Preparing For The ‘Silver Tsunami’: Sage CTO On The Future Of Elder Care In America

0:00A so-called silver tsunami is coming for the American population. By 2030, every single baby boomer will be over the age of 65. Yet at the same time, there is a massive shortage in workers who can help care for this population. Our next guest is working to solve that gap. Welcome to C-Suite Unscripted. I'm Maggie McGrath, your host. And today I sat down with Matt Lynch. He is the CTO and co-founder of Sage, an AI-powered fall detection and nurse alert system for senior care facilities. Matt and I talked about why he needed to build a solution that combined hardware and software, how AI can actually help a patient who has fallen down, and why an early job as an RA on a college dorm taught him a lot about balancing existing dogma of rules with lived reality in front of him and why this matters for entrepreneurship.

0:55Let's dive in.

1:01Matt Lynch, thank you so much for sitting down with Forbes. I'm super excited to be here. Thanks for having me. You are the CTO and co-founder of a company that's operating in what I would describe as a mission-critical aspect of the American economy, caregiving. Can you talk about Sage? Give the 60-second elevator pitch for what you're building. Sure. Yeah. So Sage is building a care intelligence platform for senior living and skilled nursing right now. And that's a combination of hardware and software providing infrastructure for senior living facilities, allowing residents to get better care, providing workflows for caregivers to make their jobs more efficient.

1:38and then ultimately providing data exhaust and data insights for the executive teams and the owners of these businesses to be able to operate them more efficiently and be able to provide a better product. Senior care, senior living doesn't sound all that sexy, but it is a tremendous economic need, as I just indicated. Can you talk about the market opportunity you see here and why the silver tsunami, what it is and why it matters? Totally. Yeah. So silver tsunami, the baby boomers are all aging into this population over 65 in the next four years. It's 77 million people by 2030 are going to be aging into this population, while at the same time, we're going to have a shortage of 1.8 million caregivers in order to keep up with the caregiving demand that we're going to see there.

2:24So those two things combined suggest that the industry as a whole is going to have to adapt and figure out new ways to be able to either incentivize caregivers to join in caregiving, which is part of the problem. And we're going to have to be able to provide technology that's going to be able to augment these caregivers to enable them to be more effective at scale. You and your co-founders all have personal experience in this sector. What was the driving force and maybe the driving force that led to the inspiration moment for creating Sage? Yeah, Raj is the mastermind. He's our CEO, came to me during the pandemic with the idea of building a business and aging.

3:02We didn't have a concrete, this is exactly what the product's going to look like when we got started. But he shared his personal anecdote, and I hadn't seeked out this industry up to that point. But his poke was an opportunity for me to do some personal reflection on my experiences with my grandparents. And I was lucky to have grandparents that lived in their 90s. But I did get to see through my childhood and all the way up through early college what aging looked like. And it was a 15 or 20 year journey for each of them. And there was no concrete moment that was like, this is exactly the moment that things changed for them.

3:41But over the course of those 15 years, there were instances where it really could have been a more dignified process. And my grandfather, I think, is a good example to talk about there. He was in his 70s living by himself, had mobility challenges. He fell down in his home by himself, ended up fracturing his hip, wasn't found for hours, ended up coming to live with us after he had surgery. We ended up convincing him to move into an independent living facility nearby so that we would have better access to him. And ultimately, he seemed like he was doing better, but had another fall while he was there, was on the ground for hours because he didn't have appropriate means to call for help.

4:20And there was no instance where we were like, the caregivers here are doing a bad job, or the apartment that he's living in isn't up to snuff. It's just, he's getting old, and that sucks for him. And this is just what it looks like to get old. But yeah, when I was reflecting on that with Raj, it was like, we could totally have a huge impact here with just basic modern technology applied to the space. So looking at it through that technology lens and entrepreneurial lens gave a whole new light to how we might actually have an impact on it, which was very motivating. And I know Ellen has a similar story.

4:52That's your third co-founder. Now I've heard you say, or rather you said to me before we walked in here that you did not set out to build a hardware business. You wanted to build a software business, but the existing technology in this space, I think we've all seen those commercials while we're watching the prices, right? Homesick from school, help, I've fallen, I can't get up. And then Life Alert is here. And I don't want to put Life Alert on blast, but that's my most, I guess, vibrant image of what someone could use when they fall, either at home or in a care facility. So did you guys start with an assessment of the existing technology and realize, oh, the hardware can't take the software that we want to build?

5:35There were a few aspects to it. I think the first one was a lot of the incumbent technologies are based on safety and fear, where the people leveraging them feel old. They feel like they have this burden now that they're carrying around an anchor, which was something that we were intentionally trying to avoid when building this. You want people to want to use it. You want them to want to carry it around and for them to feel like it's a safety blanket, not something that's dragging them down, which was a big part of it. And you're right. Building hardware is not for the faint of heart. And it is definitely not how we had originally intended to start building the business.

6:14But when we got in there, it was a combination of disparate technologies. So there was a ton of different versions of the call bell, the pendant, the pull cord on the wall. And a lot of these technologies just hadn't been updated in 50 years. You're talking about 1970s, 1980s technology. And when we were getting started, we had this vision of building this data platform where we could actually be able to change the way that care was given from reactive to proactive. Make it so that you can start to get ahead of some of these things and improve folks' quality of life. You're not going to be able to get that data with such a bad interface, right?

6:55So we needed to be able to control the entire stack in order to craft this in a way that we were going to be able to get the output we wanted. Can you talk about the pieces of hardware that you have? Because there looks like there's something that's like a wall mount that kind of monitors sleeping and activities of daily living, dressing, basic functions that can help assess a person's quality of aging, if you will. Totally. And disease progression if they have a disease. I know ADLs are important there. But then it looked like there was a wearable device. So can you talk about the categories that you are currently in?

7:25Yeah, definitely. So we have a pendant that residents will wear. They can wear it on their neck as a lanyard. They can wear it on their wrist. We have a couple of different ways that they can carry it around. That same device can be mounted on the wall. So put it next to the toilet in the bathroom, stick it on the headboard of their bed. And these are the basic reactive ways that residents call for help, right? So they push a button when they need help, and then a caregiver is dispatched, caregiver gets there. We provide workflow software that makes it easy for a caregiver to then classify what happened and record that for future analysis.

8:04We also have sensors that we deploy in communities. So door sensors are a big one of those. Door sensors being wanting to be able to monitor when somebody enters and exits. There are a lot of sensitive areas in these communities, especially in instances where you have residents with cognitive decline. So in memory care wards, you have to make sure that folks aren't going to be out in an unsafe way and actually wander from the community. And you're right, we also have Sage Detect, which is a camera-based monitoring solution that's backed by AI that allows us to do a lot of really cool things, starting with fall management, getting into fall prevention, and like you said, doing a lot of those ADL detections as well.

8:44So many areas to go into, but maybe just to continue on like the 40 ,000 foot view, I've heard you say that you can't spend a year building the technology you needed to at the beginning of this company's life, just get in the market as fast as possible and then iterate. How hard was that? And what were the key technology moves that you made in order to facilitate a faster deployment? Definitely. In the beginning, got started with what we called the least common denominator on the hardware side. And that was intentionally trying to avoid the 100 % custom hardware deployment when we got started.

9:20And we were using that as a wedge to be able to validate the software workflows that we were providing for caregivers. and that least common denominator was working with a third party to provide what ended up becoming a very reasonable proxy for the current pendants that we deploy. There were some issues with them, but those pendants or buttons that we were working with this third party to provide got us 85 % of the value that we wanted without us having to do any sort of manufacturing ourselves. We were still in the hardware business. We had supply chain challenges. We still had to support physical product that we were deploying, but it eliminated all of the complexity on the manufacturing side.

10:01And it allowed us to focus most of our internal engineering efforts on the software workflows that we were going to be exposing to the caregivers in these communities. And we've had a similar deployment ethos for most of the product development that we've done. So on the Insights side, we didn't craft this beautiful Insights ecosystem as the first thing that we deployed, it was, what are the three questions that you want answers to? Like, how can we answer those with the data that we have, provide that to you in a way that you can consume, and then start to build on that as we deploy to more? So you transitioned from licensing something to then building it in-house?

10:41Do you have manufacturers now, or are you sticking with that original model? It's a mix. So we do still have third parties that are providing components of our infrastructure, and we do prefer to buy if we can. So as an example, we use third-party networking equipment in these buildings. It doesn't make sense for us to build our own receivers and basically the means to relay all of these signals out to our cloud software. But when it comes to the user experience of the resident, almost all of those are in some way custom, whether that's wide-labeled custom development with a third-party manufacturing partner or us actually owning the entire supply chain ourselves and working with contract manufacturer to build something completely custom.

11:28You mentioned the record keeping. Well, you have the workforce management piece of this, right? You have the alert system that will tell the nurses in these facilities that someone needs help. But then there's a record that gets created so that families can access this and they can actually see what's happening. They can verify for themselves. And I know some of those family caregiver interactions can be tense sometimes. There's a record. How did you manage integrating with the existing MyCharts of the world? I'm referring to probably the dominant market category. I know there's others in the market, but - The electronic health records.

12:02Yes. Yes. It's a challenge. They're big, they're established, and they are the clinical record for all of these buildings. But what we've recognized and what we've been able to work with our partners on is identifying that we can coexist and we should coexist because we mutually benefit one another. So what we've been able to do is provide an operational layer on top of the MyCharts, so to speak. And what that does is it allows us to consume care plans that are being managed and updated through these EHRs and expose those in a way that's harmonious with the reactive workflows that caregivers are already doing.

12:45So as a caregiver is responding to a call bell alert, we can contextually tell them, while you're in there, you might as well do these three things because this is what Mrs. Smith is gonna need this morning. Because we're able to marry those two workflows together in a way that caregivers understand, we much more accurately and in the moment capture that context that we then funnel back into the health record. So there's this feedback cycle that allows us to not only operationalize what exists, but improve the care plan as they use it. And is that because of the sensor on the wall that is monitoring sleep and ADLs?

13:22It's a component of it, but we actually lean very heavily on the caregivers to do this. And this is where Ellen's genius really shines. But we've spent a lot of time embedded with caregivers to understand pain points in their workflows and specifically what they do, as well as the needs of the clinicians in these businesses and the general operational partners. Through that research, I've been able to build just a really world-class user experience that allows us to not only get more accurate documentation in the moment, but make it the least difficult way for caregivers to get the job done. So it's actually easier to do the right thing and it's easier to provide accurate documentation than it is to circumvent it.

14:05Doing the notes is often the most arduous part of it. doctor, nurse, caregiver's job. So it automates that. You mentioned on the sensors, AI has been helpful for that. And it's hard to have a conversation about technology without talking about AI tools. But I'm wondering specifically about AI hallucination in these cases, because I'm picturing someone falling, someone tripping, or maybe someone stutter steps, but then catches themselves. These are all three very different movements that can start in the same way, Right. Leaning forward, falling to the side or starting to, but they catch themselves.

14:41It's a really specific question, but I'm wondering how you've developed this technology in order for it to distinguish between movements that look very similar, but ultimately mean very different things for the patient. It's a great point. And the way that we treat AI, there's a big distinction between completely autonomous AI systems and AI augmented systems. We lean very heavily into the second camp, which is AI is there as a tool to identify things that humans would have missed or otherwise couldn't be in the room to witness. And then we provide a guess. It's like the AI thinks it saw this thing.

15:20And you present that to somebody who actually can make a clinical call about it. So fall detection is the most basic case here where we're not completely cutting caregivers out of the loop as part of our fall detection product. But instead, these cameras are leveraging these models to say, we think we've witnessed this type of an event. And you provide context. Maybe it's de-identified video footage. Maybe it's a synopsis from the model to a caregiver. And you alert them and say, we think we detected a fall in Mrs. Smith's room. you should dispatch your carrier radio, check it out. Here's the context that you should have in order to identify that.

15:59And then the same thing applies to all of the other proactive insights. I see. So it's more alerting for someone to come physically and help versus diagnostic this is happening. That's right. And you're right. Just like even the best models are going to screw it up. Being able to provide something that can give you all of this lift without completely depending on it being 100 % correct is the problem that we tried to solve with it. Do you think you'll move to the diagnostic? Because something that can happen with patients, especially in a cognitive decline or neurocognitive decline, you have good days and bad days.

16:30And if you happen to go to the doctor on a good day, if you go to PT on a good day, the assessment, I mean, if they're good at their job, hopefully they can see the disease progression, but the assessment could look very different. And if you have a camera that's monitoring on a more regular basis, does that eventually ladder up to diagnostic or is that not an area you want to play in? So what the AI is doing is it's capturing events. It's capturing moments, right? And what we're doing is we're creating a hypothesis around the things that it can measure. We're making sure that we have reasonably accurate detections for these different events that we want to see, whether that's somebody exiting a bed when they don't have their mobility assistance nearby, whether that's somebody trying to exit through a door that they shouldn't be exiting through, or maybe there's just agitation behavior that we're starting to see in somebody with advanced dementia.

17:21Those events are all recorded. And then what we're able to do is provide clinical analysis on top of those events to start to do some of the diagnostic things that you're talking about. But we draw a line there where we can start to provide analysis that show trends with these events. We can start to couple these things together and try and draw correlations between behaviors and different physical characteristics, but then leave that up to a clinician to actually go in and make the diagnosis. That makes sense. When you are having conversations that I recognize you've run technology and you're part of a team, you're involved in talking to investors and customers, but when you are talking to potential customers, what is the value proposition that they are most attracted to?

18:07Is it the upgraded technology? Is it, I've heard you talk about reduced turnover for the nurse practitioners and the folks on the ground providing care. What are you hearing from the facilities providing this care? It depends. There's always a value angle to it. And the value angle, taking a step back, we do have a different model from the traditional systems that you see deployed. But those traditional systems are typically sunk costs, right? It's I'm buying a hardware widget that I'm deploying that checks of compliance box that I need to have. The modern solutions are kind of flipping that on its head where we provide a SaaS model where it's hardware at cost or even waiving hardware fees in some instances and focusing more on how we can provide continuing value.

18:47It's a new concept for this industry. And because of that, we've had to make sure that we're actually able to justify the value that we're able to provide on top of that. Sometimes that's through labor insights, labor efficiency. Sometimes that's through liability reduction, making sure that your response times in the building are meeting thresholds, making sure that residence care plans are appropriately sized, the amount of consumption that they have. At the end of the day, the owners are going to care a lot about their net operating income and being able to demonstrate that Sage of this pays for itself, which 100 % of the time it will.

19:22In net operating income opportunities, whether through labor efficiency or care income, things like that, is an important aspect to it. But then you also have the flip side of that, where some of these guys are still running dinosaur solutions and they just need a new system and are out there shopping around to understand what their dance partner for the next 10 or 20 years is going to look like. So many times we enter that way as well. I have a failing nurse call system. What can you guys do? Which is our opportunity then to show the difference in our technology.

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20:21You raised a$65 million Series C and a round led by growth equity at Goldman Sachs Alternatives earlier this year, there was$35 million in debt also. So just a very big six months for you. What is the market opportunity that you see here? We talked about the 77 million people aging into this population, the silver tsunami. That's the people side. What's the TAM? Yeah. So the TAM is very big. I'm going to talk in terms of markets that we can work in and not specific numbers because I'm sure I'm going to butcher it, but billions in the U.S. in private pay, senior living. So we're just scratching the surface on our footprint here.

21:04And a big part of the strategy is just how can we take more market share in senior living? Another aspect of that is we've been investing in and have a deployment footprint in skilled nursing, which is smaller than our senior living footprint, but it's an equivalently sized market to senior living and actively working to expand our footprint in skilled nursing. Beyond that, there's going to be global expansion opportunities. This is not a problem that's unique to the U.S. So over the next few years, definitely expect to see an expansion into Western Europe, UK, Canada, and then eventually hopefully have a fully global presence.

21:41What's your biggest challenge when you look at the way you want to grow Sage's technology offerings today, summer 2026? What keeps you up at night? The hardware debt facility, I think, is a proof point to the way that we've been thinking about this. But I think the biggest one is it can be expensive to deploy these hardware solutions into these buildings. And if nothing else, it slows down the buy cycle when you have to figure out how to digest the$30 ,000 or$40 ,000 hardware bill going into these buildings. So us being able to provide an alternative method to finance and ultimately take these systems live faster has been a big focus for us up to this point.

22:24It's effectively a supply problem, just like how do we get out there and give this to people as quickly as we can? I want to transition to talking about managing workforce. How many people work at Sage and how many report to you? We have about 150 people at Sage now, and I think my org is roughly a third of that. So it's not a thousand people, but you're worried about hardware. You're worried about software. You're talking to customers. There's a lot to juggle for any C-suite executive. What are the leadership strategies that have been most effective for you in managing your workforce as you're growing this startup?

22:54Definitely. There's a couple that come to mind. I think the first one is we need to hire people who are creative and can think for themselves and who can own problems. And we lean very heavily into an ownership mindset where we empower our team members to go out and really do these things for themselves. And we're there to help guide them, to provide context, to make sure that they have the resources to do what they need. We're not there to micromanage them. And it's been a huge boon. I don't think we would have been successful if we didn't have that strategy. You want to hire these entrepreneurial folks who could actually go out and really figure these things out for themselves.

23:36And another aspect of that is making sure that those folks, it's easy to motivate them when they first start, right? You paint a grand vision. They can see the opportunity, which is great. But what does that look like over time? I think another aspect that's really important to that is making sure that these folks understand everybody's hungry for growth. They understand what the growth opportunity at the company is and what their place in that growth story is. So focusing a lot on that forward looking, this is what it means to grow at Sage. And this is how you're going to be able to continue to add value over time while getting out of this, what you personally want.

24:14So interesting. You say that there was another founder who sat in your seat and she said to me, I like to hire founders. And I said, doesn't that create a bottleneck of people thinking that they know exactly what's right for this company. And then you have too many people playing God effectively. And she articulated something, what you said, but how do you manage the, the entrepreneurial mindset is great. But if you have someone who wants to be CEO, in addition to software engineer, what's your strategy for managing that? We have a couple of values at our company that kind of have to coexist for it to work.

24:50And I hope everybody at Sage becomes the CEO of a startup someday. I think that would be wonderful. But there's an aspect of teamwork that comes along with that and understanding that we win if the team wins and you win if the team wins. It's not just you're an entrepreneur and you're here for yourself. That's you're an entrepreneur and you believe in the team and you believe in what you're doing. So the teamwork aspect of that is really important. We have a value that is disagree and commit. So making sure that you can have a healthy debate, but at the end of the day, understand whose decision it is to make.

25:23And ultimately, if you reach an impasse, you defer and say, great, let's see how it goes. And if it fails, I'm happy to help. And we value kindness and respect also, where you want people to challenge ideas. You want people to come to the table with ideas, but also do that respectfully and in a way that makes people feel like we're really just doing our diligence versus constantly jousting and having to defend our ideas. Disagree and commit. That's a good, that's so succinct. And I might steal that. I want to transition. We've kind of alluded to your career leading up to sage, but I always like to kind of take a step back and look at the steps that led to someone getting to the C-suite.

26:09In this case, you kind of created the C-suite position for yourself, but nonetheless, your career journey starts as an RA at Drexel in 2007. Oh man. That, I have to imagine I was never an RA, but what did you learn in that job? And maybe one hard skill, one soft skill, or was it all soft skills? Wow. Yeah. That's a, that is a throwback. Being an RA at Drexel was definitely a learning experience. And I guess one of the big ones was figuring out how to balance the dogma of the rules with the reality of the floor, if that makes any sense. Yes. Where it's just, I understand what the rules are, but that's just not reality.

26:48And we're going to do our best to make sure that nobody dies, that we're not doing anything substantially illegal, right? It's making sure that folks are having a good experience and we're being safe. But at the same time, I think some of it was like a bit of a stretch to be able to balance. Just knowing that coloring between the lines, I think, was a little bit important in that situation and learning that early on definitely helped. Dogma of the rules versus reality on the floor. Another good, succinct lesson there. From being an RA, you went to be a software engineer for the Navy. Yes. Interesting.

27:26I got my undergrad in hardware, actually. So I have an electrical engineering undergrad. And when I went to work for the Navy, I was working in a kind of a hybrid hardware software role where we were designing physical control systems for chips. And through doing that, I learned that I actually liked the software more than I liked the hardware. So I made an early career pivot from microelectronics and controls into software engineering. And then you eventually became senior software engineer. That's right. What was the biggest hard skill, soft skill you learned in that role? I think the biggest thing that we learned, I say we, because there was a few of us working on a project together where we had an opportunity to develop.

28:11And this is a long time ago. This is fun. It was a throwback. We had an opportunity to develop a novel control system framework that nobody had built before. But the general idea being, rather than designing a custom control system for every ship that gets delivered to the Navy, can we build a framework that makes it so that you don't need a fleet of software engineers to actually deploy a new control system on top of these? And it was a new idea, and it wasn't my idea, but I had the opportunity to build something new that hadn't been done before. And through that, there wasn't really any existing dogma, right?

28:48It was, we haven't done this before. We're just going to go figure it out. And there wasn't a ton of oversight. There wasn't a ton of plans or blueprints around what the thing needed to do. And through that, I just learned that you kind of just have to solve problems. Nobody's going to give you the answer. You kind of just have to go figure it out. And that has been a thread that I have very closely kept going through the whole of my career. It's just like, there's always a next step. You can always go figure it out. You don't have to wait for somebody else to give you the answer. From the Navy, you go to Palantir and you said to me, it looks like you were there a long time, but you had five different jobs without going through all five different jobs.

29:30I'm wondering, again, what did you do there that you have taken with you to Sage? What were the skills or experiences that kind of stand out? Yeah, I can talk about a couple. The first, and this is where I met Raj, I worked as a forward deployed engineer for two years on commercial use cases. one in investment banking, one in healthcare. And through that, got to see the customer lens to how you deploy software and how you manage those projects. And I had never been in a position to do that before. Working for the Navy, you have six layers of project managers between you and the customer. And there's really not a great feedback cycle there.

30:08But at Palantir, as a forward deployed engineer, you're sitting down and building product with the customers, which was an amazing insight, right? You don't have to have six layers of bureaucracy between you and the people building it. You could just go talk to the people using it and use that as input to inform how you build the product. So I thought that was really good. Maybe overcorrected a little bit when I did the forward-deployed engineering thing and felt like I had taken too many steps away from the hard engineering and moved into the product group after those two years where I was an engineering manager for a couple of years on a product that ended up becoming one of the core tools in Foundry.

30:48And I'd never been a manager before. This is my opportunity to really learn leadership and also work on a really world-class technology stack at the same time. So I guess like two very big learning opportunities while doing that. But got to see both the good and bad of management, learned a lot of things to do, a lot of things to not do. What not to do. What not to do, yeah. I think ultimately the biggest lesson I took away from that was a lot of times when people are failing to get the job done that they need to be getting done, it's not their fault that they haven't been set up for success. and without being too specific, saw a few anecdotes where I think the manager or myself included could have done a much better job of making sure that a person was set up to succeed versus kind of just throwing them out there and hoping that they can figure it out.

31:44It's interesting looking at your career because you said your degree was in hardware, but then you moved to software and then you get experience with healthcare businesses through Palantir and it all feels like it laddered up to Sage. connecting the dots, looking backwards, perhaps, maybe not while you were doing it. Does it feel that way to you? It does. One of the things that I've kind of held to is you make your own luck and you just always say, yes, I'm a curious person and I'm always hungry to learn something new. And it's why can't I go do that? So maybe I should. So just always saying yes to opportunities and seeing how they go.

32:20Some didn't go well and had to move on from them. But I picked up a lot of nuggets along the way and through that have kind of made my own luck, right? And I wouldn't say that, you know, 10 years ago I saw Sage in my future. I didn't, but it was one of those, I was curious to be an entrepreneur. And as the opportunities came up to learn skills that would ladder up to that, it was exciting to say yes and experiment with it and see where it went. That brings us to today. If you were to think about tomorrow and by tomorrow, I mean one to two to five years from now, what would you want to report to Forbes if we were to speak again that Sage has accomplished in the ensuing time?

32:59Yeah, I would love to say that we've won the U.S. senior living market and that we are the canonical operating system for senior care in the U.S., that we have a footprint internationally, that we have solid clinical traction in skilled nursing, and that we're starting to actually be able to bring our product into aging in place in the home. We'll have to have you back to give that product update. Matt, thank you so much for sitting down with us. Of course. Thank you. Thank you for having me.