant permit applications. As the healthcare capabilities of THSs are demonstrated and the regulations surrounding the use of THS are streamlined, expect more states to follow suit. Providers who manage Bundled Payment for Care Improvement programs will also look to THSs as part of a post-acute network solution to move patients to home without the need for intermediate care. Much like ambulatory surgery and home healthcare before them, THSs will be a disruptive innovation that ultimately proves itself as the accepted setting for much of the care that occurs in institutional settings today. The future of sustainable person-centered healthcare depends on it.