There’s a difference between wanting a cup of coffee, and having a heart attack.
Seems obvious enough. But in senior living communities, when a resident presses a button calling for help, the system treats all those calls the same—by design.
"There’s a philosophical question no one has a real answer to," said Andrew Smith, VP of operations and innovation at nonprofit senior living organization HumanGood. "What’s an acceptable time to wait for help? Is it two minutes, eight minutes, 15 minutes? Of course, it depends on the thing in question. But the system doesn’t tell you whether it’s an emergency, because the idea is that every button is an emergency."
Now, the overwhelming majority of button presses are service requests, like meals or bathroom trips, but Smith’s question indicates the constant, fine-line calculations senior living facilities must undergo every day. On one hand, these communities need to minimize caregiver burnout. (The annual turnover rate for senior caregivers is distressingly high, in recent years hovering around 80%.) But they also need to take all calls seriously, because a trip to the bathroom can turn into an emergency when, tired of waiting, a resident falls. These tight-rope calculations historically have been made in the dark, because most senior living-related technology has been characterized by blunt instruments—pull cords, Life Alert pendants, and sometimes even baby monitors.
"It's not that there's no technology," said Matt Lynch, cofounder and CTO of Sage, a senior living software system. "It’s that the technology isn’t being used in a way that creates accountability and visibility."
Sage was founded in 2020 to build software that, among other things, enhances visibility in the operations of senior living communities and improves the day-to-day care of residents. A major challenge that caregivers, administrators, residents, and their families all face is that everyone has a different vantage point—and quickly it can become almost impossible to know what’s going on with a loved one. What’s a serious problem, and what’s dementia talking? Is Mom saying she didn’t get fed today because it’s true—or because she doesn’t remember? Sage was built to collect and provide data, so everyone involved has the tools to have tough conversations.
"The way we thought about it was: Okay, how do we invite all these people in?" said Sage cofounder and CEO Raj Mehra. The answer: giving everyone access to data so that they’re "speaking the same language."
Founded by Lynch and Mehra (who met working at Palantir) and Ellen Johnston (previously cofounder of Makr, which sold to Staples in 2015), Sage now operates in hundreds of facilities across 26 states. This fall, Sage raised a $35 million Series B, led by IVP, Fortune can exclusively report. Friends and Family Capital and Plus Capital participated, along with existing investors Animo Ventures, Distributed Ventures, Goldcrest Capital, and Maveron. The Series B brings Sage’s total capital raised to $59 million.
IVP general partner Eric Liaw quickly points to what I think is essential about Sage—that it’s a company at the intersection of massive societal change and our own personal stories. "Just think about your loved ones, anyone in your life who’s older than you are," he said. "That’s why Sage exists." Mehra, Lynch, and Johnston came together to found Sage expressly because of their own experiences with aging loved ones, and witnessing the missteps and failures of the medical system’s existing technology for the old.
"For me, it’s about creating aging infrastructure that gives people leverage at all stages and enhances their quality of life," Mehra told Fortune.
The word "infrastructure" is key. As a society, we simply don’t have the infrastructure for a population that’s getting older en masse, and (in historical terms) quickly. In 1920, 4.9 million U.S. adults were over the age of 65. In 2020, that number was 55.8 million. Looking to 2040, it’s expected that about 78 million U.S. adults will be older than 65.
Or how about something even sooner: By 2035, Census data suggests that for the first time in U.S. history, there will be more senior adults than children.
This creates an existential, impossible crunch: As more people live long enough to need the care that comes with aging, caregivers and the companies that employ them are increasingly strained. Right now, 99% of senior care facilities report workforce shortages.
And those workforce shortages, in part, can be tied back to technological deficiencies. Often, facilities just didn’t know which caregivers were taking calls from residents, or have any documentation of what happened during those calls. This has added to the burnout many care workers experience. "Imagine if your boss had no idea what you were doing," said Ellen Johnston, Sage chief product officer and cofounder.
Technology can’t solve caregiver burnout on its own, of course. But Sage is betting that data can help reward exceptional caregivers and improve transparency by creating "very precise documentation, we can measure staff shifts, staff trends, and usage across staff members," said Lynch. (Sage reports a 20% average reduction in employee turnover in its communities and a decrease in response times from 20 minutes to under eight. The company also says it’s looking at expanding into at-home care.)
There’s an obvious question here: Why haven’t technologists been flocking to such a relevant, innovation-starved industry? Sage’s direct competitors are primarily legacy systems that have been around for decades, but agetech overall is expected to keep growing as a market, garnering more and more investor backing along the way.
"It hasn’t been relevant for that long, to start," said Liaw. "The industry's now growing because people are living longer, and the period where you’re physically well and able until the end of your days is extending. So, I think that’s why people are paying more attention."
Then, a beat.
"It’s also maybe not fun to think about, per se," Liaw added. "You know, Raj and I bonded on our first meeting over our similar experiences with our grandmothers…We had a shared experience. And I think that was, for him, the moment where he said 'I’ve got to do something different with my life.'"
Everyone has stories about those they love aging. And it’s painful to talk or even think about, because when we talk about aging, inevitably we’re talking about death. I asked the Sage team about it, point blank: How has working on Sage made them think about death?
"On a technical level, we have a way of keeping records and data, so that we can understand trends in terms of what’s happening," said Johnston. "But from an emotional standpoint, it can be difficult, of course, and difficult for us, as well. We have relationships with people, with caregivers. Their lives are part of our lives."
When I went to see Sage in action at HumanGood’s Westminster Gardens facility in Duarte, C.A., it was pretty clear how the technology worked. Each room has a white and blue Sage button near the floor, which residents wear as necklaces, and there’s a streamlined app on the caregivers' company-provided phones.
But I’ll be honest, what I most remember about the visit is encountering a Westminster Gardens resident in the hallway. We explained who Mehra, Lynch, and Johnston were, and she held up her Sage pendant.
"I wear it with pride," she told us.
Aging is inescapable, but we as a society struggle to talk about it and therefore are ill-equipped to address the end of life on a larger scale. There’s a question I’ve been obsessed with as I’ve been reporting this: What does Sage give back? Liaw thinks it’s an ill-conceived question because it implies some kind of reversal. And he’s right. Aging and, eventually, death move forward non-negotiably. Time lost can never be regained.
So, I think the answer is that Sage’s value-add is clarity, which can help everyone, from caregivers to families to residents, see their options, resolve conflicts, and maybe even find purpose.
And clarity can be hard to find at the end of a life. I keep thinking about my Grandma Cookie's final year. One morning when her nurse came in, she had chocolate all over her face, candy bar wrappers strewn across the kitchen. Grandma Cookie swore she hadn’t eaten a scrap of chocolate.
But perfect clarity is impossible, and the mundane can escalate into a crisis. So, for all the nuance Sage brings to elder care, the company’s tech has retained one notable existing practice: Each button press is still treated as an emergency.
Because what matters most is to answer the call, and fast.
See you tomorrow,
Allie Garfinkle
Twitter: @agarfinks
Email: alexandra.garfinkle@fortune.com
Submit a deal for the Term Sheet newsletter here.
Nina Ajemian curated the deals section of today’s newsletter. Subscribe here.
