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88–497 PDF 2003

S. HRG. 108–108

BABY BOOMERS AT THE GATE:

ENHANCING INDEPENDENCE THROUGH

INNOVATION AND TECHNOLOGY

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING 

UNITED STATES SENATE

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

WASHINGTON, DC

MAY 20, 2003

Serial No. 108–11

Printed for the use of the Special Committee on Aging

(

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 John Breaux ........................................................................ 2

PANEL I 

Josefina G. Carbonell, Assistant Secretary for Aging, U.S. Department of 

Health and Human Services, Washington, DC ................................................. 3

PANEL II 

Maria Greene, Director, Georgia Department of Human Resources, Division 

of Aging Services, Atlanta, GA ........................................................................... 28

Kevin J. Mahoney, Ph.D., National Program Director, Cash and Counseling 

Demonstration and Evaluation Project, Chestnut Hill, MA ............................. 48

Ronald H. Aday, Ph.D., Director of Aging Studies, Middle Tennessee State 

University, Murfreesboro, TN ............................................................................. 69

Gregory D. Abowd, Ph.D., Associate Professor, College of Computing, and 

GVU Center Director, Aware Home Research Initiative, Georgia Institute, 

Georgia Institute of Technology .......................................................................... 83

APPENDIX 

Statement from Center for Aging Services Technologies, American Association 

of Homes and Services for the Aging .................................................................. 107

Statement from Tobey Gordon Dichter, Founder, CEO Generations on Line .... 113

(III) 

(1)

BABY BOOMERS AT THE GATE: ENHANCING 

INDEPENDENCE THROUGH INNOVATION 

AND TECHNOLOGY 

TUESDAY, MAY 20, 2003 

U.S. SENATE, 

SPECIAL COMMITTEE ON AGING, 

Washington, DC. 

The committee convened, pursuant to notice, at 2:05 p.m., in 

room SD–628, Dirksen Senate Office Building, Hon. Larry Craig 

(chairman of the committee) presiding. 

Present: Senators Craig and Breaux. 

OPENING STATEMENT OF SENATOR LARRY CRAIG, CHAIRMAN 

The CHAIRMAN. The Senate Special Committee on Aging will convene. Let me first of all thank our panelists for their flexibility in 

meeting the scheduling change that we had that pushed this hearing into the afternoon. I want to thank you for that. 

Also, I want to thank Senator Breaux for being here. Yesterday, 

he held, I think, a very successful hearing by all accounts dealing 

with senior access, and certain protocols and other activities that 

relate to the formulation and development of pharmaceuticals and 

other interests and issues. 

Both John Breaux and I work to share this committee and its authority. We think this is certainly an issue for all Americans. It is 

not a partisan issue. The business of aging, I think we find that 

Democrats and Republicans age at about the same rate. [Laughter.] 

Senator BREAUX. I’m aging faster. [Laughter.] 

The CHAIRMAN. Just wanted to check him out and see if he was 

awake there. No. 

But good afternoon to all of you. I am pleased to convene this 

hearing in recognition of Older Americans’ Month and to explore a 

wide range of policy issues impacting older Americans and their 

families. Such an ongoing dialog is imperative since the first wave 

of baby boomers will turn 60 in less than 3 years. 

Today, we will hear testimony from various innovative thinkers. 

We will hear about the Older Americans Act and the Family 

Careviger Program, a new approach to Medicaid service delivery, 

plans for modernizing our nation’s senior centers, and the technological opportunities available to seniors. 

It is estimated that in 2006, over three million baby boomers will 

turn 60 and become eligible for older Americans services. This new 

wave of seniors will have a very different set of characteristics from 

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the previous generation. It is, therefore, critical that we in Congress review and design national policies to address these new demands. 

I believe the central strategy for meeting the new challenges of 

the 21st century is that of innovation, new and bold programs and 

technologies that enhance independence for all older Americans. 

Today’s testimony will highlight some of these innovations. 

We will hear about the Older Americans Act and its newest addition, the National Family Caregivers Program. It is well known 

that family caregivers are on the front lines of long-term care for 

older persons in this country. It is important that these programs 

continue to evolve and assist family caregivers so they can meet 

the challenges of caring for loved ones in their own homes. A new 

approach in providing these services to caregiver will be shared 

with us today. 

I look forward to the testimony on Medicaid consumer-directed 

services pilot project, a new concept that allows seniors and their 

families to direct their own care. An example of a self-directed service is that of cash and counseling program, which will allow older 

persons who have trouble managing their finances to hire a financial manager of their choice. 

National Senior Center Week, which ended last Sunday, was a 

national recognition of the importance of senior centers. Of equal 

importance is the need to vigorously explore a new vision for our 

nation’s senior centers. Although senior centers are created and 

funded at the local level, they serve as critical delivery points for 

various Older Americans Act services. I look forward to the testimony on how senior centers will evolve to meet the interests and 

the demands of a new generation of older Americans in the 21st 

century. 

Finally, assistive technologies are also becoming a major tool for 

older Americans. Promising areas of computers to human interaction that will allow older Americans to live more independently 

will be discussed. 

So before I turn to and introduce our first witness of our panel 

this afternoon, let me turn to my colleague from Louisiana, the 

senior Senator, John Breaux. John. 

OPENING STATEMENT OF SENATOR BREAUX 

Senator BREAUX. Thank you very much, Mr. Chairman. Thanks 

again for holding today’s hearing. I would just point out how important it is to talk about where we are headed. We are truly in a perfect storm, if you would, as far as the aging of America is concerned in the sense that we are about to receive a huge number, 

the largest in generations, of individuals who will be becoming eligible for senior programs, 77 million baby boomers. On top of the 

large number of people who are going to become eligible, that large 

number of people are living a lot longer than any other generation 

in American history. So we have a double problem of having a lot 

more people who will live a lot longer. 

I have jokingly said many times said that good news and the bad 

news is that people are living a lot longer, and the bad news is that 

people are living a lot longer. How will we take care of them? Who 

is going to pay the bills? How much is it going to cost? How are 

3

we going to be able to do what we as a society need to do with regard to allowing people to live not just longer lives, but also 

healthier lives and happier lives as they get older? 

So that is the real challenge of America, among the most serious 

challenges, and everything seems to be coming together at one 

time, which is truly a perfect storm as far as the geographics are 

concerned. So hopefully, we will hear some ideas today about how 

to address these problems. Thank you. 

The CHAIRMAN. John, thank you very much. 

Our first panel today is Assistant Secretary Josefina Carbonell. 

Josefina, welcome before the committee. The Assistant Secretary 

will discuss issues related to the Older Americans Act, will address 

the rebalancing of the long-term care system, the importance of 

family caregiving and the challenges the Older Americans Act programs face in the demand of the new baby boomers, much as my 

colleague has referred to. 

So with that, Assistant Secretary, welcome. 

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

HUMAN SERVICES, WASHINGTON, DC 

Ms. CARBONELL. Thank you very much, Chairman Craig, Senator 

Breaux, and members of the committee for inviting me to testify 

at this very important hearing. It is especially important during 

Older Americans’ Month. This month, and this year’s theme, is ‘‘What We Do Makes a Difference.’’ As we have discussed before, both globally and here in the U.S., 

we are witnessing one of society’s greatest achievements, an extension of longevity due to advancements in medicine, public health, 

and technology. At the Department of Health and Human Services, 

we are updating and reenergizing old programs and developing 

new ones that empower and serve older Americans in their communities. 

Also I am pleased to announce that today, the Departments of 

Labor and Health and Human Services have transmitted a Report 

to Congress that examines the future supply of long-term care 

workers in relation to the aging baby boom generation. Ensuring 

the adequacy and the availability of direct care workers is a critical 

goal of the Administration and we have been taking steps to prepare for the increased demand for direct care workers. Our report 

recommends how to retain existing long-term care workers and attract new pools of them. It urges continued support of many of the 

Bush Administration’s existing efforts to address the growing demand for long-term care workers. 

Let me begin with the Administration’s initiative aimed at rebalancing the long-term care system to create real choices in home 

and community-based care. Currently, 75 percent of public longterm care funding goes to institutional care, while many people 

prefer to remain at home. 

Our guiding principles for caring communities are that we give 

seniors and family caregivers affordable choices and options; that 

they have control over their consumer choices and what kinds of 

programs they wish to access; that the information is there for 

them to access the programs; that we make sure that we support 

4

the family caregivers, one of our key components of the rebalancing 

long-term care system initiative; and that quality services be available. 

In the 2004 budget, the President has proposed a $1.75 billion 

program titled ‘‘The Money Follows the Person Rebalancing Initiative,’’ as well as State systems change demonstrations that promote 

home and community-based care alternatives. These initiatives 

represent an historic turning point in Federal long-term care policy. 

Shortly, the Administration on Aging and CMS will jointly issue 

a competitive grant announcement to develop one-stop shop resource centers. This program will make it easier for consumers to 

learn about and access existing long-term care options, including 

alternatives to institutional care. 

Family caregivers are a key component to ensuring that older 

Americans can continue to remain at home. More than 23 million 

Americans are providing assistance to a family member, and interestingly enough, 30 percent of the current workforce is caring for 

a relative. If we were to pay for these services, it would cost $257 

billion per year. This is more than the amount spent on formal 

home care and nursing home care combined. 

According to our national data, one out of four caregivers report 

difficulty providing care because of their own physical limitation. 

More than six in ten take care of someone who is at least 75 years 

old. Eighty-eight percent report that our services have helped them 

provide care longer, and 95 percent of our caregivers are very or 

somewhat satisfied with the services that they have received. 

At listening sessions in communities throughout the country, I 

hear the recurring difficulties. Whether it is the 51-year-old son 

who is the sole caregiver for his blind mother, the 80-year-old 

woman who is struggling to bathe, feed, and care for her 102-yearold mother, or the grandmother who lives on a working farm in 

Idaho and is struggling to take care of her grandchildren, the message is the same. Just give me a little help, a little hope, a little 

relief, and I can take care of my loved one in my own home. Caregivers tell me that the Family Caregiver Program is the best program that the government provides and many people have thanked 

me with tears in their eyes. 

Let me just share a couple of other personal stories. A disabled 

individual is caring for his wife with Alzheimer’s and in need of 24-

hour care. With help from the Arkansas Caregiver Program, she is 

bathed and gotten ready to attend adult day care. This results in 

time for him to receive his own therapy and attend to his own 

needs. Twice, an elderly Kentucky grandmother had put off needed 

surgery because she would be unable to care for her 11-year-old 

grandson. The program arranged for home care and personal care 

for her own needs following the surgery. The North Carolina program installed a wheelchair ramp in the home of a daughter so 

that she could get her father in and out of the house without having to carry him. 

Technology is also playing a very important role in addressing 

the two greatest concerns of caregivers, safety in the bathroom and 

transporting the care recipient. Things from non-skid surfaces to 

grab bars and other safety features are being installed in bathVerDate 0ct 09 2002 13:31 Sep 10, 2003 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6633 C:\DOCS\88497.TXT SAGING1 PsN: JOYCE
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rooms and in homes across this country. Videos are instructing 

caregivers on the best way and the safest techniques for getting 

disabled individuals in and out of vehicles. Nurses are electronically monitoring frail elders and their caregivers in between doctors’ visits. 

So you see that the caregiver program is really creating a new 

way of doing business in the aging network by focusing on caregivers while allowing consumers to have choices. 

Our data further indicates that over 3.8 million caregivers have 

been empowered with information in the last year and approximately 436,000 caregivers have been served, far exceeding our target of 250,000. Significant numbers have also been reached with intensive direct services in counseling, training, respite, and many 

other supplemental services. 

We look forward to releasing the complete caregiver report at our 

national summit in September, which is designed to strengthen the 

capacity of State and community service networks. 

Today, I am delighted to release the new PSA called, ‘‘Who Cares 

for the Caregivers?’’ currently being sent to over 3,000 stations 

throughout the country. We would like to let you be the first to preview this 30-second spot following my testimony. 

As you see, the administration is taking comprehensive action to 

prepare for the aging of the baby boom population. An important 

component of this effort will be the National Aging Services Network, which is well positioned with assets to shape our future, including a deeply ingrained focus on the consumer; on commitment 

to early intervention and the social model of care; a national network grounded in the community and capable of delivering an extensive array of low-cost services; a proven track record in 

leveraging resources; and the capacity to reach out and serve private-pay consumers as well as consumers who are low-income, culturally diverse, and isolated. 

We cannot afford to maintain the status quo. By working together to create systems of care at home as well as institutional 

settings, we can develop a comprehensive approach to health and 

long-term care that truly reflects the needs and preferences of older 

Americans. 

Now is the time to join forces to ensure that the promise of independence, choice, and dignity is fulfilled for all Americans. Thank 

you very much, and I would be pleased to answer any questions 

you might have. 

The CHAIRMAN. Thank you. You had a video that you wanted to 

show? We will watch this first. [A videotape was shown.] 

Well, that was simple and straight forward. Thank you. That obviously communicates a very clear message. Thank you very much 

for your testimony, Madam Secretary. 

[The prepared statement of Ms. Carbonell follows:]

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The CHAIRMAN. Currently, would an 80-year-old woman, say, 

taking care of her 55-year-old disabled daughter be able to receive 

family caregiving services? 

Ms. CARBONELL. Any person over the age of 60 can receive any 

kind of benefits from the Older Americans Act, from 3(b) supportive 

services in senior centers, adult day care, home care, respite, to 

meals and other services that are provided under the Act. So the 

answer is yes, Senator, an 80-year-old woman can receive respite 

services and other supportive services available through the entire 

service network provided under all the titles in the Older Americans Act. 

The CHAIRMAN. In your view, how will the Older Americans Act 

need to evolve to meet the demands of this new wave of boomers 

that we are talking about and the demographics of them, I guess 

I would say, different from previous generations that we hope are 

currently covered under existing law? 

Ms. CARBONELL. As indicated, of course, in our written testimony 

and as we heard from both Senators speaking about the tremendous challenge ahead of us, I think we are looking at a future 

where the senior centers will look a little different than the senior 

centers for my mother and my grandmother looked 20, 25 years 

ago. 

So we are looking at how senior centers are evolving in many 

communities across this country. We are looking at more a comprehensive holistic approach to the scope and the availability of 

services. We are looking at a transformation from just serving an 

older population, to serving a multi-generational population and 

becoming more like community and family centers. 

So, therefore, the appeal across generations is going to be critical 

as the challenges of the baby boom generation evolve. We are going 

to see the availability or the need to provide better choices, to have 

better linkages, through technology, to caregivers across the country. That is why the new Family Caregivers Program has given us 

the ability to add an additional component to our base programs 

to ensure that we are serving the younger caregiver, or the caregiver aging with multiple generational challenges. 

We are looking at the possibility of many of the senior centers 

having both health clubs and Starbucks coffee houses and community houses where people will remain active within the community 

for a multi-generational purpose. 

We need to ensure that senior centers of the future, obviously, 

continue to address many of the challenges of the health needs to 

maintain people healthy and active in their communities. We need 

to ensure that the nutrition program, which is one of our key programs within the Older Americans Act, continues to evolve and improve to ensure that we get better outcomes on reducing malnutrition and improving health outcomes for individuals. Also, the availability of leisure and volunteer activities, employment opportunities, where they can seek a homemaker that can assist them at 

home, but at the same time maybe seek a part-time employment 

or volunteer opportunity in their community. 

The CHAIRMAN. I don’t think there is any question. I have had 

several discussions over the last couple of years about the design 

of the new center as really a point of full contact for seniors and 

22

the services that are provided for them and their needs, certainly 

unique and different from the kind that we see today. 

Dominant in my State of Idaho in many senior centers is a quilting room. Quilting, obviously a delightful art form and a pastime 

of many older Americans and now has become almost a modern art 

form again. But ironically, the newest request to go in beside that 

quilting room is a computer room. 

Ms. CARBONELL. Absolutely. 

The CHAIRMAN. With about 11 million seniors now online, I think 

it demonstrates even more that kind of transition. 

The Administration on Aging has been working on performance 

outcome measures for services provided under the Older Americans 

Act. Can you please give us an update on your progress as it relates to those reviews? 

Ms. CARBONELL. We are very excited with the outcomes that we 

are generating. We have taken a step back and really readdressed 

our issues of reporting. So we have taken a first job at ensuring 

that we reduce the reporting formats for programs to ensure that 

we get the kind and the quality of data that we need, not excessive 

data with no outcomes at the end. 

Not only are we reaching the numbers of individuals that we set 

our goals to reach, just in the actual production of the numbers, as 

we saw with the National Family Caregivers Programs, but we are 

making a difference, ensuring that we target—a high percentage to 

those most at risk or those most vulnerable. 

For instance, 30 percent of the clients served in the Older Americans Act programs are elderly poor. That means that we are targeting our priority to those in most need. We also are over-serving. 

Thirty percent of the clients are in rural communities, compared to 

24 on a national basis. In particular, States where we know that 

the rural issues are critical, with our new National Family Caregivers, we are expanding our availability to have comprehensive 

collaborations with the health care providers and others in the 

community that we had not had the opportunity to do. We are serving a large percentage of people that are from minority at-risk communities. 

We are leveraging some interesting dollars. Even with States’ economic downturn, overall States are leveraging about $2 for 

every $1 of the AOA dollar put in many of the States. For intensive 

services, like in-home care, we are leveraging $3 to every $1 AOA 

dollar. 

We are seeing excellent increases in recruiting of volunteers for 

the senior Medicare patrols, as well as who are ombudsmen within 

the communities, and improving the outcomes of the Ombudsman 

program by working together with CMS on their new quality initiative, both in the nursing home and obviously in the home health 

area. 

The CHAIRMAN. Thank you. Will you do a white paper on those 

findings, or how will they be reported to us? 

Ms. CARBONELL. They will be reported—we have an annual report which is our own specific annual report—— The CHAIRMAN. It will show up in those? 

Ms. CARBONELL [continuing]. That we are proud to—it is hot off 

the press. 

23

The CHAIRMAN. OK. 

Ms. CARBONELL. It is not out. It will be out at the end of this 

week, but we have brought a copy that we will leave with you. 

The CHAIRMAN. Fine. 

Ms. CARBONELL. In addition, the final outcome data of the national surveys, which is a new survey that has been added to the 

outcome measurements and performance data, will be ready later 

this summer, and those will be released and we will be glad to provide them to Congress and to the Chair. 

The CHAIRMAN. Super. Thank you. 

I am going to turn to my colleague, Senator Breaux. A vote has 

just started. I am going to run and vote and come back and we will 

do tag team here so that we can keep our hearing going. John? 

Senator BREAUX. Thank you, Mr. Chairman. Thank you, Madam 

Secretary. 

You mentioned in your testimony that the President’s budget for 

2004 requests for CMS a $1.75 billion program to encourage a transition of people from nursing homes or other long-term care institutions back to the community, and you correctly point out that we 

really have an institutional bias in long-term care in this country 

in keeping people in institutional care. An awful lot of people, in 

fact, need long-term, 24-hour-a-day, 7-day-a-week care, but there 

are an awful lot of them that are in institutional care like nursing 

homes that don’t need to be there. 

Yet, almost 75 percent of all the money we appropriate is being 

used principally through the Medicaid program to put people in 

nursing homes. It is really an embarrassment, because you have 

got to spend yourself poor to get money to get long-term care, 

which is a real embarrassment as a society, but that is a whole 

other point. 

How would the money that the President is proposing be used to 

end this institutional bias that we are talking about? 

Ms. CARBONELL. Well, I think that—not only the rebalancing initiative, but several other initiatives, including the New Freedom 

and the systems change grants, have allowed and are beginning to 

allow many States the opportunity to begin to rebalance their systems. In the rebalancing proposal, the opportunity, if they wish, to 

invest in shifting folks from a nursing home into home and community-based care. It provides a 1-year, 100 percent Federal reimbursement for all costs to move and to pay for services to move individuals from a nursing home into home and community-based 

care. That is virtually how we envision the framework that was 

proposed to Congress for the 2004 budget. 

In anticipation of those changes, we have been working and there 

have been system choice grants already given out to States which 

have allowed States to begin to address removing barriers, institutional and infrastructure barriers, that prevent individuals from 

living independently in their own homes. So it has addressed structural changes and reimbursements at the State level for making 

those changes, both policy and resource-wise. 

Senator BREAUX. Of course, the problem at the State level is that 

the States can do that now simply by requesting a waiver from 

HHS to use their State Medicaid funds for non-institutional care, 

like assisted living facilities. The problem has been that they don’t 

24

want to do it. The problem has been that they have a bias toward 

nursing homes, in many cases because of the political strength of 

the nursing homes that prevent legislators from allowing them to 

make the request. 

My concern is I don’t understand how this is going to help the 

situation, because the problem is with the States not wanting to do 

it. They can do it now. 

Ms. CARBONELL. Well, they can do it now, right now, Senator, 

but the current reimbursement mechanism would be the same 

match that the States have at the current time. With the rebalancing proposal, it provides 100 percent Federal reimbursement to 

States for one year, so they can begin to shift it. That, coupled with 

the fact that the Administration on Aging is partnering with CMS 

to create, again, the involvement of a single-entry or one-stop-shop 

place where people can turn for help and assistance, where there 

will be one single entry point in the system to long-term care, that 

will allow the individual better choices. Right now those programs 

are fragmented. 

So some States, a few of the States, have their long-term care 

system, including their Medicare waiver programs, managed by the 

aging network, the aging State unit. But the rest of the States 

have, of course, their Medicaid waiver and long-term care program 

managed by their State health or Medicaid agency. 

Senator BREAUX. So are we saying that under this proposal, the 

State would get the same amount of money under Medicaid plus 

the States would divide up $1.75 billion in addition to be used for 

non-institutional care? 

Ms. CARBONELL. Correct. That means that it is an historic investment, a change in the way that we offer incentives to States 

to begin to shift policy and resources to home and community-based 

care to create more balance. 

Senator BREAUX. This is not a subtraction from what they would 

normally get under Medicaid? 

Ms. CARBONELL. This proposal is an addition and it is 100 percent for one-year. This one-year reimbursement at 100 percent for 

States wishing to pilot and to begin to shift policy and programs 

to home and community-based care. 

Senator BREAUX. So a State will get 100 percent with no State 

match to allow them to move out of a nursing home? 

Ms. CARBONELL. For the first year, sir, yes, and the rest of the 

years, it comes back to the State match as stipulated. 

Senator BREAUX. Why are we doing a 100 percent match? Aren’t 

we just telling the States we are going to pay 100 percent of the 

cost if somebody moves out of a nursing home? 

Ms. CARBONELL. Well, this is an historic turning point——

Senator BREAUX. It certainly is. 

Ms. CARBONELL [continuing]. We feel very confident that a 1-

year, coupled with other supports will help. I am not CMS so I 

defer that kind of question to my colleagues—— Senator BREAUX. What happens, then, if we do it for 1 year and 

a State moves 20 percent of their nursing home population into an 

assisted living facility and the Federal Government picks it all up? 

What happens to those people when the Federal Government sunsets it after one year? 

25

Ms. CARBONELL. Well, in those States where we have seen the 

experience of shifting resources, a consolidation of resources and 

programs into one single entity for long-term care, the experience 

and the studies and the data have shown that they have actually 

reduced their costs in general, and have improved the number of 

people being able to be served under home and community-based 

services by mixing of services available both in-home and community-based care and nursing home. 

So that means that, No. 1, people have been able to successfully 

be transitioned out of nursing homes into home and communitybased care programs. We know that the data shows that those 

States that have invested dollars in shifting to home and community-based care have done so cost effectively and have been able to 

continue to do so. 

Senator BREAUX. I have no qualms with the principle that it is 

cheaper and, I think, more convenient and a better degree of care 

for a large number of people to be in non-institutionalized care. I 

think that is what we ought to be encouraging States to do, something that they can do now but they don’t in most cases. 

I need to learn more about this $1.75 billion and how it would 

actually work. I think it is the right thing to try and ultimately accomplished. I am not certain that this is the best way to do it because I am concerned about if we do it to them for one shot and 

then the next year it is not there, they are going to be left with 

an awful lot of people hanging in facilities that they didn’t think 

they were going there for one year. All of a sudden, the money is 

not going to be there in the second year and what happens to all 

of those people? 

Ms. CARBONELL. We would like to follow up with you, Senator, 

and bring you additional information with my colleague at CMS, 

Tom Scully. Obviously, that is not just the only thing it involves. 

Obviously, our role at the Administration on Aging is that the administration and the aging network is one of the largest providers 

of home and community-based care throughout this country and we 

are ready, we are experienced, we have proven to be cost effective, 

and we are ready to take on the next step, which means work collaboratively, partnering with CMS, because you have got an existing structure that is evident throughout 29,000 providers and communities. We are doing it for the grant monies right now and in 

many cases, about 30 percent of the States, the aging network is 

managing and operating the Medicare waiver home and community-based care services in communities. 

So we are—the one-stop-shop initiative will give us the ability to 

partner with CMS to ensure that we integrate the service systems 

at the community level and that we incentivize and award competitive grants that will be released later on this month to do just that, 

to begin to shift—— Senator BREAUX. We will follow up on that. 

Ms. CARBONELL. Thank you. 

Senator BREAUX. You are aware, apparently, of our hearing yesterday, because you reference it in your testimony. I think that 

what we learned yesterday is that there is an enormous bias in 

America, in our own country, against seniors in a lot of areas. One 

of the most important areas is the general area of health care. 

26

Our medical schools do not have enough geriatric degrees. Only 

five schools in the entire United States medical schools out of 125 

have full departments of geriatrics. Yet all of them have full departments in pediatrics. 

We have clinical trials for prescription drugs that are ongoing 

that do not fully utilize, if hardly at all, seniors in the testing, even 

though most of the people who take prescription drugs, over half 

are seniors, but they are not involved in the clinical trials to develop the drugs and to ensure that they are safe. 

We have a bias and a lack of utilization among seniors in preventative care programs that are available to others. We have, I 

think, a lack of understanding of depression among seniors. The 

highest suicide rates in this country is not among teenagers but 

among seniors, and we had testimony that doctors don’t recognize 

it because they haven’t been trained. Too many times, seniors are 

just dismissed as being, well, they are old people. They are going 

to die anyway. 

I think that we as a society need to be striving for not just getting seniors to live longer, but to live better lives. I have said it 

a million times. Part of living better lives is to make sure that they 

have access to the same type of quality preventative services and 

health services that someone who is in their 20’s or 50’s or even 

younger. 

So, I mean, what can the Administration on Aging, when you 

look out over America and you see this discrimination against 

aging and people who are seniors, what can the Administration on 

Aging do to become a leader in this area, to eliminate these biases 

that currently exist? 

Ms. CARBONELL. At the Administration on Aging, obviously is the 

chief advocate for aging and older Americans across the country, 

we not only are taking a chief advocacy role, but we are actually 

running programs and collaborating with other agencies to ensure 

that we begin to tear down those barriers that ensure not only 

quality of care for our seniors, but a better quality of life, obviously. 

If you look at the report released today on, long-term care workers in relation to the aging baby boom generation, you will see substantial recommendations in to Congress based on the kinds of urgency that there is to address not only the shortages of professional 

workers, but also ensure that paraprofessional quality training continues to happen. 

We are working with HRSA inasmuch as the Health Resource 

Services Administration is addressing geriatric education in their 

2003, spending approximately $12 million in continuing to fund 

geriatric education centers across this country. 

We are working with the Agency for Health Research and Quality, AHRQ, to ensure that there is safety in medications and that 

the medications’ overuse is addressed and the safety and products 

of the medication are there. FDA is expanding its consumer information opportunities, and that includes the working relationship 

between FDA and AOA, to improve that consumer information education. 

On mental health, we have just developed and are about to 

launch by the end of this month a tool kit that SAMHSA has proVerDate 0ct 09 2002 13:31 Sep 10, 2003 Jkt 000000 PO 00000 Frm 00030 Fmt 6633 Sfmt 6633 C:\DOCS\88497.TXT SAGING1 PsN: JOYCE
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vided to ensure that we address mental health, depression, substance abuse, and other issues in older populations. 

So we are taking active steps with our partners in CMS to address prevention services and the expansion of prevention services. 

The whole Medicare proposal before you in the 2004 budget, the 

President’s 2004 budget, obviously not only aspires to provide for 

prescription drug benefits for seniors, but it is looking at a more 

comprehensive reform as we improve the capacity to do prevention 

and screenings for all Medicare beneficiaries. 

So we are taking active steps with CDC in our aging State programs. Our aging network providers are partnering in ten specific 

communities across this country where there is high incidence of 

risk behaviors and health disparities. We are co-funding with CDC 

initiatives in this program with public health providers and our 

community aging providers. 

Senator BREAUX. Thank you. Thank you, Mr. Chairman. 

The CHAIRMAN. John, thank you. 

One last question, Madam Secretary, before we turn to our next 

panel group. I understand the administration has been involved in 

a series of listening sessions. What exactly have you learned from 

people out there receiving and providing older Americans’ services? 

Ms. CARBONELL. Well, the most important thing is that the flexibility and the ability of many of our providers with the new reauthorized Act has awarded us the flexibility needed to address consumer choice at the local level. So the improved capacity for program sharing, for having the new Family Caregiver Program, has 

allowed us the opportunity to create new partnerships and collaborations at the State level, whether you are looking at private sector 

elder care programs or benefit programs being matched together 

with many of our Area Agencies on Aging and caregiver providers 

in the community. 

I just came back from a town hall session in Orange County, CA. 

We held that town hall meeting in collaboration with the aging network and the disability advocates. We were able to come together 

as one to address some of the barrier removals and some of the 

challenges that we both have both in the aging and disability communities to promote independence in communities, and address 

better opportunities for home and community-based care. 

We are looking, obviously, at hearing from seniors, like I mentioned, particularly in the area of grandparents. We see that there 

are challenges in many of the grandparents raising grandchildren 

that we need to continue to address as we move forward, and the 

National Family Caregiver Program evolves and there are obviously opportunities as the reauthorization of the Older Americans 

Act becomes evident just in 2005. 

The CHAIRMAN. Thank you. Thank you very much for your testimony, the work you are doing, and all of the efforts well underway. 

I think all of us kind of view, whether we are at the policy level 

or the implementation of that policy, at your level, kind of feel we 

are in that interesting transitional time out there into a relatively 

known field, at the same time with expectations and demands that 

are not yet known in many respects as it relates to the aging of 

America. 

28

But we thank you very much for that testimony and look forward 

to our continued work with you. 

Ms. CARBONELL. Thank you. 

The CHAIRMAN. Thanks for being here. 

Let us ask, then, the next group of panelists to come forward, 

please, Maria Greene, Kevin Mahoney, Ron Aday, and Gregory 

Abowd. 

Mr. Mahoney, we will try to deal with you in dispatch. We understand you have a family problem or concern and we will move you 

through as quickly as possible. 

Let me thank our panelists for being with us. I recognize Maria 

Greene, Director of the Georgia Division on Aging. She will visit 

with us today about the features of Georgia’s family caregiving efforts, including a mobile day care program. 

Maria, welcome, and we look forward to your testimony. 

Ms. Greene. Thank you. 

The CHAIRMAN. Please proceed. 

STATEMENT OF MARIA GREENE, DIRECTOR, GEORGIA 

DEPARTMENT OF HUMAN RESOURCES, DIVISION OF AGING 

SERVICES, ATLANTA, GA 

Ms. GREENE. Good afternoon, Senator Craig. Thank you for the 

opportunity to come this afternoon. I am Maria Greene, Director of 

the Georgia Department of Human Resources, Division of Aging 

Services. Also with me today is Mr. Cliff Burt, Caregiver Specialist 

responsible for Georgia’s caregiver program. 

I would like to share information with you about five innovative 

caregiver initiatives. They are caregiver research, assessment, mediation, consumer-directed care, and mobile day care. 

Georgia conducted 11 focus groups to solicit input from family 

and professional caregivers regarding needs and gaps in services. 

We found that caregivers need more information, more direct services, training for themselves, and better trained non-ageist providers. The results of the focus groups have been used to integrate 

the National Family Caregiver Program into the existing delivery 

system, expansion of existing services, and development of new programs and services. 

Georgia was awarded grants from the Administration on Aging 

to participate in the performance outcomes measurement project. 

The Division participated in the development of instruments that 

measure caregiver support and satisfaction, nutrition risk, physical 

functioning, and emotional well-being. We tested these instruments 

over a 3-year period. We are encouraging Area Agencies on Aging 

to use the instruments in determining service outcomes, quality 

and client satisfaction, and how best to manage using data. 

We understand, Senator Craig, that the committee has an interest in mediation. Georgia is one of the three States participating 

in a caregiver demonstration grant received by the Center for Social Gerontology in Ann Arbor, MI. The goal of the project is to use 

mediation to assist frail older persons and their family caregivers 

to address and resolve problems and disputes which all too frequently arise when families face the physical, emotional, and financial demands of providing care. Elder law attorneys using mediation skills have helped many families resolve conflicts. 

29

We value the philosophy of consumer-directed care. Preliminary 

studies have found that 77 percent of caregivers utilize funds to 

hire someone to provide care, and 80 percent of the caregivers 

hired someone they know as opposed to agency personnel. Caregivers who participate in the program are considerably more satisfied with those services than those who receive traditional services. 

I will share with you a story told to me recently. The caregiver 

for 94-year-old Mr. K called the local Area Agency on Aging about 

using some of the fund from the self-directed care program to make 

needed bathroom repairs. The caregiver utilized some of the selfdirected funds to purchase needed materials and secured volunteers to make the necessary repairs. Consequently, her father is 

able to bathe by himself for the first time in many years. The caregiver stated that her dad never had a tub and had to use a very 

small shower stall. Her father, who last year would not bathe, has 

to be coaxed out of the tub. She and her father would like to thank 

all of those responsible for the program. 

Given the well-documented long-term care staffing crisis in the 

nation, the unavailability of services, and fewer workers in rural 

areas, it should come as no surprise that our preliminary findings 

show that family caregivers wholeheartedly embrace self-directed 

care. 

Through funding provided by the Administration on Aging, Georgia developed the mobile day care program. Mobile day care enables communities to have their own day care programs while sharing staff who travel between locations. Mobile day care has proved 

to be a great respite care alternative. Its flexibility with part- and 

full-time staff positions helps to retain qualified staff. Perhaps its 

greatest values is that it builds trust in rural communities and 

thus becomes the precursor of a full-time day care program. 

Georgia’s ability to do caregiver research, assessment, mediation, 

consumer-directed care, and mobile day care has enabled us to create new partnerships and paradigms to meet the diverse and increasing needs of caregivers. One of the National Family Caregiver 

Support Program’s hallmarks has been the component of supplement services, which has enabled the aging network the flexibility 

needed to become more innovative. The product of that flexibility 

is improved service delivery, new services, and increased empowerment for caregivers. Also, the demonstration grants have allowed 

States like Georgia to pilot new delivery of care systems, gather 

consumer satisfaction data, and to manage programs using those 

data. 

Mr. Chairman, with your permission, may we show a short clip 

of the mobile day care video. 

The CHAIRMAN. Surely. 

Ms. GREENE. Thank you. [A videotape was shown.] 

Thank you. 

The CHAIRMAN. Thank you. Thank you very much for that testimony and the video. 

[The prepared statement of Ms. Greene follows:]

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The CHAIRMAN. Now, let us turn to Kevin Mahoney, Program 

Manager for a demonstration project which highlights innovations 

in consumer directed care. Would you please proceed? Thank you. 

Dr. MAHONEY. If I might just have a second to get this set up. 

The CHAIRMAN. All right. Thank you. I want to also say that you 

are a National Program Director at Cash and Counseling Demonstration Project in Chestnut Hill—— Dr. MAHONEY. At Boston College. 

The CHAIRMAN. There we go. Thank you. Now we have it all out. 

STATEMENT OF KEVIN J. MAHONEY, PH.D., NATIONAL 

PROGRAM DIRECTOR, CASH AND COUNSELING DEMONSTRATION AND EVALUATION PROJECT, BOSTON COLLEGE GRADUATE SCHOOL OF SOCIAL WORKS, CHESTNUT HILL, MA 

Dr. MAHONEY. Thank you, Mr. Chairman and members of the 

committee. Today in most States, whether you are elderly or a 

younger person with disabilities, if you are on Medicaid and you 

need help with such basic things as bathing, dressing, getting out 

of bed, you rarely have any choice over who helps you, when they 

come, or what they do. But for years, people in the disability community have been saying, if I had more control over these services, 

my life would be a lot better and I think I could do it for the same 

amount of money or less. 

The Cash and Counseling Demonstration and Evaluation is, in 

fact, a real major test of just that idea. It is a test of one of the 

ultimate forms of consumer direction, where people are given the 

choice between traditional services from agencies or managing the 

equivalent amount of a cash allowance themselves with supports. 

It is a major test, one that involves over 6,700 people in three 

States who have been randomly assigned for this demonstration. 

Janice Maddox is a perfect example of the desire of seniors to 

have more control over who enters their home and who provides intimate care. At 75, Mrs. Maddox does not have the best health. She 

has diabetes and glaucoma and is confined to a wheelchair possibly 

as a result of several strokes. But despite her physical frailty, Mrs. 

Maddox possesses a tremendous asset, an extensive support network of family and friends who want to help her continue to live 

independently. 

For 5 years, Mrs. Maddox received personal assistance services 

from aides sent to her by an agency that contracted with Medicaid. 

Then her daughter read about Arkansas’s Cash and Counseling 

Program in the newspaper. Mrs. Maddox enrolled and her oldest 

daughter, Johnetta Thurman, became her representative decisionmaker. Mrs. Maddox’s monthly allowance through Cash and Counseling pays her adult granddaughter to spend at least 2 hours a 

day, 7 days a week, attending to Mrs. Maddox’s needs. Her allowance is also used to pay her grandson $10 a week to do odd jobs 

around the house and helps cover the cost of such things as overthe-counter medications and toiletries. 

Mrs. Maddox’s daughter, who lives in Chicago and travels frequently to Arkansas to make sure her mother’s needs are being 

met, believes the program has made an immense impact in improving the quality of her mother’s life. She says, ‘‘There is just something about having family look after her. She doesn’t get nearly as 

49

many allergic reactions or bedsores now, and I think that’s because 

when it’s your own you’re looking after, you pay more attention.’’ The Cash and Counseling Demonstration and Evaluation is really a rather unusual creature. It is completely co-funded by the Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation at HHS. It operates under 

Medicaid waivers granted by the Centers for Medicare and Medicaid Services. The quantitative evaluation that I am going to 

present to you, the first results, was done by Mathematica Policy 

Research. The qualitative evaluation that is my favorite follows 

about 25 people close up and personal in each of the three States 

and tells how this really affects their lives. 

The program takes place in three States, Arkansas, Florida, and 

New Jersey. In all three States, it includes older people and younger adults with disabilities. Florida is different. They also include 

children with developmental services. 

What I would like to do in these few minutes today is present 

the first of our research results. they are from Arkansas which was 

the first State to implement this. To Arkansas’s credit, they implemented the cash and counseling option within a month of when 

they got the Federal waivers. These particular findings that we get 

to share today are from a controlled experiment, so in Arkansas, 

we had a little over 2,000 people enrolled. Half of them were randomly assigned to the traditional system, half to managing the 

cash allowance. 

When we looked at quality of care measures, we looked at four: 

satisfaction, reduction in unmet need, health outcomes, and affects 

on overall quality of life. 

Just a key to sort of give a picture of this, the left side are younger adults with disabilities. The right side are the elderly. The red 

bars are the treatment group. Those are the people that got to 

manage the cash allowance. The ‘‘C’’ is the control, is the traditional system. Whenever you see an asterisk, it is statistically significant. The more asterisks, the more statistically significant. 

Rarely will you in your lifetime as a researcher get a chance to see 

that kind of results, over 20 percentage points improvement in 

some of these measures of satisfaction. 

When you turn to the second measure, unmet needs, you start 

seeing reduction, major reductions there. 

The results people were really looking for the most were the 

health outcomes, and I am pleased to be able to report that basically the health outcomes were either as good, or where there were 

differences, they favored the people who managed their own allowance. You can see the elderly had fewer contractures while younger 

persons with disabilities had fewer bedsores. Overall life satisfaction was also improved. The final slide shows the schedule for the 

rest of our reports. 

Each of these three States is looking at making cash and counseling a permanent option. The Robert Wood Johnson Foundation 

and HHS are looking at how we can expand this option to other 

States. Thanks. 

The CHAIRMAN. Thank you very much for that testimony. That 

is exciting, you are right, to see those kinds of results, Kevin, are 

very impressive. 

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[The prepared statement of Dr. Mahoney follows:]


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The CHAIRMAN. Now, let us turn to Dr. Ron Aday. Dr. Aday is 

Director of Aging Studies, Middle Tennessee State University. Welcome, Doctor. 

STATEMENT OF RONALD H. ADAY, PH.D., DIRECTOR OF AGING 

STUDIES, MIDDLE TENNESSEE STATE UNIVERSITY, 

MURFREESBORO, TN 

Dr. ADAY. Thank you, Senator Craig. It is a pleasure to be here 

today to discuss the significance of senior centers and the important role that they will play in meeting the diverse needs of our 

nation’s baby boomers. 

The challenge, of course, centers around the diversity of this population, as you mentioned earlier, in terms of ethnicity, the well, 

the frail, and, of course, an age span from 60 to 100 or more. So 

it is a tremendous challenge that we are facing. 

This year, senior centers are celebrating their 60th year as an 

entity and are serving over ten million clients annually at approximately 1,400 senior centers. They have a strong infrastructure, a 

dedicated staff that certainly has demonstrated an openness to exploring ways of how to meet the upcoming challenges for serving 

the baby boomer generation. 

There are several ways that senior centers might be able to empower this group in the coming decades. I think it is very important to provide what I refer to as survival skills for the baby 

boomers and, of course, in many cases, their aging parents, as well. 

One of the research outcomes I have recently found in surveying 

senior centers from seven States and approximately 20 senior centers, was that the senior center environment is conducive to the establishment of social support networks, where seniors feel responsible for each other and assist each other in order to help maintain 

their independence. About 85 percent of the sample reported that 

friends they have made at the senior center provided them with a 

sense of emotional security and someone that they can depend on 

in time of need. 

Eighty-five percent also said that they provided some type of assistance to their friends that they had made at the senior center. 

I think that is very significant as we look at how to create a more 

independent baby boomer generation as they progress in age. This 

social network, of course, combats depression, loneliness, especially 

for those that live alone. We have a large number of female senior 

center users in particular that live alone. 

Another, main area where senior centers can certainly empower 

and help our baby boomers is through what has been termed selfcare initiatives. Most senior centers currently provide health and 

wellness programming, which brings about positive behavioral 

changes. In the future, chronic care clinics will emerge as an even 

more important component of senior centers. 

The senior center that I have been serving on the board for for 

the last 12 or 15 years, when we reconstructed the new senior center that we opened 4 or 5 years ago, we actually built within that 

construction a nurse-on-duty program. It was actually in place, and 

so we have a nurse that comes there 2 days a week, provides a 

clinic. She also works at the university where I do. It is a partnership between the university and the senior center. They bring nursVerDate 0ct 09 2002 13:31 Sep 10, 2003 Jkt 000000 PO 00000 Frm 00073 Fmt 6633 Sfmt 6633 C:\DOCS\88497.TXT SAGING1 PsN: JOYCE
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ing students to the senior center and provide assistance and 

screening, and she has at the present time 400 open cases where 

she sees on a regular basis, providing screening and drug management kinds of—and information to them. 

A third area that we see, I think, is really looking at the baby 

boomers in the future, who many of them will want to continue to 

work into their 70’s. That is one of the things that the literature 

tells us. But the senior center can evolve, I think, to provide retirement counseling for those that may choose to retire, but also retraining and employment for those that want to continue. We know 

that based on advanced technology, that many of us will phase in 

and out of several careers over a lifetime and the senior center can 

certainly be the environment where baby boomers in their 60’s 

might be able to come and get retrained. Senior centers in this way 

will serve as continuing education centers, where they will provide 

programming and innovations and it will be, I think, beyond computer skills. We talk about computer skills today. While computer 

labs are found in many senior centers today, additional computer 

and other new information will be important technological to baby 

boomers in order to remain current in the 21st Century. 

Also, another, senior centers are now getting involved in what we 

call civic engagement programming, and that is trying to find a 

balance between leisure and recreational activities as well as civic 

commitment. We know that we need to utilize the services and the 

potential that baby boomers have as they age and as they enter 

into the long-term care continuum. So we want to utilize their services, and so attracting them to the senior center for their education, 

for their skills, for volunteer work, is going to be extremely important. 

Finally, a connection to other generations is also very important 

and senior centers can play a very important role in this process, 

by providing adult day services, services for helping family caregivers, grandparents’ support groups, latchkey children telephone 

assistance, and also mentoring for juvenile diversion programs, to 

maintain a few examples. 

While senior centers are now recognized as one of the most widely utilized services created by the Older Americans Act, they are 

in some ways still the very best kept secret based on the outcome 

measures that are telling us we really can’t afford not to utilize the 

senior center network to its fullest in the coming decades. If given 

the adequate resources, senior centers will help make aging a new 

adventure for our baby boomers. Thank you very much. 

The CHAIRMAN. Thank you very much, Doctor. The concept of a 

new or futuristic senior center was brought to my attention some 

months ago when a group met with me in Boise, ID, to talk about 

creating, if you will, a kind of model of a future center. I think, 

clearly, with the dynamics of this aging group, you are right. I have 

oftentimes thought how computer centers are important today. All 

of these folks entering will be mostly computer literate. They will 

simply be wanting to advance themselves in those skills as that 

part of our technology evolves, along with a lot of others. 

I often have thought, yes, and they need an employment center 

or an employment contact and maybe even some training. So certainly what you have talked about seems to clearly be a part of 

71

what others are visiting about and what some are thinking about 

in a sincere and direct way. Thank you. 

[The prepared statement of Dr. Aday follows:]


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The CHAIRMAN. Now, let us turn to Dr. Gregory Abowd, Associate 

Professor, College of Computing at Georgia Institute of Technology 

in Atlanta, GA. His research interests lie in human-to-computer 

interaction—hmm, I need some of your courses. 

Dr. ABOWD. We all do. 

The CHAIRMAN. I don’t interact well. [Laughter.] 

Dr. ABOWD. It is not your fault. 

The CHAIRMAN. The smart home, or the aware home research 

initiative, or the smart home project for aging Americans. Thank 

you. Please proceed. 

STATEMENT OF GREGORY D. ABOWD, ASSOCIATE PROFESSOR, 

COLLEGE OF COMPUTING, AND GVU CENTER DIRECTOR, 

AWARE HOME RESEARCH INITIATIVE, GEORGIA INSTITUTE 

OF TECHNOLOGY 

Dr. ABOWD. Mr. Chairman, thank you for giving me this opportunity to speak about such an important topic and to allow me to 

talk about how I think this country can use high technology or advanced technology to meet the needs of an increasing aged population. 

I have a very simple message, and that is that advanced technology holds great promise for promoting healthy and independent 

aging, but we must be more proactive to realize this promise. Aging 

is not a disease, and while there is significant research exploring 

how technology can provide assistance for individuals coping with 

disabilities or disease as they grow older, the role of technology in 

enhancing the lives of older but otherwise healthy Americans is not 

well understood or appreciated. 

I am a computer scientist and an expert in the area of ubiquitous 

computing, meaning the spread of computing artifacts throughout 

the physical world to support everyday activities. Though my work 

presents great technical challenges, the motivation to work in this 

area is largely the human-centered agenda of providing assistance 

in our everyday lives. 

Over the past 5 years, with support from the National Science 

Foundation, the State of Georgia, and several major computing 

companies, we have been exploring ubiquitous computing in the 

home. We refer to our efforts as the Aware Home Research Initiative, with the challenge of creating a home that serves its inhabitants because it is empowered with an awareness of their whereabouts and activities. 

A major motivation for this work is that an aware home, properly 

connected to trusted caregivers, can provide the assistance needed 

for otherwise healthy individuals to cope with the natural declines 

related to aging. Advanced technologies can be pleasingly woven 

into the fabric of our homes, allowing us to age in place. An aware 

home can promote independence and quality of life for an aging 

population, and there are tremendous social and economic incentives to do this. 

Now, what do I mean by advanced technological supports? In my 

written statement, I catalog a wide variety of technological supports for an aging population. To summarize for you here, there are 

three categories of interest. First, you have assistive devices that 

compensate for motor, sensory, or cognitive deficiencies. Then you 

84

have monitor and response systems that provide both emergency 

response to crisis situations as well as early warning for less critical and emerging problems. Finally, we have communication aids 

that provide a link between an individual and a network of formal 

and informal caregivers. 

The greatest promise for advanced technology lie with the cognitive aids, the monitoring of trends, and novel communication 

aids. I will demonstrate some of these technologies at the end of 

my statement, with your permission. 

Now, who will benefit from these technological supports? First 

and obviously, we provide assistance directly to the individual in 

an attempt to support their independence and quality of life. 

Second, this technology provides support for distributed family 

members and other more formal caregivers who share the financial 

and emotional burden of coping with the challenges of aging. 

Third, with the increase of broad-band networking into and out 

of the home, we have greater capability to support the activities of 

larger institutions providing medical, emergency, or other social 

services. 

Finally, scientific evidence of a quantifiable benefit of advanced 

technology for healthy aging will encourage the development of 

profitable business plans that drive private investment and commercial success in this important market. 

Now, what role does advanced technology research play? One of 

the key indicators of independence is the measured performance by 

an individual in activities of daily living. The role for advanced 

technology, therefore, is the detection, measurement, and even improvement of an individual’s performance with these various activities in their living environment. 

Until now, most assessment of independence has been done by 

humans and this solution won’t scale to provide proactive support 

for a large population. Hence, advanced technology is necessary. In 

my written statement, I have surveyed emerging technological aids, 

but I must stress that there remain significant advances in technologies of sensing and long-term analysis of human behaviors that 

will not occur unless sufficient funding is made available. 

I want to make two recommendations to the committee. First, we 

need basic technology research for sensing and measuring these activities of daily living. The funding for these basic technological advancements could be administered by agencies such as the NSF 

that traditionally fund scientific and engineering developments 

that eventually benefit society. 

Second, we need large-scale test beds for evaluating technology 

for healthy aging. Research into how best technology serves the 

aging should be administered by groups whose mandates focus on 

public health concerns. This funding will make sure that the technology is well matched to the needs of the community. It will also 

lay groundwork for a healthy aging industry that will bring the research success to the marketplace. 

With the permission of the Chairman, I would like a few minutes 

to demonstrate three separate projects that bring to life some of 

the ideas I have been talking about that we have been working on 

at Georgia Tech. 

The CHAIRMAN. Please, go ahead. 

85

Dr. ABOWD. I want to demonstrate three separate projects that 

are taking place at Georgia Tech as part of the Aware Home Research Initiative. 

In the first demonstration, we focus on the potential for automatically detecting behaviors. Even with proper initial training, 

people often misuse home health care devices, such as the blood 

glucose monitor that is pictured here. I am sorry you can’t see on 

the monitor. Advanced computer vision algorithms can observe the 

use of a device and automatically detect when a sequence of actions 

is done incorrectly, providing an opportunity to give immediate 

training advice. The video shown here at the top demonstrates how 

our computer vision algorithms track hands and various objects to 

label the actions as a user attempts to calibrate the blood glucose 

meter. 

An important form of cognitive aid is one that compensates for 

near-term memory lapses. When an activity such as cooking is interrupted, what visual cues provide the right information to pick 

up where you left off? In the Aware Home, we have instrumented 

the kitchen area with cameras looking down at the countertop, 

shown in the bottom figure. An LCD panel is updated with salient 

images of the cooking activity as it is occurring. When interrupted, 

a simply glance at the display shows the most recent activity. 

Now, I am going to switch to a live demonstration. What you see 

here is the image on the LCD panel that is being updated occasionally with images being detected by a wizard sitting outside the 

kitchen determining when a significant activity occurs. The bottom 

right figure in this collage is updated to show you the most recent 

activity, and the numbers in the various panels indicate repeated 

activities, such as one, two, or three cups of the same ingredient 

being placed in the bowl. So that when someone glances at the collage, they can determine where they would have left off, and frequently in our controlled studies, it has been the repeated measures activities that get forgotten. So you don’t remember the number of cups of flour that you have put in. 

Now, we don’t currently have the ability to automatically detect 

the salient images to produce this collage, but we have been simulating the collage in controlled studies to determine its value, and 

given the progress on detecting simple activities, as I showed on 

the previous example with the blood glucose monitor, I hold very 

great hope that we will be able to provide these kinds of visual reminders automatically in the home of the future. 

In my last example, I want to contrast with the previous two. In 

the previous two examples, we showed services that stayed within 

the home and serviced the individual. This last demonstration is 

about connecting to caregivers, in particular, the natural support 

group of family and friends who want to maintain peace of mind 

for the well-being of older parents or loved ones. 

The digital family portrait shown here is an ordinary picture of 

a loved one that has been augmented with information in the 

frame to communicate how that person is doing over the last 

month. This is an aesthetically pleasing way to keep in touch with 

the everyday well-being of a loved one and it can be modified to 

support the normal monitoring activities of professional caregivers 

and assisted living facilities or naturally occurring retirement comVerDate 0ct 09 2002 13:31 Sep 10, 2003 Jkt 000000 PO 00000 Frm 00089 Fmt 6633 Sfmt 6633 C:\DOCS\88497.TXT SAGING1 PsN: JOYCE
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munities, referred to as NORCs. I can also demonstrate this, but 

for the sake of time, I would like to thank you for your patience. 

The CHAIRMAN. Doctor, thank you very much for that testimony. 

I was telling staff, earlier in the day, I took a tour of a smart home 

that a large software company in Seattle, WA, developed. I guess 

for sake of not promoting advertising, I won’t mention the name. 

Dr. ABOWD. They don’t sponsor us, either, so—— [Laughter.] 

The CHAIRMAN. I found it very fascinating. It would do about everything you asked it to do by just simply voice command, and certainly could be adapted to someone with disabilities or someone 

with problems. It could make their life a good deal easier, including 

monitoring. 

I think I was recalling the thing most fascinating about it, in the 

evening before the person retired, they could go to their laptop or 

their computer and activate an automatic in-place e-mail to a loved 

one somewhere else telling them that they were safe and retiring 

for the evening, the very similar kind of thing that you see in retirement centers today in individual apartments and living facilities that go to a central station to monitor a person’s activities. I 

thought, hmm, a most useful approach. 

Thank you for that testimony. 

[The prepared statement of Dr. Abowd follows:]

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The CHAIRMAN. I am going to turn to Dr. Mahoney now, and 

then if you wish, at the end of this—I have got a couple of questions of you, Doctor—if you need to depart, please do so and we 

thank you again for being here today and your patience with us. 

You were giving us a variety of work that is going on, studies of 

comparatives. What percentage of the participants in this demonstration project classify as older Americans? 

Dr. MAHONEY. In Arkansas, from which I just presented the 

data——

The CHAIRMAN. Yes. 

Dr. MAHONEY [continuing]. About 72 percent of the individuals 

that took part were elderly, and that certainly dispels the myths 

that older people aren’t interested in managing services themselves. The percentages change in the other States, but maybe 50 

percent in New Jersey, and just by nature of the demonstration, 

maybe about a third in Florida. 

The CHAIRMAN. That is fascinating to hear, and absolutely, they 

are concerned about that kind of management. It is a matter of 

controlling their own lives or having some say in it and feeling 

comfortable about it, I would guess. 

Does the study you reference in your testimony consist of a sideby-side comparison of older Americans receiving services in the traditional fashion compared to those applying consumer-directed 

choices? 

Dr. MAHONEY. If I understand correctly, exactly. People who volunteered to take part in the demonstration were, in fact, randomly 

assigned, so half of them went to the traditional system, half of 

them got the chance to manage the cash allowance, and with that 

kind of numbers, given that we had about 6,700 people enroll in 

the three States, this is a very powerful way of evaluating these 

impacts. 

The CHAIRMAN. Does your study conclude that better services can 

be achieved at the same costs? Is there a net cost savings? 

Dr. MAHONEY. I knew you would ask that. As I was showing, the 

cost results will be our next effort. 

The CHAIRMAN. OK. 

Dr. MAHONEY. We are hoping those will come out over the summer. The good news is, at this stage, for instance, for Arkansas, 

they are meeting the Center for Medicare and Medicaid Service’s 

budget neutrality requirements, so their research and demonstration waiver has just been extended another 5 years, and they have 

been able to get rid of the randomization, so at this point, everyone 

who wants to be part of this demonstration can be. 

The CHAIRMAN. Excellent. As you know, rural areas often face 

challenges accessing services. Has the demonstration project been 

implemented in rural areas of the host States, and if so, what has 

been the results? 

Dr. MAHONEY. The demonstration was in the whole State of Arkansas, the whole State of New Jersey, and in Florida, for elderly 

people and adults with disabilities, the lower two-thirds of the 

State, children for the whole State. This is a demonstration particularly helpful in rural areas and where it is very hard for agencies to serve, where the worker shortage was at its worst. 

98

One of the things we found in Arkansas was if you interviewed 

the people 9 months after they came in, for people who were getting the cash allowance, 95 percent of them were getting personal 

assistance services, whereas for those in the traditional side, only 

about two-thirds of the adults with disabilities and only about 80 

percent of the elderly were getting their care plans met. So in 

times of worker shortage, and especially in rural areas, this is a 

wonderful, a wonderful choice. 

The CHAIRMAN. Back me up a bit. You are saying those that 

were under the cash plan. 

Dr. MAHONEY. Right. 

The CHAIRMAN. Actually were getting greater levels of service 

than those under the traditional programs. 

Dr. MAHONEY. Right. Well, for instance, in the treatment group 

the consumer got a cash allowance exactly equal to what that person would have received under the traditional program, but they 

got to decide how to spend it on meeting their personal care needs. 

They had to develop a individualized plan. They could hire friends, 

family, people who wouldn’t have been in the workforce. They could 

renovate their homes, or buy assistive devices. Whereas in the traditional system, where there was such trouble finding aides and 

workers, in many cases people just didn’t get the services that were 

called for in the care plan. 

The CHAIRMAN. I am treading into water that I will be a little 

cautious on, because I have all the respect in the world for professional, well-skilled, trained caregivers, but are we suggesting by 

this that there are others capable of rendering care and service to 

a given senior that they can seek out who may not be as well 

trained or trained in some areas as a professionally trained person, 

but certainly are capable of delivering those services, and as a result, the service got delivered? 

Dr. MAHONEY. Right. I think that is fair. I am involved in caring 

for my mother. In so many cases, basic services that families provide aren’t skilled medical services. 

The CHAIRMAN. No. 

Dr. MAHONEY. This is help bathing, dressing, toileting. 

The CHAIRMAN. Exactly. 

Dr. MAHONEY. Remember what we found here. Those results 

show that the health effects were either the same or where they 

differed better for those who manage their own allowance. The 

younger adults with disabilities had fewer bedsores when they 

could choose people who really knew them and had a personal relationship. 

The CHAIRMAN. That is fascinating. Well, I trust you will keep 

the committee and our staff abreast of your work and the conclusions, the balance of the work you are doing. As our time and our 

focus permits, we will have you back to give us an analysis of the 

studies when they are completed. 

Dr. MAHONEY. We would very much enjoy that. Thank you. 

The CHAIRMAN. Thank you. I find those findings fascinating. I 

appreciate your time, and please feel free to leave if you feel it necessary based on your schedule. 

Dr. MAHONEY. Thank you for your consideration. Thank you. 

99

The CHAIRMAN. Now, let me turn to you, Ms. Greene. What you 

are doing in the flexibility you are offering, is exciting. What challenges has your agency faced in implementing the Family Caregiver Support Program in Georgia, challenges and/or obstacles? 

Ms. GREENE. Well, when we did our caregiver focus groups to 

find out what our citizens or caregivers said they wanted or didn’t 

want, we recognized right away that we had some challenges. They 

said that they wanted more information, assistance and referral. 

They wanted more training for themselves. They felt that our current providers needed more training, that they were agist. They requested more respite care. 

Probably the most challenging, but the one that we had a lot of 

interest from other organizations, was with the training aspect. We 

have coordinated with AARP, the Georgia Gerontology Society, a 

staffing solutions workgroup, the Alzheimer’s associations, all came 

together to address the issue of not only training informal caregivers better, our personnel staff. That has been very interesting 

and I have really enjoyed the collaborative work with all the different associations to help make that happen. 

The CHAIRMAN. In what ways could the self-directed approach 

you have mentioned be applied in the delivery of other aging services? 

Ms. GREENE. We were talking most recently about we have a 

dire need for transportation, especially most of the counties in 

Georgia are rural counties. We were talking about the possibility 

of hiring or making arrangements for friends and neighbors also to 

transport people to services, and so that is another consideration 

that we are looking for. But we have a real need that we need to 

address in transportation that our current level of fund sources, 

from all different fund levels, is not an adequate amount to meet 

the transport needs. 

The CHAIRMAN. Now, here is a question that dovetails with the 

work that Dr. Mahoney is doing and it was a question lingering in 

the back of my mind that I think, well, certainly with the program 

you have established, Doctor—or let me ask the question and feel 

free, if you would, to come in after Ms. Greene to talk about this 

approach. 

Some concerns have been expressed that allowing families to hire 

relatives and friends to provide care might result in the misuse of 

funds. What has been your experience in Georgia? 

Ms. GREENE. So far, we have not seen any misuse of funds, probably better management of the funds. We have a service coordinator in every region, so the family members and the care receiver 

develop a plan or they decide how they can best use the funds. 

Right now, there is an average of $1,200 to $1,500 spent a year. 

So they just call their service coordinator and they say, ‘‘This is 

what we really need.’’ Mom has had another stroke. Now she is in 

a wheelchair. We really need to build a ramp, for example. The 

service coordinator then OKs the expenditure of the funds and then 

they are reimbursed for the service. So we really have not seen any 

misuse of the funds. 

The CHAIRMAN. Doctor, do you wish to comment on that? 

Dr. MAHONEY. I will put it in this context. The Arkansas project 

got underway in December 1998, New Jersey a year later, and 

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Florida in June of 2000. We have had no major instances of fraud 

and abuse. In this context, of people who hired their own personal 

assistance workers, I think about 75 percent hired some level of 

family member and maybe another 17 percent hired people they 

knew through church, through their neighborhood: One of the 

things you end up finding is that they have hired people that had 

a real personal relationship that made a difference. That is not to 

say that we don’t have important monitoring and quality management processes in each of these States, which again, I would be 

pleased to share. 

The CHAIRMAN. Thank you. This February, I held a hearing on 

the misuse of guardianships over the elderly. I was disturbed by 

accounts that the wishes of older Americans and their families are 

oftentimes ignored by persons bringing forth these actions. How 

does Georgia’s mediation program prevent this type of undue control over a person’s life? 

Ms. GREENE. The people who have been trained to be mediators 

have worked actively with the Probate Judges’ Association, and in 

Fulton County, which is the largest probate office in the State, they 

have agreed that prior to—when someone comes to the court to petition that they become a guardian of someone, that they are then 

provided information and educated about the mediation process. It 

is not mandated by the court, but it is strongly encouraged by the 

court that they go through the mediation process. 

So we are real excited about the relationships with the probate 

judges and that we have the largest county agreeing to work with 

us actively to seek mediation with families. So a lot of it, I think, 

is education, not only to the families about a mediation option, but 

also to the court system, that it is a viable option that could work 

and also save a lot of grief and financial cost. 

The CHAIRMAN. Thank you very much for your being here and 

your testimony and the work you are doing. I find all of that very 

fascinating. 

I had one other question as it related to mobile day care. Does 

the program have a wellness screening component in it? 

Ms. GREENE. Yes, sir, it does. In fact, we have a statewide 

wellness program and it is done in conjunction with all of our other 

service components, and so they are screened to what ability they 

might be able to participate in exercise, nutrition education, medications management. 

The CHAIRMAN. Good. Thank you. Thank you very much. 

Dr. Aday, the work you are doing is fascinating to me because 

it is always intriguing to me about anyone’s ability to successfully 

predict the future or at least to look outward and determine what 

needs might be. For a baby boomer that has just turned 60 and is 

relatively healthy and active, what would be the appeal for this 

older American to attend a senior center? I am assuming when I 

ask that question that this 60-year-old would be attending a senior 

center of today. 

Dr. ADAY. Since I turn 60 next year, I will try to answer that as 

best I can. 

The CHAIRMAN. Oh, my goodness. We are getting truly personal 

testimony here. Thank you. 

Dr. ADAY. Personal testimony. [Laughter.] 

101

I think when we look at today as well as the future, I think that 

the senior center certainly provides different functions. Certainly, 

a 60-year-old could come to the center for a very different reason 

than maybe that person’s aging parent. You might come to the senior center to bring your aging parent, as we have adult day services 

in our center, to drop them off, and you might want to go then engage in a day trip and then return that evening, for example. 

But as I mentioned earlier, I think some of the other activities 

that we see already going on in senior centers do include things 

like retirement counseling and retirement training. We have lifelong learning that has been a steadfast component of senior centers 

for a number of years. So those are some of the kinds of activities, 

educational classes that might be inviting. Basically, if you have 

partnerships with local universities, they can offer topics that 

would attract a 60-year-old. 

I think some other factors that would also attract when you are 

talking about coming into a senior center, would be the opportunity 

to provide leadership skills on a community senior center board. 

We know that if our senior centers are going to become more sophisticated, the governing boards must also be sophisticated, and 

so we have to attract really quality people in leadership roles that 

can move senior centers forward in the 21st century. I have observed that very thing happen in my community. It just so happened that the people on that board and on our city council who 

were assigned to the advisory board enabled us to do some very 

progressive things. 

So I think that you have to have forward-looking people and 

many of those are going to come from the young-old group. Someone who can come and provide leadership and volunteer services 

and assist with your other older clients that are also participating 

in senior center programs. 

The CHAIRMAN. How many senior centers in this country today 

have that kind of appeal to them, from your understanding and 

study? 

Dr. ADAY. The recent research that I did, and it wasn’t a random 

sample, but certainly 90 percent of the respondents indicated they 

were very satisfied with the knowledge and information that they 

were getting at their senior centers. We know that senior centers, 

of course, are very diverse. Some of them are open on a part-time 

basis. They may have just a director and that is all that person 

does. They are very limited in terms of funds. 

On the other hand, you have multi-purpose senior centers, and 

I don’t know the exact number that would fall into that category. 

I think we do need some additional research really to look at where 

we are today as far as providing this myriad of services and then 

also looking at what kind of projections, what kind of plans these 

1,300 or 1,400 senior centers have in the future and what they 

have currently in place. 

We know that NISC and other organizations are providing leadership with getting senior centers accredited, so they will become 

accredited entities which will, give senior centers a much more professional kind of appeal and it also enables, I think, the people that 

are funding senior centers to know that they have a quality product. But I don’t know the exact number that are certainly in what 

102

we call the progressive mode now as far as providing these kind of 

services. 

The CHAIRMAN. The one thing that I often hear from 65-year-olds 

is, well, I don’t go to senior centers. They are for old folks. But the 

kind of center you are talking about, with those kinds of dynamics 

and services and opportunities in them, wouldn’t classify in that 

sense. So 10 or 15 years down the road, should we be calling them 

senior centers? 

Dr. ADAY. That is certainly an issue that is being discussed in 

the network at the present time. I don’t think there are really any 

conclusions that have been drawn, whether you want to call them 

centers for vital aging or even taking the term ‘‘senior’’ out of it. 

I was very excited when I became a senior in high school because 

I had seniority. [Laughter.] 

When I became a senior in college, likewise. When I became a 

senior professor. So it seems like we like to be a senior executive, 

but when it comes to equating the term senior we have difficulty 

accepting it with age. It goes back to what I think Senator Breaux 

was talking about. We have kind of implanted this ageism, well, 

now, I can’t be a part of that group and rather look forward to it. 

So I think it really speaks to our society when we have trouble embracing where we are chronologically. 

So I think each center or each community will have to make that 

decision, since senior centers are built and primarily funded at the 

local level. They will determine what they are going to be termed 

and what will be the best way of getting people there. 

It could be marketing. I think one of the issues we have here is 

just the stereotype that senior centers provide congregate meals 

and bingo. So it is just a lack of knowledge of what really goes on 

in senior centers. 

The senior center campus that I work with is really more like a 

high school. If you go into it, you have a computer lab and you have 

classrooms and you have all these classes. So inside, the decor 

looks more like an educational unit than it would what we call the 

traditional senior center. Now, not all senior centers, of course, are 

at that particular stage, but I think part of it is going to be dealing 

with how we market ourselves and how we can appeal and attract 

that younger person coming in. 

We do know that the baby boomers are going to be much more 

educated than today. I think by 2030, twice as many will have a 

college diploma as today. The research that I conducted in seven 

States, 20 percent had college degrees that were coming to the senior center. So we are seeing a different kind of clientele and they 

are going to be demanding different kinds of services. I think when 

you get more of those people to come they tell their friends about 

it. Word of mouth in many cases is the best way that you can market a good product. I think what we are talking about today is 

evolving, and so this is not going to happen overnight, but I think 

over a period of time. We should see an evolvement and a change 

in the clientele and a new mission for senior centers. 

The CHAIRMAN. Thank you very much for your testimony and the 

work you are doing. I find it fascinating, because it really is a part 

of the quality of life that these baby boomers are going to be moving toward, and I think they are going to be a group of our citizens 

103

who are going to be a good deal more demanding simply by their 

level of entry into that community of interest and their 

uniquenesses that will be very different from their parents. 

Dr. ADAY. They have had an impact at every stage. 

The CHAIRMAN. Oh, yes. 

Dr. ADAY. This will be no different. 

The CHAIRMAN. Now, how, Doctor, can we move technology into 

that senior community? Let us talk about the home that you are 

talking about and the sophistication involved. In your opinion, how 

long will it be before the average person will have access to the sophisticated technologies like the awareness home that you have 

demonstrated here? 

Dr. ABOWD. It depends on what kind of service you are talking 

about. Some of the demonstrations that we have done and technology we have built, for example, the digital family portrait, is all 

done with technology and capability that we have today. There is 

no real magic behind a project like that. 

What we are lacking with something like that is a business plan 

that would encourage people to invest in and provide this kind of 

service to distribute to family members, for example, although on 

that note, we have had a number of people who have seen the digital family portrait and have on their own essentially mocked up 

their own version of sensing in their parents’ home, with a way to 

dial up and produce information to a central server that then can 

provide information at any place the individual desires. 

The best way to leverage off the kind of existing technology we 

have in the homes today is to not require identity to be part of the 

sensed equation. So if you were to use the basic motion-detecting 

sensors that are in home security systems right now and you used 

that information for a household that has one or two family members, you can make very good inferences about where an individual 

is, or even more importantly, how much that individual is moving 

around, so you can communicate to someone else in a secure way 

about that. So for those kinds of applications, we could do that 

today. 

For some of the more sophisticated applications that require understanding of an activity, like the blood glucose meter example I 

gave, where you are trying to understand where someone is in a 

relatively simple and straightforward sequential process, that is 

possible to do today in the laboratories, but in very controlled settings. It wouldn’t work if I just deployed that in anyone’s home 

without any control over the ambient lighting. So there needs to be 

a significant amount of advances in making those algorithms more 

robust, and I think we are talking a 5- to 10-year horizon before 

the research is robust enough to be able to produce those kinds of 

services. 

But before we have those kinds of capabilities, we want to be 

able to get a glimpse of what that future would be like and to 

evaluate what services would be important and which ones would 

not. That is why a project—why I showed you the cook’s collage, 

the reminder system in the kitchen. It is being done with smoke 

and mirrors, but it is being used to conduct controlled studies to 

find out if we could get the technology to do that automatically, 

would it be a valuable memory service in the home, so that we can 

104

inform the advanced technology research about what kinds of problems they do need to solve in the next 5 to 10 years because we 

see the value in terms of helping an older population. 

The CHAIRMAN. I recently reviewed a technology that would have 

to have a cooperative effort of the food manufacturer with certain 

software programs, but there was a code on the back of a given 

container of food that when moved across a scanner could project 

up on a screen a large read-out of how to prepare that food, or the 

simple instructions that might be beyond the visual capability of 

the person. It would simply plant out on the kitchen screen that 

could be used for a multitude of other purposes as to how to program the—or it may even program the microwave itself, preparing 

it for that particular food. Have you looked at any of those or seen 

any of those kinds of technologies? 

Dr. ABOWD. Yes, I have. What is very interesting about the kind 

of technology you are talking about is it is becoming very affordable 

to essentially tag all items with—in the past, we have used bar 

codes, so we can use optical scanning to be able to read them. But 

there are problems with line of sight, being able to see the code. 

With the kind of technology you are referring to, one of which is 

radio frequency identification tags, or RFID, you don’t need line of 

sight and you can essentially fashion a region of space that can 

read a code on any tagged item that comes near it. So, for example, 

placing something on the countertop, the counter then knows what 

is placed on top of it and there are a lot of activities or possibilities 

you can leverage on top of that. 

So it is because these kinds of simple sensing technologies are 

now commodity technologies that work very reliably that we can 

provide these kind of services. One simple example we have done 

in the aware home, and we are one of the first to do this kind of 

activity, is we have used that RFID technology in a slightly different way, to provide location information for individuals and objects within the house. So we fashioned floor mats that sit at various strategic points in the house and individuals wearing non-powered tags somewhere below the knee, usually attached to the shoe 

or around the ankle, then just need to walk in the aware home and 

it will pick up what room or what location they are in. 

That information feeds directly into something like the digital 

family portrait. It also feeds into a variety of other kinds of applications that can leverage off that room level awareness. So it is a 

very exciting time from the sensing perspective, because we can 

now realize these kinds of applications in the living environments 

like a home. 

The CHAIRMAN. You have mentioned several technologies. Any 

others that you see that are going to be a direct asset to this kind 

of home? 

Dr. ABOWD. I think a critical kind of technology, I talked about 

doing a purpose-built laboratory like the aware home. Also, there 

are continuing care retirement communities that are being special 

built for which you can, at the time you construct the building, can 

put in special kinds of technologies. 

But the real problem is being able to retrofit existing communities. So these naturally occurring retirement communities with 

the technology to provide the same kind of capabilities, and there, 

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I think, wireless technologies are advancing to the point where we 

will be able to retrofit relatively easily lots of sensing and communication capabilities that won’t require you to tear down the walls 

and won’t be all that difficult to be able to put into homes. So that 

is when you will start to see the real mass market effect. 

The CHAIRMAN. Well, I concur with you. Obviously, the rather 

simple process now of creating wireless technology for your home, 

for your laptop and all of that, is really phenomenally simple and 

relatively inexpensive. Of course, all new—not all, many new 

homes are now being wired with that kind of capability, so that is 

very positive. 

The interesting thing about the new technologies is that the baby 

boomers won’t be as hostile to them, obviously, as the generation 

before them, and quite understandably so. Also, the best part about 

it is if they don’t understand them, they can just ask their 

grandkids. [Laughter.] 

They will give them a rather simple explanation of how to do it, 

because they will have figured it out a long time before that. 

Doctor, we thank you very much for your testimony and your 

work. Those are exciting new opportunities, I think, as we move 

along, and we appreciate it very much. 

Dr. ABOWD. Thank you for the opportunity to present it. 

The CHAIRMAN. To all of you, thank you very much for being 

with the committee today and helping us build a record in these 

areas. We believe it is extremely important as we look at especially 

the opportunity and the challenge of this baby boomer generation 

that is about to be upon us, and as a member of that generation, 

I am going to be as demanding as any of the rest of us, I suspect. 

But I also want our public policy to be prepared for us when we 

get there. 

Thank you all very much for being with the committee today. 

The committee will stand adjourned. 

[Whereupon, at 3:53 p.m., the committee was adjourned.] 

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