[Senate Hearing 116-547]
[From the U.S. Government Publishing Office]


                                                       S. Hrg. 116-547

                      AGING AND DISABILITY IN THE
                      21ST CENTURY: HOW TECHNOLOGY
                        CAN HELP MAINTAIN HEALTH
                          AND QUALITY OF LIFE

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

                                HEARING

                               BEFORE THE

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                     ONE HUNDRED SIXTEENTH CONGRESS


                             FIRST SESSION

                               __________

                             WASHINGTON, DC

                               __________

                              MAY 22, 2019

                               __________

                           Serial No. 116-07

         Printed for the use of the Special Committee on Aging
         
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        Available via the World Wide Web: http://www.govinfo.gov
        
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
47-419 PDF                 WASHINGTON : 2022                     
          
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                       SPECIAL COMMITTEE ON AGING

                   SUSAN M. COLLINS, Maine, Chairman

TIM SCOTT, South Carolina            ROBERT P. CASEY, JR., Pennsylvania
RICHARD BURR, North Carolina         KIRSTEN E. GILLIBRAND, New York
MARTHA McSALLY, Arizona              RICHARD BLUMENTHAL, Connecticut
MARCO RUBIO, Florida                 ELIZABETH WARREN, Massachusetts
JOSH HAWLEY, Missouri                DOUG JONES, Alabama
MIKE BRAUN, Indiana                  KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida                  JACKY ROSEN, Nevada
                              ----------                              
            Sarah Khasawinah, Majority Acting Staff Director
                 Kathryn Mevis, Minority Staff Director
                         
                         
                         C  O  N  T  E  N  T  S

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                                                                   Page

Opening Statement of Senator Susan M. Collins, Chairman..........     1
Opening Statement of Senator Robert P. Casey, Jr., Ranking Member     3

                           PANEL OF WITNESSES

Joseph F. Coughlin, Ph.D., Director, Agelab, Massachusetts 
  Institute of Technology, Cambridge, Massachusetts..............     5
Cara McCarty, Director Curatorial, Cooper Hewitt, Smithsonian 
  Design Museum, New York, New York..............................     8
Brenda Gallant, RN, Executive Director, Maine Long-Term Care 
  Ombudsman Program, Augusta, Maine..............................    10
Robert Mecca, Executive, Life and Independence for Today (LIFT), 
  St. Marys, Pennsylvania........................................    11

                                APPENDIX
                      Prepared Witness Statements

Joseph F. Coughlin, Ph.D., Director, Agelab, Massachusetts 
  Institute of Technology, Cambridge, Massachusetts..............    29
Cara McCarty, Director Curatorial, Cooper Hewitt, Smithsonian 
  Design Museum, New York, New York..............................    42
Brenda Gallant, RN, Executive Director, Maine Long-Term Care 
  Ombudsman Program, Augusta, Maine..............................    46
Robert Mecca, Executive, Life and Independence for Today (LIFT), 
  St. Marys, Pennsylvania........................................    49

                       Statements for the Record

Testimony of Audrey Busch, Association of Assistive Technology 
  Act Program....................................................    55
Testimony of Mary Lee Fay, National Association of State 
  Directors of Development Disabilities Services.................    60
Testimony of Betsy Beaumon, Benetech Organization................    72

 
                      AGING AND DISABILITY IN THE
                      21ST CENTURY: HOW TECHNOLOGY
                        CAN HELP MAINTAIN HEALTH
                          AND QUALITY OF LIFE

                              ----------                              


                        WEDNESDAY, MAY 22, 2019

                                       U.S. Senate,
                                Special Committee on Aging,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 9:33 a.m., in 
Room 562, Dirksen Senate Office Building, Hon. Susan Collins 
(Chairman of the Committee) presiding.
    Present: Senators Collins, Tim Scott, Braun, Casey, Sinema, 
and Rosen.

                 OPENING STATEMENT OF SENATOR 
                   SUSAN M. COLLINS, CHAIRMAN

    The Chairman. The hearing will come to order.
    Good morning. Today we will explore how 21st century 
technology is improving the quality of life for older Americans 
and those with disabilities. We have on display an array of 
devices that are available today. I want to show you a few of 
them from up here on the dais.
    This pen, for example, is the PenFriend 2. It allows one to 
put stickers on various items and then record voice labels in 
order to identify them later. This is particularly helpful for 
people with limited vision.
    For example, let us say that there are a number of cans in 
your kitchen cabinet. One might be pears, one might be corn, 
one might be peaches. They are all about the same size, and it 
can be difficult for someone with limited vision to be able to 
discern which is which.
    Well, when the cans of corn, peaches, and pears are bought, 
each would have one of these yellow stickers put on them, and 
then using this device, you would record what the item is. 
Later on, when the person with limited vision is trying to 
select the right can, he or she can simply touch the pen to the 
yellow stickie, and it will tell him or her what it is. That is 
just one of the many examples.
    Another are spoons that make it easier for people who have 
Parkinson's, for example, to continue to feed themselves. Or 
there are other mobility issues, this intriguing spoon, if I 
can make it work here, will bend to come to the right level of 
your mouth, so there is so much that is exciting out there.
    These days, most of us carry in our pocket at least one 
device, such as my iPhone. This phone, while still used for 
making telephone calls, today offers so much more potential. A 
typical smartphone can track health measures like daily steps 
or blood sugar and can pair with other devices to predict the 
risk of falls or diabetic episodes.
    From the everyday technologies that we all use to assistive 
technologies that help seniors and those with disabilities 
improve function, these devices are poised to change the future 
of aging. Survey after survey indicates that seniors envision 
themselves living independently at home in their own community 
for as long as possible and living their lives to the fullest. 
Technology can help make that possible.
    With 10,000 Americans turning 65 every day and one out of 
five Americans set to join this group by 2035, we are in the 
midst of a major demographic shift. The fastest-growing segment 
of our population are Americans age 85 and older. While aging 
brings opportunity, it also comes with increased risk of 
multiple and interacting health conditions that can lead to 
disability, at times requiring long-term care, and making it 
more difficult to age at home.
    As our population is aging, the need for care and support 
is increasing. In 2010, there were approximately seven 
potential caregivers for each person over age 80. By 2030, 
there will be only four, and by 2050, the number drops to fewer 
than three, so more people will have to rely on fewer 
caregivers--opening the door for technology to help fill that 
gap.
    Advances in technology are working to bridge this ``care 
gap,'' improving function in activities of daily living, 
helping to manage multiple chronic conditions, reducing the 
risk of hazards, and making homes safer for seniors. Not only 
has technology allowed seniors to age in place, but also it is 
making it possible for individuals to move out of nursing homes 
or other institutionalized settings back into the privacy, 
security, and comfort of their very own homes.
    Through tools and technologies, Maine's Homeward Bound 
program, for example, has helped to transition seniors as well 
as others with disabilities back into their communities, and we 
will hear more about that this morning.
    One particularly promising avenue for new technologies is 
in the prevention of falls. Falls are a leading cause of both 
fatal and nonfatal injuries among seniors and are projected to 
cost our Nation $67 billion in the coming year alone. Falls-
related injuries can have a devastating impact, requiring 
round-the-clock institutional care, but new technologies can 
reduce the risk of falls, as well as contact emergency services 
for help as soon as a fall happens. I am excited about an 
innovative approach now being developed by the University of 
Maine, which is a pair of smart glasses that can detect edges, 
such as stairs or curbs, to help prevent falls, particularly 
for those seniors with limited mobility and limited eyesight.
    Another area where technology holds great potential is in 
reducing social isolation. Social media and video chat on 
tablets and smartphones help to reduce isolation and loneliness 
and enrich seniors' lives by keeping them connected to their 
loved ones. We have had previous hearings on the health impact 
of prolonged isolation, and they are substantial, on physical, 
emotional, and mental health and well-being. In fact, according 
to researchers, prolonged isolation is comparable to smoking 15 
cigarettes a day. That is how profound the impact on health is. 
While not a substitute for interacting directly with people, 
technology can help bring people together.
    It is important that older Americans have a key role in 
developing these technologies. That will increase utilization, 
reduce stigma, and ultimately makes for a better product.
    Older Americans also have helped companies realize that 
they want technology devices that look just like those that are 
used by younger generations. For example, many of us are 
familiar with hearing on television that old phrase, ``I have 
fallen, and I cannot get up.'' Well, that was an advertisement 
for a medical alert system that, for many years, was considered 
among the most advanced technologies to help seniors age in 
place. While many seniors still successfully rely on this 
device, breakthroughs in modern technology have brought new 
options that are far more versatile.
    Technology is opening the doors for older Americans and 
those with disabilities to live the way they prefer, and that 
really is what this is all about--accommodating the individual 
preferences as we grow older. From better managing health and 
mobility to increasing connectivity and community involvement, 
technologies on the market today and those on the horizon for 
tomorrow promise to usher in a new era of aging.
    I look forward to hearing our excellent witnesses today, 
and I now will turn to our Ranking Member for his opening 
statement. Senator Casey.

                 OPENING STATEMENT OF SENATOR 
              ROBERT P. CASEY, JR., RANKING MEMBER

    Senator Casey. Chairman Collins, thank you for your 
testimony, and also thank you for this hearing.
    Assistive technology provides an opportunity for millions 
of individuals to live independently. It can improve the lives 
of older Americans and people with disabilities, and today we 
will hear how assistive technology can help members of these 
communities enjoy the same rights as any individual. We will 
hear how it gives everyone the right to learn. We know that 
assistive technology makes it possible for students with 
disabilities to fully participate in their education.
    We will hear how it gives everyone the opportunity to work, 
and we know that assistive technology can break down barriers 
to employment and allow individuals to remain in the workforce 
as long as they choose to. We will hear how it gives everyone 
the right to live independently. Assistive technology provides 
the opportunity for older adults to live and thrive in their 
own homes and communities, and as a previous witness who 
testified before this committee, Rick Creech from Pennsylvania, 
explained, assistive technology gives everyone the right to be 
heard.
    As Chairman Collins and others will recall, Rick testified 
before the Committee with the assistance of an alternative 
communication device. Without that communication device, 
someone like Rick might have used a spelling board or may not 
have been able to communicate much at all. He told the 
Committee at that time, ``living without being able to 
communicate was like being behind four glass walls.''
    This hearing will examine how assistive technology can 
break down those walls. We hope to raise awareness about the 
availability of assistive technology for those who could 
benefit and highlight that far too many people with 
disabilities and older adults still need access to assistive 
technology.
    I also hope this hearing will jump-start a conversation in 
Congress about updating the Assistive Technology Act, a law 
passed way back in 2004 that needs an update. Technology looked 
a lot different than it does today. Just think of our 
smartphones--kind of mini computers that we all carry around. 
Certainly older adults never imagined the ability of Fitbits or 
smartwatches to promote healthy living. None of us could have 
imagined that.
    People who are blind or have limited vision--as Chairman 
Collins pointed out--did not imagine they could wear glasses, 
literally wear glasses that were connected by Wi-Fi to someone 
who can see what is around that person and communicate the way 
to get to a restaurant, a theater, or a grocery store. Every 
week there are new advances that we must harness so that every 
American who requires assistance can, in fact, benefit.
    It is for this reason that Senator Collins and I will be 
introducing the 21st Century Assistive Technology Act when we 
return from recess, a bill that can, quite literally, bring 
assistive technology into the 21st century. This legislation 
will update the Assistive Technology Act to provide more 
resources to State assistive technology programs that would 
expand access for older adults and individuals with 
disabilities.
    I will also introduce the Access to Freedom of Speech for 
All Act that will increase access to information about 
alternative communication devices for those who have speech and 
written language disabilities, areas that often limit an 
individual's access to education and employment.
    These bills are designed to ensure assistive technology and 
alternative communication devices are available to those who 
need it so they can be full participants in every aspect of 
their lives, and to help us make the case, I am pleased that we 
can showcase here today, in the back of the room, the types of 
assistive technology that we want to get into the hands, or in 
some cases be the hands, of seniors and people with 
disabilities.
    So, again, I want to thank our witnesses and thank Chairman 
Collins for agreeing to hold this hearing today. We look 
forward to the testimony of our witnesses.
    Thank you.
    The Chairman. Thank you very much, Senator. I want to 
welcome Senator Rosen, who is here today, and I am sure there 
will be other Senators in and out, which is pretty typical of 
our hearings.
    I have asked the staff to also put out some more of the 
technology in front of us that I referred to in my opening 
statement, and I would invite people after the hearing to come 
up and take a look at it, supplementing what Senator Casey 
said.
    We are delighted now to turn to our distinguished panel of 
witnesses.
    First we will hear from Dr. Joseph Coughlin. Dr. Coughlin 
is the founder and Director of the AgeLab at the Massachusetts 
Institute of Technology. He studies the role of technology in 
the lives of the 50-plus population, and what better place to 
do that than at MIT. He is also author of the ``Longevity 
Economy: Inside the World's Fastest-Growing, Most Misunderstood 
Market.''
    Next we will hear from Cara McCarty. Ms. McCarty is the 
director at the Cooper Hewitt, Smithsonian Design Museum, which 
houses exhibits featuring an array of assistive technologies 
for older adults and those with disabilities. We welcome you as 
well.
    I am, of course, particularly pleased to introduce our 
third witness, Brenda Gallant from Maine, the great State of 
Maine. Brenda is the executive director of Maine's Long-Term 
Care Ombudsman Program, and she directs the Homeward Bound 
program that I mentioned in my opening statement. Sponsored by 
Maine's Money Follows the Person, this program provides 
participants with the tools and technologies necessary to 
transfer from living at a nursing home or other 
institutionalized setting back into their own communities and 
their own homes.
    Finally, I am delighted to turn to our Ranking Member to 
introduce our final witness.
    Senator Casey. Thank you, Chairman Collins.
    I am here to introduce today Bob Mecca from St. Marys, 
Pennsylvania, Elk County, which is a pretty good drive from 
here, as we were talking before the hearing about the drive he 
had. He drove down, and his wife, Dawn, did some driving when 
she got here. I guess it is up for grabs who is driving home, 
right? But we are grateful you are here, and Bob will be able 
to speak personally about the importance of assistive 
technology. He is one of the millions of people in our country 
who use assistive technology every day in order to maintain 
their independence. Not only is Bob a user of assistive 
technology, he helps provide assistive technology to 
individuals in some of the most rural counties in Pennsylvania.
    Bob is the executive director of Life and Independence for 
Today, an organization that serves the needs of Pennsylvanians 
with disabilities in Cameron, Clearfield, Elk, Jefferson, 
McKean, and Potter counties, and take my word for it, that is a 
lot of territory in just those counties, and as I mentioned, 
his wife, Dawn, is with him. We are thankful they are here and 
that they made the journey here, I guess about 4-1/2 hours one 
way, so we are grateful for that effort that you have made and 
look forward to your testimony.
    Thanks.
    The Chairman. Thank you very much.
    Dr. Coughlin, we will start with you. Thank you.

            STATEMENT OF JOSEPH F. COUGHLIN, PH.D.,

           DIRECTOR, AGELAB, MASSACHUSETTS INSTITUTE

            OF TECHNOLOGY, CAMBRIDGE, MASSACHUSETTS

    Dr. Coughlin. Thank you so much, Chair Collins, Ranking 
Member Casey, and Committee members for the opportunity to 
discuss how technology will not just improve aging and quality 
of life for older adults and their families, but it is actually 
a new opportunity to redefine how we age in the future.
    While I am also privileged to serve on the National Board 
of AARP, I am here today as a private citizen and as a research 
scientist and director of the MIT AgeLab. I have collaborated 
for decades with researchers around the world, and it is on 
their shoulders that I make a few of these remarks, and 
particularly enjoy the fact that this is Older Americans Month 
that you chose to have this hearing.
    Senator Casey, I want to start with a resident of 
Pennsylvania that you may recall to set my remarks. Sarah 
Knauss lived to 119 years old in Pennsylvania, and she was 
asked, if you can believe this, on her 115th birthday, ``Why do 
you enjoy living so long?'' That took a lot of chutzpah, I must 
add, by a journalist, but she came back with an answer better 
than any scientist, any engineer, any policymaker: ``I enjoy my 
life because I have my health and I can do things.''
    Members of the Committee, technology is not just to help 
people age. We have an opportunity now to set a new longevity 
economy, to change how we age, to change how we live.
    Unfortunately, we are constrained by a short story. 
Unfortunately, the short story is that old age is about 
frailty. It is about what we cannot do. It is about poverty. It 
is about poor health, and that is absolutely true for a very 
large number of people, but it is also a time for us to think 
of something else. It is no longer the aging ticking time bomb 
as many have described it.
    Unfortunately, that story has permeated the consciousness 
of technology makers, so where we have companies where the 
average age is in their 30's and in some cases their 20's, they 
see someone in their 40's as being old, but more importantly, 
the story that they see is the only thing you do in older age 
starting at age 50, 60, 70, and 80 is to be reminded to take 
your medications.
    So as a result, with all the great technology and promise 
that we have there, we have technologies that may be 
functional, but they are big, they are beige, and they are 
boring, so they lead to stigma, if you will, by anyone who 
chooses to use them when, in fact, we do not want TV remotes 
that are large enough to be a self-defense device; we simply 
wish to age by stealth.
    Senator Collins, your remarks on bringing, if you will, 
older adults into the process, absolutely required. We do that 
at the AgeLab, and many other researchers around the world do 
that as well. However, I caution those who believe that putting 
the consumer in the system alone will lead to innovation. 
Consumers do not know the power of what technology can do. They 
do not know the power of new design, so we have created the Age 
Gain Now Empathy System, AGNES, that allows my students, 
marketers, engineers, designers, shall we say, to feel the 
friction, the fatigue, and often the frustration of disability 
and aging, because they know how the technology can be used and 
are less likely to edit the fact that they feel that friction 
or are too embarrassed often to voice it.
    On that note, yes, there are amazing technologies that are 
out there. Many of them are assistive, but we are also 
forgetting one other user. Fundamentally the consumer of an 
aging society are women. The future is female. The majority of 
them will live longer. They are the majority of caregivers and, 
by the way, make the majority of household consumption 
decisions. If we do not frame around what she sees as a 
consumer, we will be confusing the user with the actual 
influencer and buyer, so, yes, there are many technologies out 
there. Your house, your toilet, your toaster, and refrigerator 
will be talking to each other about your nutrition. Your spoons 
and your forks will not just be accessible; they will be 
smarter. Robots will keep you company, remind you to take your 
meds, answer the door. One, in fact, will tell you a joke or 
insult you once or twice a day to keep you cognitively well. 
Your home will become a service platform, not necessarily just 
a place, and yes, I would be remiss that my own department of 
the Center for Transportation Logistics, the driverless car is 
coming, offering great promise, but I caution all of you not to 
be overly exuberant. Think of that first 50 feet of getting 
into the car and the last 50 feet of getting out of the car. 
Think of the system, not the technology itself.
    In the spirit of Sarah Knauss, however, I ask you to think 
about how technology will help us work, stay engaged, and I 
dare say the ``F'' word--fun--as we think about the future of 
aging.
    Let me close my remarks with some serious policy 
considerations, and, Senator Collins, you touched on a few of 
them.
    One, affordability. How do we actually get this so that 
others can afford this?
    Second, smart buyer. Where do I learn about these systems? 
How do I know which to use? And how do I get them into my life 
and into my home? And given that they change faster than your 
cell phone, how will I make sure that I stay on top of what is 
possible for my family?
    Senator Collins, I speak to you particularly personally as 
a fellow New Englander. Rural accessibility. We are now looking 
on Capitol Hill about the discussion of infrastructure. 
Pavements and pipelines alone are not infrastructure. Digital 
access is a requirement for participation in the United States. 
It is no longer simply a luxury.
    Last, if I can close on this: I want you to think of the 
longevity economy as not just a matter of policy and markets 
doing what is fair, doing what is nice. The fact of the matter 
is the fastest-growing part of the population worldwide and in 
the United States is the 50 and 60 plus. This is another 
particular to create an entirely new lifestyle, an entirely new 
economy, new products, services, and experiences to improve the 
citizens and residents of the United States, but also something 
that the U.S. can export.
    To date, unfortunately, there is not a single place in the 
Federal Government where there is a podium to talk about 
technology, aging, and innovation on a positive note--not just 
about pills, not just about assistive devices, but how do we 
turn long life into a dividend to be cashed in to make life 
better?
    My closing remark: Vannevar Bush was a professor at MIT, 
science adviser to FDR, and the dean of engineering at the 
time. He said that science and technology was an endless 
frontier. Members of the Committee, I want to put in front of 
you the following: that longevity and the longevity dividend, 
in the 30-plus years that we have gained since the year 1900 is 
a new frontier to use science, technology, and commerce to 
chart not just how to live longer but how to live better.
    Thank you, Chair Collins, Committee, and I stand by for 
questions and look forward to helping you in the future. Thank 
you.
    The Chairman. Thank you very much for your excellent 
testimony.
    Ms. McCarty.

              STATEMENT OF CARA McCARTY, DIRECTOR

             CURATORIAL, COOPER HEWITT, SMITHSONIAN

               DESIGN MUSEUM, NEW YORK, NEW YORK

    Ms. McCarty. Thank you, Chairman Collins, Ranking Member 
Casey, and Committee members. It is an honor to share with you 
several examples of the beneficial ways design and technology 
are transforming the lives of people with physical, cognitive, 
and sensory disabilities. They are from two exhibits I 
organized--one in 2018 at Cooper Hewitt, Smithsonian Design 
Museum, and the other featured earlier this year at the World 
Economic Forum in Davos.
    Senator Casey, I am delighted to inform you that in 2 weeks 
the exhibition opens at the Carnegie Museum of Art in 
Pittsburgh.
    The goal of both exhibitions was to illuminate the 
innovative designs developed during the past decade for people 
with various disabilities to improve their quality of life, 
expanding their options and their ability to engage more fully 
in life.
    Design plays a powerful role in shaping our lives. When 
applying design sensibilities to people with physical and 
cognitive challenges, the shortcomings of existing products and 
environments, as well as societal barriers and social stigmas, 
are magnified. Until recently, products looked clinical, 
perpetuating psychological barriers and how we stigmatize the 
user.
    By addressing the needs of individuals with significant 
challenges, many others benefit. Curb cuts in sidewalks are a 
prime example whose mandated purpose and function have extended 
well beyond the original intended users.
    I would like to illustrate a few examples of low-and high-
tech solutions, several of which would have included what you 
showed, Senator Collins, which I included in the exhibition.
    Mobility. May I have the slides, please? Thank you. Making 
canes stylish and objects of pride empowers the user with 
confidence and dignity. Today there is considerable redesigning 
of walking sticks. They function better. They have non-slip 
handles. They can illuminate at night to help prevent falls, 
and interchangeable handles and tips and joyous colors let the 
user personalize them. It means people now have choice, which 
will continue to expand as digital technologies are integrated 
into canes.
    Next slide. Walkers, wheelchairs, scooters for older adults 
often lack elegance or grace, which stigmatizes the user. They 
are seen as medical equipment. Consequently, individuals often 
resist using them, and they do not venture outdoors, but as 
demonstrated by the Afari Mobility Aid, an all-terrain 
``walker'' designed by two older adults with mobility 
challenges--two adults from Maine, by the way--but who want to 
remain active and independent, these mobility aids are both 
useful as well as stylish. In use, it appears like walking a 
bicycle .
    Connecting and communication. Digital technologies--next 
slide, please--are undeniable game changers for many 
individuals with disabilities. They fill a void that is vital 
to maintaining a fulfilling life. Many counteract isolation, as 
has been noted.
    A poignant example are Tobii Dynavox's portable, eye-gazing 
devices that support access to communication for those not able 
to speak or who require hands-free communication to express 
themselves, their thoughts and ideas in ways and at speeds 
previously unimaginable. In addition to the product's speech-
generating capabilities, eye-tracking enables an individual to 
use their eyes as pointers to move symbols, or to type and send 
emails, or to edit images and films.
    Daily needs of bathing, dressing, eating are essential. 
Next slide, please. A man with Parkinson's disease had 
difficulty buttoning his shirt. His wife saw a design 
opportunity, not an obstacle. She was inspired by the magnetic 
covers of iPads and transferred that innovation to invisible 
magnetic buttons. It is a prime example of inclusive design. It 
looks like a regular shirt and can easily be marketed to 
individuals with limited manual dexterity.
    Next slide, please. I am excited about the recent 
legislation deregulating hearing aids. Everyone experiences 
moments of decreased hearing, a noisy restaurant, crowds of 
people. In earlier generations, concealing disability was a 
priority, but this is changing as awareness is growing, and we 
see people embrace their disability. These customized, low-
cost, over-the-counter hearing aids are not dissimilar to 
eyeglasses, which were traditionally called ``medical 
appliances'' until fashion designers got a hold of them And we 
see what happened. Why not glam them up?
    Next slide, please. Particularly striking examples of this 
shift toward outward expression are these prosthetic leg 
covers--snap-on tattoos that are intricately patterned and 
available in a variety of patterns and colors. With these, the 
conversations turn to the appealing prosthetic rather than what 
happened to you. The positive reaction gives confidence to the 
wearer.
    My last slide, how do we design transportation for 
everyone? In the U.S. 30 percent of individuals with 
disabilities have difficulties accessing transportation. 
Cities, streets, buses, subways, and other public spaces are 
not universally accessible, but as has been noted, as we plan 
for the future and upgrade infrastructure, we have tremendous 
opportunities. This Accessible Olli is a prototype autonomous 
shuttle bus, accessible to people with physical and cognitive 
disabilities, with a retractable wheelchair ramp, software that 
can process sign language and display other simplified 
information.
    In conclusion, design matters. What distinguishes many of 
these products is that they were designed with the user at the 
center. By focusing on the user and designing with the user not 
just for the user, we cannot only understand the needs better, 
the product better, but we humanize design. What is needed is a 
mindset change. We speak about the aging population or people 
with disabilities as having the problem, but isn't the real 
problem that many of our designs on all scales create barriers? 
By placing those who have been traditionally excluded central 
to the work of design, we not only value their ways of being, 
but we also reconstruct notions of inclusivity and exclusivity.
    As August de los Reyes, who is quadriplegic, said, 
``Disability is a mismatch between my own abilities and the 
world around me. Disability is a design opportunity.''
    Thank you.
    The Chairman. Thank you very much. Your slides are 
absolutely fascinating.
    Ms. McCarty. Thank you.
    The Chairman. Creative and encouraging. Thank you.
    Ms. Gallant, welcome.

                STATEMENT OF BRENDA GALLANT, RN,

              EXECUTIVE DIRECTOR, MAINE LONG-TERM

             CARE OMBUDSMAN PROGRAM, AUGUSTA, MAINE

    Ms. Gallant. Good morning, Chair Collins, Ranking Member 
Casey, Committee members. My name is Brenda Gallant, and I am 
the Maine State Long-Term Care Ombudsman. Thank you for 
inviting me to provide testimony regarding the essential role 
of assistive technology in supporting older adults and adults 
with disabilities to live independently in the community.
    We have observed the vital importance of this technology 
through our work with Maine's Homeward Bound program, the CMS-
funded Money Follows the Person Demonstration Program. Maine 
implemented this program in 2012. Since then, with the 
resources this program provides, 141 nursing home residents and 
hospital patients have been able to transition back to the 
community. MFP serves Medicaid beneficiaries who have been in a 
nursing home or hospital for at least 90 days.
    In our experience, older adults and adults with 
disabilities want to live in their own home whenever possible. 
MFP assesses the needs of each participant and develops an 
individualized care plan to provide the services and supports 
needed for a successful transition back to the community. A key 
part of the planning includes an assistive technology 
assessment.
    Here are some examples of how assistive technology has 
enabled MFP participants to gain the independence necessary to 
return to living in the community.
    A 58-year-old woman with a diagnosis of muscular dystrophy 
resided in a nursing home for 17 months. She uses a motorized 
wheelchair, and her muscular dystrophy has impacted her ability 
to use her arms and affected her ability to communicate. She 
expressed her wish to leave the nursing home, but was 
discouraged by her physician, who felt that her needs could not 
be met in the community. However, she was determined to be in 
her own apartment. A critical part of her planning was access 
to assistive technology. An assessment recommended an eye-gaze 
system that enables her to use her computer with her eyes to 
communicate through email and have access to the Internet, as 
well as remote access monitoring that provides motion detectors 
and notifies caregivers if her routine is not followed. 
Additionally, a remote door entry button that she keeps with 
her allows her to enter and exit her home independently. 
Despite the initial skepticism, she has been successful in 
living on her own for 6 years.
    A 49-year-old woman, also with a diagnosis of muscular 
dystrophy, resided in a nursing home for 5 years prior to her 
transition to her own apartment. She uses a motorized 
wheelchair for mobility. MFP funded a ceiling track lift to 
enable transfers to be done safely, requiring only one 
caregiver to be present; a smartphone and iPad allow her to 
access the camera installed outside her door so that she can 
see who is there and is able to operate an automatic door 
opener with her hand. She also utilizes an emergency response 
system that has GPS tracking so that when she is away from her 
apartment, the system will continue to operate, and she can 
call for help if needed.
    A 94-year-old woman transitioned from a nursing home back 
to her own home after falling and fracturing her hip. She has 
macular degeneration and arthritis. MFP funded a reacher to 
assist in picking up, an assistive device for administering eye 
drops due to arthritis in her hands, an electric lift chair to 
help her stand and sit, and automatic door opener to allow her 
time to enter and exit the house safely. Additionally, she uses 
an Echo Plus through voice command to control ceiling fans, 
lights, and the thermostat. She never imagined she would be 
using this type of technology; however, she has embraced it and 
has been successful living in her own home.
    MFP, and the access it provides to assistive technology, 
has enabled these participants to reside independently instead 
of in a more costly institution. MFP has enabled States to 
rebalance Medicaid dollars from institutions back to home and 
community-based services, complying with the 1999 Olmstead 
decision mandating States to provide individuals with 
disabilities the opportunity to live in the least restrictive, 
most integrated setting possible.
    In closing, despite these successes, we are concerned that 
the provision of assistive technology and other services 
accessed through MFP is at risk. We have seen firsthand how it 
has transformed the lives of Maine people who have utilized its 
services to regain their independence. The EMPOWER Care Act, S. 
548, and its companion legislation, H.R. 1342, extends funding 
for MFP for 5 years. We urge members of the Committee to 
support the EMPOWER Care Act so MFP can continue to make a 
dramatic difference in the lives of Maine people and thousands 
around the country.
    Again, thank you very much for inviting me here today.
    The Chairman. Thank you for your testimony. Great examples, 
too.
    Mr. Mecca.

             STATEMENT OF ROBERT MECCA, EXECUTIVE,

            LIFE AND INDEPENDENCE FOR TODAY (LIFT),

                    ST. MARYS, PENNSYLVANIA

    Mr. Mecca. Chairman Collins, Ranking Member Casey, and 
members of the Committee, thank you for inviting me to testify 
today. I am honored to be here on behalf of people with 
disabilities who need assistive technology to live the 
independent lifestyle that so many people take for granted. My 
name is Bob Mecca. I will be married for 29 years this year. My 
wife, Dawn, is here to support me.
    I was born with spina bifida, and I use assistive 
technology every day to live independently, work, and be an 
active part of my community. I have been working in the 
independent living field for almost 30 years with over 20 years 
as executive director of Life and Independence for Today.
    I use both high-tech and low-tech devices. I use a 
wheelchair for mobility and portable hand controls, which I 
have with me today. I can fit these hand controls in and out of 
any automatic vehicle within 5 minutes. I am currently looking 
for funding for an all-terrain tracked wheelchair, as I am an 
avid deer hunter. This outdoor wheelchair would allow me to go 
into the woods where I would not otherwise be able to go.
    One low-tech device I use is a reacher to get things out of 
high places. A few years ago I had shoulder surgery, and I had 
to use a wheelchair and a transfer board. The transfer board 
was a little bit different than the normal transfer board, as 
it had a seat on it that slid back and forth, which made it 
very easy to use. I acquired the transfer board from Life and 
Independence for Today, LIFT's reuse program, and I got the 
wheelchair from the Saint Marys Pharmacy Home Health, which is 
a durable medical equipment provider in my home town. If I had 
not had access to these priceless pieces of AT, I would have 
been stranded in my living room looking at the same four walls 
for 3 to 4 months, as I only had the use of one arm. This 
example demonstrates that AT is not only important for people 
with permanent disabilities, but it is very helpful in 
temporary situations to keep people independent and in their 
own homes,
    LIFT is one of 17 Centers for Independent Living in 
Pennsylvania. My center is located in Saint Marys. LIFT serves 
arguably the six most rural counties in Pennsylvania: Cameron, 
Clearfield, Elk, Jefferson, McKean, and Potter counties. This 
is an area of over 5,000 square miles, and we serve this huge 
geographical area with a staff of only six. We provide services 
to assist individuals with disabilities to live independently 
in the community. Currently, LIFT has 366 open consumers. We 
also receive hundreds of I&Rs, Information and Referral 
requests every year.
    LIFT is a regional center for TechOWL, Pennsylvania's 
Assistive Technology Act program. As a State AT Act program, 
TechOWL and LIFT work together to ensure people with 
disabilities have access to and acquisition of the assistive 
technology and services they need to live in their communities. 
Under the umbrella of TechOWL, LIFT provides services through 
the Assistive Technology Lending Library, ATLL, which is a free 
service that enables all Pennsylvanians with disabilities, 
regardless of age or disability, to try AT devices to see what 
best suits them before they buy something. LIFT also 
facilitates the Telecommunications Device Distribution Program, 
TDDP, for our six counties. The TDDP provides telecommunication 
devices to qualified applicants with disabilities. These 
devices allow individuals to use telephones independently. LIFT 
also has an assistive technology reuse program. We take 
donations of lightly used equipment and recycle them to those 
with disabilities who would otherwise not have the means of 
obtaining them.
    As executive director of Life and Independence for Today, I 
serve on the board of directors of the statewide Independent 
Living Council, which is a Governor-appointed position. I also 
serve on the board of the Pennsylvania Council on Independent 
Living, PCIL, which is a membership association of Centers for 
Independent Living in Pennsylvania. I travel quite a bit for my 
job, and when I need overnight accommodations, I always try to 
arrange for wheelchair access. For someone with a mobility 
disability who is active like myself, things like an accessible 
shower, shower chairs, and grab bars are essential to my 
independence outside of my home.
    In closing, I would just again like to say thank you for 
allowing me to represent people with disabilities who use 
assistive technology to ensure their independence and become 
and remain productive citizens in their communities. I would be 
happy to answer any questions. Thank you.
    The Chairman. Thank you very much, Mr. Mecca.
    Ms. Gallant, could you describe in a little more detail the 
process that you use to assess what kinds of technology would 
be useful to an individual who looks to be a promising 
candidate for transitioning from a long-term-care facility back 
to their own home? I am going to ask you to turn on your mic.
    Ms. Gallant. I am sorry. Any individual that would be 
transitioning would have an assistive technology assessment 
performed, and based on that assessment, the individual would 
be visited, for example, if they are in a nursing home or a 
hospital, so the assessment would begin in the setting that 
they are in, and then also include looking at the home that 
they are going to move into, and really look at the medical 
needs and the functional capabilities of the individual to 
develop a very individualized plan, and then the individual 
would be given training and support with respect to how to use 
the technology and then ongoing support for any questions or 
concerns, and there would be followup, so it is a very 
individualized and specific assessment for each individual.
    The Chairman. Thank you.
    Ms. McCarty, as I was listening to that explanation, I 
wondered whether it was a hard sell to get seniors to be open 
to the new technology. When you had your exhibit, what was the 
reaction of people who looked at the wonderful products that 
you displayed in your slides?
    Ms. McCarty. I would say euphoria, and we just had crowds 
of people coming to the galleries, people of all ages, all 
abilities, many expertise, and we had people coming looking out 
of curiosity. We had people coming to look what they might be 
able to get for themselves. We had people looking for friends 
or family members. We had doctors. One day I was giving a tour, 
and this man latched onto the tour, and he finally came around 
a pedestal and confronted me, and he just said--he interrupted 
the tour, and he said, ``Can I just say something? This is the 
best exhibition I have ever seen. I see many exhibitions, and I 
am a doctor. Why don't I know about these products?'' That was 
what so many people said, and it really staggered me. In this 
day of the Internet, how many people who could benefit from 
these products do not know about them? How do we get the 
information out? Many people do not even know where to look? 
They do not even know that something like this exists.
    We have a real education problem from the beginning, and I 
would say that even a lot of occupational and physical 
therapists, you know, are maybe not imparting some of that 
information, so really, I am thrilled that the exhibition is 
traveling, and hopefully that will help highlight some of these 
wonderful products and thinking.
    The Chairman. Maine is the oldest State in the Nation by 
median age, so just as soon as you get done in Pennsylvania, I 
think you should bring your exhibit----
    Ms. McCarty. Give me a place, we are there. Thank you.
    The Chairman. I do think you raise a really important 
point, that the average person is not at all aware, but even 
the medical profession often does not know about it.
    Dr. Coughlin, I see you nodding in agreement with that. You 
raised a really important point about when we think of 
infrastructure, we have got to think of access to the Internet, 
broadband, transmission speeds, all of those issues--cellular 
service. That is an issue in a lot of rural America, including 
some parts of rural Maine, so up front, many of these 
technologies, particularly those that require Internet 
capability, may still be cost-prohibitive for many families, 
and it is ironic because it actually saves so much money over 
institutionalized care, which in some cases, if it is 
rehabilitative care, Medicare may be paying, or if it is long-
term care, Medicaid is frequently the payer, so we have a sort 
of penny-wise, pound-foolish approach to this issue.
    Are there alternatives available at different price points 
that would at least make some of these technologies available 
to individuals and improve their quality of life?
    Dr. Coughlin. Yes, Senator. As I provide in greater detail 
in my written testimony, one of the greatest challenges we have 
is a coming technology inequality gap around affordability, let 
alone accessibility, particularly in rural America. The 
affordability issue, there are two ways to look at this, at 
least. The first one is that, yes, it is expensive, but they 
are getting cheaper over time. Many of these devices are coming 
down in price, and over time, many technologies, like a 
computer, flat-screen TVs, and the like, we have seen them 
markedly drop, so that is the good news. The trouble is we need 
to support people in the here and now.
    The research that we are doing is suggesting that part of 
the price problem is we are designing technologies for a 
specific market segment, which means market failure. We need to 
design technologies that everyone wants, that is cool, 
convenient, and provides care. That way we get full market 
capability, and by the way, then people want to buy it. We 
create a whole new market. The notion that we are pursuing in 
Massachusetts is creating a whole new business around longevity 
economy clusters to develop, manufacture, and export these 
technologies, not just to people in Massachusetts but around 
the world, so we get economies of scale, so yes, while there 
should be Government support, agenda setting, I think there are 
design, policy, and market forces that we can bring it down and 
make it accessible to all.
    The Chairman. Very exciting.
    Senator Casey. Thank you, Chairman Collins.
    I will start with Bob Mecca. In your testimony you 
discussed the work you do leading LIFT to provide assistive 
technology to very large and very rural communities in our 
State, and you mentioned those six counties alone are 5,000 
square miles, so that is a lot of territory and I am sure on a 
limited budget. The bill that Senator Collins and I will 
introduce will authorize more funding to support your work and 
the work of others.
    Here is my question: As someone who provides assistive 
technology in that rural part of our State, can you tell us 
about how the assistive technology needs of older adults with 
disabilities creates a challenge and how additional resources 
can help you serve such a rural area?
    Mr. Mecca. Yes. First of all, serving older adults with 
disabilities has its own challenges because we often run into--
they may call us for assistance or they need a certain device 
to help them or they want to look at different devices, and, 
you know, when we ask them, OK, what is your disability, ``Oh, 
I do not have a disability. I am just old, and I cannot do 
things like I used to.'' So that is a challenge in itself, 
getting them to identify themselves as a person with a 
disability, and then once we get them to see, you know, what a 
difference adaptive equipment or assistive technology makes, it 
makes a world of difference, and they just are so thankful that 
we can provide something to help them, say a bill reader for 
someone with a visual disability that can tell them what 
denomination their dollar bills are. That is so helpful to a 
person to get out into the community and pay for items. Then 
they know what they are giving the person at the other end of 
the register.
    Also, I wanted to point out that it is over 5,000 square 
miles that we cover, and with a staff of six, and how we do 
that is we go to our consumers directly. We do not have them 
come to us, because although we have been blessed to have the 
same transportation provider cover the same six counties that 
we cover, unfortunately there are not routes that go between 
towns and so forth, so that makes it way too expensive for 
people with disabilities of any age to come to us, and so we 
have to go to them, and as you said, it is on a very limited 
budget, so any additional funding there would just be a godsend 
for us to help so many people that we have in our area with 
disabilities and older Pennsylvanians.
    Senator Casey. Well, thanks for that answer, and I also 
wanted to followup on the nature of the technology. We have 
heard a lot today, and Senator Collins did a great job of 
explaining some of the devices we have now, some rather simple 
but helpful, but some very complex and also very helpful as 
well.
    It seems that, like anything in life, the more complicated 
the technology, the more expensive it is and, therefore, 
sometimes difficult to obtain. Certainly one of the examples of 
that might be alternative speaking devices, which we have 
learned so much about, which can restore the ability of an 
individual to communicate with the world around them. I am 
going to be introducing a bill to increase access to those 
kinds of devices.
    Bob, can you share with the Committee specifically why 
accessing this type of technology is both so challenging but 
also to share how targeted resources might help those 
individuals?
    Mr. Mecca. Well, augmentative communication devices that 
help people, you know, with speech disabilities are definitely 
one of the more advanced technologies. They can be. They can be 
as simple as a person one time that I know had a glass board 
with numbers and letters on it, and they would look at each 
number and spell everything out slowly, to the advanced 
communication boards that are very technical and they need to 
set them up oftentimes in advance to say a sentence or 
whatever, so they are a lot more expensive. The more technical 
they are, the more expensive they are.
    Also, at LIFT we used to have a program that we called 
``Within Your Reach,'' and what we did was we partnered with at 
least one library in each of our six counties, and we put 
assistive devices in the library in a prominent place where 
people could go in there and look at them and use them, and 
then if they wanted more information on it, we left our 
information there, and the library staff were trained to 
contact us, and then we set up appointments for people to help 
them. That was like a one-time funding thing, so we no longer 
have the funding to do that, although we still have the 
equipment at the libraries. It is outdated now because that was 
probably about 5 years ago, so the equipment is outdated now, 
but it still provides people that go in there with the ability 
to look at that equipment and say, ``I could use something like 
this,'' and then they contact us, and we can provide them with 
the newer equipment, so we still have a lot of equipment out at 
the libraries, although it is outdated, and getting funding for 
something like that or for adaptive equipment or services to 
adaptive equipment would be a godsend to people, especially in 
rural areas like my service area, because we call that program 
``Within Your Reach'' because people in very rural areas like 
that did not have the access that people in large cities have 
to different types of adaptive equipment, and we put that 
equipment in their back yards essentially, and they were able 
to look at that in the libraries in their own communities. That 
is priceless.
    Senator Casey. Bob, thank you.
    The Chairman. Senator Rosen.
    Senator Rosen. Thank you. Well, thank you so much for 
bringing this. Unfortunately, none of us is getting any 
younger. I think there is no glasses--there is no print that is 
too big for me anymore, but seriously, I took care of my 
parents and in-laws as they aged, so I have been through rehab 
and assisted living and all those kinds of things with my 
parents and my in-laws.
    Myself, I recently broke my wrist and had some challenges, 
although they are temporary. My husband had back surgery, so 
people do have all kinds of challenges, and as I sit here and 
listen to you, the things that I really think of are two really 
exciting areas that we could build our economy, build our job 
force. I said I see a ``Better Living Through Technology'' 
store chain out there somewhere that would be a place--you 
know, you see ``As Seen on TV,'' or some of those, that would 
be a great business venture. Anyone out there listening to 
these hearings, I would think this would be something terrific.
    The other thing that I really see--and we talk a lot about 
the people pipeline, and we talk about creating jobs, and so 
you think about all the things--not just that engineers do and 
designers, but we think about our physical therapists or 
occupational therapists and the people who work in not just 
senior facilities, assisted living, or in the care industry, 
but there are real places, I believe, that we could probably 
help fund and create certifications so then perhaps through 
Medicare and Medicaid there would be reimbursements for people 
to go into these types of fields that will help us all.
    How do you think you might see us adding some kinds of 
certifications perhaps, apprenticeships, ways that we can boost 
the people working in this area so they have a career that they 
would get paid from to do this kind of work that we are going 
to need for so many people?
    Dr. Coughlin. Senator Rosen, excellent thoughts and 
remarks. One of the challenges I think you will find in the 
education field is that while the technology, such as the smart 
technologies in the home for medicine, education, and the like, 
are advancing greatly, a study that we did in the lab showed 
that there was very few professionals being trained on actually 
how to use these technologies, so I would suggest that 
certification is not just a way to get people in the pipeline. 
Actually, most of the practitioners out there providing care do 
not know how to use the very systems that actually exist out 
there to improve our lives.
    Senator Rosen. Do you have a suggestion how we could maybe 
help our community colleges or what kind of vehicle could we 
use to train either people who are looking for new careers or 
our young kids wanting to go into a new career? What would you 
suggest that we could try to promote or discuss here from our 
bully pulpit?
    Dr. Coughlin. Just very quickly, and I will yield to my 
colleague here. Two things. One is to put it, as you do best, 
put it on their agenda. Perhaps funding is one of the things 
you can do, but more importantly I think is to actually 
highlight aging and life tomorrow as a positive issue. A good 
number of us have glasses. We are sitting here talking about 
special technologies, but these are the original assistive 
technology.
    Senator Rosen. Right.
    Dr. Coughlin. I put an Italian guy's name on the side, and 
suddenly everybody wants to buy these, sell them, and 
everything else. They are no longer that special thing. I think 
getting the idea that this is a new entire way of living that 
is exciting will get young students to want to commit to a 
profession that engages all of us in life tomorrow.
    Ms. McCarty. I think that is an excellent question. I am so 
glad you asked it because I think about this all of the time.
    First of all, I just want to say that I think there are a 
lot of young people today who are very interested in social 
impact design. The museum collaborates with a lot of design 
schools, and 30 years ago, when I did my first exhibition on 
the topic called ``Designs for Independent Living,'' it was 
difficult to find young people interested in this or even 
design schools. Today Cooper Hewitt has partnered with a number 
of schools and students doing prototype products. We included 
some of them in the exhibition, and they said that this has 
really impacted what they want to do in their career going 
forward, so I think the time is right. There are a lot of young 
people just interested in wanting to make a difference in the 
world today, unlike I have seen before during my life.
    Second of all, I am a caregiver myself, and I think about 
this all the time. I have spent several months when my partner 
was going through rehab, and my eyes, of course, were looking 
at everything and all the equipment. I asked a lot of questions 
of the therapist to train me so that when we went home, I would 
know how to lift him and do other daily tasks just helping him 
dress, et cetera, and that is not something that most people 
who are trained in, like a family member, somebody who gets a 
disability or somebody is discharged from a hospital, they are 
cared for in the hospital. Everybody is--there are high 
emotions just tending to the person. They do not know the 
questions to even ask when they go home.
    Senator Rosen. Would you say expanding this in the home 
health care certification----
    Ms. McCarty. I think the opportunity is enormous for jobs, 
and I am not talking high-level education jobs. It is really--
--
    Senator Rosen. That is what I mean, at the certification 
community college level.
    Ms. McCarty. Exactly, and I think the opportunities are 
immense, and I could just rattle off one example after the 
next, but it is really about learning how to just take care of 
people, their daily needs, so I know this is talking about a 
lot of high technology. There are a lot of low-technology 
things----
    Senator Rosen. Perhaps you might share those with us----
    Ms. McCarty [continuing]. that are very important.
    Senator Rosen [continuing]. when we talk about education 
and people pipeline, these might be some of the things we can 
take back to our community colleges and find ways that we can 
fund things or certify or ways that we partner a career with 
getting paid for that career, right? That is important.
    Ms. McCarty. Right. You know, we are doing a lot, we are 
paying a lot. We are doing a lot of medical research to keep 
people living longer, but that is just going to bring even more 
disabilities the longer people remain alive, so it is a big 
audience that we could really address.
    Senator Rosen. Thank you so much.
    The Chairman. Thank you.
    I am going to followup on the question that Senator Rosen 
just raised and direct it to Brenda, and that is talking about 
the challenges that you face and what the biggest challenge is 
as you try to do all of this planning.
    I know from talking with home health agencies in Maine that 
they feel stretched very thin, that there is a shortage of home 
health workers, and I would think that, in addition to the 
technology, that may be an important element as well. What is 
your experience about the biggest challenges?
    Ms. Gallant. Okay. Really, the biggest challenge is 
initially finding----
    The Chairman. I am sorry. I do not think your mic is on.
    Ms. Gallant. Yes, so what we are finding is finding 
affordable, accessible housing across the State is a real 
challenge. Additionally, as you said, the direct care worker 
shortage also makes it a challenge to be able to arrange home 
care services, which are so critical in terms of the planning. 
However, with the team that we have brought together, we are 
able to find housing. Usually 3 to 6 months is about the 
average time. We do have a housing coordinator through Alpha 
One, Maine's Center for Independent Living, that works on the 
housing, so really the team comes together to overcome these 
barriers, and it takes time, but we really can--as you can see, 
the assistive technology is such a critical part of this and 
really can supplement in terms of staffing, the remote 
monitoring can really help in terms of reducing the need for 
staffing, so it is really the team approach and being diligent 
in overcoming these barriers, and we found that we can--it may 
take some time.
    The Chairman. Thank you.
    Dr. Coughlin, let me pick up on a point that was just made 
about remote sensors. Obviously, this technology has the 
potential not only to allow individuals to live fuller lives 
and stay in their own homes, but in some cases, it may raise 
some privacy issues, and I would be interested in hearing your 
comments since you involve seniors on whether or not they are 
concerned about having sensors that monitor whether they open 
the refrigerator and thus are eating, for example, or cameras 
that can see them. Is that an issue that comes up? Or do people 
think the tradeoff is worth it?
    Dr. Coughlin. There is certainly an issue that comes up 
because think about the fact that it is not just your sensors 
in the house knowing that you are walking to your refrigerator. 
It is also your toilet talking about you as well. Input-output 
model is the best way to describe whether you are taking your 
medications, you are eating well, whatever, you know, the like.
    However, older adults tend to have, believe it or not, 
greater levels of trust than younger people in the institutions 
that might be so-called watching them, so yes, Senator, we have 
to balance dignity with independence, but one of the challenges 
that we see that older adults seem to be willing to do, which 
is I will give you some of my privacy if you give me some 
independence and safety.
    I will give you an analogy that many of us can identify 
with. How many of us can say we have a credit card in our 
pocket? We now know your price for privacy. My American Express 
probably knows more about me than my wife of 30-odd years.
    The Chairman. Well, anyone who goes online and does a 
search and then gets all those ads realizes----
    Dr. Coughlin. Yes, that is somewhere between cool and 
creepy.
    The Chairman. Yes, exactly. I think it tends toward creepy 
myself, but thank you. That is really very interesting.
    Ms. McCarty, did you want to add anything to that? Were 
those issues raised when you did your exhibits?
    Ms. McCarty. They were raised, and I got very similar 
reactions. Most people were very--the tradeoffs slanted more 
toward wanting the technology, but I know that it is definitely 
something that will be an issue and something that needs to be 
discussed.
    One of the products that we featured in the exhibit that 
required remote monitoring was pill taking and pill bottles 
with chips in them so that maybe a caregiver from afar could 
really monitor if somebody took their pills or not, which it is 
a real issue, you know, people not taking pills, but I mean, it 
is a real reason why many people are not getting better because 
they are not taking their pills for various reasons, so there 
are tradeoffs, but just like in the rest of society, we need to 
just keep talking about this.
    The Chairman. I should probably clarify my ``creepy'' 
comment. When I was talking about that, I was talking about the 
fact that when you are doing a search for a particular item on 
the Internet, you all of a sudden get all these unsolicited ads 
because your data is being sold or distributed. It seems to me 
that is very different from sensors that are helping you be 
independent, healthier, and live in your own home. I think 
there is a big distinction.
    Dr. Coughlin. If I may briefly, Senator.
    The Chairman. Yes.
    Dr. Coughlin. One of the other reasons we saw that the 
technology was accepted by older adults despite privacy 
concerns, if you can design systems that not only remind you to 
take your meds or to eat well on the more, shall we say, lower 
end of Maslow's pyramid, but also encourage a connection with 
family and friends, so yes, did you take your meds? And oh, by 
the way, Mom what was that recipe you used to use for cookies? 
So you can use a technology to engage people and reduce social 
isolation, and for that they are willing to tradeoff a little 
bit of privacy.
    The Chairman. Very good point. Thank you all.
    Senator Casey. Thanks very much, Chairman Collins.
    I will start with Ms. McCarty because you gave Pittsburgh 
and Pennsylvania such good publicity here, but I really open it 
up to the whole panel. The opportunity that we have when we are 
updating a law, sometimes every 5 years but sometimes a lot 
longer, like the Assistive Technology Act, in this case 15 
years, to give you a chance to, as you have already in one way 
or another, but to reiterate maybe in more of lightning round 
to say I hope you do the following when you are making changes 
to that act.
    I guess the basic question is how should we who are putting 
together legislation use this opportunity to update the act and 
make sure it is capable of making new technologies accessible 
for those who can benefit from them. Ms. McCarty, we will start 
with you, and anyone else who wants to add your 2 cents.
    Ms. McCarty. Well, I think that what is really important in 
this is that it be affordable, as has been mentioned, and the 
good thing, as we all know, is that a lot of our technology has 
been coming down in price. In fact, I think one could buy some 
of these devices for what it takes a family to buy groceries 
for a month. I mean, it is really quite staggering that it is 
so--it is mind-boggling what is in reach with us and what we 
can do with the technology.
    The other thing is: How do we get the information out that 
I mentioned earlier? That was something that just kept being 
reiterated over and over again, and I think that we can 
continue to be looking for positive ways to utilize the 
technology and to really listen to the users. That is where we 
are getting some of our best and most important information, is 
what the users need, and as I mentioned the example of the curb 
cut, a lot of these improvements that we can be making, if we 
use people with more challenging needs or complex needs and 
look at their needs and try to solve those, we are actually 
going to be solving a lot more needs of a lot more people, and 
I think that is the goal to really be striving for, is not just 
always looking at a targeted group of people. We are all going 
to age. We all get a disability at some point in our life, and 
rather than separating this group of people from this group, if 
we look at everybody together, but the more complex needs, I 
think that we are going to be much more inclusive rather than 
exclusive in what we are doing.
    Senator Casey. Thank you. Anyone else?
    Dr. Coughlin. I would chime in as well, Senator. I think 
accessibility is absolutely important. To pick up on 
accessibility, rural digital infrastructure, again, it should 
be part of the larger dialog here on the Hill with respect to 
infrastructure. We need to get these things into retail. This 
is where solutions are found by shoppers and by families and 
the like, so having a website that no one knows about, we need 
to solve what we say in Government is the smart buyer problem. 
Where is it? How is it? How much does it cost? Should I buy 
this one versus another?
    Also, I hear a lot about users. I want to introduce a whole 
larger discussion on influencers and buyers. Going back to the 
discussion, the future is female. The family caregiver, one in 
four American families provide upwards of 26 to 29 hours of 
care per week to an older adult out there. She is the one 
choosing. She is the one buying. She is the one making the 
tradeoff between life, work, job, career, and the like.
    Then last, if I may, I think that the bill that you are 
thinking of sounds like a great opportunity to also aim high. 
This is not about more older people requiring more of what we 
know about old age. This is an opportunity to have the Federal 
Government put a stake in the ground to say longevity is an 
opportunity to aim higher, to live longer, better. It is a 
market. It is a policy. It is a new vision of an older but 
still innovative America.
    Senator Casey. Thank you. Bob?
    Mr. Mecca. If I could say something as well, every State 
has an assistive technology program through the AT Act, and if 
you--you were asking what could be added into the new bill. I 
think a really good way is to--LIFT, Life and Independence for 
Today, as a Center for Independent Living, we are an assistive 
technology resource center for TechOWL, and there are several 
in Pennsylvania and I am sure across the United States. Every 
State has several ATRCs, we call them, and if you go to them 
and, you know, maybe they could talk with their consumers and 
see what people actually--what the need is out there, and what 
improvements they think could be used, that would be a very 
good outlet for you to, you know, see what is needed for the 
new bill.
    Also, Centers for Independent Living also serve people with 
disabilities of all ages, and you could go to each Center for 
Independent Living in general and ask that, you know, they go 
to their consumers with mobility disabilities or assistive 
technology needs and, you know, see what their thoughts are on 
getting what type of devices they need and so forth.
    Senator Casey. Bob, thank you.
    He gave me an opportunity to very proudly promote my State 
again. Now, what Bob is referring to is TechOWL, the Temple 
mascot, Technology for Our Lives, and you cannot see it from a 
distance, but all these categories, lending library, free 
special phones, used equipment exchange, information and 
assistance, emergency plans, so folks can go to TechOWL.pa.org 
for that, but it is really interesting what they are doing, and 
Bob works with them. Temple being in Philadelphia, you are 
hours away from them, but they have got a statewide presence.
    Ms. Gallant, I do not know if there is anything you wanted 
to add.
    Ms. Gallant. I would agree that I think it would be 
excellent to make sure that the Area Agencies on Aging and the 
Aging and Disability Resource Centers have the resources to 
provide information to older people about technology and 
perhaps funding to provide that, as well as Maine's Centers for 
Independent Living. I think that is a really important way to 
get the word out to people.
    Also, I just want to make sure that people that are in 
nursing homes and hospitals for extended periods of time have 
access to technology because we have shown that they can live 
independently through the Homeward Bound program. It saves 
money. The health outcomes are improved. Quality of life is 
improved. We have seen people come out of nursing homes after 
15 years, and actually the 141 people that we have served, the 
average length of stay in a facility was 2 years. However, we 
have had some younger people, 15 years, who went out into the 
community, and the people I have described that you would not 
think could be in the community but for the technology, along 
with the other supports, so to make sure the funding is there 
to provide the technology to make this possible, because people 
do want to be independent.
    Senator Casey. Thank you.
    The Chairman. Ms. McCarty?
    Ms. McCarty. Thank you. One more thing I would like to add, 
because it is something that I hear over and over again from 
designers, is that what can we do to incentivize manufacturers 
to take this on and produce these products and work with 
designers and people to really bring--to produce some--so many 
designers recount stories of working on a product, and it is 
all tooled up, ready to hit the button to be mass produced, and 
then suddenly the brakes are put on for various reasons, and I 
have heard that over and over again, where a product goes into 
production, has a very, very short life, even though it is a 
really good one, and I think that would be really important if 
we could find ways to incentivize manufacturers.
    A store like Target, just 2 years ago we featured one of 
their adaptive clothing items in the exhibition, and Target, 
which really is--their products are affordable to many, many 
people, they have now a line of adaptive clothing that just 
continues to sell out immediately for mostly children at this 
moment, children with various types of disabilities, but they 
are showing that it really does work.
    The Chairman. Thank you very much for adding that.
    Ms. Gallant, I am so glad that you told us of the example 
of someone who had been in the nursing home for 15 years and 
was able to transition due to the excellent planning that your 
office did and the use of assistive technology. That is just so 
encouraging, and your 2-year average is also impressive because 
I must say that when I first learned about your program, I 
assumed it was people who were in for less than a year, for 
short stays, so that is so encouraging and really underscores 
the value of the work that you are doing, so congratulations 
for that.
    I want to thank all of our witnesses for traveling to 
Washington today and increasing our understanding of how 
technology is improving the lives of older Americans and those 
with disabilities. For me, the bottom line is accommodating 
people's preferences and allowing them to live fuller lives, 
and in most cases that means staying in the privacy, security, 
and comfort of their own home, and I am excited by what I have 
learned today, by the array of technology, but I have to say if 
a lot of this is new to those of us who serve on the Special 
Committee on Aging, I cannot imagine that many of our 
constituents realize what is out there, and that is why I think 
that the work that is being done at the State level and by Mr. 
Mecca's group as well as in the great State of Maine is so 
important, but so is the technology development at MIT, the 
vision of an economy where we embrace those who are growing 
older and improve their lives and look at the job implications 
of this that Dr. Coughlin met and, Ms. McCarty, your exhibition 
cannot be understated how valuable that is for people to see 
it.
    At the risk of telling a personal story, but since Senator 
Rosen did, I am going to follow. A couple of years ago, I very 
badly broke an ankle and had to have surgery, and I have eight 
screws and a plate in it, and when they told me they wanted me 
to use a walker and I looked at the walker, I would only use it 
inside the house because it was---if I had one of those cool 
walkers that ironically are developed by the University of 
Maine, I would not have felt nearly as self-conscious, and when 
I came back--I used a can way before I was supposed to because 
I just wanted to get rid of that walker.
    Seeing the design options now are so exciting and embracing 
it and making the prosthetic limbs almost a fashion statement 
is--it is really exciting and I think really makes a difference 
to people.
    As someone who cosponsored the bill to provide over-the-
counter access to hearing aids, I was very excited to see the 
fact that you are embracing the hearing aid and using it as a 
fashion statement. That was just so fascinating to me.
    I very much look forward to working with Senator Casey on 
the 21st Century Assistive Technology Act and to reauthorizing 
the EMPOWER Act that has been mentioned as well. We want to 
make sure that these technologies reach older Americans and 
those with disabilities.
    Before I turn to Senator Casey for his closing comments, I 
want to pick up on something that Dr. Coughlin said, and that 
is the fact that we lack in the Federal Government a central 
place that can focus on these technologies in a more 
comprehensive way, and that is something I would be very 
interested in working further with you on, and perhaps we could 
include that in the legislation that we are introducing and 
that you have been the lead on. I think that would really help 
as well.
    Dr. Coughlin. We would be delighted to help. Thank you.
    The Chairman. Thank you.
    Senator Casey. Thank you, Chairman Collins.
    I want to thank the Chairman for holding this hearing on 
assistive technology. I obviously want to thank our witnesses 
for being here, for your testimony, and for the effort you made 
to be here with us and to provide your expertise, experience, 
and insight. You have provided us with important examples about 
how older adults, people with disabilities, and their 
caregivers can benefit from a variety of assistive 
technologies, and also how high-and low-tech solutions can be 
used to enable people to remain independent and socially 
connected to their families and their communities, especially 
in rural areas of our State and our country.
    I also want to thank the folks in the back who are from 
this region, from Maryland, the District, and Virginia, for 
bringing assistive technology not only here to the Capitol but 
here in this hearing room so that we could see this technology 
and see it up close.
    I look forward to working with Chairman Collins and other 
colleagues in the Senate to make sure that this technology gets 
into the hands of those who need it.
    I was struck by so much of the testimony today, but I 
wanted to point out one line from Bob Mecca's testimony. He 
said at the top of page 2, quoting where he was at this point 
in his life, he said, ``If I had not had access to these 
priceless pieces of [assistive technology], I would have been 
stranded in my living room looking at the same four walls for 3 
to 4 months, as I only had the use of one arm.''
    Many people in our families and our communities throughout 
our Nation are often imprisoned by a disability or in some 
cases more than one disability. Assistive technology unlocks 
them from that prison, and we have got to do everything we can 
as we learn about this technology, as we expand the universe of 
ideas, to make sure that as we are working on legislation that 
we keep in mind those individuals who can be very much isolated 
without that technology.
    Chairman Collins, thanks for having the hearing, and we are 
looking forward to working with--or continuing to work with you 
on these issues.
    The Chairman. Thank you very much, Senator Casey.
    Members of the Committee will have until Friday, May 31st, 
to submit additional questions for the record. If we get any, 
we will send them your way.
    Once again, I want to thank each of our witnesses for being 
here today. You really were terrific in enhancing our 
understanding, and I also want to thank our staff for their 
hard work and insights.
    Thank you very much, and this hearing is now adjourned.
    [Whereupon, at 11:02 a.m., the Committee was adjourned.]

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                                APPENDIX

   
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                      Prepared Witness Statements

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                       Statements for the Record

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