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94–289 PDF 2004

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

(

SPECIAL COMMITTEE ON AGING 

LARRY CRAIG, Idaho, Chairman 

RICHARD SHELBY, Alabama 

SUSAN COLLINS, Maine 

MIKE ENZI, Wyoming 

GORDON SMITH, Oregon 

JAMES M. TALENT, Missouri 

PETER G. FITZGERALD, Illinois 

ORRIN G. HATCH, Utah 

ELIZABETH DOLE, North Carolina 

TED STEVENS, Alaska 

RICK SANTORUM, Pennsylvania 

JOHN B. BREAUX, Louisiana, Ranking 

Member 

HARRY REID, Nevada 

HERB KOHL, Wisconsin 

JAMES M. JEFFORDS, Vermont 

RUSSELL D. FEINGOLD, Wisconsin 

RON WYDEN, Oregon 

BLANCHE L. LINCOLN, Arkansas 

EVAN BAYH, Indiana 

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) 

(1)

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 chalVerDate 0ct 09 2002 11:43 Jul 13, 2004 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 C:\DOCS\94289.TXT SAGING1 PsN: JOYCE
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lenge 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. 

3

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 

4

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 

5

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 

6

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 

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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. 

69

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 

82

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. 

83

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 

41⁄2 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 dementiarelated 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 

94

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 longterm 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. 

104

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,’’

128

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. 

129

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. 

130

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, 

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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? 

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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 

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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 imporVerDate 0ct 09 2002 11:43 Jul 13, 2004 Jkt 000000 PO 00000 Frm 00137 Fmt 6633 Sfmt 6633 C:\DOCS\94289.TXT SAGING1 PsN: JOYCE
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tant, 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 

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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. 

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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, 

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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 

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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 

139

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. 

140

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 savVerDate 0ct 09 2002 11:43 Jul 13, 2004 Jkt 000000 PO 00000 Frm 00144 Fmt 6633 Sfmt 6633 C:\DOCS\94289.TXT SAGING1 PsN: JOYCE
141

ings. 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? 

142

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 

143

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 

144

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.] 

(145)

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