My Shared Vacation

I just came back from vacation. My boys had a week left before school started; my wife had too much work to do. I figured it would be nice to take them north.

Apartment in Boston

My brother and sister-in-law were spending two weeks in Kennebunkport, ME. I only could spare two weeks and didn't think my children could tolerate a Maine beach (I was right). We decided to fly into Boston, spend a few days there and then head to Maine. I get nervous staying in hotels in old cities. I often discover, at an inopportune time, that the room is MUCH smaller than I had expected. Earlier this summer I went to San Francisco for a meeting. I stayed at a lovely hotel, but the bed was very small, and there was very little room to navigate around this bed. To accommodate the small space, the TV was mounted to the ceiling.
That didn't bother me much, because I was alone. This time, I would be with my three boys and I couldn't afford to be in cramped surroundings.
That's where "Sharing" came to the rescue. I found a terrific two bedroom apartment. It was bright and spacious. It had decks at the front and rear of the apartment and included parking. My kids had enough space that they weren't on top of one another.
We left for central Boston on the "T" (Boston's subway) Unfortunately, the line was down and a bus took us along the route. We wandered throughout the town until we were completely worn out (Boston is a great walking city) We didn't feel like dealing with our dysfunctional subway situation (weekend rail work) and took advantage of Lyft as our method of transportation. Each Lyft driver was pleasant and described a company that paid them quickly and fairly. Each driver was working the hours that worked for them to supplement their other income sources.
When we finished our time in Boston, we headed to Kennebunkport where we stayed in a beautiful 4 bedroom home. It was far better than a hotel room. We had a big family barbeque for our extended family and invited some friends. The house we rented was interesting. The back part of the house was converted into guest quarters and the owners were living back there. They were very happy to have the additional income stream and were using it to purchase another property in Florida. There are many people who attack the sharing economy. I can only tell you that I had a wonderful vacation through the advantage of sharing and, my hosts, drivers, etc. seemed very pleased with their benefits.

Introducing, the Shared Aide. The Sharing Economy Answer to Home Care

Last month, there was a nice article about Room2Care in the Miami Herald.  In that they discussed a product line that we hadn't started offering yet called the RoomAide.  A RoomAide is an individual who will move into a senior's home and provide some support.  They live there rent free and can provide services on an a la carte basis.  The feedback on the plan has been terrific and I'm working on the software.  Somehow, after the article, I received an email from Stan who wrote "Room2Care seems to have been written especially for us. I am 81 and my wife is 76...We have no one to help with the little chores around the house which we share with a friendly, thirty pound Cocker Spaniel who loves everyone, but can't take out the garbage. Jolie (her name) goes out to the fenced in yard and runs around the pool. I can no longer take her for long walks because I have two bad rotator cuffs and a bad back. My wife (Jennifer) also has severe back problems that limit her movements..."
I thanked him for his email and promised to get back to him as soon as the software was complete.  Unfortunately, unless you're Google, software always takes a bit longer than planned and I'm clearly not Google.  But it bothered me.  His story was frustrating because I knew we could help.
A few days later, at a tech conference, I met Alex.  Alex is a bright young programmer who had moved to Miami a few days before and was sleeping on somebody's floor in Hialeah.  He was an enthusiastic person who when I showed him Stan's letter he exclaimed "Free rent to take out the trash!  Where do I sign up!"
Well, I would like to introduce to you our first RoomAide relationship. Alex will start running with the dog.  He's going to help Stan with some computer issues.  I'm hoping Stan will teach Alex about archeology (he's a retired Middle East archeologist).  Maybe Alex can write an app that helps field archeologists.  Who knows?  What's important is an entirely new type of relationship is arriving in the sharing economy. I hope both of them will post to our Facebook page and we can see thing evolve. 

Who Are These People?

 Ever since we started Room2Care.com, I've been asked "Who are these people?"  "Who would want to take care of another human being?"  "Is it safe?"
We seem to worry about safety all the time.  I'm not saying that being safe is bad, but in our concern about "safety" we often cause more harm.
I am criticized by other parents because my kids ride their bicycles around the neighborhood.  "It's not safe."
I reply "I did it when I was a kid."
"But these times are different.  You can't do that now."
So, because of parents' concerns for violent crime and kidnapping, their children grow up as caged birds. But, here's the thing.  They're right.  Today is not like it was when I was a kid.  It's much less dangerous.   You read that correctly.  Contrary to the perception of suburban parents, our children's world is far less violent than ours was.

How is that possible?  Didn't Fox news show me another little white girl kidnapped last week?  Haven't I seen buildings set on fire?  You don't need me to tell you about the effects of the 24 hour news cycle and the need for total sensationalism.
So what does this have to do with people's concerns about the Room2Care.com caregivers.  Let's start with a change in perception.  These are people who are largely caregivers, but are unemployed or under employed or people who truly feel that helping another is doing God's work.  They are special, special people.  Can I promise that there are no bad people?
Look, we put everybody through the same screening that every facility put their people through.  The same background checks.  We even put the senior through a background check.  Yes, Nana and PopPop have to have a clean background before they can take part in Room2Care shared senior living.  It may seem extreme, but I don't think anybody should be living with a retired rapist.
OK, so everybody's background is clean.  That puts us at the same level as hospitals and nursing homes.  What was the experience of the last seven patients that a particular nurse saw?  You don't have any idea.  You don't have a choice.  If they do a poor job does anybody know?  Probably not.
Like every other entity in the sharing economy, EVERYBODY gets reviewed at all contact points.  If you didn't like a home, tell us why.  If a caregiver felt that a senior was rude or needed more care than they claimed, we want to know.  Everybody gains from this transparency.

We have devised several additional methods to make for a successful experience.  Care-Escrow is an escrow account that allows a senior to end the relationship by the midpoint of their care.  Caregivers are not paid until you are satisfied. Our hosts cannot take long term assignments until they have successfully navigated short term stays.
I think it's important that each of these individuals becomes a small business owner.  You are dealing with the owner, not an employee.  We all know how much more accountability exists when someone owns something.
If you add in our social worker support and the optional use of surveillance cameras, I don't think the questions is whether Room2Care is "safe."  The question becomes "when will facilities catch up to us?"
But please remember, you may like one host/caregiver more than another, but each of these small business owners is a special, special person.

Don't Judge a Book by its Old Cover

When I was a medical resident, I lived in a cool rental community in Ann Arbor.  It was filled with young physician, nurse and other young professionals.  It had a real Melrose Place feel.  There were just more of us than there were on the television show so we didn't have to keep dating each other.

In the midst of that hormone fueled housing lived Betty.  She lived across the courtyard from me. She was a 91 year old retired school teacher from Buffalo. I have no idea how she ended up there, but she was a great lady who watered her flowers and kept an eye on the complex while we were all at work.

One day I helped Betty carry in her groceries. There on her table sat a macintosh computer.  You have to remember that this was around 25 years ago.  It had the cut black and white screen and was connected to the telephone line.

"Betty, you have a computer?" I asked incredulously.

"Oh, of course.  I love it.  I play card games during the day and I send emails to my grandchildren."

Bear in mind, this was made Betty a very early adopter in email.

"There's one thing I need to do.  On account of my arthritis, I can't grip the mouse, so use the rollerball."  There, beside her Mac, sat a large plastic ball device.

I was fascinated by the clever adaptation that this elderly woman with twisted hands had made.  This simple change allowed her hours of entertainment and easy communication with distant loved ones.

A few years ago Mia came into my office.  Mia is a cool lady.  She's a writer who now paints. Her love is painting of dogs. (I have one of my mutt, Finn)  She came in with her walker.  Her walker had two adaptations.  It had the tennis balls on its feet and it had a pouch along the handles that held a Kindle.  Did I mention that, at that time, Mia was 99 years old.  "I love my Kindle!" she exclaimed, "I can have all of my books with me all of the time.  It's light weight and I can make the print as big as I want."

Since that day I get frustrated with every iPad ad that focusses on attractive young men and women.  The kids will all have devices and they'll be fickle.  But I promise you that Mia stayed in her Amazon ecosystem for the rest of her life.  Seniors may need a little more hand holding and salesmanship, but the rewards are transformational.

Having developed a web based platform for seniors (and/or their loved ones) to manage their care needs, I am often amazed by the gross ageism that I am greeted with.  "You don't expect a senior to do this," I'm told.  Those who underestimate the sophistication of seniors, who will only grow more and more tech savvy are destined to miss out on large profits and the opportunity to change lives.

How Many Mitzvah Points Does it Take to Get into Heaven?

For those of you who didn't grow up jewish, or surrounded by enough jews to make an impact, lend me your ear.  The rest of you, bear with me a moment.  A mitzvah is technically a commandment.  There are more of them than the 10 that Moses came down with.  In fact, the Talmud refers to 613 in the bible.  I'm more interested in the more colloquial term for mitzvah, that of a good deed.  It's not any simple good deed.  It's a good deed which takes on an air of holiness.
In college, I was randomly assigned an orthodox roommate one year.  He had a funny way of saying "I wonder what the school in the college football game is..." to try to get you to turn on the television so he could watch TV during the sabbath.  Any time that I did something nice for him, he would tell me that I earned some "mitzvah" points.
I liked the idea of a scorecard of holiness.  So much so,that, years later, I trademarked the term.  I still don't know what I'm going to do with it, but I like having it.  I'm hoping that if we can put together this holiness boxscore that people's competitive streaks will take over and they will do more good things.  But can it really be a good thing if you're doing it to beat your sister-in-law?
As we have been setting up Room2Care.com, we have found that people want to care for others.  There are many people who obtain a meaning and satisfaction from aiding someone else.  When I encounter that, I feel small. I want to make this caring contagious.
So how do we score it?  How many mitzvah points is making dinner worth? Helping someone get dressed?  Giving your brother a kidney? (I hope that's worth more than making dinner) I want to see people competing on Facebook to see who has the most mitzvah points instead of the highest level on Candy Crush.  Any maybe, once we've crushed the numbers, we will know how many mitzvah points it takes to get into heaven.

Is It Safe?

It's funny.  I'm a physician who has done thousands of invasive procedures and each time I perform a procedure, I have a conversation in which we discuss the risks and benefits.  There are always risks.  The insurance industry understands this.  The financial managers understand this, but sometimes, it seems like America doesn't.
Last night I barbecued steak.  I watched my youngest son cut his steak (he's really not very good with cutting) and made sure that he cut the pieces to a small enough size.  Later, one of my older sons grabbed some steak after a lacrosse game.  I was in the kitchen and heard him choke.  I ran towards him to do the heimlich (I've never done it in real life and NEVER wanted to do it on my child) when he coughed up a large piece of meat.  Did I have a discussion with him about the risks of eating, but 2500 people die each year from choking, only 200 less than die from fire. We drive to work (42,000 deaths per year) and, in Florida, go swimming (2,000 deaths per year)  Risk is all around us.
Now, I hear concerns raised about the safety of sharing economy services like Uber, Airbnb, and my company, Room2Care.  Who are these people providing these services?  Who was the guy driving the taxi who picked you up when you lifted your arm in the air.  Because Yellow Cab hired him, I should accept that he is somehow better than the next guy?  The next guy has reviews.
I used to be afraid shopping on eBay.  Who are these people?  I'd rather go to the little store near me.  Over time I realized that I have no idea what the last customer in that store felt about his shopping experience, but I can see, in a simple dashboard what the last 5,000 people felt about this operation in China that sells iPad chargers.  The guy in China has 4 1/2 stars.  Is he really riskier than the local store.
At Room2Care, we background check all care givers and all care recipients.  Everybody reviews everybody else.  Who is the night nurse at the hospital?  Do you know what her last ten patients thought about her before you let her in your room?
While there is risk in all activity, it is essential that any company that is looking to establish a brand that you trust do everything possible to minimize your exposure to risk.  And remember, little pieces of steak are best.

Trust Me, I'm Trustworthy

As a founder of a tech startup in the sharing economy (Room2Care.com), I have preached from honor and integrity from the onset.  In establishing a new marketplace for senior care, it is essential that seniors and their families trust us.  Now, if you have ever spent time with me, you would know me to be obnoxious, arrogant, sarcastic, determined, dedicated, kind, intelligent and HONORABLE.  I've told people for years that one of my major hopes is, that at my funeral, everybody agrees that I was an honest straight shooter.  I have my flaws, but lack of transparent honesty, is not one of them.
So, I, as a founder, have managed to acquire a reputation for trustworthiness.  How do I get a similar reputation for my company?  I pulled up a Forbes Article that looks at the most trustworthy brands.  The top brand on the list was Johnson & Johnson.  Sure, I like baby powder as much as the next guy, but interestingly, I'm a lifelong Jets fan and Woody Johnson (of Johnson & Johnson) is the owner and he has been far below the level of trustworthiness that I strive for.  Number 2 on Forbes list is General Mills, the maker of Lucky Charms; a company that has sold us on feeding sugar to our children. Three is Google, but, am I the only one nervous about how much they know about me? In fourth place is Kraft Food, maker of Oreos and that strange cheese.  Do we know what that white stuff in Oreos is made from.
As I go through the list, I guess that the key point is that the trust worthy companies are those that have been around long enough or have been big enough that almost everybody has interacted with them and hopefully did not have a terrible experience (sorry AT&T)
I guess that Room2Care will have to grow our trustworthiness, the same way that I have, one honorable interaction at a time.

A Note to Taxis, Stop Suing and Start Innovating

Last blog, I ridiculed  Christopher Davis, CEO of Professional Chauffeur Transportation Services for their suit against Miami-Dade, Uber and Lyft.  I found Mr. Davis pathetic in his attempts to claim that he had to stop these renegade services for the good of mankind.  Well, as pathetic as Mr. Davis is, I felt sorry for him. So, I decided to give him some advice.
First, stop.  Please, I'm begging you, stop.  Stop pushing for regulation.  Push for deregulation.  Uber and Lyft have created an advantage by calling themselves "ride sharing" and not taxis.  I don't understand the difference either.  Instead of pushing to regulate, push to deregulate. Taxis are required to charge pre-approved prices, Uber can be creative and raise and lower prices depending on demand. With the competition coming from ride-sharing, there is no need for regulation.  Get rid of it and compete.
Copy the surge pricing model.  There's no reason that there shouldn't be peak and off peak pricing.  Hotels, airlines, even baseball games and broadway musicals do it, why not taxis. Be creative.  Maybe allow people to bid on taxi fares. And please, Mr. Davis, feel free to market yourself.  You claim your drivers are more experienced.  Market it.  Explain the advantages.And, for goodness sake, get a damn app already.
Regulation is reasonable when there is no competition.  When competition exists, strip away the facade and let price and innovation win.  Please Mr. Davis, fire your lawyers and hire some app developers.  That will show me that you actually care about the public good.

When at First You Don't Succeed...Sue! Uber, Lyft and Class Action

Well, welcome to Miami, the magic city.  It must be magic because we're trying to make innovation disappear.  Yes, I'm being a little difficult.  It's not Miami's fault that Christopher Davis, CEO of Professional Chauffeur Transportation Services has sued Miami-Dade County, Uber and Lyft on behalf of all for-hire transportation companies in the county and "the public at large." Well, Mr. Davis, please leave me off of your list of coplaintiffs.  It's not difficult to see what's going on here.  The established companies have created a series of obstacles to make competition difficult to preserve their monopoly powers.  Listen, I get it.  If I had a monopoly, I'd want to protect it as well.
We like to claim in this country that we are pro-market, pro-competition, etc, but, in reality, we set up a bunch of barriers so that the old guard can scream foul! Why are Uber and Lyft growing rapidly?  Is it because customers hate their service and feel that the Taxi medallion is a better way of judging the vehicle than the last 200 reviews that the driver and his car received?  Is it because people prefer to pay more money for a service that is less customizable.
Mr. Davis, please spend your money making your services competitive.  Please do not hide behind arbitrary standards that your monopoly helped pass as if that is something demanded by the public good. I'm all for you competing on the same turf as your competitors.  If you feel that your "background check" is better than the competition, advertise that and see what the market says.  Don't waste my time with your pathetic suit against "rogue companies."
Why do I care?  As you may know, Room2Care is to Long Term Care what these companies are to transportation companies.  We leverage the sharing economy to provide accountable, affordable senior care.  I am waiting for Mr. Davis' equivalent in the Nursing Home industry to take the same swipe at me.  So, I'm hoping that Mr. Davis loses and that competition and "the public at large" win.

Go Easy on Uber, It's the Future of Senior Care

Several years ago, my father was at Lenox Hill Hospital, scheduled to undergo urgent surgery.  I quickly arranged a flight to New York and grabbed a taxi from JFK Airport.  My taxi driver had never heard of Lenox Hill Hospital, but he called someone who knew where it was.  He was eating food native to his Pakistan.  He was eating and talking on the phone when he failed to see the car in front of him break.  We slammed into the car in front of us and were then promptly rear ended by the car behind us.  I felt liquid on the cabin floor by my shoes and quickly surmised that we had ruptured our gas tank and would soon explode.

As I waited for an opportunity to escape "death-cab," I put my finger in the liquid and smelt it.  It did not smell of gasoline.  My driver, Farooq, saw me smelling the fluid.  "Oh, it is my water that was spilled."  Sure enough, my cabbie had about a 2 gallon bottle of water in his front seat that had flipped over.  "Oh, my friend, when the police come, please tell them that the horrible man in front slammed on his brakes and there was nothing I could do."

Fortunately another taxi came for me before there were any required statements.  I left my name and number and was able to get to my father.  I think about this as I hear about Uber's issues.
It's funny.  I am a New Yorker.  If you want to know where the new immigrants are coming from this week, take a cab.  You will learn the new immigrants, where the eat, what radio stations they listen to, etc.  It's always been a great piece of the tapestry of New York.  But the notion that these individuals who come from a land before stop lights represent the safest approach to urban transportation is absurd.

I think about this as I watch another new attack on Uber on an almost daily basis.  Sure, Uber's management has been aggressive, rude and probably unethical, but they have created a transparent, efficient system that has exceeded customer expectations and created a superior experience.  Why are we seeing such pushback.  They say a picture is worth a thousand words so here's the picture.

It's pretty easy to see that this is BIG business and that Uber and Lyft have begun to have an impact on this.

I mention this because, despite the limitations of taxis, I never had a huge problem getting one.  Ya, at rush hour when it rained, or on broadway right when the theaters all got out, but, by and large, not much of a problem.  At Room2Care.com  we're using the sharing economy to provide something that the American Long Term Care industry, a $300 billion industry, has failed to provide safe, accountable, affordable senior care.  Think about it.  I had no idea when I got into that taxi who my driver was.  Now, when I enter an Uber vehicle, I have the advantage of reading reviews on my potential drivers.  Trust me, the people working in long term care are low wage individuals who have very high turnover.  You never know who will be taking care of your loved one.  Compare that to Room2Care.com where prescreened caregivers work as their own small business.  

So, go easy on Uber, they are leading the way and the end result will be better for our seniors. 

Time to Care for America. New Approaches to Our Senior Surplus

My niece is a part of "Teach for America." It's a national teacher corps of recent college graduates who commit two years to teach in under-resourced urban and rural schools.  It's a fantastic program.  She is receiving wonderful training, and scholarship funds for graduate school.  I just finished listening to a podcast (Stanford's ecorner) by Jennifer Pahlka about "Code for America."  It's a neat program to encourage coders to work for little money and code for government.

Listen,  I love teaching and I love tech.  We need teachers and we need for our civic institutions to have better software.  But, what we really need is "Care for America."

Care for America is a program that I've just made up.  Being something that I just made up, the details need to be fleshed out.  We face a care crunch.  Between 2000 and 2030, the number of Americans greater than 65 will double.  The number greater than 80 will triple.  Mathematically there will be an increase in potential care givers of only 25%.  We can't simply put these individuals in nursing homes.   Just imagine what will happen to our state coffers when we have the recession of 2025, but Medicaid is paying for three times the number of nursing home beds.  It will be disastrous.

I am the founder of a company who's entire business model is based on these mathematical facts.  Room2Care.com is the innovative leader in Shared Senior Living.  By leveraging the sharing economy we are pairing up individuals with extra space and time with seniors who need some care. But, even an innovative, affordable senior care, like Room2Care will not be enough.

It is time to take our young men and women and create the Care Corps of "Care for America."  We will take ambitious high school graduates and provide basic training to allow them to check on some of Medicare and Medicaid's high risk patients.  They can be the boots on the ground that make sure that a heart failure patient checks his weight and that a diabetic checks their sugars.

We will soon have bluetooth enabled mobile devices that can provide almost all of the information of a modern ICU.  Now, there will clearly be roles that will require fully credentialed visiting nurses, but to collect the relevant data to allow for remote medical management will not require the training of a Registered Nurse.  Sure, they can supervise Battalions for the Care Corps, but it should be young men and women who will be the boots on the ground in this battle.

They will gain scholarship money and experience.  We will gain a more connected youth.  When they choose medical professions they will have a much deeper understanding of the impact involved.

We face a crises.  The ways that worked in the days of dial phones and AM radio will not be sufficient.  I truly hope that our elected officials will show us that the "Care for America."

What About Special Training? A Marketplace View of Shared Senior Living

If you've been reading any of my writings you've learned about Room2Care.com.
 Room2Care.com is a startup that is taking a new look at the senior care space.  We understand that many seniors need additional support and cannot continue to live alone in their homes.  Sure, there's the traditional method.  Let's burn off all of Dad's assets and then send him to a medicaid financed nursing home where he will be "cared" by someone.

Look, nursing homes are important and given the costs, we should be grateful that there is a program to help with them.  However, I feel the same away about financed funerals. Great to have, just let's wait a little bit for that.

We are creating a new approach; Shared Senior Living.  What's that?  Think Uber or Airbnb for long term care.  We connect seniors with individuals who have extra space in their homes and the time to provide basic care.  We are also connecting seniors together to be roommates and will be starting Care-Aids that will seek to place young men and women into seniors homes in exchange for free or markedly reduced rent in exchange for basic care.

Now, everybody in this in background checked.  But, I often am asked about specialized training.  Most seniors are cared for by their husbands, wives, sons and daughters. Most care isn't about training.  It's about caring.  It's about checking in on someone and making sure that they've taken their medicine, eaten their dinners, bathed, etc.  None of those tasks require nursing school.  Look, there are people with diabetic ulcers who will need specialized care (as a note, our Care-Commander makes ordering such care easy) We provide on-line information for support.  They are the interpersonal equivalents of "use two people to carry this television" that you see on the giant boxes at Costco.

But, we are actively recruiting nurses (active and retired) and other professional caregivers as host.  I do not think that "training" is necessary, but it is desirable.  We will encourage these hosts to state "Retired Nurse with sunny bedroom."  The free market will determine if there is value to being a nurse in these settings.

Another question I get is "who are these people?"  My response is when you go to a facility, or call an agency, who are those people.  They come, work their shift and leave.  Each Room2Care host is a proprietor who will develop their own online reputation.  Who are you paying more for? A 5 star host or a 2 star host.  I hope you will stick around to see the answer. Transparency and the free market will provide the answer and help solve the expensive care burden that we face as a nation.

Give a caregiver a break. Put mom in our home.

Respite Care

Years ago, when I was a medical resident and then, later, as faculty, I would face an uncomfortable situation.  The VA hospital had a small emergency room.  Not infrequently, a family would bring the elderly veteran to the ER with a nonspecific complaint.  We would do some tests and, when we went to report our findings, the family was nowhere to be found.  This happened commonly enough that we had a name for it.  We called it a "Pop-drop."

I was very critical of these families.  How could they take a loved one and just leave him for a few days or weeks.  It was cruel.  It was inappropriate.  It was...human.

As they years have gone by, I've discovered that watching over a family member is difficult and, just everybody else, caregivers need a break.

Unfortunately, there aren't many things that people can do.  You can hire an agency care giver for about $20 an hour.  So, that's about $500 a day.  A little pricy for most.  You can get another family member to take your mom or dad.  And, finally, the "Pop-drop;" the senior equivalent of leaving a baby in a basket with a note.  Sadly, these options are quite limited.  If you have another family member who can take over, that's ideal, but given how few people have one dedicated caregiver, the number that have multiple is quite small.

Fortunately, a new option now exists.  Room2Care.com is the leader in Shared Senior Living.  Before going away, take a look at the homes in your area with a host who can care for your loved one.  Let mom and/or dad stay with them for the weekend.  Since these are people living in their homes, they are already there.  You do not need to pay them the exorbitant fees associated with care aids.  These people have been background checked and cleared.  Many have reviews written by or for others who received care.  With all new services, it's a little scary.  Remember how scared you were the first time that you left you child with the babysitter?  Check it out.  When you need a break, dropping mom off at a Room2Care.com community home surely beats leaving her in an emergency room.

Take a look at how Room2care.com views respite care.