I know there is some concerns about privacy of seniors with the web camera and video monitoring may give challenges to want to ensure the privacy of seniors and their dignity using this technology. But we also want to make sure we are looking now for their safety. I know using privacy techniques such as old the silhouettes on video monitors to ease some of the privacy concerns over adults but the challenge for those is to maximize safety with the minimum invasion of privacy they get to the chairman and witnesses to be here today and i look forward to learning from your testimony. That is an excellent statement. We have been joined by senator perdue, a senator cater and senator casey. Thanks for joining us this afternoon. Now we will turn to the panel and first year from the up Tech Industry veteran and the founder of aging in Place Technology watch. I a understand she also has the of wisdom to have her seventh home in the state of maine. That did not mean that is where you are testifying today. I already introduced dr. Kim the Vice President for research at university of maine. The next witness will be dr. Mccarthy from the department of Veterans Affairs. The acting chief consultant for the tele Health Measures dr. Skubic the university of missouri already has been introduced by the Ranking Member and finally mr. Strickler was from virginia and knows the challenges that caring for seniors who have a desire to age in place and he will share his personal story with us and how he has used technology to assist in the care of his mother and motherinlaw. First we will start. Thanks to the aperture 92 testify today on the technology to help adults aged plays. The demographics these categories of enabling Technology Makes it feasible for older adults to meet their needs as they aged and as noted nearly 90 percent a justifiable want to remain in their own home and in fact, today they are successful aging is the ability to do things for myself, and have good health. Aging in place there for is the ability to successfully age in your home of choice and aging in place products and Services Including technology provide an enhancement of the of quality of life. We will talk about demographics but a couple of refinements there are 46 million adults 65 and older today those 20 billion a 75 rand older adult those over 75 per living alone the society of actuaries upgraded a new reality that women ages 65 can expect to live 88. 8 years old. Does 25 percent living 90 or more. Ben s. 65 will live on average 86. Six. The oneyear cost of assisted living 51,000 per year in 2020 and minority San Francisco chicago most memory care units have already reached a and exceeded. Seniors know this and dont want to move into assisted care facilities so most remain at home. Talk about the categories of technology to aging in place. They are best represented by interlocking pieces of the puzzle and that paradigm is used to show if you make out any one of these pieces of the puzzle people are risk of depression and isolation and undetected illnesses and complications for older adults benefit with related training that address their ability to connect with other people and opportunities they have a engaged to be safe and manage health and wellbeing. So each category started with the puzzle piece examine them one at a time in the category of Communications Wall devices may change over time the purpose remains the same to help older adults stay connected to others through video chat searching the internet to participate in forums finding people of a shared interest or service is Rand Resources that we to their changing needs. It can be used to monitor but also to engage people with connections of families and friends. Welfare to 9 percent of the 65 plus population 27 percent have smart phones both percentages dropoff noticeably after age 75. The second category the safety and security the most important aspect is the whole all alarmed to learn about temperature and fire and excessive moisture. Without that the other technologies are just nice to have. Others include personal Emergency Response and a safety watch. Home base motion sensors and activity monitors bacchanal monitor absence of activity or decline over time. Those that combine to detect patterns and were hoping of the other signs that indicate the risk of falling. Health and wellness technologies are on the bottom right that includes telehealth and the smart phone applications and theyre are new ones developed all the time to Health Care Workers and also to assist people of low vision and hearing impairments. The bottom lefthand corner is how we state engaged in our society which is how we remain content with our lives. Tools help people tell and record their life stories that enable them into volunteer and find work for a 20 after the age of 65 are actually working for, many are fulltime. People can learn skills that of the shirt and workrelated and all of this Online Training is free. This is the time to live that it is free. Forms are found but the biggest problem mobile device plans average rain 60 and 80 per month and wifi access access issues to libraries because the connection to the home can be costly. 50 a month or more which is a limitation. Of all categories are enhanced with the informal caregiver that you can see in the middle to include professional caregiver for the technologies that not only attract the caregivers but also what is going on with activities of daily living and mobility and functions for of a future market potential is greater than the smart phone phone features even into robotics. This is looked at as 20 billion by 2020 but in the future you will see fewer special purpose offerings more samples of Standard Hardware and vice platforms which is customizable to meet the specific needs of the users will want be special Purpose Technology it is called design for all and can be seen today in a customizable features injured car in tablets and smart phones and television and consumer electronics. It is customized for individual. Thank you for your time. Dr. . Good afternoon chairman collins Ranking Member and distinguished members of the Senate Special committee on aging. I and dr. Kim and im appreciative of the opportunity to share with you the technology the university of maine is developing to allow older individuals to age in place. We are convinced the aging and thriving in Space Movement is from the Rapid Deployment of technology and devices that maximize Human Performance including mobility navigation home environment and intelligent living, improved emergency detection to contribute to response. The university of maine aging Research Initiative in partnership with Community Agencies to establish the Interdisciplinary Research from social work to engineering true disability studies responding to Major Public Health issues for the aging public. In the area of home safety we are developing technologies for ability to increase connectivity parting outdoor exercise and improved balance. One of the most common challenges that occurs is visual contrast sensitivity can be extremely dangerous for older adults such as cement stairs or curbs or benches. Our goal is to reduce falling with a solution to be implemented without any infrastructure built out. To do this we explore the use of computervision to detect low contrast in the environment to improve disability. This technology optimizes the known perceptual and scottish changes that occur with page. Although walkers such as a cane have long been available all either minimal functional for outdoor exercise that is the stigma and inconvenient for those of the assisted jogger was to fill the need of a population that without adequate mobility will be less likely or unable to participate and regulatory exercise. The aesthetically designed floatable come three well standing support of vice that helps assistance for walking or jogging or running. Im and has biofeedback and is currently in the early stages of mobilization. Were developing advanced Energy Absorbing technology in the universe if rain is currently working to develop non stigmatizing deere to mitigate injuries for individuals with the rest of fall. The main company has developed a highly effective system that offers the head your option that can be integrated into fashionable headwear while providing protection against head injuries as shown in the slide. It is lightweight than can be incorporated in caps and scarves and hats performance tests show significant potential for reducing head injury. Hot and sign in 2013 to under 50,000 people over the age of 65 where admitted for a hip fracture. This expands the current work with hip care to were hip protection for the elderly. To collaborate to design aesthetically pleasing him protection as a shell that would be regularly worn by elders with the risk of falling. This sample of the material is here if you are interested. In the areas of response we are developing in networking technologies with wireless detection and vital signs sensors. But the motor function can lead to many safety risks for older adults living independently. Curve responses is expensive and video monitoring to recreate a typical apartment setting for a system that makes use of lowcost technology such as micro controllers the tax could be embedded into the physical structure under carpets in behind the paint on the walls. P. R. Fit reading device can be worn comfortably by an individual. It tracks the of location as they move about the home to send alerts there is a problem 02 reduce false and improve safety and independence finally i would like to think the committee for the opportunity to describe the necessary technologies researchers at university of maine are pursuing to improve the quality of life for the older population. Thinks dr. Kim. Chairman and Ranking Member and distinguished members of the committee on aging, thank you for the opportunity to discuss the high quality care and support that the Veterans Administration telehealth are privileged to provide. Our chief consultant for Geriatric Services one and a nurse at the list for Telehealth Services. Recognized as a world beater of development in Telehealth Services that our critical and one of the major transformation initiatives to ensure care is convenient and accessible and patient centered. Increases access to highquality Care Services by using secure information in telecommunications and to provide Health Services and in 2013 occurring in over 900 fights allows 17,000 patients so over 21 dash 200 telehealth episodes of care in the Specialty Care areas. To ensure excellence of health care delivery. And sometimes with support to provide care to a patient remotely. Telehealth fisker to coordinate care with technologies such as mobile monitoring and messaging and video technology. A use of technology to acquire critical and store information and for clinical evaluation. And those to chronically ill veterans under the coordination of interdisciplinary tree man. Of medication but telehealth support aspasias to send pictures of healing wounds to a nurse or doctor they can devise and what additional care is needed. Fracking is an educational tool and a support system for a caregiver. For example, espouse to be overwhelmed of the complexity of caring for all love one has access to emotional support and having many positive outcomes was specialist consultations with tell health has improved show comes resulting in utilization for Outpatient Care in fiscal year 14 those receiving home Telehealth Services was chronic care management. They had a 4 one dash 4 decrease of care in the 32 decrease of admissions feet compared to prior to their enrollment of palm telehealth one those that we Call Mental Health and a key psychiatric area. Debt dash Telehealth Services and programs to travel to the facilities with care. They have been shown to result 35 for 40 per patient. And telehealth has a decrease cost of the va and has been shown by 2,000 those of the receiving home telehealth. Most important between 80 and 94 percent approval for these types but in conclusion the Veterans Administration is changing services for many veterans and loved ones it can be complicated and sometimes arduous task. Natalie that travel time is time away from family. The telehealth is Services Program revolutionizes challenge by changing the rotation to split access to care and help them take a more active role in the management of their health and wellbeing. This concludes my testimony. I will answer any questions you may have. Dr. Skubic. Thank you for the opportunity to be here on this panel and visitors. I want to tell you a story about even of whom lived a life and aging in place in colombia and misery residents can stay there through the end of life if they need extra help for services delivered a private corporation to operate the housing and dining and Clinical Operations are handled through the Nursing School and university of missouri. A nursing professor went to investigate new ways to help seniors aged place. We started Testing Technology and 2005. My story, a eva of history of congestive Heart Failure in the history of every hospitalization as her condition and well dash conditioned worsened and got better then worsened. She volunteered to be a participant we installed sensors in her apartment that checked changes in her patterns. She knew that eva health was worsening if we did not act now should have to go back to the hospital. In this case and in changing her medication. Her doctor was resistant to a request because eva had not been enough weight to satisfy the standard protocol however the onesizefitsall protocol did not work for her. She needed to change now. Finally he was convinced to change and she never went back to the hospital for Heart Failure again. Broke the cycle and the sensors in her apartment picked up subtle changes before eva or her doctor noticed it to. Since henry had developed a clinical Decision Support system with automatic alarm sent to a nursing staff. And includes the restlessness and coughs and a fault detection system since surs are mounted do the environment and operate that are required to do anything special. For example, the best art installed under the bed and mattress. Retrospective the seniors privacy no surveillance cameras are used instead muse depth images to provide shadows so lets. We have detected pneumonia, pain, delirium, h ypoglycemia and in one case we could recognize changes of walking speed of a husband in the home that corresponded to early dementia even when his wife pluses there into they have made visitors with their links it to adapt video pictures are included in my written testimony. I would be happy to show them but as a professor i carry all my slides with me. [laughter] i have another story about my motherinlaw thats did not have this technology she got up in the middle of the night, fell down and broke her shoulder. My fatherinlaw was sleeping without his hearing aids and he did not hear her call she made on the floor for hours in paint the next morning he found her but the damage was done. Her shoulder never healed properly in she was in constant pain the rest of her life. Her mobility was severely limited she could not cukor bake or pick up her greatgrandchildren and the constant pain even though she survived the fall of quality of life was drastically diminished i can imagine and a different outcome if the censors had got her help immediately. Research studies have shown they in home Health Alert System works. Seniors have Better Health outcomes. Those with sensors have of on thursday a longer stay by nearly two years. We now have a commercial partner to bring this technology to seniors many of my colleagues have also developed Exciting Technology to help seniors. Bloodied potential for health care is significant to detect Health Problems early so treatment can be offered is less expensive than of the current approach. To keep seniors healthier to stay in their own homes. Of a bite to see a used throughout the country some others can benefit including my mom and dad and your loved ones. Thank you for your testimony. Mr. Strickland . Good afternoon. Members of the committee come on behalf of aging parents thanks for the opportunity to testify today. Is of a difficult process with technology to help our parents age in place. My wife and i have mothers 85 and 86 and both always desired to live and homes as long as possible needless to say it has been a challenge with their safety in state of mind with us privacy and living several hours apart makes them more challenging. My mother is very independent and continues to enjoy gardening and she used what she needs to remain independent but to have the security of the alert system at the touch of a button or automatically. But unlike most she is diligent about wearing it. That meant an effective for many reasons nrem motherinlaw was one such case. She experienced a much different aging scenario than my mother who has dementia. After finding a toaster oven on within 24 hours we needed to have her closer to less inc. Day walking tabret handicap accessibility features but september 2012 the existing homes Security System would alert us to detect motion in each of the four rooms so we could know when she was active progressive dementia progressed we tried products to she refused to wear the pendant and could not responded to putting her voice in the box they failed our concerns reworked with the Home Security company from alternative technologies like a toilet sensor and refrigerators and sir. Incorporating with the systems and they continue to have independence well we could monitor for normal schedule or roller one patterns changed or issues required immediate assistance we set parameters to be alerted to ourself as we could immediately check on its. It also helps to recognize her sleeping patterns before fulltime help care someone helped while many give a comprehensive approach including data summary that makes a much easier to see a trend and pattern, the userfriendly graphics make it easy to understand what is changing. Thus the system enables us to know when to have additional care and assistance matching to raise state of health. My wife and her twin sister is the acute by the breath end totality of the ocean. Epiphytes the but the second major benefit is that technology is the Priceless Gift to allow molnar to stay at home as capabilities allow. My wife also said financially it is a relief to preserve our resources to provide the best oneonone care now that she needs that if we moved her into up assisted living it would be significant now is two 1 2 years to the average of 222000 104000 for the Homemaker Services and in contrast the cost of the system was about 200 plus 59 monthly fee. Redo the to supplement our own efforts its nice to know that the technology is there with a huge cost savings of the higher standard of care in a remarkable and firemen and. The company were working with now has a system with more capabilities would have been useful when the stove is left on for a long period or to control the thermostats and lights and locks and motion sensors and activates lights or unlocked doors or medications aging in Place Technology is not a magic solution to solve all problems, but from our experience they can be an integral part of the solution these technologies can help the conversations prolong independence with a costeffective in non intrusive manner to make lifestyle choices. Thank you. Thank you very much for your first hand experience. Dr. Kim as i watched the technology that you illustrated today, i could not help but think i could have gone for years never to come up with the assistant jogger and that there is a certain stigma that is associated with walkers for example, like seniors are eager but how do you come up with the technologies and the products you are developing at the university of maine . In terms of that specific item, and that started with two faculty members in disabilities studies one member herself has walking and balance issues and wanted to develop a system so she could exercise outside to remain active as part of the community and part of her goal so she parted with day professor and students to develop the assisted jogger and could complete the five ks even though the technology was originally designed for someone with a walking issue we concede the jogger would be a great piece of equipment for someone who is aging with a knee or hip replacement and going through rehabilitation as i mentioned there are also sensors so you can make sure you dont put too much weight on a joint you are in rehab especially. Lots of technologies that can come from this original Technology Transfer to the aging population. That is where professors came up with it. To their reach out to care providers or Health Agencies . All of the above. As an example, even with a small group of students going to the local assisted living facility, of the students in engineering met with president s at this facility and in one hour period if time the residents were asked what would you redesign to help you in your daily life . They came up with 50 different items they would like. That is incredible and shows there is a view such a need for this innovative device. Lets look at the other side of this issue i read an article map that aging in place does not imply watching a sage. I do understand the concerns of privacy that some of these technologies may raise like a web cam implanted. One hagel cannery make sure we are striking the right balance between maximizing safety so people can stay in their own home but yet not making them feel that big brother maybe not big brother but the adult child is watching them . The first thing a right to say with any Monitoring Technology there is the concept to opt in to give permission basically you are willing. I know that implementation of Talk Technology not necessarily under the guise but on the basis of a threat if you dont let me put this technology and your whole level have you moved because i am too nervous about your wellbeing to the view of living alone. Will lead paint the loving threat to. [laughter] but it is important people understand that theyre not necessarily opting in to have every move watching and people who Design Technology properly designed for the absence of activity in a window of time or near the refrigerator. The presence of a catch or a dog to jump or that you go on vacation here sensors say youre not moving. [laughter] a lot of thought has to get go with sensors but when configured properly can work well. I would like to talk about cost savings a of a little bit and the financial implications of all of this. Dr. Skubic what is the cost savings that can be attributed to these advancements . One is hard to stress but many you are not directly involved dont understand it is a huge proportion of the medicaid dollars spent in this country are not spent on a family is you were not working but rather our seniors who are in Nursing Homes and the high proportion of nursinghome beds make an important hearing. If we can figure this out the cost savings and the implications of cost savings are dramatic to the longterm demographic bubble represented with my generation of an l. A. Not to have sufficient money saved. So what kind of savings can you quantify at this point that we could realize if restart embracing in peoples homes . First des moines to clarify, i am talking about an aspect of this Technology Rather than of the broad of re that lowry had mentioned in the context of what were doing were looking for early signs of functional decline angeles. And refer started to work with nurses that talked about the typical trajectory of aging then you go on a plateau until something dramatic happens then you are dropped down very quickly until the next dramatic thing happens. So our premise is always to recognize the beginning of that decline so the intervention could be offered a few key people on top of that level and some people call that to square though life curve then there is a sharp drop where do die and am hoping this is what happens to my carriage actually. To all of us that we are functional and tell the and. But to quantify that with cost savings is very hard. We have not yet done the study that quantifies the effectiveness in those economic terms with technology alone but we are involved in a randomized control study right now that we hope to have Economic Cost savings. I can tell you my collaborator has lifted the Economic Impact and costs savings one which is what theyre doing at tiger place as well it is how we do the nursing care as well as technology on top of that. They have shown quite a dramatic potential cost savings associated to organize and coordinate care. And as we compare the standard level of care between those who did not receive with so long first day so i and extrapolating to say i dont have the quantitative numbers but i suspect they are significant. If you looked at my written testimony i did include numbers based on the coordination and to this one statement that is in here that comes from maryland rarely in about 10 Million People and longterm care are older than a 65 and lived in a community. 4. 5 million have the potential of cost savings if everyone had access or participated with the intervention. That is huge. We will get the details of that survey but with the academic camlet these advancements for garner tiger place is more expensive than some of the heather facilities in the area in terms of, but i understand it is small and youre doing a lot of research and i understand but i think we have to start monetizing these savings the more quickly we can monetize the mark quickly we can adopt them as part of Public Policy preferences to have a huge impact on their availability to most people. Actually it is not that much more expensive than a lot of other facilities. Good point. Is sent to much more. [laughter] i am a big fan. Bible just say you want to deliver as to many as possible to help with the struggle to make sure hour grandchildren are not inheriting a debt that they cannot swallow. I want to echo the Ranking Member for her comments the want the best care we can but this time i hear an opportunity here a tremendous opportunity for the costs coming at us over the next 30 years. Like several of you i have a personal experience with this contrary to my political opponents i do have a mother. [laughter] she is 89 and independent but this aging in place is a new phrase for further she is living that out but contrary to that my wifes mother is a bit younger and has been diagnosed with alzheimers. We have the different trajectory to deal with. Dr. Record to nine very excited by what you were doing at the v. A. You have a Perfect Laboratory to answer the questions with a sensibility and acceptability with an independent patient who sometimes are in denial and the medical staff that may be less than receptive with a new technology. But have a bite to get your experience with the accessibility with the patients in the medical staff. I will start with home telehealth in particular a thatll device that is placed in the Veterans Home it is a device would monitor when the Blood Pressure or the temperature of the veteran and we provide those. That cost about 350 and can be 11 dash three purpose 11 veteran is finished the cost is 1,600 per year. When i talk about the cost savings i did not translate to the hospital and missions if you think before and after the use of the device from last year they had 54 percent increase of numbers of days in a facility and 32 percent decrease of actual numbers of the admissions that translates into raise significant cost savings but the devices dont exist alone. They are part of a system and for us we have home telehealth coordinator so for every 100 veterans enrolled in the program for about every 100 we have one care coordinator. We have published about this data and we have had inquiries i have been acting in his positions in september all over the world and some of the problems that people in other countries have experienced is if they dont have a core kate coordinator of the available there are for disease conditions this is extremely helpful. One is congestive Heart Failure. Basically a means the heart is not functioning as strong as it needs to because the flu weds back up the uc wage gain and waits is incredibly important to sensor when someone with congestive Heart Failure is starting to deteriorate because of their diet or another condition so when the data is conveyed to the home of telehealth coordinator that is important information. Another is c0 pd as some people call emphysema and then we can measure oxygen saturation of somebody needs to intervene the beauty is the veteran in the caregiver do not have to travel because the intervention can be made and i also want to mention a very important condition for us when people can move with their symptoms and also diabetes where blood sugar can be monitored and other conditions as well. So to serve such a crucial role to a trend to the data to communicate with the patient interventions have been appropriately. A very thorough answer thanks for your contributions. Thanks madam chairman and for holding this very important hearing. I want to focus on the aspect of security which perhaps has not been mentioned but the security of the data and the information that is collected. And perhaps we will begin with ms. Orlov to tell us what specific steps have been taken and what more has to be done to make sure personal and confidential medical information can be kept secure. We are in the midst of the data crisis in the United States. You all novell the anthem 80 million records that were stolen and the Identity Theft associated with that. This has created a heightened awareness of all of the players in the continuing of care not just for old people but everyone includes Insurance Companies for which it was stolen but also health care and management of Electronic Medical records. The good news is awareness was tragically dash to. Has been increased pressures have been tightened years ago. No and them was not expected is yours . Are you talking to me . Type dont have that data. Ask the v. A. I using crib did, yes, sir. Would you recommend that as part of the program . Is interesting for us because our journey started early 2000 decade the technology was available has changed so some rules and requirements reflect what was available then some homes for instance a using devices or technology that was required at that point and now there are new remains to conduct those type of telehealth visits we are migrating our technology that were without compromising security or safety. I will ask what seems complicated but i and the Ranking Member of the Veterans Affairs committee the ongoing controversy of the 40mile rule if that should apply to clinics or to the clinics that can provide the care that the veteran needs maybe he lives within 40 miles but the clinic fran not be able to provide the care that is needed so at that time he can go to a private provider what i am wondering is if the Telehealth Program from hospitals that there are to the hundreds of clinics would fill a gap to enable more it veterans to go to the clinic to get the care that they need. How much of that potential have explored . I hope my question is comprehensible. I think it is. We appreciate that. You are talking about the part of telehealth clinical video where a provider sees a patient if they face time or sky but that is the technology that people are most familiar to represent to provide from the Va Medical Center from time to time. That can happen to the Outpatient Clinics with from one clinic to another also in the patients home. We also looking at exploring ways for the provider to not take up the space of a Medical Center to provide this kind of care. But we probably have 20. 7 of patients engaged in clinical video telehealth or other kinds there are a lot of other communities and we are working down the barriers that we seek to expand this as an option. I can tell you that someone in her 90s roche the Biggest Barriers to the extent of telehealth is not the technology but the administrative burdens. And what we often refer to that our nation has a Health Care System that is backwards but it is based on hospitals in thirdworld countries with no hospitals but smart phones budget telehealth has taken off in an incredible way it is our goal we would get to the point that the chair can be provided timely and not clunky so it is easy probe for the provider and the veteran to have that care. You use the percentage for trantwelve and 20 . Train wreck 12. 7 . With telehealth . Yes. As the senator said it is a critical topic we will all face sooner or later. Doctor martin i to continue along the lines that at the v. A. You administratively from the providers perspective and from the patients perspective. We can tell you stories of that coach diana providers first there to their first telehealth is it in a way that has been positive for everyone engage. Technology is an issue. We have four home telehealth three kinds of the elegy that we use. We use the interactive responses and the in the web browser. The interactive voice responders is how a lot of people use to do their banking. They put the number in the phone and what they want to do with what accounts and so forth and you can do that either by pushing buttons or by voice recognition. The Device Connections can be through the telephone system the regular telephone system. Sometimes called the plain Old Television system. The server system i have looked into it. One of the things we have not talked about is the role of carriers, ted Telecommunications Carriers and boosting productivity for older adults. There have been Pilot Programs in the United States to provide discounts for Internet Connectivity for seniors and but at this point there is not a Standard Program across all the carriers in the United States that would make Internet Access affordable for many people of lower income so that is an opportunity it seems to me that can be that we could do a lot more with them the same thing with cell plans. I think the average cellular plan and the United States now is around 50 to 60 a month and an Internet Service plan at 60 a month means you are out 120 a month which is beyond the means of many people of lower income so i believe there is an opportunity to work with the carriers and come up with a better idea. I would say for the record its another example of the importance of rural rock bands. It may provide some costs up front but the savings we can achieve through medicare or our society as a whole through private insurance are no doubt substantial. Ms. Orlov building on some of the work you have done i have no doubt there are very strong markets to provide this kind of Technology Given that seniors are rapidly growing population as the baby boom generation retires and some affluent citizens in our country as well so there are strong markets in this. Are there strong legal barriers for markets for aging in place . Things that we could address as congress . Legal barriers . Enabling the use of standards even if in fact a movement at home home and you are completely ablebodied have no issues at all. Is your home able to age with you is the question. Thank you all again. Thank you very much senator and im glad you brought up the issue of rural rock band because thats a real issue in my state as well and i was thinking about some of these sensors and other devices i would simply not work in some parts of the state of maine and something nationwide we deem need to do more work on. Im going to ask a couple of other questions. Mr. Strickler i noticed that you did do a cost comparison that all of us are interested in and you talked about the cost of the setup was 2000 with a monthly fee mr. Strickler one final question that i want to ask you and that is in your testimony mentioned that your motherinlaw didnt want to wear that Emergency Alert pendant. How did you find out about the alternative ways of keeping her safe by the use of dispensers by putting them it sounded like all over the house to make sure. I dont think most people would even know where to begin. How did you get the advice he needed and what you should purchase for her and what was available . I think the approach that we try to take was to find a trusted adviser that could help us and honestly we started grappling in the dark and groping in the dark a little bit if you would and explored a couple of things that werent successful and we really reached out and visited with other people that Found Solutions that did work and then said okay lets find somebody that really knows and understands technology to help guide us through this process. My advice to anybody also trying to do that would be find a trusted adviser and they can help you identify which technologies are appropriate for the different technologies that are appropriate for different circumstances. In our case we reached out to her Home Security folks and they were able to help us zero in on things that really spoke to the needs that my motherinlaw had and when we couldnt get her to wear attendance we needed to be alerted if she fell and having those sensors being able to identify if she was up and about and didnt reach point a or point b in a timely fashion it would send a cellular alert to let us know hey you need to check on turn make sure if something is amiss so that was very helpful to be able to reach up and have that resource. Thank you and my final question is for dr. Mccarthy and that is, you mentioned that you are doing telemedicine i believe from 900 sites. Am i correct too . I believe thats the correct figure. I guess my row question about that we need to look and see how we begin distributing scooters with reckless abandon at one point in time in the Medicare Program. When i began talking about scooters we actually found one woman who worked in mouth as his grandmother had three. The list chairs list chairs and all of those things where we are in many cases they are needed but how do we get approval for all those to be paid for by the Medicare Program and what do we need to instead of paying for pay for sensors that can monitor things that will allow us to intervene in a way that is costeffective and healthy and allow seniors to age and place. And more quickly the entrepreneurial freemarket in this country comes with products that can be brought to scale that they can present to the medicare system for possible reimbursement that would result in the savings i think the more quickly we could really turn this thing so i certainly urge all of you that are in academia to continue to reach out in a publicprivate partnerships that i know many of you are engaged in with their companies at the university of maine and your partners at the university of missouri and i know the va has a lot of commercial partners. The more quickly we can get this technology to points that you dont have to have, most of us dont have a trusted tech adviser. Therein lies the problem. Most americans dont even know where to find a trusted tech adviser because if you look up on line for trusted tech adviser you are liable to get somebody who is not a trusted tech adviser so i think the more quickly we can do that the more quickly we can really make some progress and i really appreciate this hearing. I learned a lot. I think all of us are motivated at this point. I thank all of you for your work and thank you chairman for a really good hearing. Thank you very much. I think your comments are very well taken. This committee has held a number of hearings on scams and we want to make sure as we start promoting this kind of new technology that can give peace of mind to caregivers and help our seniors age in place and be in the comfort, security and privacy of their own homes that we are not opening a whole new avenue for con artists out there who will exploit any possible opening as we have found in our various investigations. I want to thank all of our witnesses for being here today. Doctors said. I love the fact that you were involving the students at the university of maine and taking them i expect to derek opines to talk the seniors there and it is incredible that he came up with 50 different ideas so that should be good for quite some time. Each of our witnesses have contributed to our understanding of this issue and i thank you for taking the time to testify for us today. Committee members will have until friday, may 22 to submit questions to any of our witnesses for additional material for the record. I want to thank senator mccaskill and all the members of our committee who participated as well as the Committee Staff put together this hearing for us today in most and most of all thank you to our witnesses. This hearing is now adjourned. [inaudible conversations] [inaudible conversations] host there is a lot to watch on cspan this weekend. Coming up tomorrow we will also be live with cspan in iowa and this will be the iowa state fair soapbox and that continues. You can see some guess they are and that includes bobby jindal and governor christie. They will both be there. On cspan2, booktv we will be live at the mississippi book festival and that begins at 11 30 a. M. And on cspan3 which is American History tv on the weekend real america is on at 4 00 p. M. Eastern time. You will see a 1971 short film about a Pilot Program to improve talese community to medications in washington d. C. All of that this weekend on cspan networks. The founder and executive chair of the Chinese Ecommerce Company ali baba was the United States. They invited jack ma to talk about his companys philosophy and how he he envisions his future and why the chinese middle class or Growth Opportunity for u. S. Businesses. He spoke were about 25 minutes. [applause] i am so honored. I never expected so many people coming here to listen to my talk thank you very much. Before my talk i would like to ask how many people here have used ali baba services . Not many. And how many of you here have never been to china . Never been to china. Good, thank you very much. Well, 20 year years ago i came to america, my first trip to america to seattle. Before that i learned so much about america from my books, from my teachers, from my school and my parents and i think i know enough about america but when i came to america i saw america was not what i learned from the books. In seattle i found the internet and i came back and told my friends that im going to open a Company Called internet. I invited 24 of my friends and had a twohour discussion and finally we had a float. 23 of them were against me. Forget about it. There is no such kind of network called internet. Dont do it. There is only one person he said i trust you. I dont know what it is but if you want to try it, go ahead and try it. At that time i was 30 years old so i started my business without knowing anything about the computer, without knowing anything about business. I started my first company. My wife and i and the schoolmate. We borrowed stuff from we started the business. It was so difficult. I called myself a blind man riding on the backs of wild tigers. I survived today. For the first three years of life was really bad. I remember i tried to borrow 3000 u. S. Dollars from the bank said it took me three months asking any friends and had to borrow the money and failed. I could not our role the money and everybody said jack, is telling a lie because theres no such network called internet, 1996. So one day later in 1996 china was connected to the internet from shanghai dialing Long Distance to shanghai. I invited 10 media friends to my apartment. I wanted to tell them im not telling a lie. There is a network called internet. We waited three and a half hours to see to download the first picture. People said is that thing going to work . I said yeah it will work but not today. In 10 years it will work but at least it proved that i was not telling a lie back. I remember when we try to help our Small Businesses to sell a line. Nobody wanted to sell as nobody would buy it so first week we have seven employees and we buy and sell ourselves. The second week somebody started to sell on our web site. We bought everything we sold. We had two rooms full of things we bought for the first two weeks in order to tell people that it works. It was not easy. Since 1995 to 1999 we go nowhere in our business. Nothing was ready. In 1999 i invited 18 friends of mine who came to my apartment. We decided to do it again. We called the name ali baba of ali baba. Com and people said why ali baba . We believe internet is a treasure island. We should open sesame for Small Business and we were using ali baba because its easy to spell and easy to remember and we wanted to focus on helping Small Business because at that time we saw the american the ecommerce focusing on Big Companies and focusing on helping big businesses to save costs. In china we have so many Small Businesses and Small Businesses difficult to survive. If we could use the internet as technology to help Small Business it would be fantastic. If america is good at helping Big Companies like america is good at making basketball we should play in china. We should have the small guys and we should not help the small guys to save costs because Small Businesses know how to save costs but Small Business should learn how to make money so our business is focusing helping Small Business to make money on line. We want to make the company lasts for 102 years and people ask why 102 years . Ali baba was born in 1999 and last century we had one year, the sentry 100 years, next century one year. 102 centuries. We gave a clear goal no matter how much money they raised no match no matter how much we achieve. Dont forget we want to live 102 years. 60 years have passed and we have another 82 years ago. An x86 years in a timely die we are never successful. When i heard this club was 188 years old i was surprised and shocked. Theres so much to learn from that. Today nobody believes ali baba could survive because people said you are tiny and especially when we ipo people said you were like amazon because in an American Point of view of amazon is the only Business Model for ecommerce that we are different. The difference between us and amazon is we do not buy and sell but we help Small Business to buy and sell. We have 10 million Small Businesses on our site vying in selling everyday. We do not deliver our packages although ourselves we have more than 2 Million People helping us to deliver 13 million packages per day. We do not own warehouses but we manage tens of thousands of warehouses for other small to mediumsized Delivery Companies and we do not own but we do have more than 350 million buyers. We have more than 150 million buyers coming to shop every day on our site. Also we sell our sales last year were 390 billion u. S. Dollars in this year possibly we are going to be vague or globally than walmart. Walmart managing bat size of business 3. 2 Million People and we grew from 18 million to two today 34,000 people. The difference is amazon is a shopping center. When you bite is exactly what you look like that with ali baba the picture you see looks like this and when you bite its different. People feel surprised. Its different and they love it. [laughter] because ecommerce in china young people are using ecommerce to change ideas to communicate. The bearer of records. You never go to starbucks to test how wonderful the coffee is. Its a lifestyle and this is how the internet commerce is changing china. What we feel proud of is not that we are bigger than walmart. Yes we are proud and in five years we sell one u. S. Trillion dollars and this is my goal we think will possibly make it. We are proud part of that but we are more proud because we create 40 million jobs for china and we created the jobs in the countryside. We created a lot of jobs for women. Over 51 of the Power Centers on the internet are women. So we feel so proud of that and people say okay now ali baba whats your future . 80 of the buying and selling on line art created by our company. We have to globalize her business. We want to globalize the infrastructure of ecommerce. Why internet ecommerce grows so fast in china than the usa . The infrastructure commerce in china was too bad. You have all the shops offline walmart kmart Everything Everywhere but in china we have nothing. So the ecommerce in the u. S. Is complementary to the Main Business but in china it becomes the main course. We created infrastructure so we think if we globalize our infrastructure the payment to Logistic Center for transparent platform all over the world helping Small Business around the world to sell everywhere help the Global Consumers to buy everywhere. Our vision is in 10 years we will help 2 billion consumers in the world to shop on line. Anywhere in the world, shopping on line within 72 hours he received the product. Anywhere in china you shop on line you will receive the products within 24 hours. And we thank our globalization is focusing on helping Small Business. And doing business in the most efficient ways. We thank that we will have another 10 million businesses on our ecommerce platform. We will empower them and give them the traffic. We given the payment and logistic system so they can do business anywhere easily. We will have 40 of our business outside of china. Today we only have 2 of our business outside of china. People keep asking you raise that much money what is your plan in america . People say when are you going to, and invade america . Where are you going to pete with amazon and when he is going to with ebay . Well i would say we show Great Respect for ebay and amazon but i think the opportunity and the strategy for us is helping Small Business in america go to china, sell their products to china. China, today the middle class in china is almost the same as the American Population and we think in 10 years it will be more than half a billion people will be middle class. The demand for the middle class for good products, good service is so powerful, so strong and i think china today cannot afford good products and Good Services in the terrible air we have the water we have and the land resources. I dont think china would be able to do that. China has focused on exporting in the past 20 years. I think in the next 10 we have a new business platform. This one is not tenacious. We will Work Together against the disease, the poverty, Climate Change and i believe this is our future. The nations are united together. Relying on young people using computers, using data to solve the human problem and societys problems and this is what im passionate about. Its not about the money, its about dreams. Its not only the Technology Changing the world its the dreams you believe that are changing the world and we know the way is not easy. In the past 20 years doing Internet Business in china today is difficult and tomorrows much what difficult than the day after tomorrow is beautiful. Most people die tomorrow evening if you dont work hard. [laughter] thank you very much. [applause] thank you very much jack for those provocative and uplifting remarks. I feel good about it. Now i question we have tom fraley of the New York Stock Exchange and when hutchens the cofounder of civil partners. If you have a question you can email them to the clubs president jan hopkins at questions at the econ club and white. Org. Tom your first question. Good afternoon jack pit welcome back to new york. It was riveting as usual. You mentioned in your talk that its not about money. As you likely know we are having a societal dialogue about income inequality in this country and people who amass Great Fortunes can bex vilified irrespectivf whether or not the activities they have engaged in to amass those fortunes have created a social good. When i think about you in the last 15 years you have clearly amassed a Great Fortune personally as well as for your employees and your investors. At the same time you have at t indirectlye you have 15 million jobs and lifted an entire swath of china up and given them a better quality of life. What do you say to people who say jack, you are too wealthy, you have a mast too great a fortune . Thank you tom. Honestly the best i had was when i graduated in 1989, 88. My first job my pay was 10 a month for three years and every time when i collected the money i said i work hard and i should be able to buy a bicycle. Today i have that much money. I dont have much to spend it on and i think the money, if you have less than 1 million you know how to use the money. If you have 10 million you start to worry because the valuation where to buy stocks in the foundation. When you have 1 billion thats not your money. Thats the trust of people in it because people say jack you can manage the money better than others. You manage the money for the others so i think the money i have gotten today is a responsibility. Its the trust by the people of may. I remember the day when i started the business. I asked my wife, i said do you really want your husband to be the richest person or do you want your husband to be respected businessperson and she said a respected business person because we will never be rich. [laughter] today the thing i got are all from my expectation and never thought this money belong to me. If i believe this money belong to me i have a problem. My life would never last long if i believe this was money in my pocket. This is the money i spend on behalf of society. And they spend it in my way, and our way. Back into most efficiently. So to me its one of the resources that i have. Its a trust that i should do better. Jack, american businesses long complained about counterfeit products in china. You have had your share of that problem which you are now grappling with. Can you explain to us how you were doing that . Okay, when i come here and i go to europe i always have a problem with counterfeit issues. For ali baba Business Model we do not bind we do not sell. We have helped 10 million Small Businesses. We have one ilium products listed on our site. People buy Fake Products on our site they will never complain to us. I remember three years ago i talked to the minister of commerce and china. He said jack thats working together fighting against the Fake Products and i said yes lets do it together because i got support from the government. After we lost the policy were taking shutting down 10,000 shops every week we put more than 2000 people even today 2000 people working for her anticounterfeit products and 5700 volunteers using data technology. I remember three years ago when we launched a campaign over 3000 people came to our office to demonstrate and took the gasoline to our company and said because they are so powerful. Its the war against the criminals. They said anybody going to ali baba to demonstrate they will pay the fare and pay for the hotel rooms and pay for every day in the daytime 100 per hour and 200 per hour if you go to ali baba because they are at the fake product owners. I was so angry and i wrote a letter to my employees into these and to these guys. I will shut down the company tomorrow if we say sorry to them and these guys now in hong kong they have opened a funeral for me for four days. They burned my picture and they burned my coffin and i said we will never take one step back. Four years have passed. Today in the real world every 100,000 transactions there are six or seven cases concerning counterfeit products. In our own line 860,000 theres only one complaint. Why . We are using data to trace who is a pirate who is the seller and who is the manufacturer. We have worked with the police and i got a lot of personal threats. I will tell you guys it was a war. It was very lonely war. I felt upset when i heard somebody sue us because we have to fight it together. Our Business Model, there are three things that become the cancer counterfeit intellectual properties and a rating system, the credit system. If these three systems anything qatar for what destroy our business. We will do anything against it. China was not the owner of branding in the past 30 years because a lot of people just produced and sold. They dont have the brand. Today more and more Chinese Companies care about the brand, care about the type problems and i believe without the internet its so difficult to solve the problem. Today we have the most unique technologies and they want to work with here with you guys in america and the european brand. Lets Work Together with your experience and knowhow, how to fight against them. Lets Work Together. I got a lot of Death Threats from these guys. The police did not understand us they were they got a report that somebody selling fake gucci and they found a lot of Fake Products and inside the room there is my coffin and pictures inside and they realized it was wrong. So this is the war and we are getting somewhere. I have confidence in the internet, with the young people we have, with the commitment and with your support and help we will win the war. Jack you have expertly navigated the political situation in china as well as chinau. S. Political tension over the years. As you look out over the next five to 10 years what are your concerns with respect to either the political situation within china or the relationship between china and the u. S. . Well, in the long run i am confident with the relationship. I remember the ambassador, the u. S. Ambassador to china asked me this question what you think about china and the u. S. . I ask america how many people here know about the chinese buddhism so with some taoism and confucianism. You have to find a competitor, good or not you must find a competitor and chinese religion buddhism is about human insight how to understand your heart, how to make your heart big enough to embrace. Tao was amiss about how to become one with the nature and confucius is how to make sure you work in society. In our philosophy and our culture confusion is some tao wisdom and confucianism you dont have to have it competitor. If china keeps on sticking to it they will have no problem at all. I think the u. S. And china should Work Together and find something that we should fight together for aids, the cancer the disease of poverty and i think the air, the Climate Change. If we work on those projects together the u. S. And china should Work Together. The Small Companies will follow. And i think i know americans so well 30 years ago before i came to america but when i came now, that is not what i learned from the books. You guys come you go to china a lot. You know china is not what you think. Unfortunately i saw so many chinese experts here they only go once a year or less than that they have become experts. I am sorry for that and i always get criticism for that. Now in the world i am on the top 10 internet companies. Of course we can do better so communication, communication making young people understand each other, learn to appreciate the other side. I am not a politician. I speak like a business person. I understand my partner and i understand my competitor. Doing business is going to the battlefield but battlefield death of people die you win. But in business you should learn to work with your competitor and learn from your competitor focusing on the customer and the future focusing on the young people. Politicals i think may be the same, i dont know. Jack you describe in your remarks had to bring her company is from amazon and ebay which a lot of americans understand and how uniquely designed it is for success in china. As an investor in the company many people complain to me that the Chinese Government is not allowed u. S. Participants to be successful in the Chinese Market because its not a level Playing Field created how do you address that concern . Well, first there are a lot of successful American Companies in china. We dont see a lot of successful Chinese Companies in america. Business you all have to prepare for the future. Microsoft, ibm walmart are successful in china because they have been there for 10, 15, 20 years. Internet if you want to win china its two or three because the internet needs speed. If you want to win china or when the market by speed you will never win. You have to think about in 10 or 20 years how i can make china different and how i can be better making customers better. The reason why we win the ebay people say is because you are free. Free is not a Business Model i agree but we know ebay can go back to china and if we lose we go nowhere. We have to create unique values for chinas customers to survive. So i think yes there are still some problems between the Chinese Government and some usaid business but there are also problems in chinas government with the u. S. Government. If you have the patience if you think about 10 or 20 years, few think like a blind tiger writing on a wild tiger for 10 or 20 years suffer everything, make mistakes, change yourself, it will come. I have confidence in that. The next 10 or 20 or so that there will be a lot of u. S. Internet Companies Successful in china because you cannot stop it. You cannot stop internet. You were only stopped by those who use the internet and a wrong way. Jack for those of us in the room who would like to start a business here and the year 2015 and grow it in a decade to 240 billion in market cap. [laughter] can you give us some advice on how you maintain that culture and the spirit of the company as you grow from i think you said 18 in the department in 1999 to 34,000 now . Yeah we feel proud because 18 people to 34,000 people. I learned so much from american business. I learned from ge, microsoft and ibm walmart especially the value system, the value. People were crazy about me. When they go to bed we talk about that. 10 years when i came to america to speak i said we offered ali baba by the value system. There is a guy called dave sitting there who is an American Company and he said jack is a crazy guy because in china is impossible. I said come to china sunday so i came to china and spent three days in my company. The day he left he said jack i know you are crazy but now i find there were 100 people that are crazy in your company. People in the crazy hospital never think they are crazy. They think the people outside are crazy. [applause] its not my vision come is not my value. Our vision and our value. We tell them from the first day this is what we believe. This is our value. This is our mission. If you agree join in if you dont agree leave. If it still doesnt happen you can leave but if you join you must follow the rules we have. Its difficult and we are going to have 50,000 people in five years. When i was talking about a freedom of the go i said 34,000 people is big enough. Our goal isnt five years by the year 2019 we will have reached 1 trillion u. S. Dollars but i want less than 50,000 people in the company because that fewer people we have the more jobs will be created for others. The more people we have we will create less jobs for the others. This is my philosophy. That came to america and our stock dropped 4 that day. People said wow a terrible business. That Major Business is terrible. I think this is traditional thinking. We think about not keeping our culture, we should create a culture 10 or 20 years later what kind of culture we should have. Now the human beings are moving from itt dt, i. T. Information to data technology. Its so different, i. T. Is to make it so powerful and dt is to make the others powerful. I. T. Is to make sure you know something you have the people dont know and dt is making sure everybody knows. How to be more creative. In that way 10 or 20 years later the culture of the company is trying to make sure the other people are employees or customers have are more powerful than you are so we are creating some new things. Every time we have young people we know we add value to our culture and we also note we can understand People Better we can create a new culture. Guys, my grandfather trusted everything the newspaper said and also listen to the radio. They watch tv. My son, my daughter they think internet. I want to get involved so you go to the new generation and everything internet, this is going to be in this century and the value will be the same division will be the same for culture will be different. This makes me half the every day to think about how we can have a better organization, better culture training those young people, relying on the same people, making sure its their future. Their future will be our future. Their hope will be our hope. All companies are different. We have 33 of the management are women. We have 49 of employees are women and in a novel business you dont have that many women leaders. And the user the userfriendliness women make a big difference. Im excited and how to make the future better but excited because they know the future will surely be better than today. A question from the u. S. Financial markets. Why did you decide to go public and why did you decide to do it in the United States . Why did i. To take your Company Public and why did you decide to do it in the United States . People ask me this question and i say if i had another life i would keep my company private. [laughter] i do it not for myself, i do it for the shareholders, customers, employees. They needed. I dont need it. Life is tough. Before ipo was already tough and now its much worse. But you know then we can help more people. Where we ipo the companies more transparent. Not only are people watch us, the globe watches us and improves us. We may not like the criticism but you have to get used to it. Every time when i see some rumors here in america because you guys dont use my services so i understand but its a great opportunity for usr to know us and working together to help american Small Business using our services and it can be better. In america we are rejected by hong kong. My First Priority will be hong kong. We have a Partnership System because i had 57 shares, closed to 60 of shares when it founded the company. Every founder has shares and today more than 70 of employees have shares for ali baba. My shares dropped to less than 7 . I want to share the prosperity together with our young people. This is the best time of their lives to join the company and you should give them good return. So such a huge confidence and so influential in china. The founder put together less than 10 . And i dont want in the future. We will die, we are sick or we will be stupid and we make a lot of mistakes. I dont want to say our founders disappeared in the companies in trouble. We have to look for successors just like you have kids. You should have kids when youre young and i started looking for a successor when i was 40 years old. Now i am 51. Training young people. We know keeping the culture is the key. I like the american system of doing business but i dont really like your current independent director system too much because its like lawyers making the decisions. Nobody really makes the final call. Let me check with my lawyers. They agree, yes agree. [laughter] Many Companies are going that way and i know a ali baba will go that way if we do not change today. We should find the people that have the same Passion Mission and tell you so we form a partnership. We think the partners of the young generation they should make sure to keep the culture of the company, keep the mission of the company, making sure to help Small Business and helping consumers. The hong kong guys they think we have been there for 100 years. You know jack ma is for change and yes jack ma is for change so we will reject it really are so lucky and so thankful. I really think 25 billion is not the money we have raised, thats the trust, thats the credit. Thats the wish and hope that we have raised in america and we will use the money better in a way that can help more and more Small Businesses. Not only china. Ali baba was founded in china but it was created for the world. That is why we call it the name ali baba not a chinese character that you would never know. [laughter]