    [Senate Hearing 108-523]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 108-523

        ASSISTIVE TECHNOLOGIES FOR INDEPENDENT AGING: OPPORTUNITIES AND
                                   CHALLENGES

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

                                    HEARING

                                   before the

                           SPECIAL COMMITTEE ON AGING
                              UNITED STATES SENATE

                          ONE HUNDRED EIGHTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 WASHINGTON, DC

                                   __________

                                 APRIL 27, 2004

                                   __________

                               Serial No. 108-33

             Printed for the use of the Special Committee on Aging

                        U.S. GOVERNMENT PRINTING OFFICE
    94-289                      WASHINGTON : DC
    ____________________________________________________________________________
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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 Elizabeth Dole..............................     2

                               Panel of Witnesses

    Eric Dishman, director and senior research scientist, Proactive
      Health Research, Intel Corporation, and chair of Center for
      Aging Services Technologies, a Program of the American
      Association of Homes and Services for the Aging................     4
    Martha Pollack, professor of Electrical Engineering and Computer
      Science, University of Michigan................................    57
    Lydia Lundberg, owner, Elite Care, Oatfield Estates, a
      Residential Care Facility, Milwaukie, OR.......................    68
    Joseph F. Coughlin, Ph.D., director, MIT AgeLab & New England
      University Transportation Center, Massachusetts Institute of
      Technology.....................................................    81
    Stephen McConnell, senior vice president, Advocacy & Public
      Policy, Alzheimer's Association................................    93
    Ronald Seiler, M.S.Ed., project director, Idaho Assistive
      Technology Project, Center on Disabilities and Human
      Development, University of Idaho...............................   103

                                    APPENDIX

    Statement from the American Foundation for the Blind.............   145
    Statement from Dr. Gregory L. Goodrich, president-elect of the
      Association for Education and Rehabilitation of the Blind and
      Visually Impaired..............................................   149
    Testimony submitted by the Independence Through Enhancement of
      Medicare and Medicaid Coalition................................   159
    Testimony submitted on behalf of the Microsoft Corporation.......   169

                                     (iii)

        ASSISTIVE TECHNOLOGIES FOR INDEPENDENT AGING: OPPORTUNITIES AND
                                   CHALLENGES

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

                            TUESDAY, APRIL 27, 2004

                                           U.S. Senate,
                                    Special Committee on Aging,
                                                        Washington, DC.
        The committee met, pursuant to notice, at 10 a.m., in room
    SD-628, Dirksen Senate Office Building, Hon. Larry E. Craig
    (chairman of the committee) presiding.
        Present: Senators Craig and Dole.

         OPENING STATEMENT OF SENATOR LARRY E. CRAIG, CHAIRMAN

        The Chairman. Good morning, everyone. The Senate Special
    Committee on Aging will convene. The topic of today's hearing
    is Assistive Technologies for Independent Aging. We are
    extremely pleased to have all of you with us this morning and
    to get a glimpse of what I think will be a better future for
    America's aging population.
        I am speaking of the potential of assistive technologies.
    Advances in such technologies have the potential of
    revolutionizing how seniors and their families experience the
    aging process, most importantly, by improving seniors' quality
    of life and making it possible to remain independent in the
    comfort of their homes and their communities.
        This comes not a moment too soon. Worldwide, the number of
    people over the age of 60 will nearly double in the next
    several decades, and of course, here at home 70 million baby-
    boomers will begin retiring only a few short years from today.
        For seniors and their families, assistive technologies
    offer hope. For America's technological industries, it offers
    an exciting and expanding marketplace. For policymakers, it
    offers real potential to free up scarce resources, resources
    urgently needed as America ages. This morning we will see
    firsthand demonstrations of some of the cutting edge assistive
    technologies being developed by America's technological
    companies and our universities. Importantly, however, we will
    also be talking about the very real challenges we are facing in
    bringing these technologies out of the lab and into the
    marketplace, and from there into America's seniors' homes.
        For example, some of the witnesses here today will testify
    that America's technologies sector has not yet fully embraced
    the potential market for such technology. Others will speak
    about the challenge of translating new technologies into
    products that are both affordable and practical. Even the most
    brilliant technology can fall short in that it may be too
    expensive or too complex for the average senior to use. Through
    the leadership of organizations like the Center for Aging
    Services Technologies, otherwise known as CAST, these
    challenges are beginning to get the attention they deserve.
        Our purpose here today is to highlight both the dazzling
    opportunity and the real challenges that lie ahead as we seek
    to bring life-enhancing assistive technologies to America's
    seniors. We appreciate our witnesses and the contributions they
    will bring before the committee today.
        Before I introduce our witnesses, let me recognize Senator
    Dole, who has joined us, for any opening comments you would
    wish to make.

                  STATEMENT OF SENATOR ELIZABETH DOLE

        Senator Dole. Thank you, Chairman Craig. I appreciate your
    holding this hearing so that we can discuss openly today the
    opportunities and challenges brought about by the latest
    technologies in elderly care.
        I certainly want to thank our witnesses who have come today
    to facilitate and educate an open discussion on the newest
    advancements in technological assistance for our seniors.
        As you know, I lost my precious mother back in January, and
    she would have been, 4 months later, 103-years-old. So,
    obviously, she has benefited from technological assistance in
    being able to stay in her own home almost to the ripe age of
    103.
        The cost of elderly health care in America is rising almost
    as quickly as the number of those in need of such attention.
    Studies have indicated that by the year 2040, 30 percent of our
    population will be considered older. That is over one third of
    our country that could be in need of some sort of specialized
    attention, be it in an assisted living facility, private home
    care, or a full-scale retirement home.
        In this age of astounding medical progress, preventive care
    is a key factor in many aging Americans' lives. Today's
    technology affords our senior options our grandmothers and
    grandfathers never even dreamed of. High-tech innovation, such
    as everyday activity assistance, fall prevention canes and Pill
    Pets act as independent living assistance for the elderly, as
    well as offering reassurance to loved ones concerned about the
    risk their aging family members have in being alone.
        I look forward to hearing more about each of these
    advancements as well as many others in today's hearing. The
    amount of money we Americans have invested to increase the
    average life span, of course, reaches into the billions. While
    medical progress has succeeded in pushing up the average life
    expectancy, we failed to adequately address how we can
    approximately care for the millions of Americans now living
    well into their 70's, 80's and beyond, such as my mother. Many
    of today's technologies in aging medical care can offset some
    of the financial burden of the increasing number of seniors
    seeking health care. It is time Congress considers the
    individual benefits of technological assistance as well as the
    economic ones.
        I look forward to your testimony this morning.
        Thank you, Mr. Chairman.
        The Chairman. Elizabeth, thank you very much.
        Before I introduce our panelists, let us proceed this way.
    We are going to take your testimony, and then several of you
    have some demonstrations, and I understand there is a bit of a
    problem of plugging and unplugging, so we will then, after all
    of your testimonies, we will do the demonstrations, and then I
    have a series of questions I would like to engage all of you
    in.
        Elizabeth, when you were mentioning your mother, I was
    thinking it is happening more and more. We understand numbers
    and demographics and we see this aging population out there,
    and we hear about centenarians and the number that are here.
    During the Easter break I attended a 100th birthday of a second
    cousin, and I then later went to a national convention in which
    the emcee of the convention of some thousands gathered--and it
    is an old organization of 133 years--said, ``Who is the oldest
    member here?'' Finally, it was determined that it was a man who
    was 99. He walked up, walked on stage and delivered a 5-minute
    speech that I would have been proud to claim as mine, and I
    think, ``Oh, my goodness, those are not just numbers on a page
    out there. They really are people,'' and it constantly reminds
    me of our work, and of course, improving the quality of life of
    those who live longer, and that is what we are all about.
        Senator Dole. Indeed.
        The Chairman. We are very fortunate to have with us today
    several of the country's leading experts on assistive
    technology and its potential application for senior
    populations. Some of these witnesses have brought with them
    examples of their work, and we will get introduced to one of
    them. I understand she is a bit under the weather.
        Anyway, while we are with that, let me first introduce Eric
    Dishman, as the Director of the Intel Corporation's Innovative
    Proactive Health Strategy Research Project, and also the
    National Chairman of CAST, the Center for Aging Services
    Technology.
        Next we will hear from Martha Pollack. Martha is a
    professor of Engineering and Computer Science at the University
    of Michigan, and is one of the country's leading academic
    scientists in developing assistive technologies for persons
    with cognitive impairments.
        Next we will go to Lydia Lundberg. Lydia comes to us from
    Milwaukie, Oregon, where she is the owner and founder of Elite
    Care, one of the country's most technologically sophisticated
    residence care facilities for seniors.
        Next we will go to Joseph Coughlin. Joe is the founder and
    director of the MIT AgeLab, one of the world's foremost
    academic centers for the interdisciplinary study of the
    application of technology for the needs of our seniors.
        Then we will go to Stephen McConnell. Steve is the vice
    president of Public Policy and Advocacy for the Alzheimer's
    Association, and will speak to us about growing care burdens
    associated with of course that terrible disease.
        Finally, we will visit with Ron Seiler, director of the
    Idaho Assistive Technology Project at the University of Idaho.
    Ron has worked tirelessly for many years to help bring needed
    assistive technologies to disabled and senior Idahoans,
    especially those that live in rural parts of our State.
        We thank you all for being with us this morning. Now, Eric,
    we will turn to you, Eric Dishman, director of Intel
    Corporation's Innovative Proactive Health Strategy Research
    Project.

        STATEMENT OF ERIC DISHMAN, DIRECTOR AND SENIOR RESEARCH
     SCIENTIST, PROACTIVE HEALTH RESEARCH, INTEL CORPORATION, AND
     CHAIR, CENTER FOR AGING SERVICES TECHNOLOGIES, A PROGRAM FOR
      THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING

        Mr. Dishman. Good morning, Chairman Craig and members of
    the committee. Thank you for holding these important hearings.
    I am honored to be here today both representing Intel
    Corporation and CAST, the Center for Aging Services
    Technologies.
        Before I even get into that, I should mention when I was
    16, living in North Carolina, I am from Charlotte originally, I
    was a caregiver for my grandmother who had Alzheimer's, so I
    have been thinking about this for a good 20 years. I am 36-
    years-old. Everyone is like, ``Why are you focused on aging?''
    I am always the youngest person in the room at most of these
    conferences on aging, but I have been thinking about this for
    20 years in trying to figure out what might we have done to
    help mitigate some of the effects that that disease had on my
    family.
        I am a social scientist. I am not your typical Intel
    person. I have spent the last 12 years working in high-tech
    companies, and in so doing, I have visited about 100 high-tech
    labs around the country, but more importantly, I have actually
    lived with and observed and had a family dinner with more than
    1,000 households across the United States, who are struggling
    with health care and care giving issues.
        When you take all of that in, after 12 years of doing that,
    I can tell you that there are literally hundreds of
    technologies sitting in the labs of American universities and
    corporations today that could dramatically improve the lives of
    all Americans, those care giving for our seniors and the
    seniors themselves, if we can figure out how to get American
    intellect and imagination and investment dollars focused on the
    health and aging issues that most of us really do not pay much
    attention to. I can tell you most people in the technology
    industry think about digital entertainment, they think about
    communication, as being the next wave of computing and
    communications technologies, but all of these things that we
    are building could radically improve people's lives in their
    everyday home, so that is the spirit in which I want to say a
    few comments today.
        About November 2002, my lab at Intel had gotten a little
    bit of press about some of the demos that you will see today,
    and I started getting calls from executives from companies
    around the Nation and from long-term care providers saying, how
    did you get Intel to talk about aging issues publicly? How do
    we get onto this bandwagon to test out some of these
    technologies?
        I started having conversations with AAHSA, the American
    Association of Homes and Services for the Aging, and what
    started out as informal conversations amongst these people who
    were e-mailing and calling over the last 2 years has just
    accelerated into what we call CAST, and now as an organization
    with more than 200 technology companies, long-term care
    providers, aging-oriented associations and university
    researchers, who have come together to try to figure out how do
    we accelerate the development of assistive home care aging in
    place technologies? How do we get them out of the lab and into
    the everyday lives of real people?
        As you well know, we did a demo day last month here in the
    Dirksen Building. There were 16 organizations, almost all of
    whom the people doing testimony today were part of the CAST
    initiative and have been leaders in getting CAST off the
    ground. That was really just to start to show a new vision for
    long-term care technologies.
        I really believe our biggest problem nationally is an
    imagination problem, not a technology problem. As I said, many
    of these technologies are sitting in labs, and no one is
    imagining the need and the market and the possibility of
    applying them to this domain.
        I am going to show you two demos later today. One is a
    fall-preventing cane, and another is what we call the Everyday
    Activity Assistant. I will not go into details of those now,
    but I want to show you, a lot of people when they think Intel,
    think personal computers. This is the kind of computer that I
    am talking about today, a little tiny computer that we call a
    ``mote'', and what the magic of this little tiny computer is,
    is that it is a wireless transmitter, it is a tiny
    microprocessor. What it means is that we can start to embed
    them in the environment without tearing apart somebody's home,
    and collecting real world diagnostic or behavioral data that
    would help to intervene in a disease process. We are not
    talking about necessarily traditional computers as we have come
    to know them.
        A lot of the demos that you will see today and a lot of the
    core technologies are really about collecting real-world data
    where people live, work and play. Today our health care system
    is optimized and operationalized for once people already have a
    problem. We have lots of expensive equipment in the hospital.
    The real question is how do we shift a lot of that technology
    and that diagnostic capability into people's homes so that you
    are getting more accurate and more ongoing feedback about how
    they are doing, so that they can intervene on behalf of
    themselves or other people can help out.
        I want to just show you a couple of pictures because I
    think it is more important to start with real people than the
    technology, so I will just bring up a couple of photos from
    field work that we have done at Intel. I am going to talk about
    Barbara in a little bit. This is Barbara. She is 61. She was
    diagnosed with dementia about 2 years ago. I called her and
    said, ``Can I use your photos and your story for this?'' She
    was thrilled because she wants her life experience to help with
    other people.
        She has enormous difficulty just doing everyday activities
    like making coffee, and there are millions of households like
    this around the United States, and you are going to see later
    in the demo, if we start thinking and getting engineers in this
    world to start imagining how can we help people do everyday
    activities of living, that is a really different use of
    technology that could be really empowering for those folks.
        Just show you a couple of other photos, this is Barbara
    struggling to use the radio, so one of our challenges is making
    the technology be useful on any device that people are already
    comfortable with. That could be a television. It could be a
    radio, whatever they are still capable of using, again, not
    necessarily a traditional PC.
        We saw a lot of households who needed help with daily
    activities, leaving notes for their families, instructions on
    how to get dressed. When you are talking about young engineers
    sitting in a technology company who have not been exposed to
    this, they cannot imagine that there is somebody who possibly
    needs a technology that could help them with the sequence of
    getting dressed by themselves. They cannot imagine how
    empowering that could be for somebody to still maintain that
    activity of daily living. So again, a lot of this is really
    about imagination.
        I will close by saying why are there not more companies
    working on this? In 1990 there were 357 million people
    worldwide over the age of 65, and by 2020 it is supposed to be
    761 million. So given this huge worldwide demographic, why are
    not more companies doing this? CAST has spent a year doing
    surveys, interviews and conferences on this topic. We hear
    things from companies saying, ``We do not want our brand
    associated with aging. We are not sure what products and
    services would make the biggest difference for seniors.'' Some
    of the researchers that we have talked to say that their
    research falls between the cracks of current Government
    agencies, and a lot of people end up saying to us, ``We are too
    afraid to even do research in this domain and pull those
    technologies out of the lab because we are afraid of being
    sued.''
        So these barriers, whether they are real or perceived, are
    keeping the wall up around some of that innovation from moving
    into this domain, and I hope that with leadership today we can
    help to galvanize some action and galvanize some attention to
    these important issues, and pull those technologies and apply
    them to the aging population.
        Thank you.
        [The prepared statement of Mr. Dishman follows:]

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        The Chairman. Eric, thank you very much for that very
    enlightening testimony. If there are companies out there with
    an age bias, my attitude toward them as I age will change.
    [Laughter.]
        Mr. Dishman. Vote with your wallet. [Laughter.]
        The Chairman. Now let us turn to Martha Pollack. Martha is
    a professor of Engineering and Computer Science at the
    University of Michigan, and is one of the leading scientists in
    the area of assistive technologies.
        Martha, welcome to the committee.

        STATEMENT OF MARTHA E. POLLACK, PROFESSOR OF ELECTRICAL
     ENGINEERING AND COMPUTER SCIENCE, UNIVERSITY OF MICHIGAN, ANN
                               ARBOR, MI

        Ms. Pollack. Thank you, Mr. Chairman. Mr. Chairman and
    Senator Dole, I really want to thank you for holding this
    hearing on this very important topic.
        Today I want to describe to you some advanced technologies
    that have the potential to help our Nation meet the challenges
    posed by its rapidly aging population. Let me be clear at the
    outset, technology is not a panacea. It will never and should
    never replace human caregiving. But when used to supplement
    human caregiving, advanced technologies that are now emerging
    in the laboratory have the potential to greatly improve the
    quality of life for older adults and their caregivers.
        Let me give you a few examples. My first two examples are
    systems developed by a consortium of researchers at the
    University of Michigan, University of Pittsburgh, Carnegie
    Mellon and Stanford. Autominder is a system designed to remind
    people with memory decline about their daily activities, so
    things like taking medicine and eating regularly. You can go
    out today and buy reminder systems, but generally they function
    like glorified alarm clocks, issuing fixed reminders for
    activities at pre-specified times, and this inflexibility
    greatly limits their effectiveness. Older adults, just like
    younger adults, do not follow ironclad schedules. In contrast,
    Autominder attempts to provide flexible personalized reminders.
    It can either run on a hand-held computer that will connect
    wirelessly to a variety of sensors, or more futuristically, on
    Pearl, the mobile robot that we have brought with us today.
        Let us consider a typical Autominder user who I will call
    Claire, a forgetful, 80-year-old, diabetic woman, who is
    supposed to eat a meal or a snack every 4 hours and who
    currently has an infection that requires her to take
    antibiotics on a full stomach. We do not tell Autominder that
    Claire has to take her medicine at say, 8 a.m. Instead we just
    tell it that she has to take the medicine at the same time as
    she eats breakfast and dinner, and then whenever Autominder
    recognizes that Claire is eating breakfast, it will remind her
    at that time to take her medicine if she forgets to do so. It
    does this by popping up a message in large type or by speaking
    aloud in a synthesized voice.
        Similarly, we do not rigidly tell Autominder that Claire
    has to eat at 7, 11, 3 and 7. We just specify the 4-hour
    interval. If Autominder can recognize that Claire has eaten
    lunch at 11:15, it will remind her to eat again 4 hours later
    at about 3:15, maybe even a little earlier if Claire's favorite
    television program is on from 3 to 3:30. We use a variety of
    artificial intelligence techniques in Autominder to achieve
    this kind of flexibility.
        My second example is IMP, a walker designed for people who
    are disoriented. IMP has a very simple interface on which
    someone selects the location to which she wants to go, and it
    then displays a shifting red arrow that guides her there. I
    will demonstrate IMP at the end of this panel's comments today.
        My final example is a system called COACH, which has been
    developed by Canadian researchers for people with moderate to
    severe dementia. Where Autominder provides reminders for many
    distinct activities over the course of a day, COACH guides its
    user through a single activity, hand washing, providing cues
    whenever a step such as soaping, rinsing or drying is forgotten
    or done in the wrong order. Follow-on versions of COACH will
    provide assistance with toileting, something that is
    particularly trying for caregivers.
        There are many more projects that I could describe to you,
    but I hope that these three are sufficient to convince you of
    the promise that is inherent in assistive technology for older
    adults. Yet there are significant technological challenges that
    must be met to realize this potential. First of all, there will
    need to be fundamental advances in using wireless sensor
    technology to monitor and measure activities of daily living.
    Second, since extensive customization for each user will be
    economically infeasible, artificial intelligence techniques
    need to be developed to make these systems work. Third, work on
    human computer interaction must by pursued to design interfaces
    that are extremely easy to use by people who may not only be
    cognitively impaired but may also have visual, auditory and/or
    motor difficulties. Finally, these systems raise crucial
    privacy concerns which must be addressed from both the
    technological and policy perspectives.
        Currently it can be difficult to find sufficient funding to
    support university research on assistive technology for elders
    because the work tends to fall between the cracks of agencies
    like the NSF, which supports scientific and engineering trials
    but not clinical trials, and the NIH, which traditionally has
    not funded computer science.
        To ensure that assistive technology will be ready by the
    time we as a Nation need it, I would propose that this
    committee explore the possibility of developing a cooperative
    funding mechanism that provides a stable source of support.
    This could plausibly involve a joint program of the NSF and the
    newly formed National Institute on Biomedical Imaging and
    Bioengineering, NIBIB, or the NIA.
        I personally feel very fortunate to be conducting research
    that can have such significant societal benefit, and I feel
    fortunate to be doing it at the University of Michigan where I
    have access to expert faculty and intelligent students from the
    many disciplines that must work together to make the promise of
    assistive technology real.
        I look forward to the day that this technology is in wide
    use, helping older adults live better lives.
        Thank you very much.
        [The prepared statement of Ms. Pollack follows:]

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        The Chairman. Martha, thank you very much for that
    testimony, and we look forward to your demonstrations.
        Now let me turn to Lydia Lundberg. As I mentioned, she
    comes from Milwaukie, OR, where she is the owner and founder of
    Elite Care, one of the country's most technologically
    sophisticated residential care facilities for seniors.
        Welcome to the committee.

       STATEMENT OF LYDIA LUNDBERG, OWNER, ELITE CARE, OATFIELD
         ESTATES, A RESIDENTIAL CARE FACILITY IN MILWAUKIE, OR

        Ms. Lundberg. Thank you, Chairman Craig and Senator Dole,
    for holding this hearing, and I am very honored to be here.
        In 1971 I immigrated to this country from Germany, and the
    only job I could find was as a nursing aide in a skilled
    nursing facility. So here I am today, and I think it speaks
    loudly for all things are possible in this country if you work
    hard at it.
        Our facility in Milwaukie, we are getting many visitors
    from around the world to see what we are trying to accomplish
    there. I am also on the commission of CAST, and I speak around
    the world actually on the subject of technology.
        We are a family run entrepreneurial business and we believe
    that if we are to enjoy our own old age, we need to shift the
    paradigm of elder care. We are investing our retirement savings
    to develop a system for long-term care that incorporates both
    technology and our mission to create elder-directed
    communities.
        While many see the increasing numbers of frail elders as a
    burden on our society, we believe that they are part of the
    solution. With the use of the power of the proper assistive
    technologies, they can retain their active positive role and
    contribute to their environment regardless of where they live.
        With our design of the Extended Family Residence and the
    use of technology, we are creating the farm families of the
    past while integrating technology of the future. In this model
    every generation has value and purpose.
        Information gleaned from the technology is used to allow
    elders to live and engage in purposeful life.
        In addition, our family portal, which is the one of the
    things I will demonstrate, brings peace of mind to the families
    of the elderly. Today, the lack of information about parents
    causes the kids to worry. We are constantly thinking, ``Mom got
    lost coming home from the store yesterday. She cannot live by
    herself any more. What is Mom doing all day? Is she eating
    properly?'' When Alzheimer's or short-term memory loss is
    involved, kids tend to fix the problem by incarcerating their
    parents in locked facilities.
        We have personal experience with this. My father was just
    diagnosed with congestive heart failure in Germany, so I am
    trying to deal with all this long distance, and my husband's
    mother lives in Florida, who thankfully is still quite healthy.
        About 50 percent of our residents would be in locked
    Alzheimer's facilities. Instead, they live in 12-suite houses
    where they can participate in life to the best of their
    abilities. Residents are not separated by diagnosis or
    cognitive ability. The technology supports their independence,
    safety, and puts the family's mind at ease.
        Although we are a residential care facility, the technology
    and algorithms we are developing will enable all elders to
    function at higher levels, thus keeping them in their own home
    longer, in assisted living or residential care facilities
    longer, and hopefully keeping them out of skilled nursing
    facilities and hospitals.
        In order to take us further, some of the areas where I
    think we really need help are as follows. There should be more
    opportunities in research dollars for supporting long-term care
    technology, especially where the private sector can benefit
    from such grants as the NIST ATP Grant, which we happen to have
    applied for.
        We also are trying to develop partnerships with
    universities, such as Oregon Health Sciences University and
    companies like Intel. It is challenging to bring together
    providers, researchers and tech companies to work together on
    these problems. It is critical that we do so.
        More work needs to be done to develop sensors that are cost
    effective and are easily used for automatic data collection.
    This can lead to predicting falls, strokes, heart attacks, thus
    allowing for interventions that may prevent these things from
    happening. There can be great savings in health care costs,
    great maintenance of quality of life.
        There should be tax incentives to encourage early adopters.
    One of the biggest struggles with taking a system such as ours
    to other facilities would be how can I pay for it? What is my
    return on this?
        We need to look at how the reimbursement of costs can be
    for implementing technology. Could there be a reduction in
    liability insurance? Will there be a reduction in management
    staff? Can insurance and Medicare payments for implementing
    technologies in homes by used?
        Then one of the other big areas where the Government can
    help would be to encourage and accept electronic data for
    Medicare reimbursement and quality control standards.
        Thank you very much.
        [The prepared statement of Ms. Lundberg follows:]

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        The Chairman. Lydia, thank you very much.
        Now let me turn to Joe Coughlin. He's the founder and
    director of the MIT AgeLab, one of the world's foremost
    academic centers for the interdisciplinary study of the
    application of technologies on the needs of seniors.
        Joe, welcome to the committee.

    STATEMENT OF JOSEPH F. COUGHLIN, Ph.D., DIRECTOR, MIT AGELAB, &
      NEW ENGLAND UNIVERSITY TRANSPORTATION CENTER, MASSACHUSETTS
                        INSTITUTE OF TECHNOLOGY

        Mr. Coughlin. Thank you, Mr. Chairman, and Senator Dole,
    and thank you very much for inviting me here to represent my
    team back at MIT and the many researchers that are involved.
        In many ways, it is a nice surprise to be here, because if
    you think about it, what we are talking about really is
    celebrating a policy success, and that is that the investments
    over the past 100 years have actually gotten us to live longer,
    and now that we are living longer we are saying, what are we
    going to do with that time, that bonus, if you will.
        Senator Dole, you inspired me with a similar story of your
    mother living to the grand old age of 103, 104, thereabouts.
    Sarah Knauss in Pennsylvania lived to 119-years-old, and she
    framed our challenged far better than any of us in academia
    certainly can that often lack poetic prose. That is that she
    enjoyed her longer life because she had her health and she
    could do things. So that is the policy challenge here. How do
    we enable people to live longer by having their health and to
    do things? Because simply having the time does not necessarily
    mean that you are going to have quality of life.
        My presentation, if you will, or thoughts on the matter are
    twofold. One, is to talk to the technology, and two, to
    hopefully leave you with some policy thoughts as to where we
    might go with this.
        I would rather not describe the technology functionality
    per se, but really challenge the assumption that what we want
    to do is to use technology to do what we do better. I would
    submit to you that we do not want to do that, and anyone who
    uses technology to do what they do today better, is actually
    not getting their return on investment and it is not a very
    good use of Federal R&D dollars as well. We want to use
    technology to do things differently, to think differently about
    the future of aging entirely, thinking about how it is going to
    bring different players to the table, thinking about how it is
    going to redefine our quality of life, and thinking about new
    ways of indeed paying and creating, if you will, inventing a
    lifestyle, not for the frail elderly, but for those of us in
    middle age so that when we become frail these things are
    already in place.
        To make that happen I would point to you a converging
    coalition of expectations. One: adult caregivers and the older
    adults themselves. People now are sandwiched, if you will, as
    you must have heard of the boomer generation that are
    interested in not only spending dollars but searching for
    solutions, if you will, to care for themselves and to care for
    their parents. Employers are a new partner at the table, not
    just in R&D, not just in terms of seeing this as a market, but
    the amount of lost productivity of caregivers coming to work
    late, leaving early or taking long lunches to take care of Mom,
    Dad or a spouse, is a very real drain on their own
    productivity.
        The distinguished Senator whose name is on this building
    once said that with a billion here and a billion there, pretty
    soon you are talking real money. One study suggests that there
    is upwards of $29 billion of lost productivity in the workplace
    due to caregiving. I would submit to you that that is real
    money.
        Chairman Craig, your own Governor from Idaho is leading the
    National Governors Association on long-term care. They are
    struggling with the fact that 25 percent of the budgets in
    State houses today are going to health and aging. There is a
    now emerging coalition of families, governments and others,
    looking for real solutions. So this growing alignment is
    actually an opportunity politically to build the coalition to
    match it with now what are, as you can see in front of you, an
    abundance of solutions that are chasing the problems associated
    with aging.
        So just three very quick ideas that we are working on to
    show you not the functionality of the technology but how it is
    different.
        Retail health: Using the information technology and the
    sensors that we are going to be talking about later on today to
    envision how the drugstore, the grocery store and institutions
    that are quintessentially private, may provide care and
    assistance in making decisions in real time in the shopping
    time about healthy decisions.
        Senator Dole, you were kind enough to mention our Pill Pet.
    The idea of using emotions and guilt, if you will, to remind
    people to take their meds, using the pharmacist, if you will,
    as part of that compliance effort as well. Facilitating that
    check up a day, using sensors to make people be able to manage
    congestive heart failure, diabetes in the home. That is
    actually not exactly very new news. Telemedicine has been with
    us for 40 years. If it is such a good idea, why is it going
    nowhere fast? I will submit to you that its great promise now
    is bringing together players that we have never thought of
    before. In Japan, Tokyo Power and Electric is now providing
    telemedicine to the home. Here in the United States, as
    indicated by the Comcast event a few weeks back, we are now
    looking at Phillips and perhaps even Comcast Cable looking at
    bringing health to the home via our cable channel.
        Let me quickly advance to one last thing which is the
    transportation issue. How can we look at transportation to make
    driving and mobility a continuing issue of safety and
    independence and freedom, using technology to make the car
    smarter for that.
        Let me close very quickly, and we can talk more about
    questions on what are those policy indications that we may want
    to think about? One, to reinforce Eric's point, is the idea of
    creating markets, and I would suggest to you that believe it or
    not I may be one of the first academics here, much to the
    chagrin of my colleagues, to ask not for money from the Federal
    Government for R&D, but actually to create tax credits for
    people that want to buy these systems in their home, to have
    companies want to invest in R&D and to have companies invest in
    elder care. If the market is there, they will get over their
    age bias. They will find that there is a market. They will find
    that there is a need.
        Second, yes, we do need research and education, not in the
    way you may think. I think we do need a stable line that has
    been talked about by Martha Pollack in terms of research for
    R&D, but there is a technological literacy problem with the
    folks who will use these technologies. The social workers, the
    gerontologists, the physicians, the nurses, who are high touch
    but are low tech, do not understand how this is going to
    fundamentally change their practice and business.
        Last, I would leave you with the third area, which is to
    facilitate partnerships. We need the Federal Government's
    support to engender a certain courageous attitude on the part
    of business, universities and caregivers, that it is OK to work
    with, say the local grocery store, to find new and novel ways
    of delivering nutrition services in the region, that it is OK
    to work with a university about commercializing a product. It
    is all right now to work with Government agencies of all levels
    to deliver care in ways we have never thought of.
        Thank you very much for this opportunity and I look forward
    to your questions.
        [The prepared statement of Mr. Coughlin follows:]

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        The Chairman. Joe, provocative testimony. Thank you very
    much.
        Now let me turn to Steve McConnell, vice president for
    Public Policy and Advocacy for the Alzheimer's Association.
        Steve, welcome to the committee again.

    STATEMENT OF STEPHAN McCONNELL, SENIOR VICE PRESIDENT, ADVOCACY
                & PUBLIC POLICY, ALZHEIMER'S ASSOCIATION

        Mr. McConnell. Thank you, Mr. Chairman, Senator Dole. Thank
    you for calling this hearing today and for inviting the
    Alzheimer's Association. We appreciate your leadership and we
    appreciate your terrific staff as well.
        This committee and the members of this committee understand
    the epidemic of Alzheimer's disease as well as anybody. There
    are 4\1/2\ million people now with Alzheimer's disease. That
    will grow to as many as 16 million by the middle of this
    century because of the aging of the baby boom population. One
    in 10 Americans over 65 and nearly half of those over 85 are
    suffering from Alzheimer's disease. Alzheimer's is the most
    important problem in our long-term care facilities. More than
    half of residents in nursing homes and at least half in
    assisted living have Alzheimer's disease.
        As a result of that, we will see Medicare expenses for
    dementia-related care increase by more than 50 percent in this
    decade alone, and Medicaid expenses by 80 percent. American
    business is spending $61 billion dealing with an Alzheimer's
    disease.
        So the Alzheimer's Association believes that assistive
    technology can be helpful, helpful to caregivers, helpful to
    people with this disease, helpful in advancing the day when we
    have treatments and eventually a cure.
        I would like to mention three areas where technology can
    play a role. In the area of diagnosis and the development of
    treatments, there is an initiative now under way sponsored by
    the National Institute on Aging and the pharmaceutical
    industry, with support from organizations like the Alzheimer's
    Association, to look at imaging technology, MRIs and PET scans,
    to be able to detect changes in the brain more quickly. This is
    important as we introduce interventions, drug and other
    interventions so we can determine their effectiveness much more
    quickly. Without this technology, we must want 10, or 15, or 20
    years for a number of people to develop Alzheimer's disease to
    determine if the intervention is effective. So Technology can
    be very helpful in diagnosing and also advancing the day that
    we have treatments available for people.
        Second, technology can help caregivers. This committee
    knows that most caregivers are family and friends, and
    caregiving is very stressful. One in eight caregivers of people
    with Alzheimer's disease suffers injuries or illnesses because
    of their caregiving. One in three older caregivers suffer
    clinical depression. We know that older spouse caregivers are
    more likely to die because of their caregiving
    responsibilities.
        Technology can support caregivers, and we are not only
    talking about family caregivers but paid caregivers as well,
    who are underpaid, and under appreciated. There is high
    turnover. Technology can help by supporting people with this
    disease so they can live more independently through monitoring
    technology and other devices to reduce the stress on
    caregiving. Technology can be helpful in training caregivers as
    well through interactive voice, robotics, dynamic video and so
    forth. Of course, telemedicine and telehealth can also be
    helpful and can work for people with dementia as long as there
    is someone cognitively intact to help out.
        Finally, technology can help people with Alzheimer's
    disease. We now know that this disease begins as much as 20
    years before symptoms appear. As we have gotten better at
    diagnosis, people are being diagnosed much earlier, and that
    enables us to use technology to help people remain independent
    and to maintain a quality of life. Smart houses with automatic
    cutoff devices, kitchen heat sensors, monitors and medication
    dispensers, some of which you are hearing about today, can help
    people function independently longer. This is not only about
    cost savings and help for families and caregivers, it is also
    about human dignity.
        We believe that we have to approach this from many points
    of view in our society. The Alzheimer's Association created a
    technology work group more than 2 years ago, and last July we
    joined with Intel Corporation to create the Everyday
    Technologies for Alzheimer's Care, ETAC, which will fund
    research to identify and develop new models of Alzheimer's
    disease care based on current and evolving technologies. We
    will do this by facilitating exchange among a variety of
    disciplines from bioengineering and robotics to architecture
    and nursing. We will fund research to seek practical
    improvements in detecting and preparing for disability, for
    delaying onset of symptoms, for providing support for
    caregivers and so forth.
        We have also joined the Center for Aging Services
    Technology, CAST, sponsored by the American Association of
    Homes and Services for the Aging. We have created a Coalition
    of Hope made up of more than 150 organizations representing 50
    million people who are dedicated to eliminating the impact of
    this devastating disease.
        There are four things we would like to recommend. (1), that
    we create a national commission on technology and aging with a
    special emphasis on cognitive impairments; (2), that the
    Government support research on assistive technology in
    partnership with private industry and organizations like the
    Alzheimer's Association; (3), convening a series of hearings to
    continue to shine a light on this issue as you are doing today,
    which is very important; and finally, that we continue to
    support research so that someday we can have a world without
    Alzheimer's disease.
        In closing I would like to pick up on this notion of people
    living much longer. I am reminded of the comment by Maggie
    Kuhn, when she said that the best thing about growing older is
    you outlive your enemies. [Laughter.]
        There are many enemies to us as we age, the cognitive and
    physical assaults. Technology can help us defeat those enemies.
        Thank you.
        [The prepared statement of Mr. McConnell follows:]

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        The Chairman. Steve, thank you very much for that good
    testimony.
        Now let me turn to our last panelist, Ron Seiler, director
    of the Idaho Assistive Technology Project at the University of
    Idaho.
        Ron.

      STATEMENT OF RONALD SEILER, M.S.Ed, PROJECT DIRECTOR, IDAHO
    ASSISTIVE TECHNOLOGY PROJECT, CENTER ON DISABILITIES AND HUMAN
                    DEVELOPMENT, UNIVERSITY OF IDAHO

        Mr. Seiler. Thank you, Mr. Chairman, Senator Dole. Thanks
    for allowing me to testify on this very important occasion.
        My testimony will focus on three major points. First I
    would like to talk a little bit about what the current research
    is telling us about the potential of assistive technology for
    helping older persons. I would also like to share with you what
    lessons have been learned by the 56 Assistive Technology Act
    projects that can be of assistance to the aging network. Last,
    I would like to provide a list of recommendations for action.
        Assistive technology is redefining what is possible for
    today's older persons. Based on emerging research, based on the
    collective experiences of the Tech Act projects, and based on
    my experience as a father of a 23-year-old son with cerebral
    palsy, who uses assistive technology every day, I am convinced
    that it holds tremendous potential for helping older persons to
    be more independent, to be safer in their homes, and for
    reducing the cost of providing long-term health care.
        However, the news is not entirely good, as policymakers
    often overlook the role of assistive technology in long-term
    care, and there are a number of systemic barriers that will
    need to be overcome. This is especially true for those elders
    that live in the rural areas of our country. More about that in
    a moment, but first, what is the research telling us about the
    potential of AT now and in the future?
        The short answer is that most observers agree that
    assistive technology is and will continue to assist older
    persons to have a higher quality of life. We have good research
    that tells us that assistive technology can slow the loss of
    functional ability among frail elders, that it can improve the
    safety of elders and prevent injury, that it can help older
    persons to compensate for memory loss, confusion and other
    forms of dementia, that it can lessen the burden of care for
    informal and formal caregivers, and it can slow the rapidly
    increasing cost of providing long-term health care to elders.
        Moving from the theoretical to the practical, the
    collective experiences of the Tech Act projects have much to
    teach us about providing AT services to elders. Collectively
    these projects form a national infrastructure for assistive
    technology and represent the Nation's most valuable repository
    of experience and expertise related to the application of
    assistive technology. Perhaps the most valuable lesson learned
    by the Tech Act projects is that AT can be of great benefit to
    older persons as it has been for persons with developmental
    disabilities, but it is critical that an array of services
    support its use.
        Nearly ever Tech Act project conducts initiatives designed
    to promote the use of AT among elders. For instance, in Idaho,
    we provide Statewide assessments for older persons with complex
    technology related needs, many whom are eligible for Medicaid
    services. In one case we recently provided an assessment for a
    low-income elderly woman living in our area who just lost her
    husband, and she was considering moving into a nursing
    facility. As a result of the intervention at a cost of just
    under $2,000, the woman has now been able to live in her home
    for nearly a year near her family and friends. Compared to the
    cost of moving into a nursing facility, the intervention paid
    for itself in less than one month.
        North Dakota has a program funded by the State Pharmacy
    Association that is designed to provide a wide range of
    automated medication dispensers to older persons who have
    problems managing their medication.
        Many States operate equipment recycling programs that
    identify used assistive devices and advertise them so that
    others might benefit from their use.
        These and many other programs just like them illustrate the
    types of innovative approaches that can be used to increase the
    use of AT devices and services for older persons.
        However, as I mentioned earlier, there are a number of
    systemic barriers faced by older persons as they attempt to
    acquire and use AT. Policymakers often overlook the role of AT
    in long-term care. There is good evidence to suggest that there
    is a real basic lack of awareness among older persons, families
    and professionals about AT, especially in those living in rural
    areas. There appears to be a lack of community-based services,
    and those services that do exist are fragmented.
        However, the most significant barrier has to do with the
    funding of assistive technology. There is a lack of coverage
    for devices used to overcome cognitive impairments. Both
    Medicare and Medicaid have restrictive funding policies for
    durable medical equipment, and there is a lack of coverage in
    private and health insurance.
        In closing, how older persons will be cared for with
    maximum independence and at what cost are two of the critical
    health care issues facing this country. Most observers now
    agree that AT has an important role to play in providing long-
    term care to older persons. As a result I have three
    recommendations for this committee.
        First, I recommend that the committee contact Senator
    Gregg, Chair of the HELP Committee, and urge him to complete
    the reauthorization of the Assistive Technology Act of 1998.
        Second, even though there are a number of studies that
    suggest AT can be of great benefit to older persons, there is
    no comprehensive research that is national in scope. Therefore,
    my second recommendation is for the committee to ask Congress
    to authorize a nationwide study related to older persons and
    assistive technology.
        Last, as part of this study, I recommend, as Stephen did,
    that we hold field hearings to gather more information about
    the potential of AT for meeting the needs of older persons.
        Thank you, and I would also like to enter into the record
    the comments from the Association of Tech Act Projects which I
    did not provide previously, so I would like to enter that into
    the record.
        [The prepared statement of Mr. Seiler follows:]

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        The Chairman. Ron, thank you very much, and that addition
    will be made a part of the committee record.
        [The comments from the Association of Tech Act Projects
    follow:]
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        The Chairman. Let me thank you all, and now let us turn to
    those who had products to demonstrate. Let me see, Eric, I
    believe you and Martha and who else? Lydia. All right.
        Mr. Dishman. I am going to have to stand to do this, so
    they will not all be recorded. Let me see if I can actually get
    it to work. Everybody loves it when the Intel guy brings
    technology and it does not work.
        The Chairman. I will never let you forget it.
        Mr. Dishman. That is right. [Laughter.]
        Actually, this is a project from Oregon Health and Science
    University, who are part of CAST, and I brought this along with
    me. Everyday Cane has the mote technology that I mentioned
    before, which was developed at Intel Research in Berkeley, at
    the University of California at Berkeley. It is a little tiny
    computer here attached to the cane, wirelessly transmitting.
    These little leads here all go to some really simple cheap
    sensors. Let me bring this up so you can all see the screen
    here from my laptop. Hopefully it will come up. There we go.
    Now you can see it. When I press down on the cane, what you are
    seeing on the screen here is the amount of force as I walk with
    the cane, and it is being wirelessly transmitted back to my
    laptop.
        The importance of this in the near term, this just could
    mean simply knowing that Mom has not used her cane today might
    be very interesting in and of itself, just knowing that little
    bit of information. But what Dr. Pavel at Oregon Health and
    Sciences University is doing is taking this raw data over time
    and looking at the patterns of somebody who would be using a
    cane to see if you are starting to notice an early indicator
    that they may be moving into a period of their life or a period
    of time where they are more likely to fall in time to intervene
    well before they actually start to fall.
        Longer term the hope of this is that you could actually
    start to detect diseases like Parkinson's and other
    neurological conditions by capturing this real-world, real-time
    sensor data, and catch it long before other diagnostic means of
    today.
        So this is just a very simple example that shows some of
    the core technologies and how you might embed that.
        Longer term this could actually go into shoes, this would
    not necessarily go into a cane. There is a possibility that
    everyday footwear could actually start to do this kind of
    analysis.
        The second demo I am going to ask my colleague from Intel
    Research in Seattle, Matthai here, to show you. This goes back
    to the photo of Barbara before I showed you. Barbara had
    mentioned that her husband would come down and tell us the
    highlight of Barbara's day, when she is actually able to make a
    cup of tea by herself. So we are starting on this research
    project that says, how can we track the everyday activities of
    somebody like Barbara and intervene?
        So back in our labs in Oregon we have a system that can
    know, for example, through just simple sensors that are part of
    a home security network, whether or not Barbara has gone into
    the kitchen today to get something to drink. If it is 2 o'clock
    or 3 o'clock in the afternoon, we find her on whatever device
    she is closest to and most familiar with--it may be the
    television--and actually put a prompt in there that says, ``You
    need to get something to drink,'' because if she does not,
    dehydration actually leads to memory loss as well, and now you
    do not know whether it is her Alzheimer's or whether it is the
    memory loss from dehydration that is causing the problem.
        Once she gets to the kitchen, it is not clear that she is
    still going to be able to remember the steps of walking through
    just the simple task of making tea. So what Matthai is going to
    show you here is again, little tiny tags. These are RFID tags.
    They have been in the news a lot lately because major retailers
    are starting to talk about putting these into every single
    product that is on the shelves. We are using it, once that
    product gets home, to have the system track everyday objects
    that they may be interacting with.
        So Matthai is going to put on a glove here. Today it is a
    glove. Research will actually make this eventually the size of
    something that could go into a watch, and it is literally,
    based on the object that he is picking up, the tea cup,
    noticing that that is the object that he picked up because of
    these little tags that are basically glorified bar codes. Or he
    picks up the carafe and starts to make tea out of it. The
    system, based on this little reader that he is wearing on his
    wrist and the objects that he is interacting with, is starting
    to guess that he is going about the process of making tea. This
    is very primitive today, and obviously this is just a starting
    point.
        The possibility of this, if we can start to make it work,
    is that you could develop a system such as that it could play
    little video clips for Barbara on her kitchen television, on
    whatever device she likes that says, ``Here is the tea. Here is
    the steps to go about it.'' It would not intervene until she
    started to have a breakdown, until she needed help from the
    system.
        This could actually be even valuable to people in nursing
    facilities who have to track everyday activities of living. We
    watched this today where these nurses are doing a great job,
    and frankly, at the end of the day they are trying to remember
    what was the person able to do by themselves? That is part of
    their record that gets sent up to CMS. This same core
    technology that could help Barbara stay in her own home longer,
    has the potential, if she moves into a facility, to
    automatically capture all of that data that so many of the
    nurses that we have observed in study are exhausted by trying
    to capture on paper today.
        So that is the long-term vision of where this research
    would need to go. Again, it is not computers as we know them.
    It is tiny computers that are embedded and are unobtrusive in
    our environment.
        The Chairman. Eric, thank you very much. All of that is
    fascinating.
        Martha.
        Ms. Pollack. I am going to have to come up here.
        The Chairman. Please do.
        Ms. Pollack. This is Jared Glover from Carnegie Mellon, who
    is going to help me get set up.
        While he is setting up, let me remind you that I described
    two technologies to you earlier this morning. One was a
    technology for helping people with memory deficits by providing
    them with reminders of their daily activities, and that is a
    technology very much like what Eric described, so I am not
    going to demonstrate that here.
        What I am going to demonstrate is a walker for people who
    are disoriented. Now, while Jared is getting the batteries
    unplugged, let me say that we also brought Pearl. Pearl is a
    futuristic mobile robot, and both the Autominder technology,
    the reminder technology, and the orientation technology, can
    run on Pearl. Basically Pearl can speak. She has a voice
    synthesizer. She can display large messages on her screen. But
    calibrating Pearl to a room is actually a fairly time-intensive
    process, and so we are not going to run her live today.
        Additionally, Pearl is extremely expensive. This is a one-
    off robot. It costs close to $100,000 to build. It is obviously
    not something that is going to be in the homes of older adults
    in the near future. Our other technologies are much more cost
    effective and much more likely to make it into homes in the
    near term.
        The Chairman. This is taking walkers to a high level.
    [Laughter.]
        My mother-in-law was in a retirement community, and it was
    the battle of the Cadillacs vs. the Chevrolet walkers. I think
    they are losing style now.
        Ms. Pollack. This is the Lamborghini.
        The Chairman. That is the Lamborghini, all right.
    [Laughter.]
        Ms. Pollack. This walker is intended for someone,
    particularly someone living in a nursing home or an assisted
    living facility, who has become disoriented and maybe has a
    hard time remembering how to get to the cafeteria or how to get
    to the exercise room. This walker has a simple device with a
    very simple interface; you can see on the screen that it says,
    ``Where do you want to go to? Here's where you are.'' Now, we
    have mapped this room out, so we have just two locations, the
    floor and the walkway. Of course, in an assisted living
    facility there would be much more. Now we will say, ``Go'', and
    the interface will give us the various options of places we can
    go. If someone could not read, you could of course have little
    pictures. I am going to say that I want to go to the walkway,
    and now what happens is a map appears to guide me--to the
    walkway. If I start to go the wrong way, you see the arrow
    turns and guides me in the right direction.
        So all I have to do is follow this arrow to get to where I
    want to go.
        The Chairman. Is that GPS?
        Ms. Pollack. No. It has actually got a laser range finder
    on here. Partly what makes this expensive is just the laser
    range finder technology.
        Because of the crowding in this room, We have only mapped
    two areas. Some people were at the demo here on Capitol Hill
    last month and they saw many more areas.
        The other thing that this system can do, although because
    of crowding again, we will not demonstrate it here, is park. So
    if you have ever been at a restaurant, for example, with an
    older adult using a walker, there is often a problem. They sit
    down and can't get the walker to a safe location. This walker
    can automatically move to a parking location and then be
    retrieved when needed.
        The Chairman. It will come back.
        Ms. Pollack. It will come back. Thank you very much.
        The Chairman. I was going to say a walker with an attitude.
    [Laughter.]
        How fascinating. Martha, and please, Senator Dole, enter
    in, one question of that. Obviously, the person using the
    walker who has forgotten his or her way needs to remember how
    to activate the system to tell it where to go.
        Ms. Pollack. That is right.
        The Chairman. How do we do that if they are in that state
    of mind?
        Ms. Pollack. That is right. We are actually in the process
    of beginning field tests to see how well this actually works,
    but the idea is to make the interface incredibly simple. Here
    we have words written out, but you could replace that with
    pictures, and often someone might be able to reason, ``I know
    this is a picture of a cafeteria. I can touch that,'' even if
    they cannot remember how to get there.
        But you are right, after a certain point of dementia it
    will not be feasible.
        The Chairman. OK. Thank you very much.
        Ms. Pollack. Thank you.
        The Chairman. Any comment or question at this point?
        Senator Dole. I have some questions, but I think you want
    to----
        The Chairman. Let us finish if we can with Lydia, and then
    we will move to questions.
        Senator Dole. Right.
        The Chairman. Yes, please.
        Ms. Lundberg. So what you are looking at here is what we
    call the family portal.
        The Chairman. This is in your current facility in
    Milwaukie, OR?
        Ms. Lundberg. That is correct. This is live. I spoke to
    this particular house----
        The Chairman. Wait a moment. This is live?
        Ms. Lundberg. Yes.
        The Chairman. So we are connecting to your facility in
    Milwaukie at this moment?
        Ms. Lundberg. Correct. This is via the Internet. it is a
    secure, password-protected connection. I am pretending to be
    Marian--who is the lady that we are following around--I am
    assuming to be her daughter because this access is for family
    and management only. But I did speak to them this morning, and
    they are all very excited to be part of this demonstration.
        So you can see that Marian is in her room right now, and so
    I am looking at this and I can tell what the temperature is in
    her room. I can tell that the door is closed. That is all I
    know right now, because she is in her room and there are no
    cameras or anything involved, so it is strictly giving me an
    idea of where she is. If you look at the top here it also tells
    me----
        The Chairman. How do you know that she is in her room. What
    sensor does she have on herself that would indicate that?
        Ms. Lundberg. She wears a badge.
        The Chairman. OK.
        Ms. Lundberg. We have sensors wired into all the rooms so
    we know which room she is in. It also tells me, if you look up
    here, that she has been there for 47 seconds, so I get an idea
    of where she has been. If she were to sit on her bed, I could
    actually get an instant weight reading, but she is not on her
    bed.
        Then I can go back and I can do some historical because we
    are collecting all this data, so I can do some historical
    checking and I can see who has been in her room, so I can see
    that this morning Genevieve was in her room for 5 minutes. Kay
    came in several times through the night to check on Marian.
        Then if I want to see where Marian has been historically
    for the last day or so, I go to this screen. I brought this up
    earlier because of time reasons.
        The Chairman. This is the result of each one of those who
    entered the facility or that location also having a badge on?
        Ms. Lundberg. That is correct, yes. All our staff wear
    badges.
        So I can tell that Marian went, if I look on the 26th at 19
    hours, which is 7 o'clock I believe, she went to her room and
    stayed there basically for the night. But if I wanted to, I can
    go through here and see where she has been spending her time. I
    can go back as far as 6 months. We are keeping this data on
    file.
        One of the other things that is very critical, and there is
    some research that is being done with Oregon Health Sciences
    Unit on load sensors, weight scale. This would be now the load
    cells for Marian's bed for the period of just one day. It takes
    a minute. So I can see that she was in bed from a little after
    9, so from 9:30 on basically until about 5:20 this morning. I
    can also see that during the day she maybe just sat on her bed.
        Now, if I would like to see how she has been doing 5 months
    ago, I can go to a different screen, and unfortunately it reset
    itself so this will take me a minute. I want to see how she did
    in December, because oftentimes you can tell when medication
    changes, sleep patterns change. Maybe she was upset about
    something, maybe depression, all kinds of things. Those are
    some of the things that Dr. Pavel actually is trying to work on
    some algorithms so we can get some actionable data on some of
    these things.
        So now it is going back into the data base, and again, this
    is live from Oatfield Estates. I can see that she actually was
    sleeping a lot less restful, and I can actually zoom in to get
    an idea how much she was tossing and turning.
        Again, this can be used for many different things. The
    big----
        The Chairman. So it not only detects her presence on the
    bed but her movement while on the bed?
        Ms. Lundberg. It is actual weight data, yes. Then finally,
    here, this locator here, this is a different house. This
    happens to be Rainier House on the second floor, and this gives
    an indication of what I can see is management. I can see who
    all is in the common area, and it is 8 o'clock there in the
    morning, so they are all pretty much gathered for breakfast.
    Some people are still in bed, and you can see this one person
    actually moving around in bed. This is real live. Maybe they
    are getting ready to get up. Susan, the caregiver, is in the
    room with Frances, so my guess is that is what they are doing,
    they are getting ready for the day.
        Thank you very much.
        The Chairman. Thank you very much. Now, you mentioned this
    woman's daughter, I believe, did you not?
        Ms. Lundberg. Yes.
        The Chairman. I am thinking of a play on words here that
    maybe is not too appropriate. We have always heard of Big
    Brother. This is taking Big Daughter to a whole new level.
    [Laughter.]
        Ms. Lundberg. Actually, initially we wanted to call the
    system Daughter 1 because daughter usually is the one that
    worries about how mother or father are doing in the later
    years, and is the memory of, ``Mom, you know, is not moving
    around as much. Mom lost weight.'' With this system we are
    trying to create that type of memory to the benefit of the
    resident.
        The Chairman. Thank you. That was a fascinating
    demonstration, and to have it live, show that kind of
    interconnectivity is phenomenal.
        Let us start with our questions, and Senator Dole, you have
    mentioned you have some so why do we not start with you? Please
    proceed.
        Senator Dole. Let me ask Ms. Lundberg. I know that some
    families have expressed concerns with some sensor technology
    because of the privacy issue. This committee has addressed
    numerous times in the past the growing concerns regarding
    crimes that target older individuals. Are there safeguards in
    place that protect a senior's privacy, and would you recommend
    any specific safeguards? Because obviously this is tracking all
    of the movements, as well as the visitors. How would you
    address that privacy aspect?
        Ms. Lundberg. The access to the information is password
    protected. You have to know how to get there to begin with, and
    then it is password protected.
        The type of information we are gathering is not medical
    information. It would seem to me that--I cannot visualize how
    that would benefit somebody that would try to do harm to an
    elder. It has helped actually. When there is suspicion of any
    wrongdoing, it has helped in the investigation to actually
    protect our elders. So it has been a benefit to have that
    information. Did I answer that well enough?
        Senator Dole. That is good. With the systems that your
    company is developing, is it possible for those who suffer from
    cognitive decline, who would traditionally be
    institutionalized, to continue to live an otherwise normal life
    with assistance from community based technology? Could your
    Extended Family Residence be the new model for long-term care
    in the United States?
        Ms. Lundberg. Actually, that is what we are hoping. We feel
    that we have been very successful in accommodating residents
    with Alzheimer's and other dementias. The campus, it is not
    just the technology in this case, it is also the design of the
    buildings, and how it is being operated.
        A good example is one of our residents named Bob, who has
    quite a bit of dementia, the other day he was telling me that
    he used to play for the youth symphony, and it was based on
    some interaction that we had. He also goes around walking quite
    a bit, and he checks on the organic garden that we have, and he
    went back to tell the chef that there were fresh brussel
    sprouts, and so then the chef went and picked them and cooked
    them. So those are some of the normal things that people
    experience. Because we have the technology, we do not have to
    worry about Bob wandering off and getting into areas where he
    would be at danger.
        Another example of technology that is a little bit hard to
    demonstrate here is we are kind of on a hill, and at the top of
    the driveway that would exit to the neighborhood, we have a
    sprinkler because what we have found is that anybody,
    regardless of their cognitive ability, pretty much knows that
    they do not want to get wet. So when you get too close to the
    driveway, the sprinkler goes on, and people turn around. That
    has been extremely successful.
        Senator Dole. Very interesting.
        Mr. Dishman, Eric, if I may.
        Mr. Dishman. Sure.
        Senator Dole. North Carolina has many low-income seniors in
    rural areas, who want to live at home, but they require, as my
    mother, assisted living. In fact, I think 85 of our 100
    counties in North Carolina are designated as rural. These rural
    areas lack the technology, the infrastructure that is enjoyed
    in other parts of our State. For instance, they may lack high-
    speed Internet. Obviously, that is something that we are hoping
    to correct, or the health care workers may not be trained in
    the newest technology. Do you foresee these technologies
    developing to the point where they are both financially
    accessible and able to be integrated and implemented in these
    more remote areas for this sector of the population?
        Mr. Dishman. That is a great question. I was thrilled to
    see President Bush yesterday actually out talking about wanting
    to have affordable broadband available to every home in the
    United States by 2007. There are some particular technologies
    that we could at some point go into detail on, and there are
    probably FCC and other regulations around a technology called
    WiMAX, which is really a technology about bringing high-speed
    wireless interconnectivity to every part of the Nation, and I
    think that is going to be an exciting technology that is really
    going to open up that potential for people over the coming
    three, four, maybe even sooner than that, if there are things
    that we can help to work on. I am not a WiMAX expert so I
    should not go too deep into policy issues.
        I think the magic of what a lot happening here
    technologically is, and with my own grandfather, he is not able
    to use a PC, but we are basically taking consumer electronic
    devices and putting PC functionality onto a TV, which he is
    very comfortable with, and what we are really trying to do is
    to figure out how to make consumer electronic devices that are
    in many people's homes, part of this home health care
    technology network. No need to go buy your own separate $2,000
    box. Use the infrastructure that you are familiar with and
    comfortable with, and some new really quite cheap technologies
    that help to interconnect those things and make them useful for
    people.
        Senator Dole. You just anticipated my next question,
    because I was going to say that seniors obviously have not had
    a lifetime of using computers and cutting edge technology, and
    obviously, some have difficulty adjusting their lifestyles to
    incorporate all of these new advances. So helping our seniors
    with education and information that helps them be more
    receptive to technology is so important, and outreach that will
    help to push assistive technology to areas that are fairly
    removed is very important I think.
        Mr. Dishman. I wanted to just comment on the privacy
    question as well.
        Senator Dole. Yes.
        Mr. Dishman. We have been testing these concept prototypes
    and we are actually testing some of the actual technologies
    here today with a whole range of seniors. The overwhelming
    response is that, ``Let me make that choice. Give me the
    ability to decide who gets that data,'' ``me'' being the senior
    if they are still cognitively capable. ``Give me that choice.''
    We have found the privacy issue is almost like the fingerprint.
    Everybody has one, but they are all different. Some people do
    not want to share how many steps they take a day with somebody
    else. Others are like, ``I will share that data with anybody.''
    Others say, ``I will share my medication compliance data with
    my daughter but not with my doctor.''
        We have to develop the system to make it easy enough and
    robust enough, and to do the training so that people can make
    the choice about who gets the data and how they are going to
    use the system, and I really agree with the issue of training
    people on using it so they can do that.
        Senator Dole. That is very helpful. Thank you.
        Just one final question to Mr. McConnell, please.
        There is much discussion about the impact of Alzheimer's on
    the aging community, but it is often accompanied by conditions
    that lead to physical complications. Have you been able to
    quantify the financial impact of Alzheimer's as an isolated
    condition? If so, what is its annual cost to the Medicare and
    Medicaid system?
        Mr. McConnell. We have not separated it out, because most
    people that have Alzheimer's disease are very elderly and they
    have other chronic conditions.
        Senator Dole. Physical conditions, right.
        Mr. McConnell. We know that when Alzheimer's is present and
    other physical disabilities are present, it costs Medicare
    three times as much to care for them. The reason for that is
    that the care is much more complicated. It is more difficult.
    Our system really is not set up to deal with people, as you
    know, that have multiple chronic conditions, particularly with
    cognitive impairment. So I think some of these technologies can
    help in providing better care, which will result in better
    quality of life and lower costs to Medicare.
        Senator Dole. All right. Thank you.
        Thank you, Mr. Chairman.
        The Chairman. Elizabeth, thank you, and thank you for your
    time with the committee today.
        Senator Dole. Yes, indeed.
        The Chairman. The questions I am going to ask, anyone of
    you can respond to, if you feel you have--I may direct it at
    one, but certainly all can respond to it.
        Lydia, the kind of visual locator, the technology that we
    sought, you demonstrate today, is that experimental or is that
    now available for direct application in facilities like yours?
        Ms. Lundberg. It is a prototype at our facility. However,
    we are in the process of trying to develop a package that can
    be purchased by other facilities. One of the big issues at this
    time is the hardware cost because we have to wire IR sensors
    into every room. We are actually working on a system, if it is
    successful, which would really take us the next step where we
    would only need four antennas for about a six-acre campus to
    locate people within one foot of each other. If that is
    successful, that would make it a lot easier.
        The Chairman. Does anyone else wish to respond to that
    particular question?
        Mr. Dishman. I often get questions about is this technology
    here now or is it 10 years off, and I think the answer is both/
    and I will give you a simple example.
        The load cell sensors in the bed in Elite Care or the
    sensors that we are using just to know whether or not Mom
    opened her coffee cabinet, knowing that Mom did not get coffee
    today, might be a best indicator. Those are off the shelf,
    simple to use, here and now. The wireless connectivity is here
    and now.
        The research to figure out whether the way in which Mom is
    rolling around at night and the restlessness is an indicator of
    this particular disease. That may take 5, 7, possibly even 10
    years, because there are really hard computer science problems
    as well as clinical research that needs to be done.
        I think with almost all these systems, there is some low-
    hanging fruit, to use the phrase, where elders could get value
    out of it today. People have seen our wireless technologies. I
    have gotten 30,000 e-mails from consumers in the last 6 months
    who have seen this and said, ``I could use that simple cabinet
    switch sensor now or the simple sensor that lets me know
    whether Dad has gotten up out of his chair or not, because he
    sits in the same chair most of the day.'' That is here and now.
        There are some things to do to get the market going and get
    the companies who are starting to productize those to focus it
    on this domain and somehow figure out a way to have it be
    assistive technology without calling it that, because nobody
    wants an assistive technology. It is just a technology that is
    part of their life.
        The Chairman. Yes?
        Mr. McConnell. Mr. Chairman, I think also that this will
    become more affordable as it is used more widely. For example,
    we are working with Joe and the MIT AgeLab on electronic
    tracking technology. We now have a safe return program, in
    which people register. It is a bracelet and a registry. You
    have to be found in order to be brought back home. We have just
    put out bids for companies to help us develop technology that
    will track people when they wander. That technology is likely
    to be relatively expensive now, but over time as the demand
    increases, we know that the cost will come down. So we are
    likely to see that the technology becomes more accessible in
    the future.
        The Chairman. Anyone else wish to respond to that?
        Mr. Coughlin. Mr. Chairman, one of the things I would also
    like to address, particularly picking upon Eric's point of
    affordability and reaching different populations, is not only
    do people not want assistive devices in their homes or have to
    purchase assistive technologies because of what that may mean
    to them symbolically, companies do not necessarily want to be
    in that market.
        The Chairman. Well, I was heading in that direction, so
    expand on that, and any other individual on the panel who has
    had that experience, why are companies resisting this?
        Mr. Coughlin. OK. Let me give one example of, for instance,
    the technology of making a cup of tea or not necessarily
    monitoring where people are in their facility or their home,
    but the idea of opening a cabinet or using the toilet or
    something like that would be very useful. We need to redefine
    these things as not just assistive technologies, but actually
    redefine them as lifestyle services that, in fact, many
    companies out there would be very interested to be able to do
    home delivery and know you are out of a product before you know
    you are out of a product, and try to reinvent the fact that
    people are out of milk in the refrigerator or they haven't
    touched their meds to be a way of triggering a CVS or a
    Walgreen's or triggering Wal-Mart to know that a home delivery
    is needed or something like. Extending the supply chain of
    industry to the shelf in the home is a way of making these
    things pay for thank you very much. Because if we continue to
    define these--frankly, as you know in politics and in markets,
    symbols and words are the currency of politics. If we continue
    to use the phrase ``assistive technology,'' this will go
    nowhere very quickly.
        To your question on why business is not interested, I came
    to the aging area because of my interest and research in older
    drivers, and the adage goes that you cannot create an old man's
    car, because a young man will never buy it and neither will an
    old man. The fact of the matter is today's older generation
    does not know that they are older; tomorrow's older generation,
    most of us at this table and behind us, will not accept that
    they are older. The fact of the matter is that corporate
    executives and the consumer themselves do not think that, A,
    they will ever need something called assistive technology, that
    is something my mother or grandmother needed; and, second, I am
    selling a lifestyle, not just a product.
        So really what we need to do is to think innovatively by
    stealth in trying to reinvent how people live at age, say, 45
    and 50 so that these things are in place when they are 75 and
    80. Therefore, then companies will find this of more interest
    and will invest as well.
        The Chairman. One of the things that I think, Eric, you
    alluded to and possibly you did, Martha, as it relates to
    application and how seniors may or may not use a certain
    technology, while a lot of this is coming online, there will be
    a substantial transition of time into the baby-boomer
    population that is growing rapidly smarter when it comes to
    technology. We have watched now the demographics or the numbers
    of the senior population going to the Internet. Why? So they
    can communicate with their grandkids. What was once a hurdle is
    no longer a hurdle, or it is but it is a necessity that they
    hurdle it. I am not so sure that we need to be terribly afraid
    of its application, more so the ability of the individual at
    the time to apply it or to use it, because that is going to be
    changing very rapidly over the next decade, as a lot of this
    comes online.
        Would you wish to respond to that, any of you? Martha?
        Ms. Pollack. Yes, I think you are absolutely right. I think
    there is a myth, a clear myth that older adults are afraid of
    technology. I can tell you when we have taken Pearl out to a
    nursing home, many of the residents there were just thrilled,
    just loved to interact with her. In fact, if I can share a
    quick anecdote, we were there one day. We were doing some field
    tests, and partway through the day, the battery died,
    completely died, and we had to cancel the field tests. The
    people who were scheduled and did not get their opportunity to
    interact with the robot were just sorely disappointed.
        So I don't think we have to worry as much about people
    being afraid of technology as we do about the very important
    issue you mentioned, which is making sure the technology is
    completely transparent, completely easy to learn, and perhaps
    making sure that it gets introduced at an earlier age so that
    by the time people begin to have cognitive decline, they are
    already familiar with the technology. Some of the kinds of
    systems I have talked about, reminder systems, frankly would be
    very valuable for many of us who are not yet older but who have
    very busy lives. If you get used to using this technology
    earlier on, you can continue to use it for a longer span.
        The Chairman. Certainly the staff has probably heard this
    analogy or observation one too many times. My mother-in-law
    lives in a retirement community in Tucson. The pool room that
    was once built into that retirement center for those who played
    pool disappeared. It is now a computer center. The reason was
    nobody played pool. But you go by there now, we were a small
    part of helping educate and move people in that direction
    because my wife is a bit more literate with computers than I
    and started teaching. Now the room is full at almost all hours
    of the day and night because, instead of having a computer in
    their residence, they go to the room and they interact, whether
    they are surfing the Net or if they are talking to their
    children or their grandchildren or e-mailing. It is absolutely
    a transition that I have watched, you know, visually and
    physically in the last decade as we visited that community and
    watched that transition go on. I find it really very
    fascinating.
        Affordability, again--excuse me, yes.
        Ms. Lundberg. If I could speak just a little bit to
    acceptance of technology.
        The Chairman. Yes.
        Ms. Lundberg. We have found that it is very accepted by our
    residents. We have the occasional person who refuses to have
    load sensors under the bed for varying reasons. But other than
    that, people like the idea that they can be located anywhere,
    if they have any issues, problems. Then we also have computers
    in every person's room, and they do like to take advantage of
    the e-mail to stay in touch with their grandkids and also do
    some videoconferencing.
        The Chairman. Ron, the disability community is in many
    respects further ahead than the aging community in probably
    understanding and applying assistive technology. What do you
    believe are the major lessons that we might draw from the
    experience of the disability community in this area?
        Mr. Seiler. Well, I think the major lesson is, first of
    all, that it works. Assistive technology can have a significant
    impact, and I often point to my son as an example. Larkin, my
    23-year-old son, with cerebral palsy, is probably getting ready
    to go to work this morning and, you know, is using a variety of
    technologies that allow him to work.
        Collectively, though, I think in terms of the assistive
    technology projects, what we have learned is that technology,
    again, can be very effective, but the trick is you have got to
    have those support services in place. You just cannot throw the
    technology out there and expect people to be successful in its
    use.
        In particular, with older people, I think, again, we are
    talking about this transition and this acceptance of
    technology. I think with older persons we have to be
    particularly sensitive to that issue, that, in fact, there is a
    lot of education that has to take place. The family members
    have to be educated. Clearly, the professionals and
    paraprofessionals who work with elders have to be familiar with
    how the technology works.
        So, again, I think the major message here is that
    technology is wonderful, it is fabulous, it works. But without
    those support services, it will not be successful. The thing
    that concerns me--and we found this early on, way back in the
    early 1990's when we started these projects--is that technology
    often is abandoned. Early studies show that up to one out of
    three devices that were purchased ended up sitting on a shelf
    collecting dust.
        So we have to be very cautious, and one of the things that
    I have really been focused on is the front end of the process;
    that when we go through that selection of the device, the
    assessment, the evaluation to determine what device is
    appropriate for that person, that we do a good job there, that
    we use appropriate best practice protocols to do that. Because,
    in fact, if we don't pick the technology that matches the needs
    of that person, they will not use it. You know, this is
    expensive stuff, and if we buy things that are not used, then
    we are wasting an awful lot of resources.
        So, for me, that front end, the assessment and evaluation
    is very critical, and there are some issues there because, in
    fact, you know, at this point it is very fragmented. Who is
    performing these evaluations? Who is going out and matching the
    person with that technology? It is a real mixed bag right now.
    In many cases, you know, the medical professionals that are
    involved do a fine job. But in many cases, we have vendors that
    are involved with that assessment process, and sometimes I
    don't know that that is appropriate.
        So I do get concerned about the abandonment rates that we
    saw early in the 1990's that that not be repeated with the
    older population.
        The Chairman. Let me ask, Eric, do you wish to respond to
    that?
        Mr. Dishman. Mr. Chairman, I wanted to add one thing. I
    think we are at a big transition point here in the research of
    these kinds of devices in that we are actually moving from
    devices to systems. We are not very good at doing this kind of
    research in our Nation. Most of the disability research that
    has been done has been on a particular device, and you can do
    your controlled study. You put the device in this house and the
    device into this house--or you do not put it into this house,
    and you compare them.
        The research challenge as we go forward in this kind of
    more connected world where the medication caddy can speak to
    the cell phone, can speak to the TV, this is just enormously
    difficult research to do. It takes more researchers coming
    together because there are multiple touch points that people
    are interacting with, not just a single device, which also
    means it is very difficult to know what part of that whole
    system was the magic for that particular consumer. It may have
    been getting the medication reminders on their TV.
        This is a new frontier of research that traditionally the
    U.S. has not funded a lot of systems research. We fund API
    going and looking at a device as opposed to bringing multiple
    principal investigators together to build all the pieces, get
    them all working together, and test the value of the whole
    system as opposed to the single device.
        Mr. Coughlin. I would also encourage the committee to
    really consider the idea of even going beyond systems and
    looking at solutions. In fact, in part of the research that
    needs to be done on whether these technologies are efficacious
    and whether they will continue to be adopted or go the way of
    my treadmill as a sweater dryer is whether or not they connect
    to what. What is the value? You mentioned the older adults
    using computers now. They are using the computers because they
    can contact their grandkids, they can find health care
    information and the like. There was a value that was worth
    overcoming the usability dilemma.
        Having talking houses and sensors talk to each other and
    having someone monitor remotely has a certain value. It has
    more value, however, for those who are not yet in the position
    where they are required to use these if it connects to local
    commercial providers or Government agencies that provide
    services.
        So I would say this is now a research agenda, not on
    devices, not on systems, but how it connects to all those
    institutions and total solutions that are out there.
        I would also suggest that we need to have a greater sense
    of urgency. We don't have the luxury any longer of digging deep
    into the research. We need to move forward quickly because it
    will take years, if you will, to deploy these things into
    people's homes, cars, retail stores, and the like. The average
    car, for instance, we keep our average car about 8.3 to 9
    years. That means even if you had everything necessary today
    for safety in an older driver, it will take at least 10 to 15
    years before it actually impacts the fleet.
        One last comment and I will stop. The issue on usability,
    we like to talk about older adults and whether they like
    technology or not or whether they can use it. The fact of the
    matter is that in about 20 to 30 years, our children will be
    sitting at these tables and be talking about why is it that my
    parents seem enamored with the use of icons, and why does
    everything look like something they used to call a PalmPilot?
    The fact of the matter is technology continues to change, and
    our mental model of how things actually work is formed early
    on. The technology keeps moving. We need to move with it and,
    incredibly enough, make design more usable not just for our
    parents, but we are going to need that as well.
        The Chairman. A variety of you have offered suggestions,
    and we appreciate that a great deal. Let me ask this question.
    Joe, you had mentioned in one instance that probably it was
    better that Government got out of the way in some respects. Yet
    Government can be a tremendous facilitator if it approaches it
    right.
        We are having a debate on the floor right now about taxing
    the Internet, and we are not going to go any further than to
    suggest that Government really did create the Internet and then
    it kind of got out of the way. It was initially Government
    dollars that got there, but then it was Government who got out
    of the way, and the private sector took it over and ran with
    it. Now we are trying to get back in the way for a variety of
    different reasons because this technology has matured to a
    level where it is now being used in ways that were probably not
    originally anticipated. That is all well and good.
        So now the great debate going on over there is: Should we
    get back in the way? Or should we stay out of the way and let
    this marketplace work and continue to work?
        The question I am going to ask all of you is: If the
    Government today, this Government, this Senate, Judd Gregg's
    committee--who mentioned Senator Gregg? All right, Ron--had
    half a billion dollars to spend in your area, your area of
    interest, whether it be in tax credits, incentivizing, or
    whether it be in actual program, whether it be in grants, where
    would you recommend that money get spent if that money were
    available? Because we all know how scarce resources are. They
    always are scarce, and especially if an advocate like myself
    would suggest as a member of the Appropriations Committee that
    it get spent in a new area, it is much less likely to go there
    because we are habitual people and we like to spend in areas
    that we traditionally know about.
        Eric, let me start with you.
        Mr. Dishman. Well, if you are asking where would the
    money--where should the money be housed, I think one of the
    important things that we have determined in CAST is that the
    right way to house a bucket of money like that is to actually
    do a cross-agency funding initiative. There are great
    technologies in DARPA and DOD, and before 9/11, there used to
    be a lot of attention from those folks on issues of aging in
    place and home health care and those kinds of sensor
    technologies.
        What we really need is to bring together places like NIST
    and NSF and NIH where we bring the clinical, the systems, you
    know, the future sensors that they are working on the
    battlefield, bring all of that together in one domain focused
    on the aging-in-place challenge. Then outside of that, I think
    we ought to be identifying the top conditions, if you will, or
    the top behavioral changes that these technologies could help
    do.
        The only way we are really going to solve the aging
    challenge and the economic challenge is to actually change
    people's behavior before they start having some of these
    problems, some of the ones that are in the news today of
    medication errors and compliance, but in the home not just the
    hospital. Obesity, we are doing little experiments with some of
    these technologies to help know when your walking buddy--if you
    are 80 and you are at home alone, is your walking buddy going
    out for a walk now because they have picked their shoes and
    their jacket up and that might be a good time for you to go
    with them.
        I believe that there are ways to use these technologies to
    connect people with other people outside of the institutional
    care setting, and that is where we are going to get the huge
    economic cost savings. So identifying some of those things like
    how do we get people to go out and actually walk 10,000 steps a
    day. We have said we want them to do that. How can technology
    be deployed to actually do that? How can we help reduction
    medication errors in the home? How can we help people with
    cognitive decline and mobility? Those would be four of the big
    areas.
        Chairman Craig. Thank you.
        Martha.
        Ms. Pollack. Yes, largely I want to echo what Eric has
    said. I think incentivizing companies is fine for relatively
    short-term solutions, but most of our companies have relatively
    short-term sights. When you look at the kind of technology that
    many of us are trying to build, the end product may look
    simple--in fact, it has to look simple if people with cognitive
    impairment are going to use it. But the design is anything but,
    and it requires the collaboration of large groups of
    multidisciplinary folks. It is difficult at this point to get
    sustainable funding for that.
        There are two other quick points I want to make. First, I
    want to stress that the hope of many people like myself is that
    while there is a reasonably sizable investment to be made up
    front, enabling people to age in place longer, to stay out of
    institutions, is an economic win. It is a win-win situation
    because virtually all studies show that people want to remain
    at home longer. There is an enormous cost savings in enabling
    them to do that.
        The final thing I would like to say is if I had a huge pot
    of money at my disposal, I would like to reserve at least a
    little bit of it to get some folks who are not technologists
    but who are policy experts to consider the policy implications
    of privacy. I agree with my fellow panelists that, by and
    large----
        Chairman Craig. Policy implications of privacy.
        Ms. Pollack. I am sorry. I meant the development of
    policies that would help protect the privacy of people using
    this technology. Many older adults whom we have talked with are
    willing to trade some concern about privacy for the ability to
    have technology that can help them stay at home longer. But I
    am concerned that as this technology becomes widespread, there
    are potentials for abuse. We can solve some of that
    technologically, with techniques like encryption, but some of
    that has to be done at a policy level.
        Chairman Craig. I don't disagree with that.
        Yes, Lydia?
        Ms. Lundberg. Being from private industry, obviously I
    would like to see more funding for grants to private companies.
    Currently it is very difficult to get any kind of research
    dollars. We did apply for the NIST grant, and I don't know if
    that will go anywhere. Because with the type of system that we
    have, there are a lot of things that can be developed. For
    instance, we are working toward having more tutorial
    information to the caregivers to make them smarter through the
    PDA, which may be extinct at some point, but right now it is
    the hot thing, where we could actually tutor them specific to
    the resident that has implications across not just in
    facilities but also in people's homes for non-traditional
    caregivers.
        Then also to make that easier for companies to work
    together with grant money. Right now I think that is very hard
    to do.
        The Chairman. OK. Joe?
        Mr. Coughlin. Two things that Government does best is not
    necessarily spending money but agenda setting and creating an
    environment of innovation. So this committee hearing is part of
    the agenda-setting issue of getting this on people's screens.
        Second, though, I really do think if I had that bucket of
    money, would be to create the markets that business is not sure
    exist. I think the money will come for research from other
    sources other than Government if, in fact, they believe that
    there is something that someone will buy and that there are
    people out there to buy it. So in that sense, we need to set
    the personal agendas of families to think about how they invest
    in their own homes and the homes of their parents with respect
    to technology and related services. We also need to have
    companies incented, whether it is a tax credit or otherwise, to
    create the innovations necessary to get these products out
    there.
        Today, unfortunately, we are confronted by reimbursement
    paralysis or what I like to call ``innovation by regulation.''
    The devices or the specifically, if you will, of innovation is
    now based upon whether CMS will reimburse it. We need to
    convince industry and all those other places of innovation that
    there is another revenue stream that they can aim for. I would
    say that the research dollars that we have today in places like
    U.S. Department of Transportation Research Centers, the
    Department of Education, and certainly NIH have done a very
    good job of creating the seed corn. Now what we need to make
    sure that these things become affordable over time and move
    quickly is to make sure that people have the money and the
    incentive to do so.
        Chairman Craig. Thank you.
        Steve?
        Mr. McConnell. Mr. Chairman, it seems that the Government
    has a stake in at least four things: first, the cost of
    Medicare and Medicaid, and there ought to be some investment in
    preventing some of the diseases like Alzheimer's that
    contribute to the need for the issues we are talking about
    today.
        Second is in the protection of people's rights. I think
    this is a whole new area. We are talking about people with
    cognitive impairments where decisions about privacy will
    probably be made, certainly for people in later stages of
    Alzheimer's, by a family member or a surrogate. We have done a
    lot of work in that area regarding participation in research,
    but we need to develop those ideas and help people understand
    what are the tradeoffs I think people are willing to make
    tradeoffs but we have not defined that area very well.
        Third is creating awareness, this hearing and other kinds
    of things that help people just know about these issues. Most
    Americans don't know even the little bit we are talking about
    here today, and this hearing can help, especially with the
    presence of C-SPAN.
        Finally, I think some incentives for industry--I mentioned
    the imaging initiative where you have the Government, NIH, and
    private industry working together. There are ways that we can
    incentivize industry to invest in this area.
        The Chairman.. Ron.
        Mr. Seiler. This will come as no surprise, but, of course,
    I would endorse that some of those dollars go to the Tech Act
    projects. At this point we have got a huge mandate with not a
    lot of funds to accomplish that. But maybe beyond that, I would
    like to see some dollars to increase the capacity of the aging
    networks in all the States to provide AT services, and Idaho is
    a perfect example, working with our aging network over the past
    10 years. Their capacity to deliver AT services to elders in
    rural areas has really increased as a result of that
    interagency collaboration between the Tech Project and the
    aging network. I would like to see that encouraged in whatever
    way would be appropriate.
        Obviously, to echo some of the previous comments,
    increasing awareness about assistive technology, in particular
    that focus on rural areas where those things are so difficult
    to deliver. Also, training, education, training of older folks,
    obviously their family members, but in particular, with
    professionals. We don't see a lot of pre-service training
    programs in this country that talk about assistive technology,
    at least in my neck of the woods. So I would like to see a lot
    more training take place at the pre-service and in-service
    level related to assistive technology.
        I guess in closing, what I would like to do is maybe put in
    a notion about low technology. For me, it is very--and I am the
    first one to admit I can be very seduced by some of the high-
    tech wonderful solutions that we see. But we should never
    overlook the role of low-tech solutions, simple devices that
    can help older folks to function in the kitchen, in the
    bathroom, those kind of things. You know, in this current
    economic climate, I just see that as being very viable and
    somehow we should stimulate the use of low-tech devices and not
    just, you know, focus on the high-tech stuff.
        The last one, I would like to see some resources go into
    tech transfer, and we have heard this earlier, just getting
    the--again, as Eric mentioned, all these wonderful technologies
    that are in the lab, how do we get these out to real people in
    the real world? In particular, how do we provide, you know,
    those solutions into the rural areas? That is the lens that I
    always look through. How do we get it out to the people living
    in the rural areas?
        The Chairman. Well, I thank you all very, very much for
    your time before the committee today, your presentations, your
    demonstrations, your suggestions.
        I will say I recently introduced a piece of legislation
    recognizing that a major part of caregiving is done by families
    and individuals and not by institutions. Yet we have not--we
    are trying to recognize through tax credits and by lifting that
    cap dramatically that by doing so and in an identifiable way
    you actually are creating a greater marketplace that will
    incentivize that individual who is giving the care to begin to
    look at some of these technologies that may assist her,
    dominantly--his or her responsibility as it relates to the
    burden involved. That is the toughest one of all. It is a
    burden of responsibility and love that gives us those
    statistics that I think you had mentioned, Joe, and others,
    that are pretty dramatic out there and yet very real.
        It is my great hope that not only will that assist, but it
    also continues to recognize what most Americans really do want
    to do and what we should continue down through our culture in
    time is that families care for families and work to continue to
    do that connectivity where it exists and where we can help
    further that kind of caregiving. So that is one thing that we
    have looked at, and there will be others along the way. But I
    must tell you, we thank you very much for being here today,
    taking time from your schedules to add to this committee's
    record. We hope it will be valuable, if you will, in creating
    that, first of all, awareness agenda and ultimately then the
    environment in which some of your ideas and thoughts can
    flourish.
        Thank you all, and the committee will stand adjourned.
        [Whereupon, at 11:40 a.m., the committee was adjourned.]

                                A P P E N D I X

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