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U.S. versus European Views on Elder Care

Technology drives a wedge between opinions
By Patrick Pilch and Steven Shill

THE FUTURE of elder care puts patients at the center and is focused on maximizing independence and quality of life. The role of technology, though, will vary between both sides of the Atlantic, an international analysis by BDO found.

BDO’s “New Perspectives on Elderly Care”reveals that ways elder care stakeholders are preserving seniors’ independence varies by country. While U.S. providers are leaning on home health—and technologies like telemedicine, wearables and mobile phone apps that support home health models—European countries tend to lean more on the role of the family.

For example, in BDO USA’s “Candid Conversations on Elder Care,” 63% of healthcare companies said the greatest opportunities for tech disruptors to improve elder care by 2020 were in home health. And 93% said electronic or telemedicine capabilities could impact improving the quality and safety of elder care. Technologies like driverless cars, virtual reality and smart home tools can help mitigate social determinants of health by keeping seniors comfortable in their own homes for longer, connecting them with their loved ones more easily, and providing them with greater independence and mobility.

BDO’s international analysis, which in addition to the U.S., looked at data from Belgium, Bulgaria, Denmark, Germany, Lithuania, Luxembourg, Netherlands, Norway and the U.K., however, found that the key to preserving independence and mitigating social determinants of health may lie with seniors’ own familial units. For example, Denmark and Norway’s “culture of caring” emphasizes the family’s role in caring for their loved ones as they grow older. While tech may augment these efforts and cultural norms—especially smart home tools—tight knit families lead the effort. In contrast, many seniors in the U.S. live far away from their loved ones or relatives and must rely on video conferencing technology to remain in contact. For U.S. seniors, tech will be key to keeping them in contact with their loved ones, and tools like telemedicine can keep them in more regular contact with their doctors or care providers.

Patients at the Center
Both studies found that, like the broader industry, elder care will be increasingly patient-centric. This is largely because of changing patient expectations, and more emphasis placed on providers having end-of-life care conversations with their patients. Since an estimated 10,000 people worldwide will turn 65 every day over the next 20 years, there’s also increasing urgency to reduce cost and improve care quality in the face of accelerating demand.

PACE as a Model for the Future
Just 12% of U.S. providers say they’re planning to invest in the Programs of All-Inclusive Care for the Elderly (PACE) by 2020 to prepare for the growing aging population. But PACE has the potential to be one of the biggest opportunities for providers and investors alike. We believe PACE, and models like it, are the future of elder care– maximizing independence and offering flexible care options that can be customized to patients’ individual needs.

In New York state, the quality of health for PACE beneficiaries is about twice as high as that of other managed long-term care participants. In California, 2015 PACE programs generated 31% cost savings for the dual-eligible population compared to facilities-based care models, according to CalPACE.

An initiative like PACE is underway in the Netherlands, where a fixed amount is allotted to individual neighborhoods for the provision of local care. Health professionals in these neighborhoods are given free rein to consult with their clients and customize care accordingly. This freedom to customize care has led to new conversations between patients and providers about what matters most to them.

The Dutch program has also created greater senior independence: instead of having groceries delivered to elderly participants’ door, the program empowers seniors to do the shopping themselves. It has resulted in a 20% cost reduction and greater happiness among participants.

In the U.S. and Europe, the role technology will play in elder care may differ, but one thing is certain: the future of elder care is in models that prioritize senior independence and maximize quality of life.

Patrick Pilch and Steven Shill are national leaders of The BDO Center for Healthcare Excellence and Innovation. They can be reached at and at

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