Testing & Invalidating 15 Startup Ideas in the Eldercare & AgeTech Space
Sameer Dhar sold a startup in the eldercare space in 2016. He kept digging into the industry looking for the next opportunity. (#39)
If you’ve been reading Focused Chaos for awhile, you know that I’m interested in the eldercare / agetech space. It’s a space I’ve explored personally with my venture studio team. I shared our learnings, which covered how we did our research, the prototypes/concepts we tested and what we learned. Our goal was to validate a big enough problem and solution, such that we felt it was worth building & funding a startup.
We didn’t find anything compelling enough to start a company, but we learned a ton. And I remain committed to building and funding startups in the eldercare space.
One of the most interesting things that came out of the work was the number of founders, investors and domain experts that reached out sharing their interest and experiences in the space. I met (and continue to meet) a lot of great people, which only proves how important it is to share your ideas and interests—you never know what comes back.
A perfect example of this serendipity is my connection with Sameer Dhar.
He reached out via LinkedIn after seeing a post I made about my experience exploring eldercare / agetech. Sameer’s got a lot of experience in the space. He co-founded Sensassure in 2014 out of university. The company built a hardware and software platform for incontinence management.
To validate and test the idea, he and his co-founders actually lived in three separate long term care facilities for 12 months! Talk about commitment. 😄
In 2016, two years after launching, Sensassure was sold to Essity, a ~$180B global CPG company.
Since that time Sameer has been exploring many new ideas in the eldercare / agetech space. In fact, he’s researched and invalidated 15 separate startup ideas!
When Sameer shared the research with me, I asked him if he’d be willing to share it with the world. And he agreed! We’ve now compiled a bunch of the research Sameer did and shared it at the end of the interview.
I spent hours digging into this material and learned a lot. While Sameer has yet to find the one thing he wants to pursue in the space, you may find his work valuable for your own startup ideas.
Sameer has an amazing story and I’m glad I can share it with you now.
Of all the companies you could have built, why Sensassure?
I wanted to build a company that was solving a meaningful problem. To me, if you’re solving a problem in healthcare, it’s quite often socially impactful. I started the journey by researching different verticals in healthcare and noticed that eldercare was a fast growing sector with an aging population, but perhaps not as much attention paid to the space from an innovation perspective. I talked to a ton of stakeholders—geriatricians, caregivers, nursing home admins, home care owners, etc. and asked them where their biggest pain points were. Incontinence kept coming up. I started shadowing at different nursing homes to understand the pain point better and continuous curiosity led me to understanding in-depth the problem of incontinence management and eventually birthed Sensassure.
This was your first startup and your first go in the hardware space. The learning curve must have been very steep? What were some of the lessons you learned from the experience?
1. First principle thinking really matters because there’s a lot of noise in the world.
You get a lot of contradictory opinions from smart people (i.e. mentors, advisors, investors, industry experts, etc.) so the only way to think through that is to develop and test your own frameworks on problems, assessing people, etc.
For example, when we had the opportunity to sell the company, 50% of the people we spoke with said sell while 50% strongly argued for us to take additional capital and keep building the company. We had to figure this out as a team, ourselves.
On the one hand, we had the foundations of a scalable, compelling business. We'd become knowledge experts while developing a novel solution that showed clinical efficacy. On the other hand, we saw clearly that building our own distribution network to cash-strapped nursing homes as a single-product company wasn't viable. We needed a distribution partner. In the end, we found that partner in Essity. I weighed the risk of Essity quashing our project post-acquisition against the opportunities to leverage their global distribution network, and felt the second path was in the best interests of those we wanted to help, our shareholders and our team. We earned a 5.5x return for our investors immediately, in lieu of what I analyzed to be a relative limited upside potential if we built it ourselves. So in the end, I made the call to sell, but had to do so through our own careful consideration, amid contradictory advice.
You’ll also get mixed signals even when you study a problem closely so you need to become attuned to thinking clearly and isolating variables you can efficiently test. With early adopters, many nursing staff said that our solution wasn’t required for various reasons, one of which was that the briefs patients wore were so good they could hold a litre of urine without any negative health consequences (so you didn’t need a sensor to tell you when it was wet.) From our own experience being the first users of our own product, we had an inkling this didn’t make sense! So we probed further to understand how it was that briefs reportedly could hold 1L+ of urine. Upon digging further, we found that the industry standard for measuring brief capacity is called the Rothwell method—essentially dunking the product into a tub of water, taking it out, and when it stops dripping you weigh it. From a first principles perspective, this doesn’t translate to when a product is actually wet against a resident’s skin.
The journey taught me what it means to think critical and make my own judgments, something I think traditional education does a poor job of. I find it to be a more liberating way to live in all arenas of life.
2. Spaces considered difficult to play in are often ripe with opportunity if you are willing to be persistent enough, and actually aren’t as scary as they seem on the surface.
Sensassure was developing a medical device and had regulatory considerations to deal with. It was also a healthcare company, which means catering multiple stakeholders with misaligned incentives. It was an IOT device which meant hardware and software development on top of that.
We isolated each of these challenges and found the right subject matter experts in each discipline to tackle the problem—who, not how;
I now see regulation / hardware development as just another box to check on the evaluation of an opportunity. It’s a known risk that you can fairly efficiently flesh out if you have the right folks at the table;
These complex spaces often have less competition because the problems / companies tend to be less sexy.
Multiple stakeholders is one of the key challenges in the eldercare space. Residents who would stand to benefit from our product were cognitively impaired and didn't have a direct voice in adoption, though it benefited them the most. Families of residents wanted their loved ones to be dry so in theory wanted them to be changed as often as possible. Admin at a nursing home wanted to deliver on their value promise to families but at the same time didn't want families breathing down their necks calling them out on untimely changes. Nursing staff were often overworked and there was a perception this could possibly increase the number of changes required, adding to their workload.
3. Do insane things to be one with your user.
We lived at 3 nursing homes for 12 months and this became a big part of our narrative as a company and as individuals.
It allowed us to buck conventional wisdom and really understand the problem and right product to build. Interviewing stakeholders is a good start, shadowing them to observe behaviour is even better, but living with them and getting acquainted with the rhythms and nuances of your user’s environment is the best you can get to empathize with them. Here’s a quick example of the impact (of living in the nursing homes). One of them used iPads for documenting care, so we designed our interface and notifications to work with iPads. The administrators of the nursing home assumed that caregivers carried these iPads in with them when they delivered care. Brief shadowing experiences indicated this to be true. However, from living there (and having familiarity with caregivers such that their guards weren’t up), we became aware that a number of caregivers across shifts found the iPads got in the way of their ability to deliver care so they left them at the central nursing station and documented their activities at the end of the shift. This of course would have significant implications on our product’s utility, which we only discovered through living with our users.
It allowed us to iterate quickly and stay close to what our users needed. We could ask nursing staff what they thought of a prototype and immediately get working on the next revision. This type of access, particularly in healthcare, is hard to come by and invaluable to moving quickly.
It engendered a commitment to the cause for our team that is tough to replicate. Our entire team woke up each day with an alignment of purpose and work that perhaps is only possible for a group of 20-something year olds. It wasn’t great for our dating lives but for that period in life, it was an incredible experience. Our team’s unprecedented commitment also aligned other stakeholders (care home administrators, nursing staff, investors, etc) to our cause.
Interviewing stakeholders is a good start, shadowing them to observe behaviour is even better, but living with them and getting acquainted with the rhythms and nuances of your user’s environment is the best you can get to empathize with them.
Would you do another hardware company? And do you think hardware companies are harder to validate early on, build and scale?
I would if I validated a large market opportunity. From a validation perspective, hardware means you need to over index on customer discovery, understanding the business model, etc. at the start so you have conviction that the problem is worth solving.
Each iteration cycle is more expensive (time and money) so being hyper intentional about the intent behind each cycle / what you’re trying to de-risk / prove is important. I think the “move fast and break things” mentality doesn’t work well in hardware and especially in healthcare.
You sold Sensassure to Essity in 2016 and stayed on for almost 2.5 years. What can you share about the acquisition process and experience? And what was it like working inside a large organization (Essity has ~15k employees)?
We got lucky! Essity was a great organization to work with and for. Great people with great values who shared our interest in making a meaningful difference.
On the cons side, it’s no secret that big companies work at a different pace than startups, evaluate risk differently, and are much more process driven. But as a business person, I feel this was all additive to our life experiences as young people in our 20s. And Sensassure lives on in one of Essity’s products, the TENA Smart Care Change Indicator.
After leaving Essity you went on a very deep journey into the eldercare / agetech space. A lot of founders prefer to switch verticals after spending years in one space, but you decided you double down. Why?
I came out of my experience at Sensassure with insights and hypotheses about problems I wanted to work on next. I felt that the healthcare / eldercare / agetech space was one that I was personally mission-aligned towards so it felt natural to leverage the relationships, understanding, etc. of the space to explore those problem spaces.
You went on to explore at least 15 separate ideas in the eldercare space. And you documented everything! What were you determined to do differently from your previous experience with Sensassure?
I’ve found that the prospect of being a second time founder is more difficult than I expected. I’ve been thinking about this a lot of late, and here are some initial thoughts:
1. I now have higher expectations for success.
I am driven by social impact and financial success. The universe of opportunities that are simultaneously personally meaningful from a social impact lens and 10x in terms of potential financial outcome have become more limited than when I first started Sensassure, when there was no real expectation of what success should look like.
What is meaningful from a social impact perspective has also taken on a different tone because now I have developed passions for a space based on previous experience which I didn’t have before. I came out of the Sensassure journey with insights that I wanted to pull on from a social impact perspective that became part of my own personal narrative / identity / quest and while I have extensively pulled on this thread, I have thus far concluded that while the needs I’ve identified are real, they don’t translate into viable 10x business outcomes.
Navigating the tension between social impact within a defined category based on my lived experiences and 10x business objectives is challenging.
2. I now have the curse of experience, which I’ve found affects me in two ways:
The search for perfect information. When I first started Sensassure, I had no idea how to do proper diligence. I committed to the idea based on a cursory level of validation that there was a problem and potential solution. Now, anytime I think of a problem or solution space, I think about all the risks and reasons why an idea won’t work. I then systematically conduct diligence on those risks and inevitably uncover a more realistic sense of an idea’s potential, all before committing. Time and time again, I’ve found that ideas don’t meet the rigorous bar I set for my aforementioned expectations for success and have consistently invalidated ideas through this diligence process. The risk is that I don’t go far enough on an idea. Through jumping in and having your back against the wall, you’re forced to figure it out as you go with no safety net / escape chute. At the edge, you’re able to push boundaries and be more creative, the risk with failing to launch is that you don’t get deep enough to get the data needed to make the right next decision.
I’m now an expert in the industry. In the eldercare tech space in particular, I feel I have become somewhat of a subject matter expert. While this is a desired endpoint for many people in their careers, I believe it can be detrimental to an entrepreneur because you rely excessively on assumptions and frameworks you’ve developed during your time in a given sector, which hampers your ability to have fresh thinking and new insights.
In some way, this second time around, it feels like forcing it in a way that is different from the first time. The first time around, you forced it but you didn’t have the weight of expectations and the knowledge of what pitfalls you might face so it was more natural. It was like being a bull in a china shop and not caring about what the downfalls / pitfalls might be. Now you’re in the china shop and you’re afraid to break all the fine glass surrounding you.
In some cases you did very light / quick validation and in others you went very deep. Can you share a bit about your process?
I’ve explored different frameworks on validating a startup idea and would say the Startup Owner’s Manual is the most comprehensive. However at this point I am not as rigid with following a textbook framework and instead evaluate each idea based on its unique characteristics / risk.
The goal at any stage is to identify the biggest risks for a given opportunity and find the most efficient path to de-risk.
Where I start, before building anything:
Problem: What is the pain point being solved for? How big a pain point is it? For how many people? Willingness to pay?
Use customer discovery / landing page testing to understand this in combination with market research to understand if the problem is large enough to go after
Spend most of my time evaluating / invalidating ideas in this segment
Potential solution: How does the solution solve the problem in a way that is unique from the competition?
Spend time here understanding the competition, working with a technical partner to my hands wrapped around the key tech/dev risks, timeline etc.
Most ideas get killed at this stage. For the few that don’t, I go into experimentation mode where the goal is to try to test key elements of the product / solution as efficiently as possible. I try to simulate the product experience with minimal development to understand how the pain point might be solved and if built, what the product needs to be.
You ended up invalidating all 15 ideas you looked at. Do you think you’re being too risk-averse at this stage and not taking the plunge into one of these ideas?
Perhaps. What I can say is that for any of the concepts that I’ve tried thus far, no big companies have been built. But I’d love to be proven wrong as I feel the problems I’ve explored are worthy of being solved at scale.
I do much more diligence now than I did before. And the bar to jumping all in feels quite high compared to being fresh out of undergrad and starting Sensassure.
Do you think the eldercare / agetech space is simply too complicated/messy to really break into successfully?
I don’t want to discourage people from trying to make a dent in such a worthy space, but the barriers are real:
Funding constraints for the most in-need populations (long-term care operates on single digit margins in NA).
Willingness to Pay is low by institutions other than for innovations that directly save costs (improving quality of care alone doesn’t easily sell nor does saving nursing staff time)
Sales cycles are long. There are a wide variety of stakeholders with differing incentives that are challenging to scalably align. There are immature innovation adoption processes at eldercare organizations across the spectrum. And decision makers / key influencers often include the adult children (most often a daughter) in addition to the elder patient—aligning family dynamics is tough to scale.
It’s a highly relationship-driven business. Many of the issues in eldercare come down to humans (lack of caregivers, lack of companionship, etc.) It’s inherently difficult to scale relationships, which are not a commodity (i.e. “Uber for home care” doesn’t work as well).
What are you looking for as you’re evaluating these ideas to decide, “that’s the one, that’s what I want to do”?
Customer demand where I can consistently find early adopters who have the pain point and need the solution I’m proposing.
Unit economics that check out immediately or I can see a path to them checking out in the future.
“Gut” instinct and passion for the problem / space, which I hope I haven’t lost!
Are you still looking actively at the space?
I’m always open to new ideas but am currently spending time diving into the longevity space.
We’re sharing a lot of your research below, in Google Doc format, essentially the way you tracked everything, evaluated ideas, and summarized your results/thinking. This is an amazing resource for founders that are looking at the eldercare space, but also just to understand how you systematically went about doing validation. What are you hoping people take away from seeing all of your research?
I hope people go through the research and point out flawed assumptions / conclusions I’ve drawn, evolve my work, share new ideas / approaches, and hopefully connect to discuss! And if I can save founders time while they explore the eldercare / agetech space, that’s great!
15 (Invalidated) Ideas in Eldercare / AgeTech
As mentioned before, Sameer went through many ideas in the eldercare / agetech space after exiting Sensassure.
He was gracious enough to share most of his research, which you can access here.
That links to a Google Docs file, which subsequently links to many of the ideas Sameer pursued, in separate Google Docs files and a couple Notion files as well.