Have those who have difficulty hand quilting tried the "stab stitch" technique. You may or may not like it but might be an alternative. Also there is a "thimble" somewhat like a paddle that I am told is good for those having difficult with the traditional thimble.
Hand quilting is still alive and well. For years and up to this year I taught for a traveling convention and usually had one class per event with from 15-20 students and 8 events a year - do the math.