    [Senate Hearing 108-108]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 108-108

                           BABY BOOMERS AT THE GATE:
            ENHANCING INDEPENDENCE THROUGH INNOVATION AND TECHNOLOGY

    =======================================================================

                                    HEARING

                                   before the

                           SPECIAL COMMITTEE ON AGING
                              UNITED STATES SENATE

                          ONE HUNDRED EIGHTH CONGRESS

                                 FIRST SESSION

                                   __________

                                 WASHINGTON, DC

                                   __________

                                  MAY 20, 2003

                                   __________

                               Serial No. 108-11

             Printed for the use of the Special Committee on Aging

    88-497              U.S. GOVERNMENT PRINTING OFFICE
                                WASHINGTON : 2003
    ____________________________________________________________________________
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                           SPECIAL COMMITTEE ON AGING

                          LARRY CRAIG, Idaho, Chairman
    RICHARD SHELBY, Alabama              JOHN B. BREAUX, Louisiana, Ranking
    SUSAN COLLINS, Maine                     Member
    MIKE ENZI, Wyoming                   HARRY REID, Nevada
    GORDON SMITH, Oregon                 HERB KOHL, Wisconsin
    JAMES M. TALENT, Missouri            JAMES M. JEFFORDS, Vermont
    PETER G. FITZGERALD, Illinois        RUSSELL D. FEINGOLD, Wisconsin
    ORRIN G. HATCH, Utah                 RON WYDEN, Oregon
    ELIZABETH DOLE, North Carolina       BLANCHE L. LINCOLN, Arkansas
    TED STEVENS, Alaska                  EVAN BAYH, Indiana
    RICK SANTORUM, Pennsylvania          THOMAS R. CARPER, Delaware
                                         DEBBIE STABENOW, Michigan
                          Lupe Wissel, Staff Director
                 Michelle Easton, Ranking Member Staff Director

                                      (ii)

                                C O N T E N T S

                                  ----------
                                                                       Page
    Opening Statement of Senator Larry E. Craig......................     1
    Statement of Senator John Breaux.................................     2

                                    Panel I

    Josefina G. Carbonell, Assistant Secretary for Aging, U.S.
      Department of Health and Human Services, Washington, DC........     3

                                    Panel II

    Maria Greene, Director, Georgia Department of Human Resources,
      Division of Aging Services, Atlanta, GA........................    28
    Kevin J. Mahoney, Ph.D., National Program Director, Cash and
      Counseling Demonstration and Evaluation Project, Chestnut Hill,
      MA.............................................................    48
    Ronald H. Aday, Ph.D., Director of Aging Studies, Middle
      Tennessee State University, Murfreesboro, TN...................    69
    Gregory D. Abowd, Ph.D., Associate Professor, College of
      Computing, and GVU Center Director, Aware Home Research
      Initiative, Georgia Institute, Georgia Institute of Technology.    83

                                    APPENDIX

    Statement from Center for Aging Services Technologies, American
      Association of Homes and Services for the Aging................   107
    Statement from Tobey Gordon Dichter, Founder, CEO Generations on
      Line...........................................................   113

                                     (iii)

    BABY BOOMERS AT THE GATE: ENHANCING INDEPENDENCE THROUGH INNOVATION AND
                                   TECHNOLOGY

                                  ----------                              --

                             TUESDAY, MAY 20, 2003

                                           U.S. Senate,
                                    Special Committee on Aging,
                                                        Washington, DC.
        The committee convened, pursuant to notice, at 2:05 p.m.,
    in room SD-628, Dirksen Senate Office Building, Hon. Larry
    Craig (chairman of the committee) presiding.
        Present: Senators Craig and Breaux.

           OPENING STATEMENT OF SENATOR LARRY CRAIG, CHAIRMAN

        The Chairman. The Senate Special Committee on Aging will
    convene. Let me first of all thank our panelists for their
    flexibility in meeting the scheduling change that we had that
    pushed this hearing into the afternoon. I want to thank you for
    that.
        Also, I want to thank Senator Breaux for being here.
    Yesterday, he held, I think, a very successful hearing by all
    accounts dealing with senior access, and certain protocols and
    other activities that relate to the formulation and development
    of pharmaceuticals and other interests and issues.
        Both John Breaux and I work to share this committee and its
    authority. We think this is certainly an issue for all
    Americans. It is not a partisan issue. The business of aging, I
    think we find that Democrats and Republicans age at about the
    same rate. [Laughter.]
        Senator Breaux. I'm aging faster. [Laughter.]
        The Chairman. Just wanted to check him out and see if he
    was awake there. No.
        But good afternoon to all of you. I am pleased to convene
    this hearing in recognition of Older Americans' Month and to
    explore a wide range of policy issues impacting older Americans
    and their families. Such an ongoing dialog is imperative since
    the first wave of baby boomers will turn 60 in less than 3
    years.
        Today, we will hear testimony from various innovative
    thinkers. We will hear about the Older Americans Act and the
    Family Careviger Program, a new approach to Medicaid service
    delivery, plans for modernizing our nation's senior centers,
    and the technological opportunities available to seniors.
        It is estimated that in 2006, over three million baby
    boomers will turn 60 and become eligible for older Americans
    services. This new wave of seniors will have a very different
    set of characteristics from the previous generation. It is,
    therefore, critical that we in Congress review and design
    national policies to address these new demands.
        I believe the central strategy for meeting the new
    challenges of the 21st century is that of innovation, new and
    bold programs and technologies that enhance independence for
    all older Americans. Today's testimony will highlight some of
    these innovations.
        We will hear about the Older Americans Act and its newest
    addition, the National Family Caregivers Program. It is well
    known that family caregivers are on the front lines of long-
    term care for older persons in this country. It is important
    that these programs continue to evolve and assist family
    caregivers so they can meet the challenges of caring for loved
    ones in their own homes. A new approach in providing these
    services to caregiver will be shared with us today.
        I look forward to the testimony on Medicaid consumer-
    directed services pilot project, a new concept that allows
    seniors and their families to direct their own care. An example
    of a self-directed service is that of cash and counseling
    program, which will allow older persons who have trouble
    managing their finances to hire a financial manager of their
    choice.
        National Senior Center Week, which ended last Sunday, was a
    national recognition of the importance of senior centers. Of
    equal importance is the need to vigorously explore a new vision
    for our nation's senior centers. Although senior centers are
    created and funded at the local level, they serve as critical
    delivery points for various Older Americans Act services. I
    look forward to the testimony on how senior centers will evolve
    to meet the interests and the demands of a new generation of
    older Americans in the 21st century.
        Finally, assistive technologies are also becoming a major
    tool for older Americans. Promising areas of computers to human
    interaction that will allow older Americans to live more
    independently will be discussed.
        So before I turn to and introduce our first witness of our
    panel this afternoon, let me turn to my colleague from
    Louisiana, the senior Senator, John Breaux. John.

                  OPENING STATEMENT OF SENATOR BREAUX

        Senator Breaux. Thank you very much, Mr. Chairman. Thanks
    again for holding today's hearing. I would just point out how
    important it is to talk about where we are headed. We are truly
    in a perfect storm, if you would, as far as the aging of
    America is concerned in the sense that we are about to receive
    a huge number, the largest in generations, of individuals who
    will be becoming eligible for senior programs, 77 million baby
    boomers. On top of the large number of people who are going to
    become eligible, that large number of people are living a lot
    longer than any other generation in American history. So we
    have a double problem of having a lot more people who will live
    a lot longer.
        I have jokingly said many times said that good news and the
    bad news is that people are living a lot longer, and the bad
    news is that people are living a lot longer. How will we take
    care of them? Who is going to pay the bills? How much is it
    going to cost? How are we going to be able to do what we as a
    society need to do with regard to allowing people to live not
    just longer lives, but also healthier lives and happier lives
    as they get older?
        So that is the real challenge of America, among the most
    serious challenges, and everything seems to be coming together
    at one time, which is truly a perfect storm as far as the
    geographics are concerned. So hopefully, we will hear some
    ideas today about how to address these problems. Thank you.
        The Chairman. John, thank you very much.
        Our first panel today is Assistant Secretary Josefina
    Carbonell. Josefina, welcome before the committee. The
    Assistant Secretary will discuss issues related to the Older
    Americans Act, will address the rebalancing of the long-term
    care system, the importance of family caregiving and the
    challenges the Older Americans Act programs face in the demand
    of the new baby boomers, much as my colleague has referred to.
        So with that, Assistant Secretary, welcome.

      STATEMENT OF JOSEFINA G. CARBONELL, ASSISTANT SECRETARY FOR
         AGING, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES,
                             WASHINGTON, DC

        Ms. Carbonell. Thank you very much, Chairman Craig, Senator
    Breaux, and members of the committee for inviting me to testify
    at this very important hearing. It is especially important
    during Older Americans' Month. This month, and this year's
    theme, is ``What We Do Makes a Difference.''
        As we have discussed before, both globally and here in the
    U.S., we are witnessing one of society's greatest achievements,
    an extension of longevity due to advancements in medicine,
    public health, and technology. At the Department of Health and
    Human Services, we are updating and reenergizing old programs
    and developing new ones that empower and serve older Americans
    in their communities.
        Also I am pleased to announce that today, the Departments
    of Labor and Health and Human Services have transmitted a
    Report to Congress that examines the future supply of long-term
    care workers in relation to the aging baby boom generation.
    Ensuring the adequacy and the availability of direct care
    workers is a critical goal of the Administration and we have
    been taking steps to prepare for the increased demand for
    direct care workers. Our report recommends how to retain
    existing long-term care workers and attract new pools of them.
    It urges continued support of many of the Bush Administration's
    existing efforts to address the growing demand for long-term
    care workers.
        Let me begin with the Administration's initiative aimed at
    rebalancing the long-term care system to create real choices in
    home and community-based care. Currently, 75 percent of public
    long-term care funding goes to institutional care, while many
    people prefer to remain at home.
        Our guiding principles for caring communities are that we
    give seniors and family caregivers affordable choices and
    options; that they have control over their consumer choices and
    what kinds of programs they wish to access; that the
    information is there for them to access the programs; that we
    make sure that we support the family caregivers, one of our key
    components of the rebalancing long-term care system initiative;
    and that quality services be available.
        In the 2004 budget, the President has proposed a $1.75
    billion program titled ``The Money Follows the Person
    Rebalancing Initiative,'' as well as State systems change
    demonstrations that promote home and community-based care
    alternatives. These initiatives represent an historic turning
    point in Federal long-term care policy.
        Shortly, the Administration on Aging and CMS will jointly
    issue a competitive grant announcement to develop one-stop shop
    resource centers. This program will make it easier for
    consumers to learn about and access existing long-term care
    options, including alternatives to institutional care.
        Family caregivers are a key component to ensuring that
    older Americans can continue to remain at home. More than 23
    million Americans are providing assistance to a family member,
    and interestingly enough, 30 percent of the current workforce
    is caring for a relative. If we were to pay for these services,
    it would cost $257 billion per year. This is more than the
    amount spent on formal home care and nursing home care
    combined.
        According to our national data, one out of four caregivers
    report difficulty providing care because of their own physical
    limitation. More than six in ten take care of someone who is at
    least 75 years old. Eighty-eight percent report that our
    services have helped them provide care longer, and 95 percent
    of our caregivers are very or somewhat satisfied with the
    services that they have received.
        At listening sessions in communities throughout the
    country, I hear the recurring difficulties. Whether it is the
    51-year-old son who is the sole caregiver for his blind mother,
    the 80-year-old woman who is struggling to bathe, feed, and
    care for her 102-year-old mother, or the grandmother who lives
    on a working farm in Idaho and is struggling to take care of
    her grandchildren, the message is the same. Just give me a
    little help, a little hope, a little relief, and I can take
    care of my loved one in my own home. Caregivers tell me that
    the Family Caregiver Program is the best program that the
    government provides and many people have thanked me with tears
    in their eyes.
        Let me just share a couple of other personal stories. A
    disabled individual is caring for his wife with Alzheimer's and
    in need of 24-hour care. With help from the Arkansas Caregiver
    Program, she is bathed and gotten ready to attend adult day
    care. This results in time for him to receive his own therapy
    and attend to his own needs. Twice, an elderly Kentucky
    grandmother had put off needed surgery because she would be
    unable to care for her 11-year-old grandson. The program
    arranged for home care and personal care for her own needs
    following the surgery. The North Carolina program installed a
    wheelchair ramp in the home of a daughter so that she could get
    her father in and out of the house without having to carry him.
        Technology is also playing a very important role in
    addressing the two greatest concerns of caregivers, safety in
    the bathroom and transporting the care recipient. Things from
    non-skid surfaces to grab bars and other safety features are
    being installed in bathrooms and in homes across this country.
    Videos are instructing caregivers on the best way and the
    safest techniques for getting disabled individuals in and out
    of vehicles. Nurses are electronically monitoring frail elders
    and their caregivers in between doctors' visits.
        So you see that the caregiver program is really creating a
    new way of doing business in the aging network by focusing on
    caregivers while allowing consumers to have choices.
        Our data further indicates that over 3.8 million caregivers
    have been empowered with information in the last year and
    approximately 436,000 caregivers have been served, far
    exceeding our target of 250,000. Significant numbers have also
    been reached with intensive direct services in counseling,
    training, respite, and many other supplemental services.
        We look forward to releasing the complete caregiver report
    at our national summit in September, which is designed to
    strengthen the capacity of State and community service
    networks.
        Today, I am delighted to release the new PSA called, ``Who
    Cares for the Caregivers?'' currently being sent to over 3,000
    stations throughout the country. We would like to let you be
    the first to preview this 30-second spot following my
    testimony.
        As you see, the administration is taking comprehensive
    action to prepare for the aging of the baby boom population. An
    important component of this effort will be the National Aging
    Services Network, which is well positioned with assets to shape
    our future, including a deeply ingrained focus on the consumer;
    on commitment to early intervention and the social model of
    care; a national network grounded in the community and capable
    of delivering an extensive array of low-cost services; a proven
    track record in leveraging resources; and the capacity to reach
    out and serve private-pay consumers as well as consumers who
    are low-income, culturally diverse, and isolated.
        We cannot afford to maintain the status quo. By working
    together to create systems of care at home as well as
    institutional settings, we can develop a comprehensive approach
    to health and long-term care that truly reflects the needs and
    preferences of older Americans.
        Now is the time to join forces to ensure that the promise
    of independence, choice, and dignity is fulfilled for all
    Americans. Thank you very much, and I would be pleased to
    answer any questions you might have.
        The Chairman. Thank you. You had a video that you wanted to
    show? We will watch this first. [A videotape was shown.]
        Well, that was simple and straight forward. Thank you. That
    obviously communicates a very clear message. Thank you very
    much for your testimony, Madam Secretary.
        [The prepared statement of Ms. Carbonell follows:]

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        The Chairman. Currently, would an 80-year-old woman, say,
    taking care of her 55-year-old disabled daughter be able to
    receive family caregiving services?
        Ms. Carbonell. Any person over the age of 60 can receive
    any kind of benefits from the Older Americans Act, from 3(b)
    supportive services in senior centers, adult day care, home
    care, respite, to meals and other services that are provided
    under the Act. So the answer is yes, Senator, an 80-year-old
    woman can receive respite services and other supportive
    services available through the entire service network provided
    under all the titles in the Older Americans Act.
        The Chairman. In your view, how will the Older Americans
    Act need to evolve to meet the demands of this new wave of
    boomers that we are talking about and the demographics of them,
    I guess I would say, different from previous generations that
    we hope are currently covered under existing law?
        Ms. Carbonell. As indicated, of course, in our written
    testimony and as we heard from both Senators speaking about the
    tremendous challenge ahead of us, I think we are looking at a
    future where the senior centers will look a little different
    than the senior centers for my mother and my grandmother looked
    20, 25 years ago.
        So we are looking at how senior centers are evolving in
    many communities across this country. We are looking at more a
    comprehensive holistic approach to the scope and the
    availability of services. We are looking at a transformation
    from just serving an older population, to serving a multi-
    generational population and becoming more like community and
    family centers.
        So, therefore, the appeal across generations is going to be
    critical as the challenges of the baby boom generation evolve.
    We are going to see the availability or the need to provide
    better choices, to have better linkages, through technology, to
    caregivers across the country. That is why the new Family
    Caregivers Program has given us the ability to add an
    additional component to our base programs to ensure that we are
    serving the younger caregiver, or the caregiver aging with
    multiple generational challenges.
        We are looking at the possibility of many of the senior
    centers having both health clubs and Starbucks coffee houses
    and community houses where people will remain active within the
    community for a multi-generational purpose.
        We need to ensure that senior centers of the future,
    obviously, continue to address many of the challenges of the
    health needs to maintain people healthy and active in their
    communities. We need to ensure that the nutrition program,
    which is one of our key programs within the Older Americans
    Act, continues to evolve and improve to ensure that we get
    better outcomes on reducing malnutrition and improving health
    outcomes for individuals. Also, the availability of leisure and
    volunteer activities, employment opportunities, where they can
    seek a homemaker that can assist them at home, but at the same
    time maybe seek a part-time employment or volunteer opportunity
    in their community.
        The Chairman. I don't think there is any question. I have
    had several discussions over the last couple of years about the
    design of the new center as really a point of full contact for
    seniors and the services that are provided for them and their
    needs, certainly unique and different from the kind that we see
    today.
        Dominant in my State of Idaho in many senior centers is a
    quilting room. Quilting, obviously a delightful art form and a
    pastime of many older Americans and now has become almost a
    modern art form again. But ironically, the newest request to go
    in beside that quilting room is a computer room.
        Ms. Carbonell. Absolutely.
        The Chairman. With about 11 million seniors now online, I
    think it demonstrates even more that kind of transition.
        The Administration on Aging has been working on performance
    outcome measures for services provided under the Older
    Americans Act. Can you please give us an update on your
    progress as it relates to those reviews?
        Ms. Carbonell. We are very excited with the outcomes that
    we are generating. We have taken a step back and really
    readdressed our issues of reporting. So we have taken a first
    job at ensuring that we reduce the reporting formats for
    programs to ensure that we get the kind and the quality of data
    that we need, not excessive data with no outcomes at the end.
        Not only are we reaching the numbers of individuals that we
    set our goals to reach, just in the actual production of the
    numbers, as we saw with the National Family Caregivers
    Programs, but we are making a difference, ensuring that we
    target--a high percentage to those most at risk or those most
    vulnerable.
        For instance, 30 percent of the clients served in the Older
    Americans Act programs are elderly poor. That means that we are
    targeting our priority to those in most need. We also are over-
    serving. Thirty percent of the clients are in rural
    communities, compared to 24 on a national basis. In particular,
    States where we know that the rural issues are critical, with
    our new National Family Caregivers, we are expanding our
    availability to have comprehensive collaborations with the
    health care providers and others in the community that we had
    not had the opportunity to do. We are serving a large
    percentage of people that are from minority at-risk
    communities.
        We are leveraging some interesting dollars. Even with
    States' economic downturn, overall States are leveraging about
    $2 for every $1 of the AOA dollar put in many of the States.
    For intensive services, like in-home care, we are leveraging $3
    to every $1 AOA dollar.
        We are seeing excellent increases in recruiting of
    volunteers for the senior Medicare patrols, as well as who are
    ombudsmen within the communities, and improving the outcomes of
    the Ombudsman program by working together with CMS on their new
    quality initiative, both in the nursing home and obviously in
    the home health area.
        The Chairman. Thank you. Will you do a white paper on those
    findings, or how will they be reported to us?
        Ms. Carbonell. They will be reported--we have an annual
    report which is our own specific annual report----
        The Chairman. It will show up in those?
        Ms. Carbonell [continuing]. That we are proud to--it is hot
    off the press.
        The Chairman. OK.
        Ms. Carbonell. It is not out. It will be out at the end of
    this week, but we have brought a copy that we will leave with
    you.
        The Chairman. Fine.
        Ms. Carbonell. In addition, the final outcome data of the
    national surveys, which is a new survey that has been added to
    the outcome measurements and performance data, will be ready
    later this summer, and those will be released and we will be
    glad to provide them to Congress and to the Chair.
        The Chairman. Super. Thank you.
        I am going to turn to my colleague, Senator Breaux. A vote
    has just started. I am going to run and vote and come back and
    we will do tag team here so that we can keep our hearing going.
    John?
        Senator Breaux. Thank you, Mr. Chairman. Thank you, Madam
    Secretary.
        You mentioned in your testimony that the President's budget
    for 2004 requests for CMS a $1.75 billion program to encourage
    a transition of people from nursing homes or other long-term
    care institutions back to the community, and you correctly
    point out that we really have an institutional bias in long-
    term care in this country in keeping people in institutional
    care. An awful lot of people, in fact, need long-term, 24-hour-
    a-day, 7-day-a-week care, but there are an awful lot of them
    that are in institutional care like nursing homes that don't
    need to be there.
        Yet, almost 75 percent of all the money we appropriate is
    being used principally through the Medicaid program to put
    people in nursing homes. It is really an embarrassment, because
    you have got to spend yourself poor to get money to get long-
    term care, which is a real embarrassment as a society, but that
    is a whole other point.
        How would the money that the President is proposing be used
    to end this institutional bias that we are talking about?
        Ms. Carbonell. Well, I think that--not only the rebalancing
    initiative, but several other initiatives, including the New
    Freedom and the systems change grants, have allowed and are
    beginning to allow many States the opportunity to begin to
    rebalance their systems. In the rebalancing proposal, the
    opportunity, if they wish, to invest in shifting folks from a
    nursing home into home and community-based care. It provides a
    1-year, 100 percent Federal reimbursement for all costs to move
    and to pay for services to move individuals from a nursing home
    into home and community-based care. That is virtually how we
    envision the framework that was proposed to Congress for the
    2004 budget.
        In anticipation of those changes, we have been working and
    there have been system choice grants already given out to
    States which have allowed States to begin to address removing
    barriers, institutional and infrastructure barriers, that
    prevent individuals from living independently in their own
    homes. So it has addressed structural changes and
    reimbursements at the State level for making those changes,
    both policy and resource-wise.
        Senator Breaux. Of course, the problem at the State level
    is that the States can do that now simply by requesting a
    waiver from HHS to use their State Medicaid funds for non-
    institutional care, like assisted living facilities. The
    problem has been that they don't want to do it. The problem has
    been that they have a bias toward nursing homes, in many cases
    because of the political strength of the nursing homes that
    prevent legislators from allowing them to make the request.
        My concern is I don't understand how this is going to help
    the situation, because the problem is with the States not
    wanting to do it. They can do it now.
        Ms. Carbonell. Well, they can do it now, right now,
    Senator, but the current reimbursement mechanism would be the
    same match that the States have at the current time. With the
    rebalancing proposal, it provides 100 percent Federal
    reimbursement to States for one year, so they can begin to
    shift it. That, coupled with the fact that the Administration
    on Aging is partnering with CMS to create, again, the
    involvement of a single-entry or one-stop-shop place where
    people can turn for help and assistance, where there will be
    one single entry point in the system to long-term care, that
    will allow the individual better choices. Right now those
    programs are fragmented.
        So some States, a few of the States, have their long-term
    care system, including their Medicare waiver programs, managed
    by the aging network, the aging State unit. But the rest of the
    States have, of course, their Medicaid waiver and long-term
    care program managed by their State health or Medicaid agency.
        Senator Breaux. So are we saying that under this proposal,
    the State would get the same amount of money under Medicaid
    plus the States would divide up $1.75 billion in addition to be
    used for non-institutional care?
        Ms. Carbonell. Correct. That means that it is an historic
    investment, a change in the way that we offer incentives to
    States to begin to shift policy and resources to home and
    community-based care to create more balance.
        Senator Breaux. This is not a subtraction from what they
    would normally get under Medicaid?
        Ms. Carbonell. This proposal is an addition and it is 100
    percent for one-year. This one-year reimbursement at 100
    percent for States wishing to pilot and to begin to shift
    policy and programs to home and community-based care.
        Senator Breaux. So a State will get 100 percent with no
    State match to allow them to move out of a nursing home?
        Ms. Carbonell. For the first year, sir, yes, and the rest
    of the years, it comes back to the State match as stipulated.
        Senator Breaux. Why are we doing a 100 percent match?
    Aren't we just telling the States we are going to pay 100
    percent of the cost if somebody moves out of a nursing home?
        Ms. Carbonell. Well, this is an historic turning point----
        Senator Breaux. It certainly is.
        Ms. Carbonell [continuing]. We feel very confident that a
    1-year, coupled with other supports will help. I am not CMS so
    I defer that kind of question to my colleagues----
        Senator Breaux. What happens, then, if we do it for 1 year
    and a State moves 20 percent of their nursing home population
    into an assisted living facility and the Federal Government
    picks it all up? What happens to those people when the Federal
    Government sunsets it after one year?
        Ms. Carbonell. Well, in those States where we have seen the
    experience of shifting resources, a consolidation of resources
    and programs into one single entity for long-term care, the
    experience and the studies and the data have shown that they
    have actually reduced their costs in general, and have improved
    the number of people being able to be served under home and
    community-based services by mixing of services available both
    in-home and community-based care and nursing home.
        So that means that, No. 1, people have been able to
    successfully be transitioned out of nursing homes into home and
    community-based care programs. We know that the data shows that
    those States that have invested dollars in shifting to home and
    community-based care have done so cost effectively and have
    been able to continue to do so.
        Senator Breaux. I have no qualms with the principle that it
    is cheaper and, I think, more convenient and a better degree of
    care for a large number of people to be in non-
    institutionalized care. I think that is what we ought to be
    encouraging States to do, something that they can do now but
    they don't in most cases.
        I need to learn more about this $1.75 billion and how it
    would actually work. I think it is the right thing to try and
    ultimately accomplished. I am not certain that this is the best
    way to do it because I am concerned about if we do it to them
    for one shot and then the next year it is not there, they are
    going to be left with an awful lot of people hanging in
    facilities that they didn't think they were going there for one
    year. All of a sudden, the money is not going to be there in
    the second year and what happens to all of those people?
        Ms. Carbonell. We would like to follow up with you,
    Senator, and bring you additional information with my colleague
    at CMS, Tom Scully. Obviously, that is not just the only thing
    it involves. Obviously, our role at the Administration on Aging
    is that the administration and the aging network is one of the
    largest providers of home and community-based care throughout
    this country and we are ready, we are experienced, we have
    proven to be cost effective, and we are ready to take on the
    next step, which means work collaboratively, partnering with
    CMS, because you have got an existing structure that is evident
    throughout 29,000 providers and communities. We are doing it
    for the grant monies right now and in many cases, about 30
    percent of the States, the aging network is managing and
    operating the Medicare waiver home and community-based care
    services in communities.
        So we are--the one-stop-shop initiative will give us the
    ability to partner with CMS to ensure that we integrate the
    service systems at the community level and that we incentivize
    and award competitive grants that will be released later on
    this month to do just that, to begin to shift----
        Senator Breaux. We will follow up on that.
        Ms. Carbonell. Thank you.
        Senator Breaux. You are aware, apparently, of our hearing
    yesterday, because you reference it in your testimony. I think
    that what we learned yesterday is that there is an enormous
    bias in America, in our own country, against seniors in a lot
    of areas. One of the most important areas is the general area
    of health care.
        Our medical schools do not have enough geriatric degrees.
    Only five schools in the entire United States medical schools
    out of 125 have full departments of geriatrics. Yet all of them
    have full departments in pediatrics.
        We have clinical trials for prescription drugs that are
    ongoing that do not fully utilize, if hardly at all, seniors in
    the testing, even though most of the people who take
    prescription drugs, over half are seniors, but they are not
    involved in the clinical trials to develop the drugs and to
    ensure that they are safe.
        We have a bias and a lack of utilization among seniors in
    preventative care programs that are available to others. We
    have, I think, a lack of understanding of depression among
    seniors. The highest suicide rates in this country is not among
    teenagers but among seniors, and we had testimony that doctors
    don't recognize it because they haven't been trained. Too many
    times, seniors are just dismissed as being, well, they are old
    people. They are going to die anyway.
        I think that we as a society need to be striving for not
    just getting seniors to live longer, but to live better lives.
    I have said it a million times. Part of living better lives is
    to make sure that they have access to the same type of quality
    preventative services and health services that someone who is
    in their 20's or 50's or even younger.
        So, I mean, what can the Administration on Aging, when you
    look out over America and you see this discrimination against
    aging and people who are seniors, what can the Administration
    on Aging do to become a leader in this area, to eliminate these
    biases that currently exist?
        Ms. Carbonell. At the Administration on Aging, obviously is
    the chief advocate for aging and older Americans across the
    country, we not only are taking a chief advocacy role, but we
    are actually running programs and collaborating with other
    agencies to ensure that we begin to tear down those barriers
    that ensure not only quality of care for our seniors, but a
    better quality of life, obviously.
        If you look at the report released today on, long-term care
    workers in relation to the aging baby boom generation, you will
    see substantial recommendations in to Congress based on the
    kinds of urgency that there is to address not only the
    shortages of professional workers, but also ensure that
    paraprofessional quality training continues to happen.
        We are working with HRSA inasmuch as the Health Resource
    Services Administration is addressing geriatric education in
    their 2003, spending approximately $12 million in continuing to
    fund geriatric education centers across this country.
        We are working with the Agency for Health Research and
    Quality, AHRQ, to ensure that there is safety in medications
    and that the medications' overuse is addressed and the safety
    and products of the medication are there. FDA is expanding its
    consumer information opportunities, and that includes the
    working relationship between FDA and AOA, to improve that
    consumer information education.
        On mental health, we have just developed and are about to
    launch by the end of this month a tool kit that SAMHSA has
    provided to ensure that we address mental health, depression,
    substance abuse, and other issues in older populations.
        So we are taking active steps with our partners in CMS to
    address prevention services and the expansion of prevention
    services.
        The whole Medicare proposal before you in the 2004 budget,
    the President's 2004 budget, obviously not only aspires to
    provide for prescription drug benefits for seniors, but it is
    looking at a more comprehensive reform as we improve the
    capacity to do prevention and screenings for all Medicare
    beneficiaries.
        So we are taking active steps with CDC in our aging State
    programs. Our aging network providers are partnering in ten
    specific communities across this country where there is high
    incidence of risk behaviors and health disparities. We are co-
    funding with CDC initiatives in this program with public health
    providers and our community aging providers.
        Senator Breaux. Thank you. Thank you, Mr. Chairman.
        The Chairman. John, thank you.
        One last question, Madam Secretary, before we turn to our
    next panel group. I understand the administration has been
    involved in a series of listening sessions. What exactly have
    you learned from people out there receiving and providing older
    Americans' services?
        Ms. Carbonell. Well, the most important thing is that the
    flexibility and the ability of many of our providers with the
    new reauthorized Act has awarded us the flexibility needed to
    address consumer choice at the local level. So the improved
    capacity for program sharing, for having the new Family
    Caregiver Program, has allowed us the opportunity to create new
    partnerships and collaborations at the State level, whether you
    are looking at private sector elder care programs or benefit
    programs being matched together with many of our Area Agencies
    on Aging and caregiver providers in the community.
        I just came back from a town hall session in Orange County,
    CA. We held that town hall meeting in collaboration with the
    aging network and the disability advocates. We were able to
    come together as one to address some of the barrier removals
    and some of the challenges that we both have both in the aging
    and disability communities to promote independence in
    communities, and address better opportunities for home and
    community-based care.
        We are looking, obviously, at hearing from seniors, like I
    mentioned, particularly in the area of grandparents. We see
    that there are challenges in many of the grandparents raising
    grandchildren that we need to continue to address as we move
    forward, and the National Family Caregiver Program evolves and
    there are obviously opportunities as the reauthorization of the
    Older Americans Act becomes evident just in 2005.
        The Chairman. Thank you. Thank you very much for your
    testimony, the work you are doing, and all of the efforts well
    underway. I think all of us kind of view, whether we are at the
    policy level or the implementation of that policy, at your
    level, kind of feel we are in that interesting transitional
    time out there into a relatively known field, at the same time
    with expectations and demands that are not yet known in many
    respects as it relates to the aging of America.
        But we thank you very much for that testimony and look
    forward to our continued work with you.
        Ms. Carbonell. Thank you.
        The Chairman. Thanks for being here.
        Let us ask, then, the next group of panelists to come
    forward, please, Maria Greene, Kevin Mahoney, Ron Aday, and
    Gregory Abowd.
        Mr. Mahoney, we will try to deal with you in dispatch. We
    understand you have a family problem or concern and we will
    move you through as quickly as possible.
        Let me thank our panelists for being with us. I recognize
    Maria Greene, Director of the Georgia Division on Aging. She
    will visit with us today about the features of Georgia's family
    caregiving efforts, including a mobile day care program.
        Maria, welcome, and we look forward to your testimony.
        Ms. Greene. Thank you.
        The Chairman. Please proceed.

      STATEMENT OF MARIA GREENE, DIRECTOR, GEORGIA DEPARTMENT OF
        HUMAN RESOURCES, DIVISION OF AGING SERVICES, ATLANTA, GA

        Ms. Greene. Good afternoon, Senator Craig. Thank you for
    the opportunity to come this afternoon. I am Maria Greene,
    Director of the Georgia Department of Human Resources, Division
    of Aging Services. Also with me today is Mr. Cliff Burt,
    Caregiver Specialist responsible for Georgia's caregiver
    program.
        I would like to share information with you about five
    innovative caregiver initiatives. They are caregiver research,
    assessment, mediation, consumer-directed care, and mobile day
    care.
        Georgia conducted 11 focus groups to solicit input from
    family and professional caregivers regarding needs and gaps in
    services. We found that caregivers need more information, more
    direct services, training for themselves, and better trained
    non-ageist providers. The results of the focus groups have been
    used to integrate the National Family Caregiver Program into
    the existing delivery system, expansion of existing services,
    and development of new programs and services.
        Georgia was awarded grants from the Administration on Aging
    to participate in the performance outcomes measurement project.
    The Division participated in the development of instruments
    that measure caregiver support and satisfaction, nutrition
    risk, physical functioning, and emotional well-being. We tested
    these instruments over a 3-year period. We are encouraging Area
    Agencies on Aging to use the instruments in determining service
    outcomes, quality and client satisfaction, and how best to
    manage using data.
        We understand, Senator Craig, that the committee has an
    interest in mediation. Georgia is one of the three States
    participating in a caregiver demonstration grant received by
    the Center for Social Gerontology in Ann Arbor, MI. The goal of
    the project is to use mediation to assist frail older persons
    and their family caregivers to address and resolve problems and
    disputes which all too frequently arise when families face the
    physical, emotional, and financial demands of providing care.
    Elder law attorneys using mediation skills have helped many
    families resolve conflicts.
        We value the philosophy of consumer-directed care.
    Preliminary studies have found that 77 percent of caregivers
    utilize funds to hire someone to provide care, and 80 percent
    of the caregivers hired someone they know as opposed to agency
    personnel. Caregivers who participate in the program are
    considerably more satisfied with those services than those who
    receive traditional services.
        I will share with you a story told to me recently. The
    caregiver for 94-year-old Mr. K called the local Area Agency on
    Aging about using some of the fund from the self-directed care
    program to make needed bathroom repairs. The caregiver utilized
    some of the self-directed funds to purchase needed materials
    and secured volunteers to make the necessary repairs.
    Consequently, her father is able to bathe by himself for the
    first time in many years. The caregiver stated that her dad
    never had a tub and had to use a very small shower stall. Her
    father, who last year would not bathe, has to be coaxed out of
    the tub. She and her father would like to thank all of those
    responsible for the program.
        Given the well-documented long-term care staffing crisis in
    the nation, the unavailability of services, and fewer workers
    in rural areas, it should come as no surprise that our
    preliminary findings show that family caregivers wholeheartedly
    embrace self-directed care.
        Through funding provided by the Administration on Aging,
    Georgia developed the mobile day care program. Mobile day care
    enables communities to have their own day care programs while
    sharing staff who travel between locations. Mobile day care has
    proved to be a great respite care alternative. Its flexibility
    with part- and full-time staff positions helps to retain
    qualified staff. Perhaps its greatest values is that it builds
    trust in rural communities and thus becomes the precursor of a
    full-time day care program.
        Georgia's ability to do caregiver research, assessment,
    mediation, consumer-directed care, and mobile day care has
    enabled us to create new partnerships and paradigms to meet the
    diverse and increasing needs of caregivers. One of the National
    Family Caregiver Support Program's hallmarks has been the
    component of supplement services, which has enabled the aging
    network the flexibility needed to become more innovative. The
    product of that flexibility is improved service delivery, new
    services, and increased empowerment for caregivers. Also, the
    demonstration grants have allowed States like Georgia to pilot
    new delivery of care systems, gather consumer satisfaction
    data, and to manage programs using those data.
        Mr. Chairman, with your permission, may we show a short
    clip of the mobile day care video.
        The Chairman. Surely.
        Ms. Greene. Thank you. [A videotape was shown.]
        Thank you.
        The Chairman. Thank you. Thank you very much for that
    testimony and the video.
        [The prepared statement of Ms. Greene follows:]

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        The Chairman. Now, let us turn to Kevin Mahoney, Program
    Manager for a demonstration project which highlights
    innovations in consumer directed care. Would you please
    proceed? Thank you.
        Dr. Mahoney. If I might just have a second to get this set
    up.
        The Chairman. All right. Thank you. I want to also say that
    you are a National Program Director at Cash and Counseling
    Demonstration Project in Chestnut Hill----
        Dr. Mahoney. At Boston College.
        The Chairman. There we go. Thank you. Now we have it all
    out.

        STATEMENT OF KEVIN J. MAHONEY, PH.D., NATIONAL PROGRAM
      DIRECTOR, CASH AND COUNSELING DEMONSTRATION AND EVALUATION
       PROJECT, BOSTON COLLEGE GRADUATE SCHOOL OF SOCIAL WORKS,
                           CHESTNUT HILL, MA

        Dr. Mahoney. Thank you, Mr. Chairman and members of the
    committee. Today in most States, whether you are elderly or a
    younger person with disabilities, if you are on Medicaid and
    you need help with such basic things as bathing, dressing,
    getting out of bed, you rarely have any choice over who helps
    you, when they come, or what they do. But for years, people in
    the disability community have been saying, if I had more
    control over these services, my life would be a lot better and
    I think I could do it for the same amount of money or less.
        The Cash and Counseling Demonstration and Evaluation is, in
    fact, a real major test of just that idea. It is a test of one
    of the ultimate forms of consumer direction, where people are
    given the choice between traditional services from agencies or
    managing the equivalent amount of a cash allowance themselves
    with supports. It is a major test, one that involves over 6,700
    people in three States who have been randomly assigned for this
    demonstration.
        Janice Maddox is a perfect example of the desire of seniors
    to have more control over who enters their home and who
    provides intimate care. At 75, Mrs. Maddox does not have the
    best health. She has diabetes and glaucoma and is confined to a
    wheelchair possibly as a result of several strokes. But despite
    her physical frailty, Mrs. Maddox possesses a tremendous asset,
    an extensive support network of family and friends who want to
    help her continue to live independently.
        For 5 years, Mrs. Maddox received personal assistance
    services from aides sent to her by an agency that contracted
    with Medicaid. Then her daughter read about Arkansas's Cash and
    Counseling Program in the newspaper. Mrs. Maddox enrolled and
    her oldest daughter, Johnetta Thurman, became her
    representative decisionmaker. Mrs. Maddox's monthly allowance
    through Cash and Counseling pays her adult granddaughter to
    spend at least 2 hours a day, 7 days a week, attending to Mrs.
    Maddox's needs. Her allowance is also used to pay her grandson
    $10 a week to do odd jobs around the house and helps cover the
    cost of such things as over-the-counter medications and
    toiletries.
        Mrs. Maddox's daughter, who lives in Chicago and travels
    frequently to Arkansas to make sure her mother's needs are
    being met, believes the program has made an immense impact in
    improving the quality of her mother's life. She says, ``There
    is just something about having family look after her. She
    doesn't get nearly as many allergic reactions or bedsores now,
    and I think that's because when it's your own you're looking
    after, you pay more attention.''
        The Cash and Counseling Demonstration and Evaluation is
    really a rather unusual creature. It is completely co-funded by
    the Robert Wood Johnson Foundation and the Office of the
    Assistant Secretary for Planning and Evaluation at HHS. It
    operates under Medicaid waivers granted by the Centers for
    Medicare and Medicaid Services. The quantitative evaluation
    that I am going to present to you, the first results, was done
    by Mathematica Policy Research. The qualitative evaluation that
    is my favorite follows about 25 people close up and personal in
    each of the three States and tells how this really affects
    their lives.
        The program takes place in three States, Arkansas, Florida,
    and New Jersey. In all three States, it includes older people
    and younger adults with disabilities. Florida is different.
    They also include children with developmental services.
        What I would like to do in these few minutes today is
    present the first of our research results. they are from
    Arkansas which was the first State to implement this. To
    Arkansas's credit, they implemented the cash and counseling
    option within a month of when they got the Federal waivers.
    These particular findings that we get to share today are from a
    controlled experiment, so in Arkansas, we had a little over
    2,000 people enrolled. Half of them were randomly assigned to
    the traditional system, half to managing the cash allowance.
        When we looked at quality of care measures, we looked at
    four: satisfaction, reduction in unmet need, health outcomes,
    and affects on overall quality of life.
        Just a key to sort of give a picture of this, the left side
    are younger adults with disabilities. The right side are the
    elderly. The red bars are the treatment group. Those are the
    people that got to manage the cash allowance. The ``C'' is the
    control, is the traditional system. Whenever you see an
    asterisk, it is statistically significant. The more asterisks,
    the more statistically significant. Rarely will you in your
    lifetime as a researcher get a chance to see that kind of
    results, over 20 percentage points improvement in some of these
    measures of satisfaction.
        When you turn to the second measure, unmet needs, you start
    seeing reduction, major reductions there.
        The results people were really looking for the most were
    the health outcomes, and I am pleased to be able to report that
    basically the health outcomes were either as good, or where
    there were differences, they favored the people who managed
    their own allowance. You can see the elderly had fewer
    contractures while younger persons with disabilities had fewer
    bedsores. Overall life satisfaction was also improved. The
    final slide shows the schedule for the rest of our reports.
        Each of these three States is looking at making cash and
    counseling a permanent option. The Robert Wood Johnson
    Foundation and HHS are looking at how we can expand this option
    to other States. Thanks.
        The Chairman. Thank you very much for that testimony. That
    is exciting, you are right, to see those kinds of results,
    Kevin, are very impressive.
        [The prepared statement of Dr. Mahoney follows:]

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        The Chairman. Now, let us turn to Dr. Ron Aday. Dr. Aday is
    Director of Aging Studies, Middle Tennessee State University.
    Welcome, Doctor.

    STATEMENT OF RONALD H. ADAY, PH.D., DIRECTOR OF AGING STUDIES,
          MIDDLE TENNESSEE STATE UNIVERSITY, MURFREESBORO, TN

        Dr. Aday. Thank you, Senator Craig. It is a pleasure to be
    here today to discuss the significance of senior centers and
    the important role that they will play in meeting the diverse
    needs of our nation's baby boomers.
        The challenge, of course, centers around the diversity of
    this population, as you mentioned earlier, in terms of
    ethnicity, the well, the frail, and, of course, an age span
    from 60 to 100 or more. So it is a tremendous challenge that we
    are facing.
        This year, senior centers are celebrating their 60th year
    as an entity and are serving over ten million clients annually
    at approximately 1,400 senior centers. They have a strong
    infrastructure, a dedicated staff that certainly has
    demonstrated an openness to exploring ways of how to meet the
    upcoming challenges for serving the baby boomer generation.
        There are several ways that senior centers might be able to
    empower this group in the coming decades. I think it is very
    important to provide what I refer to as survival skills for the
    baby boomers and, of course, in many cases, their aging
    parents, as well.
        One of the research outcomes I have recently found in
    surveying senior centers from seven States and approximately 20
    senior centers, was that the senior center environment is
    conducive to the establishment of social support networks,
    where seniors feel responsible for each other and assist each
    other in order to help maintain their independence. About 85
    percent of the sample reported that friends they have made at
    the senior center provided them with a sense of emotional
    security and someone that they can depend on in time of need.
        Eighty-five percent also said that they provided some type
    of assistance to their friends that they had made at the senior
    center. I think that is very significant as we look at how to
    create a more independent baby boomer generation as they
    progress in age. This social network, of course, combats
    depression, loneliness, especially for those that live alone.
    We have a large number of female senior center users in
    particular that live alone.
        Another, main area where senior centers can certainly
    empower and help our baby boomers is through what has been
    termed self-care initiatives. Most senior centers currently
    provide health and wellness programming, which brings about
    positive behavioral changes. In the future, chronic care
    clinics will emerge as an even more important component of
    senior centers.
        The senior center that I have been serving on the board for
    for the last 12 or 15 years, when we reconstructed the new
    senior center that we opened 4 or 5 years ago, we actually
    built within that construction a nurse-on-duty program. It was
    actually in place, and so we have a nurse that comes there 2
    days a week, provides a clinic. She also works at the
    university where I do. It is a partnership between the
    university and the senior center. They bring nursing students
    to the senior center and provide assistance and screening, and
    she has at the present time 400 open cases where she sees on a
    regular basis, providing screening and drug management kinds
    of--and information to them.
        A third area that we see, I think, is really looking at the
    baby boomers in the future, who many of them will want to
    continue to work into their 70's. That is one of the things
    that the literature tells us. But the senior center can evolve,
    I think, to provide retirement counseling for those that may
    choose to retire, but also retraining and employment for those
    that want to continue. We know that based on advanced
    technology, that many of us will phase in and out of several
    careers over a lifetime and the senior center can certainly be
    the environment where baby boomers in their 60's might be able
    to come and get retrained. Senior centers in this way will
    serve as continuing education centers, where they will provide
    programming and innovations and it will be, I think, beyond
    computer skills. We talk about computer skills today. While
    computer labs are found in many senior centers today,
    additional computer and other new information will be important
    technological to baby boomers in order to remain current in the
    21st Century.
        Also, another, senior centers are now getting involved in
    what we call civic engagement programming, and that is trying
    to find a balance between leisure and recreational activities
    as well as civic commitment. We know that we need to utilize
    the services and the potential that baby boomers have as they
    age and as they enter into the long-term care continuum. So we
    want to utilize their services, and so attracting them to the
    senior center for their education, for their skills, for
    volunteer work, is going to be extremely important.
        Finally, a connection to other generations is also very
    important and senior centers can play a very important role in
    this process, by providing adult day services, services for
    helping family caregivers, grandparents' support groups,
    latchkey children telephone assistance, and also mentoring for
    juvenile diversion programs, to maintain a few examples.
        While senior centers are now recognized as one of the most
    widely utilized services created by the Older Americans Act,
    they are in some ways still the very best kept secret based on
    the outcome measures that are telling us we really can't afford
    not to utilize the senior center network to its fullest in the
    coming decades. If given the adequate resources, senior centers
    will help make aging a new adventure for our baby boomers.
    Thank you very much.
        The Chairman. Thank you very much, Doctor. The concept of a
    new or futuristic senior center was brought to my attention
    some months ago when a group met with me in Boise, ID, to talk
    about creating, if you will, a kind of model of a future
    center. I think, clearly, with the dynamics of this aging
    group, you are right. I have oftentimes thought how computer
    centers are important today. All of these folks entering will
    be mostly computer literate. They will simply be wanting to
    advance themselves in those skills as that part of our
    technology evolves, along with a lot of others.
        I often have thought, yes, and they need an employment
    center or an employment contact and maybe even some training.
    So certainly what you have talked about seems to clearly be a
    part of what others are visiting about and what some are
    thinking about in a sincere and direct way. Thank you.
        [The prepared statement of Dr. Aday follows:]

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        The Chairman. Now, let us turn to Dr. Gregory Abowd,
    Associate Professor, College of Computing at Georgia Institute
    of Technology in Atlanta, GA. His research interests lie in
    human-to-computer interaction--hmm, I need some of your
    courses.
        Dr. Abowd. We all do.
        The Chairman. I don't interact well. [Laughter.]
        Dr. Abowd. It is not your fault.
        The Chairman. The smart home, or the aware home research
    initiative, or the smart home project for aging Americans.
    Thank you. Please proceed.

    STATEMENT OF GREGORY D. ABOWD, ASSOCIATE PROFESSOR, COLLEGE OF
        COMPUTING, AND GVU CENTER DIRECTOR, AWARE HOME RESEARCH
              INITIATIVE, GEORGIA INSTITUTE OF TECHNOLOGY

        Dr. Abowd. Mr. Chairman, thank you for giving me this
    opportunity to speak about such an important topic and to allow
    me to talk about how I think this country can use high
    technology or advanced technology to meet the needs of an
    increasing aged population.
        I have a very simple message, and that is that advanced
    technology holds great promise for promoting healthy and
    independent aging, but we must be more proactive to realize
    this promise. Aging is not a disease, and while there is
    significant research exploring how technology can provide
    assistance for individuals coping with disabilities or disease
    as they grow older, the role of technology in enhancing the
    lives of older but otherwise healthy Americans is not well
    understood or appreciated.
        I am a computer scientist and an expert in the area of
    ubiquitous computing, meaning the spread of computing artifacts
    throughout the physical world to support everyday activities.
    Though my work presents great technical challenges, the
    motivation to work in this area is largely the human-centered
    agenda of providing assistance in our everyday lives.
        Over the past 5 years, with support from the National
    Science Foundation, the State of Georgia, and several major
    computing companies, we have been exploring ubiquitous
    computing in the home. We refer to our efforts as the Aware
    Home Research Initiative, with the challenge of creating a home
    that serves its inhabitants because it is empowered with an
    awareness of their whereabouts and activities.
        A major motivation for this work is that an aware home,
    properly connected to trusted caregivers, can provide the
    assistance needed for otherwise healthy individuals to cope
    with the natural declines related to aging. Advanced
    technologies can be pleasingly woven into the fabric of our
    homes, allowing us to age in place. An aware home can promote
    independence and quality of life for an aging population, and
    there are tremendous social and economic incentives to do this.
        Now, what do I mean by advanced technological supports? In
    my written statement, I catalog a wide variety of technological
    supports for an aging population. To summarize for you here,
    there are three categories of interest. First, you have
    assistive devices that compensate for motor, sensory, or
    cognitive deficiencies. Then you have monitor and response
    systems that provide both emergency response to crisis
    situations as well as early warning for less critical and
    emerging problems. Finally, we have communication aids that
    provide a link between an individual and a network of formal
    and informal caregivers.
        The greatest promise for advanced technology lie with the
    cognitive aids, the monitoring of trends, and novel
    communication aids. I will demonstrate some of these
    technologies at the end of my statement, with your permission.
        Now, who will benefit from these technological supports?
    First and obviously, we provide assistance directly to the
    individual in an attempt to support their independence and
    quality of life.
        Second, this technology provides support for distributed
    family members and other more formal caregivers who share the
    financial and emotional burden of coping with the challenges of
    aging.
        Third, with the increase of broad-band networking into and
    out of the home, we have greater capability to support the
    activities of larger institutions providing medical, emergency,
    or other social services.
        Finally, scientific evidence of a quantifiable benefit of
    advanced technology for healthy aging will encourage the
    development of profitable business plans that drive private
    investment and commercial success in this important market.
        Now, what role does advanced technology research play? One
    of the key indicators of independence is the measured
    performance by an individual in activities of daily living. The
    role for advanced technology, therefore, is the detection,
    measurement, and even improvement of an individual's
    performance with these various activities in their living
    environment.
        Until now, most assessment of independence has been done by
    humans and this solution won't scale to provide proactive
    support for a large population. Hence, advanced technology is
    necessary. In my written statement, I have surveyed emerging
    technological aids, but I must stress that there remain
    significant advances in technologies of sensing and long-term
    analysis of human behaviors that will not occur unless
    sufficient funding is made available.
        I want to make two recommendations to the committee. First,
    we need basic technology research for sensing and measuring
    these activities of daily living. The funding for these basic
    technological advancements could be administered by agencies
    such as the NSF that traditionally fund scientific and
    engineering developments that eventually benefit society.
        Second, we need large-scale test beds for evaluating
    technology for healthy aging. Research into how best technology
    serves the aging should be administered by groups whose
    mandates focus on public health concerns. This funding will
    make sure that the technology is well matched to the needs of
    the community. It will also lay groundwork for a healthy aging
    industry that will bring the research success to the
    marketplace.
        With the permission of the Chairman, I would like a few
    minutes to demonstrate three separate projects that bring to
    life some of the ideas I have been talking about that we have
    been working on at Georgia Tech.
        The Chairman. Please, go ahead.
        Dr. Abowd. I want to demonstrate three separate projects
    that are taking place at Georgia Tech as part of the Aware Home
    Research Initiative.
        In the first demonstration, we focus on the potential for
    automatically detecting behaviors. Even with proper initial
    training, people often misuse home health care devices, such as
    the blood glucose monitor that is pictured here. I am sorry you
    can't see on the monitor. Advanced computer vision algorithms
    can observe the use of a device and automatically detect when a
    sequence of actions is done incorrectly, providing an
    opportunity to give immediate training advice. The video shown
    here at the top demonstrates how our computer vision algorithms
    track hands and various objects to label the actions as a user
    attempts to calibrate the blood glucose meter.
        An important form of cognitive aid is one that compensates
    for near-term memory lapses. When an activity such as cooking
    is interrupted, what visual cues provide the right information
    to pick up where you left off? In the Aware Home, we have
    instrumented the kitchen area with cameras looking down at the
    countertop, shown in the bottom figure. An LCD panel is updated
    with salient images of the cooking activity as it is occurring.
    When interrupted, a simply glance at the display shows the most
    recent activity.
        Now, I am going to switch to a live demonstration. What you
    see here is the image on the LCD panel that is being updated
    occasionally with images being detected by a wizard sitting
    outside the kitchen determining when a significant activity
    occurs. The bottom right figure in this collage is updated to
    show you the most recent activity, and the numbers in the
    various panels indicate repeated activities, such as one, two,
    or three cups of the same ingredient being placed in the bowl.
    So that when someone glances at the collage, they can determine
    where they would have left off, and frequently in our
    controlled studies, it has been the repeated measures
    activities that get forgotten. So you don't remember the number
    of cups of flour that you have put in.
        Now, we don't currently have the ability to automatically
    detect the salient images to produce this collage, but we have
    been simulating the collage in controlled studies to determine
    its value, and given the progress on detecting simple
    activities, as I showed on the previous example with the blood
    glucose monitor, I hold very great hope that we will be able to
    provide these kinds of visual reminders automatically in the
    home of the future.
        In my last example, I want to contrast with the previous
    two. In the previous two examples, we showed services that
    stayed within the home and serviced the individual. This last
    demonstration is about connecting to caregivers, in particular,
    the natural support group of family and friends who want to
    maintain peace of mind for the well-being of older parents or
    loved ones.
        The digital family portrait shown here is an ordinary
    picture of a loved one that has been augmented with information
    in the frame to communicate how that person is doing over the
    last month. This is an aesthetically pleasing way to keep in
    touch with the everyday well-being of a loved one and it can be
    modified to support the normal monitoring activities of
    professional caregivers and assisted living facilities or
    naturally occurring retirement communities, referred to as
    NORCs. I can also demonstrate this, but for the sake of time, I
    would like to thank you for your patience.
        The Chairman. Doctor, thank you very much for that
    testimony. I was telling staff, earlier in the day, I took a
    tour of a smart home that a large software company in Seattle,
    WA, developed. I guess for sake of not promoting advertising, I
    won't mention the name.
        Dr. Abowd. They don't sponsor us, either, so----
    [Laughter.]
        The Chairman. I found it very fascinating. It would do
    about everything you asked it to do by just simply voice
    command, and certainly could be adapted to someone with
    disabilities or someone with problems. It could make their life
    a good deal easier, including monitoring.
        I think I was recalling the thing most fascinating about
    it, in the evening before the person retired, they could go to
    their laptop or their computer and activate an automatic in-
    place e-mail to a loved one somewhere else telling them that
    they were safe and retiring for the evening, the very similar
    kind of thing that you see in retirement centers today in
    individual apartments and living facilities that go to a
    central station to monitor a person's activities. I thought,
    hmm, a most useful approach.
        Thank you for that testimony.
        [The prepared statement of Dr. Abowd follows:]

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        The Chairman. I am going to turn to Dr. Mahoney now, and
    then if you wish, at the end of this--I have got a couple of
    questions of you, Doctor--if you need to depart, please do so
    and we thank you again for being here today and your patience
    with us.
        You were giving us a variety of work that is going on,
    studies of comparatives. What percentage of the participants in
    this demonstration project classify as older Americans?
        Dr. Mahoney. In Arkansas, from which I just presented the
    data----
        The Chairman. Yes.
        Dr. Mahoney [continuing]. About 72 percent of the
    individuals that took part were elderly, and that certainly
    dispels the myths that older people aren't interested in
    managing services themselves. The percentages change in the
    other States, but maybe 50 percent in New Jersey, and just by
    nature of the demonstration, maybe about a third in Florida.
        The Chairman. That is fascinating to hear, and absolutely,
    they are concerned about that kind of management. It is a
    matter of controlling their own lives or having some say in it
    and feeling comfortable about it, I would guess.
        Does the study you reference in your testimony consist of a
    side-by-side comparison of older Americans receiving services
    in the traditional fashion compared to those applying consumer-
    directed choices?
        Dr. Mahoney. If I understand correctly, exactly. People who
    volunteered to take part in the demonstration were, in fact,
    randomly assigned, so half of them went to the traditional
    system, half of them got the chance to manage the cash
    allowance, and with that kind of numbers, given that we had
    about 6,700 people enroll in the three States, this is a very
    powerful way of evaluating these impacts.
        The Chairman. Does your study conclude that better services
    can be achieved at the same costs? Is there a net cost savings?
        Dr. Mahoney. I knew you would ask that. As I was showing,
    the cost results will be our next effort.
        The Chairman. OK.
        Dr. Mahoney. We are hoping those will come out over the
    summer. The good news is, at this stage, for instance, for
    Arkansas, they are meeting the Center for Medicare and Medicaid
    Service's budget neutrality requirements, so their research and
    demonstration waiver has just been extended another 5 years,
    and they have been able to get rid of the randomization, so at
    this point, everyone who wants to be part of this demonstration
    can be.
        The Chairman. Excellent. As you know, rural areas often
    face challenges accessing services. Has the demonstration
    project been implemented in rural areas of the host States, and
    if so, what has been the results?
        Dr. Mahoney. The demonstration was in the whole State of
    Arkansas, the whole State of New Jersey, and in Florida, for
    elderly people and adults with disabilities, the lower two-
    thirds of the State, children for the whole State. This is a
    demonstration particularly helpful in rural areas and where it
    is very hard for agencies to serve, where the worker shortage
    was at its worst.
        One of the things we found in Arkansas was if you
    interviewed the people 9 months after they came in, for people
    who were getting the cash allowance, 95 percent of them were
    getting personal assistance services, whereas for those in the
    traditional side, only about two-thirds of the adults with
    disabilities and only about 80 percent of the elderly were
    getting their care plans met. So in times of worker shortage,
    and especially in rural areas, this is a wonderful, a wonderful
    choice.
        The Chairman. Back me up a bit. You are saying those that
    were under the cash plan.
        Dr. Mahoney. Right.
        The Chairman. Actually were getting greater levels of
    service than those under the traditional programs.
        Dr. Mahoney. Right. Well, for instance, in the treatment
    group the consumer got a cash allowance exactly equal to what
    that person would have received under the traditional program,
    but they got to decide how to spend it on meeting their
    personal care needs. They had to develop a individualized plan.
    They could hire friends, family, people who wouldn't have been
    in the workforce. They could renovate their homes, or buy
    assistive devices. Whereas in the traditional system, where
    there was such trouble finding aides and workers, in many cases
    people just didn't get the services that were called for in the
    care plan.
        The Chairman. I am treading into water that I will be a
    little cautious on, because I have all the respect in the world
    for professional, well-skilled, trained caregivers, but are we
    suggesting by this that there are others capable of rendering
    care and service to a given senior that they can seek out who
    may not be as well trained or trained in some areas as a
    professionally trained person, but certainly are capable of
    delivering those services, and as a result, the service got
    delivered?
        Dr. Mahoney. Right. I think that is fair. I am involved in
    caring for my mother. In so many cases, basic services that
    families provide aren't skilled medical services.
        The Chairman. No.
        Dr. Mahoney. This is help bathing, dressing, toileting.
        The Chairman. Exactly.
        Dr. Mahoney. Remember what we found here. Those results
    show that the health effects were either the same or where they
    differed better for those who manage their own allowance. The
    younger adults with disabilities had fewer bedsores when they
    could choose people who really knew them and had a personal
    relationship.
        The Chairman. That is fascinating. Well, I trust you will
    keep the committee and our staff abreast of your work and the
    conclusions, the balance of the work you are doing. As our time
    and our focus permits, we will have you back to give us an
    analysis of the studies when they are completed.
        Dr. Mahoney. We would very much enjoy that. Thank you.
        The Chairman. Thank you. I find those findings fascinating.
    I appreciate your time, and please feel free to leave if you
    feel it necessary based on your schedule.
        Dr. Mahoney. Thank you for your consideration. Thank you.
        The Chairman. Now, let me turn to you, Ms. Greene. What you
    are doing in the flexibility you are offering, is exciting.
    What challenges has your agency faced in implementing the
    Family Caregiver Support Program in Georgia, challenges and/or
    obstacles?
        Ms. Greene. Well, when we did our caregiver focus groups to
    find out what our citizens or caregivers said they wanted or
    didn't want, we recognized right away that we had some
    challenges. They said that they wanted more information,
    assistance and referral. They wanted more training for
    themselves. They felt that our current providers needed more
    training, that they were agist. They requested more respite
    care.
        Probably the most challenging, but the one that we had a
    lot of interest from other organizations, was with the training
    aspect. We have coordinated with AARP, the Georgia Gerontology
    Society, a staffing solutions workgroup, the Alzheimer's
    associations, all came together to address the issue of not
    only training informal caregivers better, our personnel staff.
    That has been very interesting and I have really enjoyed the
    collaborative work with all the different associations to help
    make that happen.
        The Chairman. In what ways could the self-directed approach
    you have mentioned be applied in the delivery of other aging
    services?
        Ms. Greene. We were talking most recently about we have a
    dire need for transportation, especially most of the counties
    in Georgia are rural counties. We were talking about the
    possibility of hiring or making arrangements for friends and
    neighbors also to transport people to services, and so that is
    another consideration that we are looking for. But we have a
    real need that we need to address in transportation that our
    current level of fund sources, from all different fund levels,
    is not an adequate amount to meet the transport needs.
        The Chairman. Now, here is a question that dovetails with
    the work that Dr. Mahoney is doing and it was a question
    lingering in the back of my mind that I think, well, certainly
    with the program you have established, Doctor--or let me ask
    the question and feel free, if you would, to come in after Ms.
    Greene to talk about this approach.
        Some concerns have been expressed that allowing families to
    hire relatives and friends to provide care might result in the
    misuse of funds. What has been your experience in Georgia?
        Ms. Greene. So far, we have not seen any misuse of funds,
    probably better management of the funds. We have a service
    coordinator in every region, so the family members and the care
    receiver develop a plan or they decide how they can best use
    the funds. Right now, there is an average of $1,200 to $1,500
    spent a year. So they just call their service coordinator and
    they say, ``This is what we really need.'' Mom has had another
    stroke. Now she is in a wheelchair. We really need to build a
    ramp, for example. The service coordinator then OKs the
    expenditure of the funds and then they are reimbursed for the
    service. So we really have not seen any misuse of the funds.
        The Chairman. Doctor, do you wish to comment on that?
        Dr. Mahoney. I will put it in this context. The Arkansas
    project got underway in December 1998, New Jersey a year later,
    and Florida in June of 2000. We have had no major instances of
    fraud and abuse. In this context, of people who hired their own
    personal assistance workers, I think about 75 percent hired
    some level of family member and maybe another 17 percent hired
    people they knew through church, through their neighborhood:
    One of the things you end up finding is that they have hired
    people that had a real personal relationship that made a
    difference. That is not to say that we don't have important
    monitoring and quality management processes in each of these
    States, which again, I would be pleased to share.
        The Chairman. Thank you. This February, I held a hearing on
    the misuse of guardianships over the elderly. I was disturbed
    by accounts that the wishes of older Americans and their
    families are oftentimes ignored by persons bringing forth these
    actions. How does Georgia's mediation program prevent this type
    of undue control over a person's life?
        Ms. Greene. The people who have been trained to be
    mediators have worked actively with the Probate Judges'
    Association, and in Fulton County, which is the largest probate
    office in the State, they have agreed that prior to--when
    someone comes to the court to petition that they become a
    guardian of someone, that they are then provided information
    and educated about the mediation process. It is not mandated by
    the court, but it is strongly encouraged by the court that they
    go through the mediation process.
        So we are real excited about the relationships with the
    probate judges and that we have the largest county agreeing to
    work with us actively to seek mediation with families. So a lot
    of it, I think, is education, not only to the families about a
    mediation option, but also to the court system, that it is a
    viable option that could work and also save a lot of grief and
    financial cost.
        The Chairman. Thank you very much for your being here and
    your testimony and the work you are doing. I find all of that
    very fascinating.
        I had one other question as it related to mobile day care.
    Does the program have a wellness screening component in it?
        Ms. Greene. Yes, sir, it does. In fact, we have a statewide
    wellness program and it is done in conjunction with all of our
    other service components, and so they are screened to what
    ability they might be able to participate in exercise,
    nutrition education, medications management.
        The Chairman. Good. Thank you. Thank you very much.
        Dr. Aday, the work you are doing is fascinating to me
    because it is always intriguing to me about anyone's ability to
    successfully predict the future or at least to look outward and
    determine what needs might be. For a baby boomer that has just
    turned 60 and is relatively healthy and active, what would be
    the appeal for this older American to attend a senior center? I
    am assuming when I ask that question that this 60-year-old
    would be attending a senior center of today.
        Dr. Aday. Since I turn 60 next year, I will try to answer
    that as best I can.
        The Chairman. Oh, my goodness. We are getting truly
    personal testimony here. Thank you.
        Dr. Aday. Personal testimony. [Laughter.]
        I think when we look at today as well as the future, I
    think that the senior center certainly provides different
    functions. Certainly, a 60-year-old could come to the center
    for a very different reason than maybe that person's aging
    parent. You might come to the senior center to bring your aging
    parent, as we have adult day services in our center, to drop
    them off, and you might want to go then engage in a day trip
    and then return that evening, for example.
        But as I mentioned earlier, I think some of the other
    activities that we see already going on in senior centers do
    include things like retirement counseling and retirement
    training. We have lifelong learning that has been a steadfast
    component of senior centers for a number of years. So those are
    some of the kinds of activities, educational classes that might
    be inviting. Basically, if you have partnerships with local
    universities, they can offer topics that would attract a 60-
    year-old.
        I think some other factors that would also attract when you
    are talking about coming into a senior center, would be the
    opportunity to provide leadership skills on a community senior
    center board. We know that if our senior centers are going to
    become more sophisticated, the governing boards must also be
    sophisticated, and so we have to attract really quality people
    in leadership roles that can move senior centers forward in the
    21st century. I have observed that very thing happen in my
    community. It just so happened that the people on that board
    and on our city council who were assigned to the advisory board
    enabled us to do some very progressive things.
        So I think that you have to have forward-looking people and
    many of those are going to come from the young-old group.
    Someone who can come and provide leadership and volunteer
    services and assist with your other older clients that are also
    participating in senior center programs.
        The Chairman. How many senior centers in this country today
    have that kind of appeal to them, from your understanding and
    study?
        Dr. Aday. The recent research that I did, and it wasn't a
    random sample, but certainly 90 percent of the respondents
    indicated they were very satisfied with the knowledge and
    information that they were getting at their senior centers. We
    know that senior centers, of course, are very diverse. Some of
    them are open on a part-time basis. They may have just a
    director and that is all that person does. They are very
    limited in terms of funds.
        On the other hand, you have multi-purpose senior centers,
    and I don't know the exact number that would fall into that
    category. I think we do need some additional research really to
    look at where we are today as far as providing this myriad of
    services and then also looking at what kind of projections,
    what kind of plans these 1,300 or 1,400 senior centers have in
    the future and what they have currently in place.
        We know that NISC and other organizations are providing
    leadership with getting senior centers accredited, so they will
    become accredited entities which will, give senior centers a
    much more professional kind of appeal and it also enables, I
    think, the people that are funding senior centers to know that
    they have a quality product. But I don't know the exact number
    that are certainly in what we call the progressive mode now as
    far as providing these kind of services.
        The Chairman. The one thing that I often hear from 65-year-
    olds is, well, I don't go to senior centers. They are for old
    folks. But the kind of center you are talking about, with those
    kinds of dynamics and services and opportunities in them,
    wouldn't classify in that sense. So 10 or 15 years down the
    road, should we be calling them senior centers?
        Dr. Aday. That is certainly an issue that is being
    discussed in the network at the present time. I don't think
    there are really any conclusions that have been drawn, whether
    you want to call them centers for vital aging or even taking
    the term ``senior'' out of it.
        I was very excited when I became a senior in high school
    because I had seniority. [Laughter.]
        When I became a senior in college, likewise. When I became
    a senior professor. So it seems like we like to be a senior
    executive, but when it comes to equating the term senior we
    have difficulty accepting it with age. It goes back to what I
    think Senator Breaux was talking about. We have kind of
    implanted this ageism, well, now, I can't be a part of that
    group and rather look forward to it. So I think it really
    speaks to our society when we have trouble embracing where we
    are chronologically.
        So I think each center or each community will have to make
    that decision, since senior centers are built and primarily
    funded at the local level. They will determine what they are
    going to be termed and what will be the best way of getting
    people there.
        It could be marketing. I think one of the issues we have
    here is just the stereotype that senior centers provide
    congregate meals and bingo. So it is just a lack of knowledge
    of what really goes on in senior centers.
        The senior center campus that I work with is really more
    like a high school. If you go into it, you have a computer lab
    and you have classrooms and you have all these classes. So
    inside, the decor looks more like an educational unit than it
    would what we call the traditional senior center. Now, not all
    senior centers, of course, are at that particular stage, but I
    think part of it is going to be dealing with how we market
    ourselves and how we can appeal and attract that younger person
    coming in.
        We do know that the baby boomers are going to be much more
    educated than today. I think by 2030, twice as many will have a
    college diploma as today. The research that I conducted in
    seven States, 20 percent had college degrees that were coming
    to the senior center. So we are seeing a different kind of
    clientele and they are going to be demanding different kinds of
    services. I think when you get more of those people to come
    they tell their friends about it. Word of mouth in many cases
    is the best way that you can market a good product. I think
    what we are talking about today is evolving, and so this is not
    going to happen overnight, but I think over a period of time.
    We should see an evolvement and a change in the clientele and a
    new mission for senior centers.
        The Chairman. Thank you very much for your testimony and
    the work you are doing. I find it fascinating, because it
    really is a part of the quality of life that these baby boomers
    are going to be moving toward, and I think they are going to be
    a group of our citizens who are going to be a good deal more
    demanding simply by their level of entry into that community of
    interest and their uniquenesses that will be very different
    from their parents.
        Dr. Aday. They have had an impact at every stage.
        The Chairman. Oh, yes.
        Dr. Aday. This will be no different.
        The Chairman. Now, how, Doctor, can we move technology into
    that senior community? Let us talk about the home that you are
    talking about and the sophistication involved. In your opinion,
    how long will it be before the average person will have access
    to the sophisticated technologies like the awareness home that
    you have demonstrated here?
        Dr. Abowd. It depends on what kind of service you are
    talking about. Some of the demonstrations that we have done and
    technology we have built, for example, the digital family
    portrait, is all done with technology and capability that we
    have today. There is no real magic behind a project like that.
        What we are lacking with something like that is a business
    plan that would encourage people to invest in and provide this
    kind of service to distribute to family members, for example,
    although on that note, we have had a number of people who have
    seen the digital family portrait and have on their own
    essentially mocked up their own version of sensing in their
    parents' home, with a way to dial up and produce information to
    a central server that then can provide information at any place
    the individual desires.
        The best way to leverage off the kind of existing
    technology we have in the homes today is to not require
    identity to be part of the sensed equation. So if you were to
    use the basic motion-detecting sensors that are in home
    security systems right now and you used that information for a
    household that has one or two family members, you can make very
    good inferences about where an individual is, or even more
    importantly, how much that individual is moving around, so you
    can communicate to someone else in a secure way about that. So
    for those kinds of applications, we could do that today.
        For some of the more sophisticated applications that
    require understanding of an activity, like the blood glucose
    meter example I gave, where you are trying to understand where
    someone is in a relatively simple and straightforward
    sequential process, that is possible to do today in the
    laboratories, but in very controlled settings. It wouldn't work
    if I just deployed that in anyone's home without any control
    over the ambient lighting. So there needs to be a significant
    amount of advances in making those algorithms more robust, and
    I think we are talking a 5- to 10-year horizon before the
    research is robust enough to be able to produce those kinds of
    services.
        But before we have those kinds of capabilities, we want to
    be able to get a glimpse of what that future would be like and
    to evaluate what services would be important and which ones
    would not. That is why a project--why I showed you the cook's
    collage, the reminder system in the kitchen. It is being done
    with smoke and mirrors, but it is being used to conduct
    controlled studies to find out if we could get the technology
    to do that automatically, would it be a valuable memory service
    in the home, so that we can inform the advanced technology
    research about what kinds of problems they do need to solve in
    the next 5 to 10 years because we see the value in terms of
    helping an older population.
        The Chairman. I recently reviewed a technology that would
    have to have a cooperative effort of the food manufacturer with
    certain software programs, but there was a code on the back of
    a given container of food that when moved across a scanner
    could project up on a screen a large read-out of how to prepare
    that food, or the simple instructions that might be beyond the
    visual capability of the person. It would simply plant out on
    the kitchen screen that could be used for a multitude of other
    purposes as to how to program the--or it may even program the
    microwave itself, preparing it for that particular food. Have
    you looked at any of those or seen any of those kinds of
    technologies?
        Dr. Abowd. Yes, I have. What is very interesting about the
    kind of technology you are talking about is it is becoming very
    affordable to essentially tag all items with--in the past, we
    have used bar codes, so we can use optical scanning to be able
    to read them. But there are problems with line of sight, being
    able to see the code.
        With the kind of technology you are referring to, one of
    which is radio frequency identification tags, or RFID, you
    don't need line of sight and you can essentially fashion a
    region of space that can read a code on any tagged item that
    comes near it. So, for example, placing something on the
    countertop, the counter then knows what is placed on top of it
    and there are a lot of activities or possibilities you can
    leverage on top of that.
        So it is because these kinds of simple sensing technologies
    are now commodity technologies that work very reliably that we
    can provide these kind of services. One simple example we have
    done in the aware home, and we are one of the first to do this
    kind of activity, is we have used that RFID technology in a
    slightly different way, to provide location information for
    individuals and objects within the house. So we fashioned floor
    mats that sit at various strategic points in the house and
    individuals wearing non-powered tags somewhere below the knee,
    usually attached to the shoe or around the ankle, then just
    need to walk in the aware home and it will pick up what room or
    what location they are in.
        That information feeds directly into something like the
    digital family portrait. It also feeds into a variety of other
    kinds of applications that can leverage off that room level
    awareness. So it is a very exciting time from the sensing
    perspective, because we can now realize these kinds of
    applications in the living environments like a home.
        The Chairman. You have mentioned several technologies. Any
    others that you see that are going to be a direct asset to this
    kind of home?
        Dr. Abowd. I think a critical kind of technology, I talked
    about doing a purpose-built laboratory like the aware home.
    Also, there are continuing care retirement communities that are
    being special built for which you can, at the time you
    construct the building, can put in special kinds of
    technologies.
        But the real problem is being able to retrofit existing
    communities. So these naturally occurring retirement
    communities with the technology to provide the same kind of
    capabilities, and there, I think, wireless technologies are
    advancing to the point where we will be able to retrofit
    relatively easily lots of sensing and communication
    capabilities that won't require you to tear down the walls and
    won't be all that difficult to be able to put into homes. So
    that is when you will start to see the real mass market effect.
        The Chairman. Well, I concur with you. Obviously, the
    rather simple process now of creating wireless technology for
    your home, for your laptop and all of that, is really
    phenomenally simple and relatively inexpensive. Of course, all
    new--not all, many new homes are now being wired with that kind
    of capability, so that is very positive.
        The interesting thing about the new technologies is that
    the baby boomers won't be as hostile to them, obviously, as the
    generation before them, and quite understandably so. Also, the
    best part about it is if they don't understand them, they can
    just ask their grandkids. [Laughter.]
        They will give them a rather simple explanation of how to
    do it, because they will have figured it out a long time before
    that.
        Doctor, we thank you very much for your testimony and your
    work. Those are exciting new opportunities, I think, as we move
    along, and we appreciate it very much.
        Dr. Abowd. Thank you for the opportunity to present it.
        The Chairman. To all of you, thank you very much for being
    with the committee today and helping us build a record in these
    areas. We believe it is extremely important as we look at
    especially the opportunity and the challenge of this baby
    boomer generation that is about to be upon us, and as a member
    of that generation, I am going to be as demanding as any of the
    rest of us, I suspect. But I also want our public policy to be
    prepared for us when we get there.
        Thank you all very much for being with the committee today.
    The committee will stand adjourned.
        [Whereupon, at 3:53 p.m., the committee was adjourned.]

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