This article first appeared in TechCrunch.
The world’s population is aging, but the needs of elderly people are still being underserved. A United Nations report found that older people make up more than onefifth of the population in 17 countries, and by 2100, a majority of the world’s population, or 61%, will be aged 60 and above.
One of the most urgent needs for families is caregiving, with demand outstripping the pool of qualified providers. This means many people in their thirties and forties are now part of the “sandwich generation,” juggling jobs and child care while looking after elderly relatives. This creates both an opportunity and challenge for tech startups and investors in almost every market around the world.
In Southeast Asia, Homage is addressing the issue with a platform that takes a curated approach to pairing caregivers and families, using a combination of in-person screening and its matching engine to make the process more efficient. Currently operating in Singapore and Malaysia, the startup announced earlier this year that it will use its Series B funding to expand into five new countries in the region.
Backed by investors, including HealthXCapital, Golden Gate Ventures and EV Ventures, Homage was co-founded in 2016 by chief executive officer Gillian Tee, who grew up in Singapore and was inspired by her family’s own experiences looking for caregivers. Tee says she wanted to build a platform that would make the process of matching caregivers and clients easier, and be scalable into different markets.
“It’s not the easiest space to be in, and I would say that you do need to want to be intentionally working in this space, rather than just falling into it. It goes hand in hand,” she told TechCrunch. “We found that there is a huge market opportunity, but why we’re doing it goes way beyond that.”
How Homage addresses the talent pool shortage
Seemant Jauhari, a partner with HealthXCapital, said “Asia has about 60% of the world’s population, and a significant section of that is turning more than 60 years old. There needs to be consistent, quality services to take care of them. In Asia, there is a huge gap in the number of people who need services and what is out there.”
Because the need for eldercare in many markets is quickly outpacing the growth rate of qualified caregivers, tech companies like Homage can help more people get help sooner and faster, while keeping costs affordable, he added.
In many Asian countries, caregiving has traditionally been the responsibility of relatives, especially women. But social and cultural shifts — for example, more people living away from their families, the increase in dual-income households, people deciding to have children later and lower birthrates — means that more families are balancing jobs with caring for children and elderly relatives, and desperately need outside help.
“The burden of caregiving becomes overwhelming. This is of course anecdotal, but then we look at the macro trend that’s happening,” said Tee. “The dependency ratio is an inverted pyramid where the family unit is shrinking and people are having less children.”
Many countries also face shrinking talent pools. In Singapore, a study commissioned by the Lien Foundation, a philanthropy focused on seniors, children with special needs and low-income households, found that barriers to increasing the number of skilled caregivers included low pay, few opportunities for career advancement and long working hours. “There is a huge need to mobilize, grow and professionalize caregiving, because a lot of the needs are actually non-medical,” said Tee.
“Something I say often, and I’ll be very open about it, is that if you have three or four years of caregiving experience taking care of someone with chronic illness, and you have the motivation for it, you might be a better caregiver than a nurse who has trained for 10 years, working in an ICU for example, but is not motivated to deliver care for someone who is disabled or elderly,” she added.
Understanding what clients and caregivers need
Homage’s matching engine and other features, which include compliance tools for managing information about licenses, background checks and other important documentation, are key to its ability to scale while maintaining a sustainable business model.
Before adding them to the platform, Homage interviews and screens caregivers. Then it builds a profile for each one, including details like their training and what kind of manual transfer techniques they can perform, because a lot of caregiving involves helping patients move around. Homage’s matching engine uses that data to create a shortlist of caregivers for clients, and the final assessments and matches are done by Homage’s team.
Homage pairs caregivers with families depending on their experience and qualifications, and providers on its platform offer services ranging from part-time assistance with daily living to long-term care and rehabilitation.
Because some families only need a few days of care, Homage’s platform manages providers’ availability, while also scheduling rest days. Tee said it is important to not only make sure caregivers’ time is utilized efficiently, but ensure they are placed in jobs that match their abilities to avoid burnout. The company also works with health organizations to provide continuing education for caregivers on its platform.
For many families, finding a qualified caregiver usually means relying on word-of-mouth referrals. But that often slows down the process, and Tee said many families also don’t understand exactly what a caregiver needs to be able to do. They may not understand exactly what their relative needs, or the different kinds of qualifications, training and abilities caregivers have.
“A family member might suffer a stroke, and you have no idea how to vet for this person, whether they’re good or not, so it’s kind of a wild goose chase,” she said. “It becomes cycling through caretakers, vetting them, and that experience is quite common.”
Tackling market fragmentation
To decide which Southeast Asian countries it will expand into, Tee said Homage is examining factors ranging from the affordability of care and financial support available to families, to population size and density. While families around the world face similar challenges, each country has different structural challenges to solve.
“Generally speaking, we are really interested in developing markets because a lot of the solutions are very ad hoc in structure,” she said. “There is no proper standardization of care, and the professionalization of long-term care, or what we call step-down care, is lacking.”
Homage prefers to work with governments because many are also trying to understand how to care for ageing populations, and cope with related economic issues, like absenteeism costs as workers take time off to care for relatives. For example, in 2012, Singapore created the Ministry of Social and Family Development, and there are calls for it to launch another ministry focused on elderly people. Other countries with similar government agencies include Australia and many Scandinavian countries, and more may follow suit.
In many markets, infrastructure for long-term care not only needs to be developed, but awareness of the support systems and funding available for families needs to increase, said Tee. Many families are either unaware of the services available, or face bureaucratic bottlenecks when trying to take advantage of them.
“It’s a human need, but the way the government has supported the market, the way that privatization has happened, and the way policies and regulations are put into place for support, and awareness of what is required, vary according to different cultural factors,” said Tee.
She added that while tech companies are working on services and products to help with eldercare and assisted living, one obstacle to their adoption is fragmentation in the healthcare market.
Smart wheelchairs, robots that help with mobility issues and other new tech developments can only reach a critical mass of people if there is a managed solution that includes awareness and distribution. This can include partnerships between different parts of the healthcare industry, including insurance companies, hospitals and care providers.
“There need to be more startups working on these kinds of partnerships where it’s either the private-public partnerships or it’s B2B partners, that can lead to the walled garden coming down,” Tee added. “Any consortium of eldercare would be great, because there’s just more fragmentation in this market.”
Eldercare investment in Southeast Asia
This fragmentation creates an opportunity for Homage and other startups to help build the care continuum, said Jauhari. This means services that help ensure that patients stick to care regimes after doctor visits or hospital stays to improve recovery and outcomes, and can include platforms like Homage, which make finding caregivers easier, and devices like wearables that can be used to monitor health at home. Ultimately, this can not only make care more efficient, but also decrease costs.
“There is a big opportunity in this part of the world to understand healthcare and be able to converge capital with clinical perspectives, and then commercialize it in an accelerated fashion,” he said. “These dots need to be joined.”
While there are funds in the United States that focus on technology for geriatric care, there still isn’t that kind of investor specialization in Southeast Asia despite the market opportunity.
The lack of funds specifically for eldercare so far in Southeast Asia stands in contrast to the U.S. and China, he added, and one reason may be that investors there are generally more risk-averse. Many health tech companies need to deal with regulations and clinical trials and then convince providers to adopt their products once they launch, which means it may take longer for investments to see returns.
But there are signs that the investment landscape may become more open to startups like Homage. Jauhari noted that in India, startups like Portea Medical and Nightingale have been successful at taking a curated approach to matching healthcare professionals and caregivers with patients.
Tee said she has seen investments in healthcare increase over the past year, following interest in areas like consumer technology, e-commerce and SaaS services. “You’re seeing a tremendous amount of interest coming into Southeast Asia as emerging markets, across all the industries, healthcare being one of the key ones,” she said.
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