68. Amba- Personalized, Proactive Care using AI in Senior Living

In this episode of Raising Tech, host Amber Bardon chats with Ernie Ianace, North America President of Amba, an AI-powered health platform for senior living. Ernie shares his journey as a serial entrepreneur and how personal experiences led him to the world of senior care. Amba’s platform is all about proactive, personalized care, helping communities tackle staffing issues and improve resident outcomes by using AI to reduce falls, catch health concerns early, and optimize care with smart, data-driven insights.

Ernie explains how Amba's passive monitoring system tracks vital signs and safety indicators, alerting staff when needed and significantly reducing falls and rehospitalizations. The platform integrates smoothly with existing systems, helping communities become more efficient.

Learn more about Amba on their website & LinkedIn. 

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Transcript

Amber: Welcome to Raising Tech Podcast. I'm your host, Amber Bardon. And today we have a guest on the show who actually has a company that's very similar to my name. So if there's any confusion, that's why. So 

today's guest is Ernie Ianace, who is the president of Amba.

Amba's health platform and AI driven solutions empower senior living operators to deliver personalized health care and safety checks precisely when needed.

So I personally first met Amba when I was in the UK at the ARCO conference, and you guys are actually a UK based company with recent expansion to the US, so I'm really excited to learn about that. But Ernie, welcome to the show. 

Ernie: Thanks for having me. Excited to be here. 

Amber: So give us all the details on Amba. Tell us who you are, what you do. How did you come to be part of the organization? 

Ernie: Yeah, back in 2015, I got into senior care because of personal experience, right? As your parents and grandparents get old, you just start [00:01:00] really paying attention and saying, gosh, someone has to fix this. We have so many problems delivering care and this monster demographic wave about to hit us is only going to make it worse.

So anyway, I've set out to build a senior friendly watch that did all kinds of cool things. a great watch came to market, sold tons of them until Intel said we don't want to do the chip anymore. And I immediately pivoted, said, okay, I'm not going to do watches anymore. I'm just going to do the platform called it vital tech COVID hit, which changed everything.

Operators locked down, they had no choice, and the big health care companies, all the big hospitals, called me and said, we need your help. And so, I pivoted there but all the things I wanted to do at VitalTech add activities of daily living, add help for social determinants, add things like fall prevention.

Now, everybody does fall detection, but man, if you can prevent the fall. You're way ahead of the curve. And so anyway, VitalTech got an offer to be acquired. I thought I was going to be done. And then someone said, Hey, look at this Amba thing. It looks amazing. It's what you want to build.

And I'm like, Oh my gosh, they're like two generations ahead of anything I've [00:02:00] ever seen. They do all this cool stuff and it's, they solve the whole problem. So they asked me to help them expand. They were already in the UK a little bit in Canada, but honestly, They want to do the U S as their primary market.

That's where their investors are. And I said, will you run North America primarily for us be president of the company? And I said, absolutely. I'm back fully in senior care where I thought I started and excited to be here. And, getting enormous amounts of traction and interest in Amba in North America.

Amber: You can never leave once you get into senior living, it just can't. 

Ernie: And honestly, everybody knows each other. So you've got so many old friends, 

Amber: yeah, absolutely. So when I first heard about your platform, I was super excited because you're doing some really innovative things and solving a lot of really specific challenges with the solution that you have.

So tell us more about what Amba is. 

Ernie: It started as wellness, health and safety, right? So a couple of things. It's helping with the operators problem of staff turnover, [00:03:00] not enough staff. How do you solve that? So the whole concept was being proactive instead of reactive or routine is way better instead of going, every hour at night doing a room check.

What if you just knew, hey, the resident is, they're asleep, they're peaceful, their vitals are wonderful. No risk. Let them sleep. Don't go bother doing the room check. But Mrs. Jones just got out of bed. She's a very high fall risk. Go help her. And honestly, we're seeing like an 80 to 90 percent reduction in falls by just preventing that, by being proactive, right?

But on the flip side, when you're looking now at lots of different things, and we use almost all passive, right? You can't really ask that staff that you're worried about constant turnover and already overstressed or the senior resident to do much. You just got to be able to read what's going on.

Passively, you can say, you know what, Mrs. Smith's resting heart rates been going up her sleep from very restless and she's. Going to the bathroom five more times in the last two nights, right? Sure. Looks like a UTI is developing. [00:04:00] Someone should pay attention to that the next day and, look into it, especially with a memory care patient.

They can't even tell you there's a problem until the problems extremely acute. And it's things like that, those type of insights, or a congestive heart failure resident, right? Their weight's up four and a half pounds, and they're starting to see a little bit more shortness of breath. That's bad. They don't need to go to the ER maybe right now, but if you don't do something right now, they probably will be there tomorrow.

So the system's really designed to give the care team the ability to have way more information than they had and be proactive in their delivery of care. We're changing lots of outcomes. We have 1 operator. They've seen like an 80 percent reduction in falls the 90 percent reduction in psychotropic drug use on memory care patients because they now know what's going on in their world when they're not in front of them and just again,

hospitalization rate dropped by 75%. So all things that operators really are focused on right now. It does a bit more than that, but that's the primary Genesis and it's an open platform. [00:05:00] We don't make the tech that connects to it. We connect to everything and we do really connect everything.

And if you want a wearable, there's a half a dozen, including an Apple watch or a withings. If you want the cameras from Vayyar, foresight or any of those guys. But what we found is that all people don't like cameras. People don't like to be recorded and people don't really like to be asked to do anything.

So the more passive the better and most of the sensors that we found can read all these things. I just referenced without anybody doing anything. 

Amber: Yeah, I think the 2 buzzwords that we're hearing in the industry for the last few years are workforce and AI. It's a joke. Now, if you go to a conference, how many times you hear the word AI and before that it was workforce, which is still really relevant.

So I feel like Amba really combines these two concepts. So can you talk a little bit about that? Like how does using Amba help with workforce challenges? And then what are the restrictions? Because I've had some of our clients ask us about using tools like this and say we can't really reduce our [00:06:00] staffing count in skilled nursing, for example.

So talk a little bit about that from all different levels of care perspectives. 

Ernie: Yeah then let me start with the most restrictive first that you just said it's skilled nursing. You can't reduce your staffing count, but you can get dramatically better patient outcomes, right? If you get that dramatically lower re hospitalization rate, if you avoid most of those falls if you catch a UTI early, they may not be in there remotely for that, but you're going to still avoid

really negative consequences. So for them, it's not really about reducing staffing. It's making their staff dramatically more effective and delivering better care. Now, let's go to the other extreme, AL or even IL. That's where you can start seeing a staffing impact. And it's really not about eliminating staff, though.

Sometimes it's just they can't find staff. But, often we see operators redeploy night staff, which is really hard to fill. Into the daytime, because again, we're giving them visibility of what's going on all night long. While that seniors asleep, we're tracking heart rate, respiratory rate activity, bed exit and entry, bathroom visits.

Are they okay? Are they [00:07:00] active? Did they get up? Did they fall? Did they make it to the bathroom and back? All those things. And if you know all that stuff, and you can simply tell the AI then says, hey, You know, Mrs Smith isn't a fall risk, but she's gotten up and she's not been in the bathroom for 25 minutes.

There's a high probability. She might need a little bit of a hand. Go knock on the door, right? Or something like that. So the AI running is looking at trends and looking at all the various data points and saying we see a problem. Either it's a red alert. Get there right now. Or Let the nursing staff know tomorrow that we think maybe, say, an infection or UTI is developing because of all these data points that started to happen.

The AI is like a helping hand to the care team. And again, it's usually the nighttime staff that you're able to use much more effectively. You're seeing the resident during the day often, though you do get a lot of insights during the day because you're not seeing 12 hours. You've just seen them once or twice, right?

So if their activity level goes way down, or they stop leaving their room, they're getting depressed, or maybe they're getting early onset dementia, things like that. So a [00:08:00] lot of different ways to use it. And again, different operators see the value in different spaces, AL, IL, skilled and memory care a little bit differently, but it works across all of them.

And most of them start with one and deploy it everywhere. 

Amber: Yeah, I think there's a strong use case for all the different scenarios. Skilled nursing, I think the biggest challenge was staffing. And like you're saying, how can we not reduce staff, but how can we make their job easier day to day and give them more tools to do their job more effectively.

And then on the independent living side, when I meet with sales and marketing teams at all the different organizations I go to, I ask them, are you being asked, If you have technology like this as part of prospect, and the answer is, yes, people are getting asked. How do you know if I got up? How do you keep me safe?

And that's a lot of that independent living. We're starting to see a shift where people want more of that technology. One of the questions I have for you is with all this data you're gathering and all the different pieces of information that you're pulling together. How do you bring that together to give

communities data driven decision making power. [00:09:00] Like, how is that data look on the front end from like a reporting perspective, a notification perspective? Tell me a little bit about that. 

Ernie: It's super customizable. And honestly, we actually say, listen, there's a lot of things you probably don't really know about your resident, right?

You're not tracking them 24 seven. But we are now, so don't even set anything custom for them for about a week or two. Let the AI learn what normal looks like, tell you what normal looks like, and figure out is normal even a problem. And, it'll suggest settings to start saying, okay, deviations by X or Y would be bad.

So alert someone. Or you can go in and, have your nursing director or anybody change settings. We have really elegant dashboards. Really easy to look at. You can glance at 97 percent of my residents are asleep. They're happy.

They're good. And this one's out of bed. And there's a problem. I got to go fix it. But again, we're not really expecting a med tech. That's busy. Patrolling right to be looking at a dashboard. So we'll communicate in just about any method that the community already uses, or we can add 1 right? We can send a text.

We [00:10:00] can send an email. We can send an SMS. We can send it through their nurse call system through their normal way. They receive any type of alert. So for them, they're not going to be staring at that dashboard. They're just saying, I need to get to room 102 right now to go help Mrs. Smith.

And usually it's for us, avoid the fall. We'll catch the fall if you don't get there in time. But honestly, we'd much rather you get there and avoid the fall in the first place. So and as far as reporting anything you could remotely imagine, we can report on and we can display. It's very user friendly, but we see a lot of communities doing is they're sending out a customized weekly report to the family saying, Hey, mom's doing great, which is wonderful.

Family's happy about that. Or let's put it on the flip side. Those really hard discussions of care upgrades, right? Where it's going to cost a little bit more. Invariably, I talk to operators like, yeah, the family always is unhappy. They're pushing back. I just was with mom. She's great. Nothing's wrong.

And if you have data, this is now, see, look at all these issues. She really does need more help. It's much easier conversation to be able to have with that family to say, yeah, mom really does [00:11:00] need a little bit more help. So lots of different ways to use it. Massively customizable.

And if you do want to send out the sort of that report to the family, the AI will even write it for you, you can say, hey, give me an analysis and natural language for, the kids and it just spits it out. And then you can obviously review and edit. But that's the other place we've employed a lot of AI is to make documenting and, those types of things much, much easier on staff if it can just have the AI do it and you validate it.

 I know our listeners hearing this are probably feeling really excited about the possibilities technology has. And I know when I first heard about it, I was like, this is what we've been waiting for.

Amber: This is what we need. And this is the direction that we're going. If a community is listening to this and they want to start using Amba or look into it, what do they need to know as far as like an implementation, back end infrastructure? what would you say are like the prerequisites and the success indicators to a good implementation?

Ernie: So 1, we usually say, start a little bit smaller. Don't try to put in a medication management module where you're changing [00:12:00] every procedure all at once, right? Because you're not going to get buy in and to try to get your staff to do this crazy. Our most basic system, which we call health, Sleep and activity.

Really, they'll monitor vitals, it'll monitor activity, it'll monitor safety, it'll do fall prevention and detection, bed exit and entry, all that kind of stuff. It's completely passive. You just put it in. We do it. You don't have to do anything. And essentially, we'll just tell you, hey, this needs attention.

Now, your nursing director is probably looking at and doing lots of different things. But what we typically do is come put it in, let it sit for a week, learn everything about your residents, and then come back and give you some training on it. And it depends on the size of facility and a big campus.

There's obviously a lot more if it's a small operator that maybe 40, 50 rooms or beds or even less for that 1 person at night, but not much training they even need because they're going to get an alert on their phone. Or their pager or their nurse caller, or just says, hey, go help Mrs Smith. Again, it's just what is needed, but it's a pretty light lift.

We're doing everything and the infrastructure load is extremely low because it's really [00:13:00] small bits of data flowing usually across their wifi. If they don't have good wifi, we have ways to fix that with cellular. But typically again, we do it all for them. We do it at a monthly fee, so there's no capital cost.

And we support just about every piece of hardware you can imagine. So if you have made an investment in more of a point solution, right? Maybe you've got Safely You or you've got Vayyar or you've got Nobi lamps. We talk all that. So we'll just incorporate that data and use it too. And the gets even richer and better at giving you more data.

Amber: Tell me about integrations, because that's another thing that all of our clients are looking for. They don't want yet another system that they have to have a separate login. And they're trying to get into this like unified health record is a big trend.

Tell me about how that works. 

Ernie: So we integrate with everybody, both devices and EHR and care management. So whether it's Yardi or Point Click Care.

So we made it so it's extraordinarily easy to integrate and whatever they need, we can give them. Point Click Care doesn't have a standard API. They don't do HL7. They have the gives and gets type of concept. But [00:14:00] that's no problem for us, right? Where Yardi does it differently. Matrix Care does it differently again.

But we made our system support all of it. So that it doesn't matter what your legacy systems look like. We can talk to them and what operators seem to love is how easy it is for us to add new stuff. We had an operator in Canada that we really want to do urine analysis. And we're like five years ago, that would be really hard, but there's a bunch of smart toilet solutions, right?

Toilet has a pretty good one right now. so we picked the best three and integrated him in a week. It just takes us that long. It's that simple. We have these things called agents that every piece of every device is a little bit different language and say, okay this is sleep data or this is heart rate data.

You may not exactly label it or call it the same. But we have an agent that says this is sleep data. So we're going to translate it. And standardize it and put it in the system. And give me an example why that's important seniors with this technology that you can put it under the mattresses and it reads all this kind of stuff passively is ridiculously accurate.

I don't know how they do it. But then you find that there's a bunch of seniors don't spend all night in bed. So you need a different sensor for the [00:15:00] chair, but you still need the data to be homogenized and presented to the care team with the AI analysis all as one thing. So that's why it's really important that you can speak to everything, but make it all standardized 

Amber: that leads me to two more.

Follow up questions are somewhat related. So I think 1 of the really exciting things about this type of technology is that it's ultimately going to allow independence for a longer period of time, which I think is the goal that we have in a lot of. Places both like in the home and in our communities, but I also feel like maybe the technology culture for residents is not quite there yet.

So how do you deal with technology resistant residents and staff even sometimes? And how do you see this shifting over the next few years? 

Ernie: It's really crazy. One, it's mostly invisible. The residents, once it's there, they don't know it's there, right? It's in almost invisible sensors and it goes under their mattress.

So they don't really pay attention to it. So they don't have to do anything for 1 thing. If they are tech savvy, they have an [00:16:00] Apple watch and they want that data sent. Great. We take it. They don't have to do anything. We just flip a switch and we ingest that data. 

Okay. The nursing directors, the ops, VPs, they can look at all the fancy reports, dashboards, analytics, but the staff on the ground, they don't care. They don't know. They don't want to care. Most of the time. They're busy. They're stressed. They're overworked and the turnover side. You just got to alert them in the way they're used to getting an alert saying, hey, go help

miss Smith. We have one operator. They didn't even have cell phones right for their night staff. We call the front desk with an automated call and say, Mrs. Smith in room 103 needs help and they go help. And it's crazy. They saw falls dropped by 65 70 percent the 1st month or send an alert

to them. But then also let the director of nursing off site know this just happened. And by the way, it was taken care of. So we get rid of that barrier to tech. But I do see quite a shift when I started. And you brought new tech into a senior living community in 2017. A lot of the seniors were not comfortable where we had an operator who [00:17:00] was putting this in alia or al.

And SNFs, but they weren't sure about IELTS. They go, let's go ask our best community. If the IELTS residents would like to try it, maybe 10 of them won't raise their hand, they put a hundred in a room, all 100 said, Oh my gosh, we want this right now, right? Because all of them don't want to have to put forth a lot of extra effort.

But when they found out it was just going to be passively watching them. And if something went wrong and no one knew. Then someone would know. I'll use my mother as an example. She's pretty mobile. She's with it but she tripped over the dog at 2 a. m. last month and couldn't get up for two hours.

She wasn't a fall risk, right? But the dog like barreled into her, knocked her down, stuff like that, that seniors are thinking about as they get older. And if you tell them there's a way that you don't have to do anything, you won't even notice, but we'll know if we can help you.

Amber: Yeah, I think this type of technology is going to become so prevalent in the next few years that it's going to be a requirement

for senior living communities to have this as a competitive differentiator, I think, we'll see people making decisions on where to move [00:18:00] in based on who has this technology and who doesn't. Given that this is out there and available and you're putting it in now, what do you see as new developments or more innovation or what else do you think we can do in the next couple of years to 5, 10 years with this?

Ernie: Actually, I'm going to change it from a technology discussion to a business model and healthcare discussion, because that's where I see the innovation really happening. And again, remember, I was pulled out of senior living into the broader healthcare. So I've got a lot of experience in post acute, long term care at home and what the big health systems are struggling with.

And now senior living is being forced to struggle with it. As acuity levels go up in AL and memory care. All of a sudden you're a care provider and it's going to get more and more pervasive as seniors wait longer and longer to go to AL. They're going to show up with higher acuity. So there's a whole bunch of remote payment codes designed to take care of people remotely.

And they were designed for seniors because it was Medicare that put them out there. Nobody's using them in senior living. So if [00:19:00] you marry the care provider with the technology and with the senior living operator, you can actually subsidize all of this, bring a whole layer of clinical help to the table without the operator having to spend anything.

They can even maybe get our system at no cost, and there's reimbursement codes for that, and Medicare wants you to use them because they know that if you do this, the outcomes are dramatic. You're going to see ER visits drop, you're going to see falls drop, you're going to see hospitalizations drop precipitously.

And now let's take this one step further. This monster wave of demographic is hitting us over the next 10 years, and prices keep trending up because all of our costs keep rising, right? There's nothing operators can do about that. And they're being asked to deliver more and more care. But seniors incomes aren't going up.

So what happens in 5, 8 years when it's 10, 000 for an AL rent because that's the only way you can deliver good care. There's no way a senior can afford that. Value based care. And I know you're probably hearing that at [00:20:00] a lot of conferences as well as a buzzword. is the solution, right? There's big piles of money to take care of people as they get older or that have a chronic condition, and if you can affect the outcome, the payers, Medicare Advantage, will share that with you, but they want you to share the risk.

If you do what I'm talking about, you will know I can actually reduce hospitalizations by this much. I can reduce ER visits by this much. I can reduce falls by this much. Your risk goes away. And now it's safe to say, you know what? I'll sign up for value based contract and, give me an extra 6, 000 a month per resident because I know I'm going to get to keep 5, 500 of it.

Add that to the rent and all of a sudden everybody wins. I think we must go there or there is going to be a massive gap in the ability for people to afford to pay for what's required. And the operators have no other way to get that money. But the value based payments are available. Nobody's giving it to senior living right now where we actually get our sickest and our most expensive time.

[00:21:00] And then I'm going to say one last thing. Healthcare is grappling with social determinants of health. I don't know how familiar this audience is going to be with social determinants of health. It's in healthcare. It's everywhere. You can do all the right things for someone's disease, but if you don't affect how they live, how they eat, are they getting exercise, is someone interacting with them and there's a host of other things, you have really bad outcomes usually.

In senior living, we control all that. We know they are eating well. We know that they're getting checked on. We know that they live in a good environment. We can help with the social determinants and the health area. So actually, I think senior living is the best place to affect outcomes, which is what Medicare has designed value based care for.

So I think it's a perfect marriage. It's just a journey that's going to take a while. It's taken healthcare 10 years and they're not 100 percent there. It's going to take senior living probably another 10 years. 

Amber: I love that you answered the question this way because I saw Tiffany Village present at the Arco conference in the uk and they're doing [00:22:00] exactly you know what you're talking about.

And actually, we really wanna get them on the podcast as well to talk about this care model because they're using Amba to enable this care model. And it's really cool. And they're Canadian companies. They've got a couple of different things with their payer model, but. It also reminds me of, I was just on site with the client who has the PACE program, and if you're familiar with that, so I think that's similar to what you're talking about.

And I would, side note, love to introduce you to them to see if they can help with their PACE program. But I just, it's just exciting to think about how many applications there are for this technology and how it can help shift, like you said, the care model. 

Ernie: Yeah, I don't see how we pay for this, right? We need to provide this care.

There is money. It's just in the wrong place. So this is a way for senior living to be included in that. And yet the money needed to do what they know they need to do. So to me, that's my mission. That's why I said, I'm not going to stay on the bench. I'm going to go do this because this will enable what I think has to happen.

And again, my mom is right there. She's living this journey [00:23:00] now. So I'm like, who's going to take care of the other 20 million of her, right? If we don't figure this out. 

Amber: Ernie, this has been such an amazing conversation. Is there anything we haven't covered yet that you want to let everybody know about Amba?

Ernie: Maybe just that I think all of us are on a mission to solve this problem. 

We're doing this because we all have personal experiences to fix this problem. So we'd love to help. We're really open to innovative partnerships. And again, just give us a call or come to our website at Ambahealth. com. Reach out to us. And we'd love to figure out how best to help you.

Sometimes it's a very different flavor for every different type of operator in every different state, but we have that level of flexibility and a huge amount of expertise on our team. People have done this for a while that know how to okay, we get your problems. We've lived them.

Let's figure out how to solve your problem. 

Amber: Wonderful. Thank you so much for coming on the show today. 

Ernie: Thanks for having me. This was great. 

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