AI, Innovation, and Care: How Sequoia Living’s Michael Skaff is Transforming Senior Living with Tech | The AgeTech Podcast S4E15

Keren Etkin: Michael, welcome to the show.

Michael Skaff: Karen, thank you so much for having me. It’s always a pleasure to talk to you and it’s a privilege to be on here with you today.

Keren Etkin: Likewise. So, you and I go way back, so I know your, at least your recent career history from the time that we’ve known each other, but could you maybe Tell a little bit of your backstory to our audience because I think it is incredibly, incredibly interesting.

Michael Skaff: I think both the professional backstory and maybe a touch on the personal backstory too because it’s relevant at least to me so on the professional side i’ve been in tech for about 30 years starting out in a number of software companies back in the 90s And I started in a couple of industries, probably a little too early.

So an example of that is I worked for one of the very first chatbot AI chatbot companies, 24 years ago, a company called neuromedia and then called native minds. we built. What they called a V rep at the time, a virtual customer service representative in an AI chat bot that we thought would be a great idea to answer customers questions about toothpicks and toothpaste and all other manner of other things. again, probably about 15 years too early back then, nobody really knew what a chat bot was or why they’d want one, unfortunately. so now. You know, just about everybody has a chat bot and we’re seeing the explosion of AI and LLMs and all these other exciting opportunities, but that was a little early.

another sort of early mark there in the technology industry was digital signage work for an early digital signage company called ad space networks. Later, cool sign media. we built out. Amazing display technology, both hardware and software, that companies like Nike and Dick’s Sporting Goods and others would use.

So, in the stores they’d have digital signs. Now everybody sees digital signage everywhere, so I don’t have to explain the concept. But back then, this was in the days of the $10,000 to $20,000 plasma screen TV. it was really in the early days of digital signage when it was just emerging out, at least in the U.

S. emerging out of Las Vegas, which is sort of where it was born in the U. S. to other industries and other customers that saw the potential of large scale digital signage and digital video content controlled centrally. so. I’ve seen a few industries early on and I like to try to learn lessons from those challenges or maybe those failures, in healthcare over the last decade, in senior living.

So we are still, I believe in the early days of really seeing the maximum efficacy of age tech and other technologies in aging and senior living. but 30 years in tech, most of it in IT. The last 10 years, uh, chief information officer, chief operating officer of a couple of senior living operators in and around California. and really, a privilege to do what I do every day, which is to serve older adults, really try to find the best ways to deliver care and services, focusing on the care and services, not focusing on the technology. And I want to make that key point because it’s not in the what and the how we do are what we do.

It’s in the why we do what we do that matters to me. and that always has and always will, so really appreciate working for Sequoia Living Now and really excited about our mission to deliver housing and services out to older adults, in California and finding new ways to do that, potentially via technology sometimes.

So on the personal side, uh, my mother got her PhD in gerontology back in the day, and, my father actually surprised my mother by falling out of a tree. Thank you. 40 something years ago and breaking his back, and has lived his life, most of his life, in a wheelchair since then, uh, which didn’t really slow him down.

If anything, it’s really, uh, motivated him to get out there and do work for people with disabilities and older adults as well and look at different ways of making the world accessible. So I Got the chance to travel to Japan with him, probably 30 years ago now when he was meeting with governments over there, to try and make Japan more accessible.

He started the mayor’s office on accessibility in San Francisco. to make San Francisco more accessible. He continues to do work even after his retirement in, working with the state architect in California and lots of different, uh, ways of making communities more accessible. So it, it comes to me both personally and professionally.

And I feel like I’ve ended up, people talk about ikigai guy as sort of the centralized point between what you want to do, what the world needs and what you’re good at. And this seems to be the sweet spot for me where I both care about what I’m doing. And I have some personal background in this as well.

Keren Etkin: Wow, your father sounds like a huge inspiration and you can tell him that at least from my observation when I visited Tokyo, that was the most accessible place I’ve ever been to. Way more accessible than San Francisco.

Michael Skaff: It both are making progress. 30 years ago, I had the experience of trying to get him on the trains, for example, in Tokyo and all up and down Japan. We traveled the full length of Japan, visiting the prefectures along the way and had incredible experiences there, but most of it was very inaccessible at the time and they’ve made significant progress. So it’s, it’s nice to see the world finally focusing on accessibility. both from a governmental standpoint as well as sort of a local area standpoint and businesses are starting to take this up more now to instead of, trying to resist accessibility, they’re trying to enable accessibility so that they can serve the broadest audience as well. So,

Keren Etkin: So, Currently, you’re in the CIOs, you’re wearing the CIOs hat, but you have worked for multiple senior livings in the past, and how would you say that the CIO role has been transformed over time, and is it different for different organizations?

Michael Skaff: That’s a really good question. I actually had this same conversation around the same topic with a group of CIOs, not in senior living, because you’re starting to see a shift, not just in senior living, around the CIO role, but in general, you’re starting to see CIOs move into chief operating officer roles.

you’re starting to see CIOs, Move into chief executive officer roles in some cases as well. The CIO of a large food company that’s well known in the U. S. called Whole Foods that was then bought by Amazon. but their CIO became their CEO because I. T. These days technology is really distributed across the organization and is really sort of the lifeblood of a lot of the operations. now that everybody relies on data to do their work. So as an IT person, we see more of the operations and more of what’s working, what’s not working so well, and some of the opportunities to bring different departments together to do, you know, to, to envision new services or optimize services. So it’s, it’s a privilege to get to do things like this, to see those opportunities come together. And to be able to leverage that for the benefit of an organization, especially when I’m working in nonprofit now, but see, the CIO role has changed from really sort of a utility provider to now being a strategic asset in organizations. and senior living is just starting to wake up to this as an opportunity. Now that we’re starting to leverage tech more technology more in this industry. and you’ll, you’re starting to see more CIOs in senior living operators, which you didn’t for a long time. so. These operators, both on the health care and residential services side are saying, Hey, it’s not just Wi Fi. We need in our buildings.

But if we can do amazing things with, shift management on the operational side or resident engagement platforms on the resident services side, open up new revenue opportunities. So there are myriad opportunities that senior living operators are taking an advantage of with a CIO role and with broadly speaking, in more strategic investment in technology and services that really are less about the technology and more about what it enables from an operations standpoint and from a resident and staff experience standpoint. You’ll hear me talk about that a lot, the staff experience and the resident experience.

Because again, it’s not about technology, we’re not a tech company, we’re not doing this for tech’s sake, we’re doing it for the sake of our residents that we serve and the community members when we serve the outward community, as well as for our staff, because we want to make sure that they’re having a great time.

They have a wonderful experience working for us as well and that turns around and makes, staff stay for or want to stay for 10, 20, 30, 40 years in some cases.

Keren Etkin: Which is one of the most important metrics that anyone in this industry should be tracking retention, staff retention.

Michael Skaff: Yes. We all know it’s still a challenge. Uh, labor is still a challenge as you’ve, you’ve mentioned before too. but I think there’s some opportunities now, the operators looking in addition to diversifying the services that they’re providing to the residents, really looking at, um, How do you attract and retain the best staff?

Keren Etkin: So speaking of retention and, and the labor shortage, what role do you see technology currently playing in tackling the staffing crisis in senior living? And how would you envision it evolving in the future? Like what are still the existing gaps?

Michael Skaff: it to some degree, the answer I give you will depend on the context. So in the US. are focused on technology. I would say just and this is a generalization. Of course, there’s some organizations that are doing more or less of this But on optimization and delivery of labor and optimization of that labor.

So shift management as I mentioned Some ways of bringing in effectively efficiently cost effectively as well outside labor where and when it’s necessary it’s looking at optimizing how we’re delivering services to our residents, automating things, you’re starting to see robotics show up, whether it’s bear or other companies that are bringing robotics into senior living, in interesting new ways, to sort of lift the burden of the day to day maintenance of those facilities or communities, outside the U.

S. You’re starting to see more robotics and other, automation directly on the caregiving side. I will say you’re also seeing having just come from a year in a technology provider as well, you are seeing more investment, both in the U. S. and around the world in technology for safety and enhancement of some of the services for senior living in again, both in the residential services side, as well as in the health care side. So all of these things, theoretically, at least are. Should be helping to relieve the burden on the staff and really let them focus on on the face to face time. The caregiving time that the hands on time that they’re with the residents and the people that we’re caring for. In some cases, that’s not always living up to the dream or the focus.

still seeing EHR companies. Uh, especially in, in our, our industry, on their model to try and lighten the burden that we all know EHRs can be sometimes, rather than just being a billing and documentation tool, there are some opportunities, being taken by some companies to turn the data around and look at ways to optimize staffing. And so they trying to send staff to where they’re needed the most, for example. So when a resident, you have. Residents with higher acuity or higher fall risk, for example, really trying to optimize the care to those. It’s still, I would say, in its early stages, but I’m really excited to see where that will go because hopefully, again, that lets the staff do what they do best, that helps technology sort of wrap around them as a service and and enables them to focus on the caregiving experience primarily and foremost.

Keren Etkin: Which is at the end of the day what we want. Absolutely.

Michael Skaff: that’s what that’s what we care about. That’s why we’re here. It’s not for the technology. It’s not for anything else It’s really to make sure that we’re delivering excellent care and services and housing to the people we care for

Keren Etkin: Absolutely. And what would you say? How would you describe like the ideal technology procurement process for senior living? If you were now standing in front of an audience of 100 aspiring CIOs, what would you tell them to do? How would you tell them to go about finding what the challenges are and looking for tech solutions?

Michael Skaff: That’s a really good question. And I just did something similar to that not that long ago, speaking engagement I had recently but hasn’t actually changed that much in the last 10 or 15 years Other than just maybe some opportunities around the edges, you still have to spend time with the group that you’re trying to serve, whether it’s the residents as the end sort of users or customers or the staff that are using the services and really understand the requirements, do a lot of listening. and gathering around, what is necessary and what is needed. because I think a little too often we have very bright technologists and I’ve been guilty of this as well. thinking we have a great idea and jumping a little farther ahead with an idea before really understanding all of the unanticipated consequences or ramifications of what those technologies might be. So really on the requirement, spending extra time. Gathering requirements, understanding the use cases, understanding the user journeys, doing goods. Jon Warner and others will talk about the jobs to be done. And I’m a big fan of that methodology. Really understand why you’re doing it, not just the what and the how as I talked about before, but why we’re doing what we’re doing, and ask why a couple of times, sort of unpack what is what you’re trying to accomplish and challenge it once, twice, three times and say, why are we doing this?

Let’s see, what, what are we really trying to get to here? And that helps you make. better, more informed decisions around these technologies. so that by the time you do roll it out, by the time you do that, and there’s a whole methodology around change management, that’s very important again, it shouldn’t, these things shouldn’t just be an I.

T. Initiative ever again, they really should be a partnership between technology as sort of the ambassador or supporting service and whatever end department you’re working with. H. R. Operations, any of these departments and making sure that this is for them by them and with them so that they’re involved at the beginning, middle, and end.

And it’s not just something that IT is forcing on them, because people, there’s still concerns and questions about adoption rates. And I will just be the first to say that that would not be a problem if you involve the people you are actually trying to serve. on in the process. So my guidance there would be just make sure that you’re asking those questions early.

You’re keeping people involved early and throughout the process. And that will lead to the greatest success in technology adoption. and as, as people want to learn how to do the best way of, or sort of find the best way of rolling out these technologies. and I, I was part of a four hour session, I think in front of the American Society on Agings, recent.

Conference as well as well as Cala. I think it was the Cala conference. I talked about AI for about four hours with a panel of other folks in this industry. just providing the guidance around asking these questions, making sure you consider the ramifications. We actually brought up some of the important subject in our industry compliance. For example, that sometimes gets left till the end when again, that should be asked early on because of some of the ramifications from a data standpoint and other things, but asking some of these questions early on and making sure you’re doing sort of a well informed, discovery process is the best possible way to make sure you end up with success and adoption on the back end.

Keren Etkin: Wonderful, wonderful advice, and I want to dive deeper into the change management bit,

Michael Skaff: yes.

Keren Etkin: because even if you get everything right, there comes a day when you need to roll out new technology within the organization, and different people within the organization naturally will have different, a different tolerance for imperfections in the product, which can You know, no product is perfect.

So how do you, how do you deal with rollout? How do you deal with adoption? How do you, keep people on track and, helping them keep their eye on the ball and understanding that their interests are aligned with the organization, even if what this technology is doing isn’t something that they’re directly being measured on.

Michael Skaff: I think part of that is just simply good project management rigor and making sure you’re doing things in a structured, organized fashion so that people predictable process comes predictable outcomes. Usually, not always. but so part of it is, is just rigor and methodology in your approach. And part of it, as I said, is really the communication and how you’re involving people.

The right people early on and making sure you’re understanding and asking the right questions. because if you don’t, you end up in the wrong place. so by involving those people early on, you’re much more likely, they will feel personally bought into the process and the outcomes, and they will feel personally invested in what has been decided and everything else. Even if it’s a disagree and commit in some cases where they, there’s disagreement there sometimes will be, but making sure that you achieve that early on will mean that they are then Invested in the success and the outcomes at the end of the project. And they’re much more likely to be a net promoter of the product or the service or whatever you’re trying to roll out.

And again, it varies widely, of course, but the outcomes and the sort of flow of that tend to be fairly similar regardless of what type of technology or what type of change, again, technical or non technical, we could be simply talking about a process change that has nothing to do with technology. Change management really is based in and more successful when you’re able to because of communication, and a technologist, I think I’ve learned that through painful mistakes over my career and sort of through the bumps and bruises you achieve, by doing things the wrong way sometimes until you figure out that it goes so much better if you simply, work with people rather than trying to work, for them or against them eventually.

So early in the process and then involved throughout is the best possible outcome.

Keren Etkin: Absolutely.

I want to talk a little bit about AI. So it’s not new in AgeTech. I mean, loads of products have been using AI for years, but with generative AI, it’s getting to a point where the technology is, is sometimes so good that it’s scary. So I wonder. How do you, what are the views of people, that you’ve, you’ve, you’ve been talking to on a daily basis?

How do they view this, Is it a piece of technology or a type of technology that they’re excited about, scared of, want to adopt, or is it, or just using AI is a deterrent? Because I just stumbled upon an article a few weeks ago that just using the words artificial intelligence in the product description can actually deter people.

Michael Skaff: I will say as a blanket. Yes to all of what you just said. Sorry to make you laugh while you’re drinking, but it’s yes, there’s there’s as with most things, especially with something that has achieved the hype cycle that AI has, it is. You’ll find people all the way along the spectrum. You’ll find people who are who think it’s the worst thing that could ever happen to the world and the world will end because of AI.

And I’m not being hyperbolic there. you have people that are actively predicting the end of the world because of AI. And then you also have people that think it will save us and it will fix all of the problems in the world. And you have most of us who sit in between along that spectrum somewhere. I am.

I am cautiously optimistic as usual. I’m an optimist, about the potential of AI, especially where it’s progressed to given that certain things have changed again, having worked for an AI company 24 years ago. I have a little bit of perspective on this. Just just one perspective. But the fact that we can do things now that we couldn’t have done back then, given factors like Computing power and GPU power and other things that were simply not possible back then.

So we are more capable of doing some truly incredible things with data. And I’m gonna make a point there of talking about the right date at the right time. A little later, that will potentially change how we work, how we live, in really positive ways. As well as in some slightly scary ways to, so I’m, I’m very excited about what the potential is.

Yes, there are people both in our industry and outside of our industry who are everything from scared to excited about this. I think we’re starting to see some real use cases show up, not just in senior living, of course, because we tend to be, near the end of the cycle where it comes to adoption for new technologies, a little late adopter, as we would say politely. but there are real. Proven use cases, everything from resident safety technologies to revenue enhancing technologies to some basic operational enhancement, streamlining, use of AI that are very practical, that are real, that are proven, grounded in data and proven in data. And that’s worked well now.

So it is real. It is something that is here. It’s not coming. It’s now, what is coming is sort of. Iteration iterations on what is now and what is working, the challenge I will see, as I mentioned data a moment ago, most of us don’t have our data organized our data house organized, what you call it a data lake, a data warehouse or other things that the necessary underpinning for a lot of this AI work is. Are good sources and types and structures of data and many of us do not have that well organized or well clean. So hygiene of data are very important to make. Otherwise we’ve seen AI can hallucinate. It hallucinates even more potentially if you give it bad data. as you can imagine, so garbage in, garbage out, but there are real opportunities.

This is the time we will see people spending time and investing in the data, layers so that we can turn that around and use that as the source of revenue. so it’s a foundational element that we have to build out and we have to take time so that we have the clarity and structure and hygiene of our data, and access to our data so that we can turn that around and really optimize the potential outcomes of AI. Did that answer your question?

Keren Etkin: That, yeah, it answers questions that I

Michael Skaff: Okay.

Keren Etkin: didn’t even ask, which is great. So if I were, an entrepreneur and I really wanted to do something in the aging space, but I wasn’t quite sure what is the problem that I’m going to dedicate five, 10 years of my life to solving. What would you recommend that I go after?

Michael Skaff: Before I recommend what you go after, I’d recommend you spend some time in aging space or learning. The aging space a little bit. So, I was actually just commenting on something on LinkedIn today. United, church homes. I think it is, Michael Hughes has done a wonderful, set up a wonderful program of an entrepreneur in residence that lets folks actually spend a month in one of his communities to really immerse themselves in what it is to be a senior living operator. so before you start trying to answer questions or addressing pain points, you think, you know, it’s really good to get the deep context because as we see both in senior living, but also in health care, sort of at large, the complexity and the outcomes really lie, the devil’s in the details. so if you’ll think you’re solving for a really tough, thorny problem that will have a great TAM and, you’ll have a great exit potentially, then you figure out why nobody else has done this is because X, Y, and Z.

So it’s really important to immerse yourself. are opportunities, I will say, bothpretty much everything is using AI these days, but, I will say everything from compliance, there’s some interesting opportunities in compliance, there are interesting opportunities in staff experience and resident experience, especially with the interesting things that, or interesting opportunities that AI and LLMs bring along in UI and UX user interface and user experience, and bringing together disparate data sets for things like care coordination, which has been a focal point of the work Um, I’ve been working on this project of mine for probably the last 10 years, trying to do better care coordination in various ways. I feel like we’re going to enter into the golden era of care coordination here because of both some of the underpinnings on the government reimbursement side, but also on the technology side. I just recently gave a keynote speech. Thanks to you for making that referral, on the inflection point, I believe we’re going through because reimbursements in place, the technology is mature enough and senior living operators are going Finally, adopting these technologies, and I think we’re going to see some of this take off really around care coordination around compliance around sort of operational streamlining that other industries have done already.

So there’s some opportunities to do revenue cycle enhancement and other things there. so there are a number of different areas, but going back to where I started. To really make sure that they’re solving for the right pain point. They’ve got to spend time in the industry or really learn the industry without just trying to get a superficial start and then thinking you have the answers.

Keren Etkin: I couldn’t agree more, and I love that Michael is doing an entrepreneur in residence program. I think that is so incredibly valuable for the entrepreneurs who are able to spend that time in senior living to really get an immersive experience, at least for a couple of weeks.

Michael Skaff: Yeah.

Keren Etkin: And so, And so, that was actually, I think my last question for today.

Is there anything that we didn’t talk about that you want to add?

Michael Skaff: you think, where we, where you think we’re going. you’ve asked me a lot of questions. I think I love seeing your annual market map. I, I’m curious to see if you’re, Anticipating and not to ask you to release anything that hasn’t been released yet, but we’ve seen some new areas sort of open up that are new opportunities, as well as some combinations of different areas.

where do you think, what do you, what is one new thing you think we’ll see in 2025? If, is something to that degree

Keren Etkin: well, I I can say I can tell you what I hope we will see.

Michael Skaff: Please yeah,

Keren Etkin: hope we will see more startups tackling dementia and Alzheimer’s because it is not only an incredibly painful problem to people with Alzheimer’s and dementia and their families, but it’s also an expensive problem. And we do have organizations funding and accelerating solutions.

Michael Skaff: Yes,

Keren Etkin: types of startups. I hope we will see more startups tackling scams because scammers are getting so, so creative that, I mean, we don’t need one or two startups screening calls. We need 100 startups tackling 100 different types of scams. so that, those are the things that I hope we will see more of in 2025.

And. When I release the market map, we will see if my predictions have come true.

Michael Skaff: I think I you talk about caregiver supports, too I think that’s the one other thing I’d call out is we’ve seen an improvement and an increase in caregiver targeted supports We’ve seen the guide program in the u. s. Emerge to support caregivers for folks with dementia. But I really would love to see more caregiver support.

and really people focus more because of the myriad challenges, the stress, the exhaustion that that leads to. So we really need to support our caregivers more in many different ways. So I’d love to see someone come up with some new ways of doing that.

Keren Etkin: Absolutely. We definitely need to support caregivers because we are all either are caregivers or will be caregivers.

Michael Skaff: We’ll be

Keren Etkin: So, we need to support ourselves. No one guarantees, no one guarantees that you will get to grow old, but I can guarantee that you will become a caregiver.

Michael Skaff: yes, one way or the other.

Keren Etkin: Awesome.

Michael Skaff: you.

Keren Etkin: Thank you, Michael, for joining the show.

It was an absolute pleasure chatting with you, as always. And I wish you lots of success in your new role. Sequoia is lucky to have you.

Michael Skaff: and I’m grateful to be there. So thank you, Karen, again.

Keren Etkin: Thank you.