A chance encounter on a playground led to the launch of a startup aimed at streamlining the work of assisted living staff members and operators through technology. The case of August Health provides a look at how technology is transforming the senior living industry.
Justin Schram, M.D., and Erez Cohen come from very different backgrounds. But in between casual conversations about their young sons at the playground, they found a shared desire to build a modern operating and data platform specifically for assisted living.
“Operators are struggling to manage a deluge of paperwork, increased compliance requirements and still collecting checks on paper,” Cohen said. “Meanwhile, related industry players — pharmacy, referral, healthcare payers / providers — don’t have any interfaces to exchange information. Fax is still the state of the art.”
The two founded August Health in 2020 to try to address this gap, building a platform to “unblock” essential workers, guide them to best practices and build an underlying platform to “wire up the industry.”
The startup, which began using its platform to manage care in more than 60 senior living buildings within six months of the initial launch, recently raised a $15 million Series A, led by venture capital firms Matrix Partners and General Catalyst as well as industry veterans Columbia Pacific founder Dan Baty and Formation Capital founder Arnie Whitman. The company has raised $17.6 million to date — including $2.6 million in initial seed money — and assembled a team of ex-operators from Apple, Google, Adobe and digital health companies.
Schram, former medical director at California-based home care provider Landmark Health, said that with each home care visit to his patients — many living in senior living communities — his frustration grew at his inability to provide quality care because most records were on paper or “held hostage” within inaccessible, antiquated systems.
“It was hard to get medication lists, code status, what’s going on with a resident,” Schram said, adding that paperwork was consuming the time and energy of frontline workers trying to keep residents from going to the emergency department.
“I saw the burn, the churn,” Schram said. “So much of what was frustrating them could be addressed through automation, technology — a modern, elegant platform. The old systems of senior living were operating like 1950, or using older server-based software built for skilled nursing and bent into an afterthought for assisted living.”
Today, a new generation of operators who are digital natives are coming into the field, along with families demanding technology they already use in all other aspects of their lives. Sensing an opportunity with the demographic change led by the baby boomers on the horizon, Schram left his clinical job to explore his idea.
“The old system cracked, and the fault lines became clear, and people realized the old systems weren’t doing the trick,” he said.
Birth of a partnership
While pushing his son on a swing set, Schram met Cohen, founder and CEO of Mapsense, a data mapping company that was acquired by Apple. Cohen, a Silicon Valley IT expert, recently had left his role as an engineering director at Apple and was contemplating his next project.
The two started talking, and Schram shared his idea, which he couldn’t quite execute.
“Justin opened my eyes,” Cohen said.
Looking into the long-term care industry, Cohen discovered that 74% of senior living communities did everything on paper — medication, allergies, diagnoses, care plans, schedules. Of the 26% of communities using technology, he said, it was legacy technology typically designed for an adjacent industry.
“There really wasn’t a tool out there,” Cohen said.
Together, the two began visiting senior living communities in the Bay area, where Schram had patients, speaking with staff, administrators and families. Senior living communities, Cohen said, face problems related to resident care, staffing, transportation and occupancy, and families don’t have insight into what’s going on in a community.
“We did a lot of learning,” Cohen said. “It kept coming back to everything — every problem — there was no system to do that.”
At one community, for example, Cohen said, residents and staff members spent hours signing papers. After a resident moved in, that information was locked in paper forever and did not translate into care.
“Communities are doing a good job of recording data on a resident,” but they’re not doing anything with it, Cohen said. “Coming from a data science and analytics background, that was shocking. Alarm bells went off in my head.”
Cohen said that was his “aha moment” and when he knew there was a business opportunity there.
August Health signed its first customer, San Francisco-based CiminoCare, a family-run California senior living owner and operator focused on middle-market assisted living and memory care communities. The company worked closely with the organization and its staff members to design a platform, while at the same time raising funds, hiring a designer and building a company.
“We built something around their daily workflows to meet their needs,” Cohen said.
CiminoCare CEO Mark Cimino called August Health “grassrootsy,” saying Cohen and Schram showed him that CiminoCare could have a “very good” return on its investment by changing its software platform.
“We were impressed right off the bat, even before they started on the product,” Cimino told McKnight’s Senior Living. “They immersed themselves and understood the industry. They can talk the talk with just about anybody.”
He cited “the spirit of where they’re coming from, and the grassrootsy attitude they have of making even the one-off or middle-market operator feel like they’re special and the software is going to help them individually.”
Looking to the future
Schram said he looks at what the residential care community of 2040 will look like and what technologies are coming. Some of that technology is available today with virtual reality headsets to address loneliness, sensors to detect falls and toilet seats to track infections. But if each emerging technology needs its own login and portal, it complicates usage.
“You need one central platform to know who’s in what room, what medications they are taking, who their emergency contact physician is,” Schram said. “Essentially, we are the system of record. We are the platform to integrate those and be the interface the community uses to enable technologies for senior care.”
Cohen said discontent in the broader technology market fed interest by engineers and designers in joining their company.
“We’re building a company that will have a demonstrable change on peoples’ lives,” Cohen said. “People are starting to see their parents reach an age where they need this support.”
Schram said that in working with staff at client buildings, they are hitting success measures that show their platform is doing its intended job: making the jobs of senior living employees easier.
Legal, clinical care, billing, compliance and regulatory expertise, a family portal and best practices all are built into the tool. “We’re not trying to just build another assisted living software,” Cohen said. “We’re building something that is a different, bigger vision. It’s service-embedded.”
Josh Allen, RN, principal with Allen Flores Consulting Group, a senior living nurse consulting company, has become a cheerleader for August Health, telling McKnight’s Senior Living that he was impressed with the simplicity of the platform.
“It’s very intuitive, easy to use and has a short learning curve for a new nurse — one of the biggest struggles in the industry,” he said. “It sounds like a simple thing, but if you have an EHR platform a nurse can learn and get comfortable with in a few hours, it can have a really big impact on retention, turnover and job satisfaction.”
Allen serves as a sounding board for Schram and Cohen, providing weekly feedback on how to improve the product at each step.
The name August
Although they have many stories after the fact on how they landed on the name August Health, including that the domain name was available, Schram said he sees August as the season in someone’s life when the person is starting to think about later life.
“The word August means venerable, respected,” Schram said. “That word for me resonates about how we feel about residents of communities and what elderhood is.”
The partners said they are working to build a national brand and company to make an impact on senior living.
“We have a long way to go,” Cohen said. “We’re still very focused on solving the problem for the senior living operator who runs a building and the staff in that community.
“There is a roadmap a mile long for building a company. There is opportunity after opportunity after opportunity.”