A Conversation with Neal Shah

Welcome back everybody to another brand new

episode of the truth, lies and Alzheimer's show. I'm Lisa

Skinner, your host, and I'm really excited to be here today

with you all, and grateful that you have chosen to spend part of

your valuable days with us, and we've got a really special guest

here with us today. I'm going to introduce you to him. His name

is Neal Shah, and he is the CEO of a corporation that is called

care ya ya health technologies. And as I told Neal when we

talked before, Yaya is close to my heart, because that is

exactly what my grandchildren call me, is Yaya. And a lot of

people don't even know that that is a word that, you know a lot

of people use Nana. My kids call me ya ya. And so I thought that

was pretty special, that we had that connection. But care Yaya

Health Technologies is a social enterprise that does research,

lab research advancing health equity for aging populations.

That was named one of America's top 50 startups for 2025 I mean,

what a huge accomplishment. And Neal also brings his personal

experience as both a dementia and cancer caregiver to his

current work, he's an NIH funded healthcare researcher focused on

aging and caregiving, leading artificial intelligence projects

at Johns Hopkins University to improve care for older adults.

And this is really exciting, innovative stuff. So we're going

to let Neal tell us all about what care Yaya does, what it's

all about, how he came up with it. And we are going to start

with one of his core pillars of his organization, which is

caregiving for aging populations on the boomer horizon, because

we're the ones that are aging quickly and starting to develop

Alzheimer's disease and related dementia, and he has got Our

backs. So Neal, with that said, why don't you take it from here

and tell us a little bit about your company and all the

exciting things that are happening with it, and then let

us know exactly what you guys do.

Sure. Yeah, thanks, Lisa for such a warm

introduction and exciting to share share with your audience.

You know, I think that we are heading into, if not already in,

a caregiving crisis. You know, in our country, you know, we

have a rapidly aging population. You know, the oldest of the baby

boomers just started turning 80 this year. You know, if you kind

of think about when world war two ended, 1946 you know, here

we are 2026 in the next five years, we're going to have a

historically unprecedented wave of people turning 80, that's

typically the age when dementia rates and probabilities

skyrocket. By 2030 our country will be more people above 65

than below 18, first time ever in recorded human history. So

we're heading into a big demographic shift that I think

is going to impact a lot in our society. I learned this

firsthand, and I started karaya because in my mid 30s, I became

a caregiver. Went through a very long caregiving experience for

my grandfather through dementia, and I kind of realized how

broken our caregiving system is and how little support there is,

and how that results in so many families bearing the burden on

their own. I think family caregivers are like some of the

most hardest working and empathetic people out there in

the country, and they're getting the least support from

government and private sector, so they're bearing a lot of

burden on their own. And, you know, in our case, like my

mother, ended up quitting her career to become a full time

caregiver. So it was really eye opening for me after he passed.

Actually, my wife went through a multi year cancer battle where I

became her primary caregiver. So I've kind of gone through this

firsthand twice, and realized just caregiving is so under

supported. And, you know, I kind of wanted to do something, so I

shifted the whole focus of my career and my work into

improving things for caregivers, you know. So that was kind of

like the genesis of how this came about. And I saw that,

given how fast our society is aging, I thought that there was

going to be a just absolute epidemic that was going to crush

millions of middle aged people as they as it came their turn to

care for aging parents. Some of the innovations that we've done,

I'll talk through and where I think kind of the opportunities

are, are, you know, in thinking through, what are the problems

in care? Number one, there is a massive shortage of people doing

care. So if you are a family caregiver and you need some

affordable help, there aren't people around. Do it. And if you

get lucky and find someone, the prices are rates too high. Why

is that? My entire hypothesis is the care industry is completely

broken. The way these home care companies work is that they

typically charge in most cities across America, 40 to $50 an

hour, and they turn around and pay less than half of that to

the care worker. The rest goes into sales, marketing profits,

franchise fees, overhead and all that other stuff.

I was just reading something recently where

somebody posted an article that said, baristas receive more

training than dementia caregiver

and more pay, you know, and more pay. Why would

you ever do this, you know? Why would you ever do care for

someone you know, if you're just like trying to make income, when

you could work at Starbucks, you could work at Walmart, you could

work at McDonald's, anywhere, pays better, and by the way,

compared to barista, caregiving is very, very psychologically,

emotionally, physically demanding work, as we all know

from our favorite family caregiving experience. So how

could we as a society expects somebody to do this for in my

home state of North Carolina, the average caregiver makes 1215

hour.

You think there's something wrong with this

picture? Yeah, I'll

tell you. I'll tell you exactly what's wrong with

this picture.

The companies,

the companies in the way the private sector treats

caregiving. You know, I think it's absolutely absurd. And you

know, I don't mean to offend anyone. It's just my

observation. So apologize in advance, if somebody's

listening, as a home care agency owner, but these home care

companies in my area charge 40 bucks an hour and pay the care

workers, you know, somewhere in the low teens, like 12 to 15

bucks an hour. They keep the rest of the money for

themselves. That creates true two problems. One, how many

families can afford 40 bucks an hour? Not a lot. So if you need

40 hours a week of caregiving, because you have to go to your

job and you need somebody to sit with your mom. You know, that's

adding up to 16 hour bucks a week. You know, over the course

of year, it's like 80 grand, and then the care worker is making

30 grand, so the care workers barely able to survive.

There's no subsidy for dementia care, for in the

home, or if you don't already happen to have

agreed

long term care insurance policy, or you qualify

for veterans benefits that will pay a stipend for care, either

in home or in assisted living or memory care. This is all out of

pocket expense. Exactly. Yeah,

exactly. So it really the affordability issue crushes

families, and frankly, the quality issue because the care

worker's not being paid well. So one of our earliest innovations,

which I kind of observed from my years of being in caregiver

support groups, was healthcare students out there, pre medical

students, nursing students. You know, some of our young people

who want to go into clinical careers are amazingly empathetic

and passionate people who want to help people in their

communities. We started mobilizing them as caregivers,

and we made them available through our carry out platform

to be able to be digitally, booked, scheduled, paid, etc,

for no fees are up charged to anyone. So across America now

we're running $20 an hour caregiving platform where all

the money is going to the students. So through the

innovation and anyone can check this out, cariad.org, you're

welcome to do it, and it's all like Grant and social impact

funded. We charge families nothing. They can book schedule

and pay caregivers near them who are pre medical or nursing

students at, you know, good universities in their area.

We're now operationalized at approximately 35 universities.

We have 50,000 students on the platform, and you can get it for

20 bucks an hour, and all that 20 goes to the students. So I

thought this was like a very simple, common sense type of

innovation based on years of what I observed. You know, the

best kept secret in family caregivers was people would try

to go through care agencies find that, hey, I'm spending way too

much money. I can't afford it. The care workers aren't very

good. Then many people would post flyers at church or ask

local support groups, where can I find informal caregivers? And

then many people who took the time and effort would find ways

through universities nearby them and asking professors and

saying, do some of your nursing students or medical students you

don't want to help. So there's already a very robust informal

care market happening like that, but for most it's a lot of

manual work. So we said, Okay, we'll do that work for you. We

will find the students, vet them, interview them, background

check them, make Booking and Scheduling easier, almost like

Uber does, you know, with getting it, getting a ride or

getting a taxi, right? You know, where you can just kind of do it

very conveniently and affordably. So that was our

first innovation, and the multiple reasons for the

innovation were one, I just thought cost of care were way

too high, so a lot of families can't afford it, and they're

priced out. So by doing it at 20 instead of 40, you significantly

expand affordability. I thought the quality of the care was low

because the care worker is not getting paid much, so the care

workers turnover is very high, and many people leave. I thought

by paying the students the fair share, in this case, all of it

makes them very motivated. And of course, they want to go into

clinical careers anyway, so they're already naturally

motivated. So it makes them show up much better and do a better

job of care. And then I thought the whole streamline the booking

process through digital booking, no contracts, kind of none of

these business tactics that the care agencies use allow much

more seamless and. Whole experience that a lot of what I

you know, what you would call sandwich generation caregivers,

you know, busy middle aged people who are still trying to

manage their careers. They would prefer an experience like this

instead of the old school method, where the local care

company sells you, makes you sign a contract and, you know,

do a lot of manual paperwork. So that was kind of like the early

innovation, in a nutshell. And I'm shocked at after running it

for three years, it's grown from a local, grassroots effort into

this, like very large thing that's spreading around the

country. And I'm also very pleased that we're making a

tremendous social impact on many, both people who would be

priced out of the care market, and encouraging a lot of young

people to step up and address the care crisis, which I think

is,

I have to say that what you're doing, you're an

absolute godsend, because this is exactly what our communities

have needed for as long as I've been around this industry, which

has been 50 years, 30 professionally, but 20 dating

back to my first experience with a family member having

Alzheimer's disease. So you raised a good point. You

mentioned the sandwich generation.

Tell

us exactly how this new sandwich generation,

and when we say sandwich generation, we're referring to

adult children who are caring for an elderly parent, but they

also have children still at home, and they're standing in

between the two generations. So how, how, what have you been

observing in terms of how this sandwich generation factors into

elder care?

Yeah, thanks for the question. You know, over 20

million people are in this sandwich generation, you know,

caught between caring for aging parents and children.

Interestingly enough, this is a lot of women who quit their

careers. Most people think it's because of child care. Actually,

over 60% is because of elder care, because child care is now

University acknowledged and recognized and by many employers

supported things like maternity leave policy are commonplace

now. Support for a daycare center. Some some large

employers even having the center on site. These were things that

didn't exist that much in the 1980s and 1990s but I think

thanks to a lot of pressure and movements and social awareness,

now child care is recognized as like we need to offer some

solutions in order to support working parents of both genders,

but specifically women, elder care support does not exist. You

know, minimally and Harvard Business School had a big study

on this, that what does the sandwich generation need?

Something like 33% the highest number on the survey was elder

care support. 33% of people request. Only 6% of employers

even have anything around that topic. And mostly it's, oh, let

me get you some counseling with a social worker so no one offers

actual caregiving support. So I think it's a big gap in terms of

what employers are providing versus what employees are

needing. And as a result, many people are scrapping it together

on their own, or potentially taking time off from work to

manage it past, you know, turning down promotions, being

passed over for promotions, or sometimes just leaving the

workforce entirely to do it themselves when the cost of

elder care in America is $82,000 a year, just for 40 hours a week

to get a care through a care agency, you have to make pre

tax, over $120,000 just to then pay the tax and then spend all

the rest of your remaining money on paying the care company. So

you know, most people, unless they have, like, high six figure

incomes, they'll just be like, maybe I should do it myself. So

I think that, yes, the sandwich generation is experiencing an

enormous crisis, and if we don't want millions of people to drop

out of the workforce, I think we need to do caregiving innovation

to address the cost and affordability. But I also think

we need to reform and pressure the private sector in to start

addressing this issue and supporting employee caregivers.

And I think we need to change government policy. You know, why

doesn't Medicare cover any respite care? You know, they pay

30,000 bucks a year for dementia drugs. That unclear if they even

work, but they space $0 for you getting a caregiver in your

home, and everybody knows that does work, getting a caregiver

in your home reduces nursing home admissions and it improves

the health of the family caregivers. So I think these are

common sense things that the government isn't doing, the

private sector isn't doing. And I think isn't doing, and I think

you can build advocacy and create pressure to change the

system.

And everything you are saying coincides with and

this is just something that's total, totally coincidental. I

just recently was asked to write a magazine article for San

Francisco magazine on this very subject, on how corporations are

supporting employees, because all of these things are

happening with this sandwich generation. And also we have to

be mindful that the World Health Organization and the Alzheimer's

associations are are trying to prepare us that by the year 2050

if a cure or treatment is not found, the number of people, and

you touched on this a little bit, that are expected to

develop Alzheimer's disease are. Um, it's estimated it's going to

triple from the number of people who live with it today, and this

is worldwide. So we're looking at, you know, another almost

like a pandemic of Alzheimer's disease. And I think you are

probably about the closest thing to helping society prepare for

this that we've ever had. So we are now going to segue right

into what the future of dementia care looks like for him. For you

know, in his mind's eye, he's a very vision, visionary kind of

guy, obviously. So I can't wait to hear what he has to tell us.

Yeah, thanks, Lisa. So I'll share a few things. One,

you know. So where I live in the American South, dementia rates

are expected to go up over 50% in the next four to five years,

you know. So it is, you're right. It is absolutely an

epidemic, and I think it's partly because of the aging

population. I think it's partly because social isolation triples

the risk of getting dementia, and we just went through a multi

year pandemic where people had to isolate, especially older

adults, so we're coming out of that. But I think the brain

impact is pronounced, and then also early signs suggest even

mild covid infections that people recovered from resulted

in neuroinflammation in the brain that suggests very typical

of early Alzheimer's pathology. So I think with these three

factors, you know, if a boomer is turning 80 in large numbers,

as well as isolation and covid, we are about to have an epidemic

of dementia. And heading into that, I think that there is a

lot of opportunity to help people. So where I think

technology is making promising strides, stuff that we're

working on and stuff that I see other people working on are both

in screening. You know, I think dementia is significantly under

diagnosed and under screened. Many people don't catch it until

too late, and usually it's due to lack of resources. It affects

both rural populations that sometimes don't have access to a

neurologist. You know, something like 37% of Americans live in a

neurology desert, where there's a neurologist within an hour,

plus of them that can even make a diagnosis. So that's where we

see a lot of technology tools helping. We're working on a big

project with Harvard and Mass General developing artificial

intelligence tools that can simply help with cognitive

screening over a voice AI phone call a landline. So help you

kind of screen fast through just a natural language conversation,

even process biomarkers in your voice, and then help warn you

and or the family member that, hey, maybe it's actually time to

drive two hours to a neurologist because you have a higher risk

and you should go do a proper assessment. So I think tools

like that are going to be breakthrough of just like being

able to access, improve accessibility to care for a lot

of the population. I also think there's a lot of tools coming

around caregiving. You know, dementia, caregiving is one of

the most under supported things that I've learned myself and in

years of support groups, less than 11% of family caregivers

going through dementia get any sort of training. I think it's

our medical system almost views it as okay. We gave you the

diagnosis, and here's a pamphlet, and then you know you

as a son or daughter or spouse. It's like you're on your own at

home. Now, meanwhile, you're supposed to become a doctor and

a nurse and a physical therapist and a social worker all at the

same time. Suddenly, when you're 5060, years old, and you've

never done any of those jobs before, and I think that's very

hard, and by not covering caregiver training, a lot of

people end up making mistakes. Their loved one ends up in the

ER. They themselves end up with a lot of stress and burnout and

even potentially their own health issues. So AI is becoming

a promising ground. One of our biggest NIH funded projects is

that that we've developed an artificial intelligence powered

caregiver and training system that, again, we're giving you

know, all of our innovations are free, so we give this away for

free to individuals to practice, learn how to do care, understand

and personalize. Who is the loved one that you're caring

for. What diagnosis do they have? What skills do you

currently have? And then let's upskill you through bite sized,

two to three minute personalized videos of the next skill you

should learn, and then give you short quizzes. So I think things

like that are very promising innovations. And then I also

think there's a lot of cool innovations happening that I see

in neurotechnology, like ability to kind of, like, use non

invasive interfaces, and, you know, put on your head. And it

sounds very futuristic, but Brain Computer interfacing is

improving. And, you know, we have been working on some

projects just kind of on the side, is almost like a research

lab to see if we can help people who have lost ability to

communicate, who have, for example, aphasia, be able to

visualize and try to communicate, you know, through

an interface, what they're what they want to say at early

stages. But there's some interestingly promising signs,

and I think that is going to be, if I to make a bold prediction

over the next five years, I think Brain Computer interfacing

technology is going to get really good, and a lot of people

who are unable to communicate might actually be able to

communicate, so we might be able to restore

that. How do y'all address comorbidities?

Yeah, that's a great question. So comorbidities? Why?

I think again, speaking about like, because we're located in

the American South, diabetes is a massive comorbidity. We

ourselves

cardiovascular disease.

Agreed, agreed. Cardiovascular Yeah, another,

another, big one. You know, we ourselves don't do a lot in that

realm. We try to manage and guide people to nutrition

programs that we can recommend. But you know, we are not the

innovators of those programs. Interestingly, on the diabetes

side, I have seen some amazing results from non pharmacological

diabetes reversal programs out there that I'm like blown away

by, and I'm surprised these are not more widely known. So I do

think there's some help coming. One interesting thing which I

have mixed feelings on is these new GLP one weight loss drugs.

Many people I'm finding are actually quite successfully

managing, you know, their diabetes and, frankly, their

obesity and just like overall weight levels through those

drugs. However, I do think there are also some pronounced side

effects that are unintended that I'm seeing a lot of people

experiencing. So I'd say the jury's still out. But between

that and between the non pharma, pharmacological diabetes

rehearsal programs, I do think that big strides can be made.

And then one positive side is, I do think, regardless of your

opinion on politics and etc, I do think the public awareness

through the Make America healthy again movement is resulting in a

lot of people realizing that, hey, food does impact your

health, sugar levels and what you eat and ultra processed

foods maybe should be significantly reduced. And I

think that population health is going to change over the next,

you know, three to five years, which I think it couldn't come

fast enough, you know, like chronic disease and diabetes

rates are skyrocketing, which means future dementia rates, you

know, are going to be skyrocketing. So I'm very happy

about about that.

Wow. Well, unfortunately, we are at a time

today, we'll just have to have you come back and continue this

conversation, because this is absolutely fascinating, and I

think it's, it's what our future holds for and you know, as I

mentioned, I've been exposed to the dementia world for 50 years

now, and the change has come incredibly slow, and it's really

just been in the last few years that we're starting to pay more

attention to everything we talked about today, it couldn't

come fast enough for me, but hopefully it'll just, you know,

go at lightning speed now, and things will change dramatically,

because we've been stuck in, you know, a quagmire of quicksand

for decades. So anyway, I am just so pleased to hear that

you're doing what you're doing, and there is a lot of hope now

for all of us who have family members who have lived with one

of the brain diseases that causes dementia and that, you

know, it's looking promising that things will will literally

change themselves more rapidly than they have. I was going to

ask you one more question. Oh,

sure,

just out of curiosity, I noticed since

covid, there's been a pivotal shift in the US. And I would

just wanted to hear your, your comments about this, because

culturally, the United States doesn't typically, or hasn't in

the past, typically taken care of our elderly parents, like a

lot of cultures do. I've seen that changing since covid

Because of what we saw in the high incidence of death due to

depression and isolation and also covid itself, are you? Have

you noticed that since covid, that that we are changing, that

culturally we are taking

Yeah, I think so, you know, I think, obviously, I

think it's happening fast enough, but I'm glad that it's

changing. And I do think it's changing. I think there's a few

things going on. One, the former Surgeon General, Dr Vivek

Murthy, put out a great book, which I would recommend to

anyone called together, and it's the art of connection in a

lonely world. And he basically framed it right before covid, as

loneliness, especially in our older adult population, is an

absolute epidemic. Obviously, covid made it way worse. And he

was saying, if you're above 65 and your self report is lonely,

which, by the way, 37% of people do, if your self report is

lonely, it's worse for you than smoking 15 cigarettes a day in

terms of predicting if you'll die early. So loneliness is an

absolute epidemic, and I think now, unfortunately, it's

happening to our young people too, because they're glued on

their phones and social media. So I think that it. You know,

covid has certainly accelerated awareness of that. And I think

public movements to kind of reduce loneliness have now

spread the who has now, you know, piggybacked off that, and

they're calling loneliness and epidemic. So I do think that's

changing. I also think the baby boomers, you know, if you kind

of think about the assisted living in the nursing home

industry, it really grew in the 1980s 1990s and 2000s so baby

boomers have the experience of putting their parents in those

facilities, oftentimes near the last few years, and now as a

baby boomers become the predominant kind of aging

population, and seeing what happened during covid to people

who lived in those places, many of them unfortunately, very

sadly, died and couldn't spend time with their family during

their last days. Boomers are really hesitating, like, do not

I've heard from so many people it's like, I would rather die in

my house than don't put me in a facility. They're telling their

kids. So I think that the preference has shifted

tremendously. And I think on a positive side, technology and

Affordable Care is enabling people to stay in their home

longer and age longer. And then I think final, finally is, I

would credit the media and social media to this. Societal

attitudes are changing as people build awareness about aging and

caregiving as now, you know, Martha Stewart was on the cover

of Sports Illustrated right like I think this wouldn't have never

happened 2030, years ago. So I do think that people are

recognizing that aging isn't something to shy away from and

something to embrace. So I think there are a lot of positive

trends going on that might build a culture that more respects its

elders and cares about the aging population, not just their own

parents, but even older people in their community, in their

neighborhood. So I think that's a pretty good thing. And I see

this every day. We have so many 1000s of 20 year olds

interacting with 80 year olds through our care platform that

are not their grandparents, and they're learning a lot about

what it's like to be an older person. Talk with people who

have completely different views and completely different even

backgrounds and upbringings in them, and I think that it's

benefiting both sides, bringing people closer together. So yeah,

I'm excited about that, and I think the change couldn't happen

fast enough.

I couldn't agree with you more. So anybody who is

as fascinated as I have been with this conversation by Neal

Shah, you can find out more information about him and his

company at care, yaya.org, so make sure you take some time to

further look into this really, really exciting time in elder

care. Thanks again for being with us. I'm Lisa Skinner, your

host. I will be back next week with another brand new episode

for everybody, and in the meantime, have a great rest of

your week. Stay happy and healthy. We need y'all and I'll

be back next week with another episode for you. Take care for

now. Bye, bye.

Thanks. Lisa.