Are eight definite. Definites. And there are others out there. But there are some republicans who are opposed, even though some republicans have said they would vote to proceed with the bill, at least move to an open debate on it. But it has they have two weeks coming up to get it done. Host some of those republicans up in 2016. What happens then . The senate, if they are able to get it done, what happens in the house deco house . Emma dumain i was going to say, the numbers in the house tricky. There are more members obviously. If you are not the whip, it is harder for vicki and i to even put the numbers on the table about where people are. A few of the House Democrats i was speaking to lessig who are either for or against tpa and are being very vocal about it said, you know, very few democrats have very few democrats are get to make up their minds. That is to say, there are a very few number of democrats who are for it or against it. And no those are the members that president obama and joe biden need to lobby one way or the other, the pending on with it are. Host in the pool of House Democrats who have said yes . Vicki needham 10 that are for sure yes. And about 26 have decided for sure. But there is another huge pot of undecided, and we figured that they are in several different batches. The ones that are going to say yes now, the ones who are going to say no now, and the ones who are going to stand on the floor and wait to see if the vote is needed. Emma dumain and i think republicans fall into that category as well. 2 yes Vicki Needham yes. Host thank you very much for explaining it. Appreciate it. Up next, a Senate Hearing looks at how technology is helping senior live longer Senior Citizens live longer and remain independent. Then a cspan mothers day special presentation remembering life in the white house. And later, attorney general more adamant makes her first appearance on capitol hill to defense to discuss her department path departments budget. With color photos of every senator and house member, plus bio and Contact Information. Also, district maps. A foldout map of capitol hill. At a look at congressional committees, federal agencies and the governors. Order your copy today. It is 13. 95 plus shipping and handling at cspan. Org. On wednesday, the Senate Aging Committee held a hearing on how technology is helping seniors live independently longer. The committee examined advancements in Technology Like electronic sensors and medical alerts, and how they allow seniors tuesday at home as opposed to living in Nursing Homes. This is one hour and 25 minutes. [indistinct chatter] this hearing will come to order. Good afternoon. This afternoons hearing will explore the potential of new technologies to help seniors safely and to retain their independence. The u. S. Population is aging. According to Census Bureau projections, 21 of our population will be 65 and older by the year 2040. That is up from just under 14 in 2012. Every day 12,000 10,000 baby boomers turn 65. As many as 90 of them have one or more Chronic Health conditions. Americans age 85 and older our oldest old, are the fastestgrowing segment of our population. And this is the very population that is most at risk of multiple and interacting Health Problems that could lead to disability and the need for longterm care. At the very time our population is growing older, the need for care and support is increasing. The population of professional and Informal Caregivers is however, declining. Today, there are seven potential caregivers for each person over age 80 and at the highest risk of reclaiming longterm care. Requiring longterm care. By the year 2030, there will be four. And by the year 2050, the numbers drop to fewer than three. As a consequence in the future more and more people will have to rely on fewer and fewer caregivers. As people age, they naturally want to remain active and independent for a long as as long as possible. Aging in place is the ability to live in ones own home and community safely, independently, and comfortably, regardless of age or ability level. Surveys taken by aarp consistently reflect the fact that aging in place is the preferred option for seniors who want to continue living independently and avoiding Nursing Homes and other institutionalized care for as long as possible. Todays hearing will examine some of the recent advances in technology that are providing new options to allow seniors to remain in their homes longer by monitoring their Health Status detecting emergency situations such as debilitating falls, and notifying families and Health Care Providers of potential changes in Health Status form or urgencies. While it is not a replacement for professional care or personal attention from family members, technology can help to bridge the care gap and extend the amount and length of time a person is able to live independently. Technology can also help to reduce isolation and enrich the lives of seniors by keeping them engaged and connected to their families and their communities. We will also hear this afternoon about technologies that can make the lives of Family Caregivers easier by giving them the tools they need to support their loved ones as they age in place. Finally, we will hear from the veterans administration, a real pioneer in health, which has used technologies such as videoconferencing and smart monitors to reduce hospital admissions and to shorten hospital stays. This has resulted in lower costs and has also allowed some of our older veterans with Chronic Health conditions to live independently at home, right where they want to be. Many of us are familiar with the decades old and wellknown phrase, i have fallen and i cannot get up. That phrase was an advertisement for a medical alert system. While many seniors still rely on this device, breakthroughs in modern technology have brought us a long way. Providing many new options for seniors and their families. Technological solutions can be costeffective and tailored to meet specific needs of a senior and his or her living situation. Companies that develop these technologies are starting to realize that not only is there a growing need to design products that meet seniors needs, but also that there are many seniors who want technology and devices that look just like those used by younger generations. For example, this phone is an over older generation device that is specifically designed for seniors to be easy to use. It has large numbers, for example. This new generation version of the phone is the smart phone that still has the same easeofuse as the old version of the jitterbug phone, but looks like the smart phone that peoples children and grandchildren use. Much more important than its appearance, however, this new generation device also includes technologies that help seniors maintain their independence. For example, it has features to help with medication adherence provide 24 7 access to medical emergency operators, as well as an app the Family Caregiver can download to keep them up to date on their loved ones wellbeing. We will also explore the challenges posed by these technological advances, such as privacy concerns and the unequal access to the internet that exists across the country. Before i turn to senator mccaskill for her opening statement, i want to give a special welcome today to dr. Carol kim, the Vice President for research at the university of maine. Dr. Kim overseas oversees the sail program. Aging and thriving, in Place Movement that will benefit significantly from the development of new technologies and devices. I look forward to hearing not only from her, but all of our witnesses this afternoon. Senator mccaskill. Senator mccaskill thank you. Helping our seniors remain in their communities and age with dignity is an important issue and a top priority of this committee. You have assembled a great panel today and i am look forward to looking forward to hearing about exciting innovations that could help seniors and their families. There is a disconnect between the number of seniors who say they want to stay in their homes and communities and the number of seniors who end up having to move into nursing facilities. A recent aarp study found that 87 of older adults would prefer to remain in their own communities as they age. While it may not be possible for every person depending on risk factors to remain in their homes, for many of us, it is possible. And it is preferable in terms of quality of life and financial reasons. Advances in technology are providing these new options for these seniors and their families that allow them to remain home for longer by monitoring home status, and notifying Health Care Providers about changes in in Health Status. This can make the caregiver life easier by providing tools to support left once loved ones and giving them peace of mind. This really is a winwin situation. Seniors are much happier keeping their routines, families can make sure their loved are safe ones and society as a whole benefits from significantly reduced health care and longterm costs. Many of these technologies are already on the market. Even Health Communications companies also versions of connected home systems that can keep seniors secure in their home. Developers are creating senior specific monitoring devices such such as bed, toilet, and pillbox sensors that can monitor activity in the home. Pillbox sensors are so simple in nature and can prevent tragic accidents by making sure seniors are not mixing medications or taking too many pills. Wearable devices are also popular for tracking physical activity and helping to prevent falls. Falls are the leading cause of injuries in older adults, with one out of every three senior seniors falling each year. Some of the newer monitoring devices do not even require the push of a button. They detect when a person has fallen. Technology has been critical to the growth of health and helpful to seniors in particular who, by using the services, can have their health monitored from the comfort of their home rather than the doctors office. These technologies are being developed by researchers across the country, one of whom is with us here today. I am so pleased and proud to introduce dr. Marjorie, the director of the center at my university, the university of missouri. The center has created a Living Environment that utilizes a number of advanced technologies in senior apartments. The doctor and her team have found a way to use radar and 3d sensors to monitor seniors risk level for fall. I look forward to learning more about this. I know there are some concerns about preserving the privacy of seniors, and that using webcams and video monitoring my present some challenges. We also want to make sure we are looking out for their safety. I know the university has used privacy techniques, such as using only silhouettes on video monitors that could help ease privacy concerns of older adults. The challenge for those who develop these technologies is to find ways to maximize safety with minimal invasion of privacy. Thank you to chairman collins and for our witnesses for taking the time to be here today and i look forward to listening and learning from your testimony. Chair collins thank you very much for that excellent the meant. I want to note we have been joined by senator purdue senator kaine, and i am very pleased you could join us this afternoon. We are now going to turn to our panel. We will first hear from lori, a Tech Industry veteran and the founder of aging in Place Technology watch. I understand she also has the wisdom to have a summer home in the state of maine. That is, for me, i enough to invite you to testify today. I have already introduced dr. Carol kim, the Vice President for research at the university of maine. Our next witness is dr. Mccarthy at the department of veterans affairs, the active chief consultant for Health Services. And will discuss the v. A. s health program, which, by many measures, has been a success and has helped to reduce costs. And has already been introduced from missouri by the committings ranking member, and finally, i would like to welcome mr. Strickler knows well the challenges for caring 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. Thank you. I want to thank you for the opportunity to testify today for the requirement for Technology Innovation to help older adults age in place. As you have noted, demographics make this Technology Market essential. These categories will help make it feasible for older adults meet their needs as they age. As we have already noted, nearly 90 of adults aged 65 want to remain in their own homes. In fact today, they actually are remaining in their own homes. Successful aging has been described as the ability to do things for myself, feel safe and have good health. Aging in place, therefore, is the ability to successfully age in your home of choice. Aging in place products and services, including technology provide a useful underpinning and enhancement of the quality of life for seniors as they age in place. We have talked about demographics. I want to add a couple of refinements to things we already heard. We know 46 million adults 65 or older today, 24 million of those are 75 or older. 46 of women aged 75 plus today are living alone. The society of actuaries recently updated Life Expectancy at age 65 to reflect a new reality that women aged 65 can now expect to live on average to be 88. 8. With 25 of them living to 90 or more. Men at 65 are going to live on average to 86. 6. The average oneyear cost will be 61,000 per year by 2020 and in northeast chicago, and most memory care units, that number has already been reached and exceeded. Seniors know this and are deferring movein to assistedliving facilities until they reach mid 80s p or most of but most of them still remain at home. So lets talk about categories of technologies for aging in place. If you could bring up that slide. Thank you. They are best represented by what i describe as interlocking pieces of a puzzle. The puzzle paradigm is used to show if you leave out any one undetected illnesses, and all types of complications in their lives. Kinds of competitions in their lives. Older adults benefit from innovations and particularly related training and how to benefit from them that adjust their ability to connect with other people, opportunities, they engage in their communities, be safe and manage health and wellbeing. Looking at each category starting with the upper left puzzle piece, lets admit examine them one at a time. In the communication and engagement technologies, while devices may change over time and have changed significantly, as you showed by your example, the purpose remains the same. They help older adults connect connected with others through email and video chat, playing games, fining people with shared finding people with shared interests, and finding services and resources to meet their needs. With video it can be used to monitor and also to engage people with social connections with family and friends are friends. While 27 have smartphones, both percentages drop off noticeably at age 75. The second category, the most important aspect is a home alarm system that can monitor and alert about fire, temperature, and moisture in the home. Without it, the other technologies are just nice to have. Other uses of technologies listed here include emergency response, which we have already talked about, and safety watches. Following sensors, motion sensors, and activity monitors that could now monitor absence of activity and decline over time. Increasingly, information from various devices can be combined to detect the changes and other patterns over time. Health and wellness technologies in the bottom right, that includes health as we heard, but also wearables, smart phone apps, as people acquire smartphones, that may be useful, and Online Health information. There are new tools are being developed all the time to help with dementia care, and help home care workers. And a variety of these new devices can assist with people with low vision and able with and people with hearing impairment. The bottom lefthand corner is about learning and contribution and how we stay engaged in our society as we continue to learn new things, which is how we remain content with our lives and interested and help keep our minds sharp. Tools that help people tell and record their life story, for example, online sites that enable them to volunteer, enable them to find work. 20 of people after age 65 these days are actually working. Many of them fulltime. People can learn new skills. They can learn new skills that are leisure and workrelated and all of this Online Training is free. These are the times we live in now. It is free. Forums are developed are available to ask questions. The biggest problem we have is that mobile device data plants today average 60 to 80 per month and wifi access is typically being used by people in coffee shops and libraries because having a highspeed Internet Connection to the home can be quite costly. 60 a month or more. That is a limitation on access for a lot of folks. As people age, all of the four categories are enhanced by inclusion of the role of the formal and informal caregiver which you can see in the middle. That could include the professional caregiver. There are new technologies that not only track time and attention of caregivers but also communicate care status. That is, mobility, eating, and cognitive function. The future market potential of this market is greater than the availability of smartphone features, technologies, and will move into robotics. It has been sized at the low end of 20 billion by 2020. In the future, you will see your special purpose you are special purpose re fewer special purpose offerings for seniors. More examples of standard Standard Hardware and device platforms with Customizable Software that will meet the specific needs of the user so we do not have to put in vent specialpurpose technology for everything. That concept can be seen today in the customizable features in your car, your tablets smartphones, television, and consumer electronics. Designed once, customized for the individual. I hope the overview has been helpful for you and i hope and thank you very much for your time. Chairman collins thank you for your testimony. Dr. Kim. Dr. Kim good afternoon, distinguished members of the Senate Committee on aging. My name is dr. Carol kim and i appreciate the opportunity to share with you technologies the university is developing allowing older individuals to age and thrive in place. It could not be timelier. We are convinced the aging and thriving movement is destined to benefit greatly from the Rapid Deployment of technologies products, and devices that maximize Human Performance improve mobility, navigation home environment, and intelligent living. Improve emergency detection and contribute to older adult falls prevention mitigation, and response. The university of maine has launched a cross Campus Initiative in partnership with Community Agencies and has established a Research Incubator from social work to engineering to disability studies responding to Major Public Health issues that affect aging americans. In the area of home safety optimization and falls prevention, we are developing technologies to promote mobility, increase contrast sensitivity, promote out to exercise, and improve balance. One of the common challenges that occurs with age is the loss of contrast sensitivity. This can be dangerous for older adults as it turns low contrast features, such as cement stairs, curbs, or benches into falling hazards. Our goal is to improve safety and reduce falling be a costeffective solution that can be implemented without any infrastructure buildout. To do this, we are exploring the use of Computer Vision as a means to detect low contrast edges and improve visibility. This technology will likely reduce the falling problem because it is optimized to the tech likely factors that occur with age. Although, crutches and canes have been available. These are minimally functional for exercise. In this movie, the assistive jogger was created to fill an unmet need for populations who would be less likely or unwilling to participate in ambulatory exercise. It is convenient, foldable three wheeled standard support device. That improves allens and weightbearing assistance improves balance and weightbearing assistance during jogging. It is fitted with biofeedback and load Sensing Technology and is in the early phase of commercialization. In the area of falls mitigation, we are developing advanced Energy Absorbing clothing technology. A team at the university of maine is working to develop nonstigmatizing protective gear to mitigate injury for individuals at risk for falls. The main company has developed an impact resistant material system and offers headgear for older adults that can be integrated into fashionable headwear well providing protection against injury. It is lightweight and can be it has potential for reducing head injury. In 2013, 25,800people were admitted for treatment for hip fracture. Researchers are collaborating to design departments in a changeable shell that will be worn by elders at risk for falling. I have samples of the material here. If anyone is interested in taking a look at that. In the areas of fall response, we are developing Wireless Networking technologies with wireless detection to assist first responders. Loss of sensory, cognitive and motor function that occurs as people age can lead to many safety risks. We have recreated a typical apartment setting for testing a new, sensible system that makes use of lowcost technology. Rfid tags can be embedded into the physical structure of an apartment. The reading device is small and designed to be worn comfortably. The system tracks the users location and sends an alert that there is a problem. The system will help reduce inhome falls and improve safety, efficiency, and independence. I would like to thank the committee for the opportunity to describe the exciting and necessary technologies that researchers are pursuing to improve the quality of life for our older population. Senator collins thank you. Dr. Mccarthy. Dr. Mccarthy thank you for the ability to speak. Joining me today is the chief consultant for geriatric and longterm services. She is recognized as a world leader in the development of teleHealth Services. They are one of the major transformational initiatives aimed at ensuring care is convenient, accessible and patient centered. It is one of the v. A. s major transformational issues. It increases access to highquality services. By utilizing secure information and telecommunication technologies to provide Health Services when the patient and practitioner are separated. In fy 2014, it allowed more than 717,000 patients 12. 6 of our , enrolled veterans to receive care through telehealth. This amounts to over 2 million episodes of telehealth care. Currently, it is available in over 45 Specialty Care areas. At v. A. , we use three telehealth modalities to ensure excellence in health care delivery. Clinical video telehealth is the use of realtime conferencing. Sometimes, with the support of peripheral technologies to assess, treat, and provide care to a patient remotely. Home telehealth is a program for veterans that applies care and Case Management principles to coordinate principles. Lastly, telehealth is the use of technology to acquire and store clinical information that is forwarded or retrieved by a provider at a nether location for clinical evaluation. Homebased primary care provides longterm primary medical care to veterans and their homes under the coordination of an interdisciplinary treatment team. Telehealth support can include recording the weight of the patient, sending reminders about medication, taking medication, asking key symptoms that indicate the need for intervention. It also allows the patient to send pictures to a nurse or doctor to advise on what additional care is needed. It can act as an educational cool and an educational tool and support system p or to who might be overwhelmed is provided with knowledge and skills and access to emotional support. We have increased access to primary care and consultations. It results in reduced utilization of inpatient care. In fiscal year 14, when we studied veterans, those enrolled veterans had a 54 decrease in bed days of care and a 32 decrease in hospital admissions when they were compared to themselves in the year prior to their enrollment. Veterans receiving mental Health Services, what we called Telemental Health led to reduced psychiatric care. In addition, they reduce the necessity for veterans to travel to facilities for care. Home telehealth has decreased costs for v. A. And nonv. A. Care. Most importantly, veteran satisfaction scores have rated high, with approval for these types of modalities. For many veterans and their loved ones, travel can be a complicated and arduous task. Travel time is time away from work or family. The teleHealth Services programs revolutionizes the time challenged by changing the location where Health Care Services are provided. It helps veterans take a more active role in the management of their health and wellbeing. This concludes my testimony, and i am prepared to answer any questions you or other members may have. Dr. Skubic thank you for the opportunity to be here. I want to tell you a story about eva. The Senior Housing facility with 54 apartments. Residents can stay there. If they need extra help, services are delivered to them. A private corporation built it and Clinical Operations are handled by the nursing school. A nursing professor set up tiger place to investigate new ways to help seniors age in place. We started Testing Technology there in 2005. Eva had a history of congestive Heart Failure and a cycle of hospitalization as her condition worsened and got better and worsened again. She volunteered to be a participant in a sensor study, and we installed a motion bed and chair centers in her apartment. The sensor system detected changes in her patterns. When marilyn saw this, she knew that even as evenevas health was worsening. If we did not act now, she would have to go back to the hospital. In this case, it meant changing her medication. Her doctor was resistant to the request because she had not gained enough weight to satisfy his protocol. His onesizefitsall protocol did not work for eva. She needed to change now. Maryland convinced the doctor to change her medications and she never went back to the hospital again. This broke the cycle of rehospitalization. The sensors pick up subtle changes before eva or her doctor noticed it. Since then, we have developed a support system with Automated Health alerts sent to nursing staff. It has a fall detection system and a walking gait analysis system. Sensors are mounted in the environment and operated without the sensor having the operator having to wear anything or do anything special. Two sensors can be installed in the same bed for couples. To respect privacy, no surveillance cameras are used. We use depth images that produce silhouettes. It learns patterns and send alerts to clinical staff when there are signs of Health Problems. We have good signs of pneumonia, pain, delirium, hypoglycemia. We were able to recognize changes in walking speeds and stride length of the husband in the home that corresponded to his early dementia. Even when his wife was living there and they had many visitors coming into the home. In the case of a fall, alerts are sent to staff. They can see what happened leading up to the fall. Residents get help immediately. Pictures and links are included in my testimony. I would be happy to show them to anybody. As a professor, i carry all of my slides with me. I have another story about my motherinlaw, who did not have this technology. She got up in the middle of the night, fell down, broke her shoulder. My fatherinlaw was sleeping without his hearing aid, so he did not hear her call. The next morning, he found her but the damage had been done. With her damaged shoulder, her mobility was limited. She could not cook or bake anymore. Gore pick up her greatgrandchildren. The constant pain was a drain. Even though she survived the fall, her quality of life was diminished. I can imagine a different outcome if she had sensors in her home and had gotten help immediately. Research studies have shown the inhome Health Alert System works. Seniors with sensors have a better help out,. Seniors with sensors have a longer stay in independent apartments in tiger place compared to those without sensors. I nearly two years longer. We now have a commercial partner that is bringing this technology to seniors. Many of my colleagues at other universities have developed Exciting Technology to help seniors. The potential for Proactive Health care is significant. Detecting Health Problems early so that early treatment can be offered is more effective and less expensive than the current approach and will keep seniors healthier so they can stay in their homes. We have seen this work in missouri. I would like to see this so others can benefit. Including my mom and dad in south dakota, and your loved ones too. Senator collins thank you for your testimony. Mr. Strickler. Mr. Strickler thank you. On behalf of caregivers, thank you for the opportunities to testify. My wife and i have it has widowed mothers. Both have always desired to live at home as long as possible. Needless to say, it has been a challenge to stay in tune with their state of mind and wellbeing while respecting their spirit of independency and privacy. Living several hours apart makes it more challenging. My mother is independent. She lives alone. She is active in her community and continues to enjoy gardening. She uses a cellular pendant so she can remain independent but with the security of help at the touch of a button, or automatically if she is incapacitated. It works wherever she goes. She is diligent about wearing her pendant. We know solutions have been ineffective for the majority of users for many reasons. My motherinlaw aging experience is one such case. My motherinlaw experienced a much different aging scenario than mine mother. She has dementia. It became apparent you need more assistance and we needed to have her closer to us. We modified a cottage next to our home by incorporating a walkin tub. She moved in september 2012. We tried several different products. We were able to know when she was active. As they dementia progressed, we became concerned about falls. She would not respond to the voice in the box. The products are ineffective. We worked to find a company to install alternative technologies including beds sensors, chair sensors, toilet sensors and three b easy buttons to help summon help. Incorporated with the existing door and motion sensors, it enabled her to have independence and privacy and get alerts when patterns changed or when issues arose and she required assistance. Bed sensors facilitated tracking sleep patterns. The refrigerator sensor helped recognize when she would forget to eat. Before she had fulltime caregiving, pressing the care of an summoned help. The system provides many of the alerts based on individual sensors, but provides a wellness overview, including data summary overviews that make it easier to see trends and patterns. The graphics make it easy to understand what is changing. The system has enabled us to know when to layer in additional care and assistance. Matching it to her state of health as her capabilities changed. My wife and her twin sister are the two primary caregivers. They would tell you the three most valued benefits are encompassed by the breadth and totality of the solution. The system provides a tremendous piece of mind, ensuring mom is safe, allowing us to check on her when we are not in her cottage. The technology is a Priceless Gift enabling us to honor her request to stay at home and live as independently as her capabilities allow. Financially, it has been a relief to preserve resources allowing us to provide the best possible oneonone care. Had we moved her into assisted living, the cost would have been significant. To date, the cumulative costs for 2. 5 years moving into an average virginian nursing home as 223,000 plus 104,000 for services. In contrast, the cost of our system was 2200 plus a 59 monthly fee. We still need to supplement our own caregiving efforts with contracted home care support nominal investment in technology has provided cost savings and a higher standard of care. The company we are working with continues to innovate and our system has more capabilities. A sensor alerting when the stove is left on over a prolonged period. Remote control over thermostats, lights, and locks. Motion sensors activating lights. Alert pendants which can unlock the doors. Aging in place technologies are not a magic solution. It will solve all of our problems by costeffectively caring for an aging population. From our experience, they can be an integral part of the solution. These technologies can be tools that can help difficult conversations, prolonged independence, and guide assistance in a costeffective and nonintrusive manner. Affording caregivers and their loved ones excellent lifestyle choices. Thank you. Senator collins thank you for your firsthand experience and sharing it with the committees. Dr. Kim, as i watch the technology that you illustrated for us today, i could not help but think i could have fought for years and never come up with the assisted jogger. I realize that there is a certain stigma that is associated with walkers. Seniors are eager to avoid those. How do you come up with the technologies and products that you are developing at the university of maine . Dr. Kim in terms of the assisted jogger, that started with two faculty members in disability studies. One faculty member has walking and balance issues and wanted to develop some kind of system so she could exercise outside and remain active and part of the community. Her goal was to participate in a 5k. She developed this jogger. She would be able to complete a 5k. Even though the technology was originally designed for someone with walking issues, you could see this jogger would be a great and is going through rehabilitation. There are sensors included in the assisted jogger so you can make sure you are not putting too much weight on a joint. Lots of technology can come from this originally technology this original technology that can be tracked to the aging population. Do you survey seniors and see what their biggest problems to your reach out to Health Care Providers . Home Health Agencies . Dr. Kim all of the above. Even with a small group of students going to the local assisted living facility, it is right there. Students in engineering met with residents at this facility and in one hour, they were asked what can we design that would help you in your daily lives. In one hour, they came up with 50 designs. Senator collins that shows there is a need for these innovative devices. Lets look at the other side of this issue. I read an article in which you were quoted as aging in place does not imply watching us age. I understand the concern. About privacy that these things may raise, particularly webcams implanted devices even. How can we make sure that we are striking the right balance between maximizing safety so people can stay in their homes and not making them feel that they brother, not big brother, the adult child, who is watching them . Dr. Kim the use of any Monitoring Technology is the concept of opting in and giving permission that you are willing. A lot of implementations of Monitoring Technology have been done under the basis of threats, if you do not let me put this in your home, i will have to help i will have to have you moved to assisted living. I would call that the loving threat. The loving threat has worked in many cases, but it is important people and what their opting into. It is not necessarily into having their every move watched. People who Design Technology properly designed the absence of activity in a particular window of time, or the absence of going near the refrigerator, the presence of a cat or a dog that may jump by the sensors, there are the sensors saying you are not moving, but you are away for several weeks. A lot of thought has to go into how these things are set up. When configured properly, they can work well. Senator mccaskill i would like to talk about taking things to scale. What are the cost savings you can attribute to some of these advancements as it relates . We have tried to stress, many people out there, who are not directly involved, they do not under and a huge proportion of medicaid dollars are not spent on struggling families. Rather, they are spent on our seniors, who are in Nursing Homes. The high proportion of medicaid beds makes this an important hearing for our deficit. If we can figure this out, the cost savings and the implication of the cost savings are dramatic to the problem we have with the demographic double that is represented with my generation going into medicare and not having sufficient money saved. What kind of savings can you actually quantify at this point, that we might be able to realize that if we embrace these monitors in peoples homes, these sensors. Professor skubniic we are looking for early signs of Health Changes and declined. When we started working with the nurses, they talked about the trajectory of aging and functional decline in a stairstep fashion where you will go on a plateau until something dramatic happens and you get dropped down to the next level very quickly until the next dramatic thing happens. Our premise was, if we can recognize the beginning of the decline so and intervention could be offered, we can keep people at the top of the level and some people call it squaring the life curve. You go along for some time and then theres a sharp dropoff when you die. Im hoping this is what happens to my parents, actually. To all of us, that we would end up being very functionally active until the end. Trying to quantify that in terms of cost savings is hard. We have not done the study that quantifies the effectiveness in those terms, in economic terms of the technology alone. We are involved in an nih control funded and we are hoping to have some Economic Cost savings figures associated with this. I can tell you my collaborator has looked at the Economic Impact of using nursing care coordination. That is what they are doing an entire place as well. It is how they do the nursing care and how you add the technology on top of it. They have shown a dramatic potential associated with what they have been able to do, just to organize and coordinate it, we have seen the standard level of care at tiger place with those between those who have sensors and those that do not. We see improved Health Outcomes and a longer stay in independent living. I am extrapolating. I do not have the numbers for you. I suspect they are significant. This one statement in here comes from maryland marilyns work about 10 Million People need longterm care in the United States of the 4. 6 million older than 65 and live in the community. These represent a potential 89 billion in class savings. Senator mccaskill we would love to get the numbers. Tiger place is more expensive than some of the other facilities in the area in terms of care, but it is small and you are doing research. We have got to start monetizing the savings as quickly as possible. The more quickly we can monetize, the more quickly we can adopt them. That would have a huge impact on their availability to most people. Dr. Skubic it is not too much more expensive than other facilities. Senator mccaskill i am a big fan of what youre doing. I want to deliver this to as many people as possible. It helps us struggling with how we are going to make sure our grandchildren are not inheriting debt they cannot swallow. Thank you. Senator perdue there is an old terrier motive. There is an ulterior motive. We want the best care we can for our parents. The second is, i am hearing an opportunity to deal with one of the largest cost items we have coming at us. Like several of you, i have a personal experience with this. Contrary to political opponents, i have a mother. She is 89yearsold. She is tech savvy. This aging in place is a new phrase for me. She is living it out. Contrary to that my wifes , mother is a bit younger. She has been diagnosed with alzheimers disease. We have a different trajectory to deal with. Dr. Mccarthy, i am excited about what you are doing with those the a doing with the v. A. You have a perfect laboratory. You have patients who are sometimes in denial about need and you have a medical staff that might be less them receptive to some of these new technologies, or not. Maybe it is a perfect lab to develop these. Give us a general sense of cost, acceptability with the patients and also with the medical staff. Dr. Mccarthy we have an example of a device that would be placed in the veterans home. This would monitor the Blood Pressure or the weight or the temperature or something of the veteran. We provide those devices. The cost about 350 and can be repurposed when one veteran is finished with it. The cost of using a device like that are about 1600 a year. When i talk about cost savings i did not translate that days of care for hospital admission into savings. Patients last year had a 54 decrease in bed days of care. They had a 32 decrease in the number of admissions. It is important to know the devices do not exist alone. They are part of a system. For us, we have home telehealth coordinators. For about every 100, we have one Care Coordinator. For every 100 veterans enrolled, it needs to be the right population. People have published about this data. We have inquiries from all over the world. Some of the problems people in other countries have experienced is not having the Care Coordinator available or electing the wrong group of patients. There are four disease conditions for which this is helpful. Congestive Heart Failure means the heart is not functioning as strongly or effectively as it used to. Congested because the fluids back up. You see things like weight gain. Weight is an incredibly important sensor for someone with congestive Heart Failure is starting to deteriorate, because of their diet or some other condition. That is a very important piece of information, to notice the trend. Another is copd, lung disease, what people sometimes called emphysema. Sensors are attached that can detect oxygen saturation. The veteran and the caregiver do not have to get in the car and travel. The intervention can be made. I also wanted to mention ptsd would is a very important condition for us, where people can track their moves and symptoms. The fourth one is diabetes where blood sugars can be monitored. The Care Coordinator serves a crucial role in trending the data and communicating with the patient and the Health Care Team to make sure the interventions happen appropriately. Senator perdue thank you. Senator blumenthal thank you for holding this hearing. I want to focus on an aspect of security, which has not been mentioned so far. The security of the data. The information that is collected. Perhaps begin with you, ms. Orlov. Records that were stolen and the Identity Theft associated with that. If you can tell us what steps have been taken and what more has to be done to make sure that the personal information confidential medical and other information can be kept secure. Ms. Orlov we are in the midst of a data crisis. You know about the records that were stolen and the Identity Theft associated with that. It has created a heightened awareness of all of the players that are in the continuum of care for older adults and for everyone. That includes insurance companies, for which the state but also includes Health Care Providers and their management of Electronic Medical records. Awareness has been dramatically heightened in the past four to six months. Senator blumenthal it should have been heightened years ago. Anthems data was not encrypted. Is yours . Ms. Orlov i do not have any data. The v. A. , maybe. Senator blumenthal should it be encrypt to through this kind of program . We recommend protection and privacy. Our journey started around the early 2000 decade. The Technology Available to ensure answer your he has changed. Some of the rules and requirement reflect what was required then. There are newer means to conduct those kinds of visits and we are migrating our technology that way. Senator blumenthal as you know, we have an ongoing controversy about the 40 mile rule, whether it should apply to clinics, to the clinics that can provide the care that the veteran may need. They are able to go to a private health provider. What i am wondering is, whether the Telehealth Program from hospitals, the 100 plus hospitals that there are would fill a gap that would enable more vets to go to clinics to get the care they need. How much of that have we explored and fulfilled . Miss mccarthy thank you. You are talking about Clinical Video Health in particular in which a provider sees a patient. A lot of folks are familiar with skype or facebook not facebook facetime. Im sorry. That is the Technology People are familiar with that represents what goes on with telehealth. Those clinical visits can happen from one of our parent hospitals to the communitybased Outpatient Clinics. They can happen from one Outpatient Clinic to another. They also happen into the patients home. We are looking at exploring ways for the provider to not have to take up the space of a Medical Center to provide this kind of care. We have about 12. 7 of our patients engaged in clinical video telehealth. There is a large opportunity for expansion. It is music to my ears that you asked. We are working down the barriers that we see in expanding this as an option. Someone wrote in the mid1990s that the Biggest Barriers to the extension of telehealth are not the technologies. They are the administrative burdens. What we often refer to is the fact that our nation has a Health Care System that is excellent, but it is a bricks and mortar based Health Care System. There is not a system of hospitals. It is our goal to get to the point where the care can be provided timely. Not clunky. It will be easy for the provider and the veteran to be able to have that care. Senator blumenthal you said 12 to 20 . Dr. Mccarthy i said 12. 7 . Senator blumenthal thank you for your excellent work. Senator collins senator cotton. Senator cotton dr. Mccarthy, i would like to continue along the lines that the senator is discussing. I want to expand that more about home telehealth. In a state like arkansas, we face a couple of challenges. In east arkansas, we have low population density. And what you have experienced at the v. A. , how much of the challenges do you think are going to revolve around that kind of infrastructure will revolve around the novelty of it or the resistance to change that we all have is a natural human instinct . Dr. Mccarthy there is a requirement for buyin on multiple part. We can tell stories of elderly patients that have coached our younger providers through their first telehealth visit in a way that has been positive for everybody engaged. Technology is an issue. We have three kinds of technology that we use. We use device connection, the Interactive Voice Response is and the web browsers. The voice responses is how a lot of people used to do their banking, put in their number in the phone and what they want to do. You can do that by pushing buttons or by voice recognition. The Device Connections can be through the telephone system. It is some times called the pots or plain old telephone system. We have some devices rolling out that have builtin cellular antenna that allow for that kind of connection. Sometimes the technology is a barrier. It has been my experience that so many of our aging veterans who have grandchildren at a distance are becoming more familiar with facetime and skype. They are very engaged in this incredible inconvenience of not having to travel, to figure out whats going on. Moving around the Medical Centers and so forth. The whole process has been well received. They are very positive about it. Senator cotton have you worked on the challenges on one hand and Consumer Preferences and habits on the other . One of the things we have not talked about is boosting conductivity for older adults. There have been pilot programs to provide discounts. At this point, there is not a Standard Program across the carriers in the United States that would make Internet Access affordable for many people of lower income. That is an opportunity that it seems we could do more with. Same thing with cell plans. The average plan is around 60 a month. An Internet Service plan at 60 month now means you are out 120 a month. That is beyond the means of many people of lower income. There is an opportunity to work with the carriers and come up with a better idea. Senator cotton another importance of broadband. It may provide some cost on the upfront, but the savings we can achieve through the government and medicare, or in our society as a whole are no doubt that substantial. Building on some of the work you have done, i have no doubt they are strong incentives in the market given that Senate Seniors are a rapidly growing population. They are generally some of the most athletic editions in our country. There is a strong incentive, but there are strong legal barriers. Things that we could address is a congress . Looking at the physical environment, which is the home looking at Building Code and the way new housing for older adults is being designed, there is no code that would make homes modestly accessible. Nothing that requires smooth thresholds or wide doorways for bathrooms. Nothing that requires singh think sink heights to be accessed if you are in a wheelchair. If you want to think about something that can be done to enable people to age longer in their home, it would be to talk to organizations and look at what are the barriers. There are probably barriers at the state level. That will enable use of standards. Even if you move into the home and youre able body, its your home able to age with you . Senator cotton thank you again. Senator collins senator cotton thank you. I am glad you brought up the issue of rural broadband. That is an issue in my state as well. I was thinking about some of these sensors and other devices would simply not work in some parts in the state of maine. It is something we need to do more work on. I have a couple of other questions. I noticed you did do the cost comparison that all of us are interested in. You have talked about the cost of the set up. 2000 and then a monthly fee of 59. If my math is right, when you look over the two point five years, if you had Nursing Homes plus help, is over 300,000. I think this has important cost implications for us. One of the issues i think Congress Needs to work with the administration on is what is reimbursable for Health Care Providers under the medicaremedicaid program. A lot of times, we will pay for the consequences of unchecked diabetes, but we wont pay for the ongoing prevention that prevents a person from having the complication. I can see many of you nodding. That is something we need to look at as well. One final question. In your testimony, you mentioned your motherinlaw did not want to wear the Emergency Alert pendant. How did you find out about the alternative ways of keeping her safe by use of sensors. By putting them all over, it sounds like all over the house to make sure she is eating, you put one in the refrigerator door. I do not think most people would even know where to begin. How did you get the advice you needed on what you should purchase for her and what was available . Mr. Strickland we tried to find a trusted advisor. We started groping in the dark and explored a couple of things that were not successful and visited with people who Found Solutions that did work and said lets find some money that knows technology. My advice would be to find a trusted advisor and they can identify which technologies are appropriate. Different technologies are appropriate in different circumstances. In our case, we reached out to our Home Security folks and they helped us zero in on things that spoke to the needs that my motherinlaw had. When we couldnt get her to wear the pendant, we needed to be alerted if she felt. Fell. Having the sensors be able to identify if she was up and about and did not reach point a or point b in a timely fashion, it would send cellular alerts to let us know hey, you need to check on her if something is amiss. That was helpful, to be able to reach out and have that resource. Senator collins thank you. My final question is for dr. Mccarthy. You mentioned you were doing telemedicine from 900 sites. Is that correct . Dr. Mccarthy i believe that is the correct figure. Senator collins is this happening from the communitybased clinics and your v. A. Hospital . It is not individual, outside providers that you are contracting with. Dr. Mccarthy could include that, but that is primarily v. A. Driven. Some of the sites where the care is provided with the other clinics or other parts across the country. As a network we are supporting one another, but also at home as much as possible, too. Senator collins the cost to savings you have quoted, you star multiplying that, you get into real numbers very quickly. This has been an interesting hearing. I want to call on senator mccaskill for any final questions. Senator mccaskill i think we need to go back and look and see how we began distributing scooters with reckless abandon at one point in time in the Medicare Program. When i began talking about scooters, we found a couple of one woman worked in my office, her grandmother had three. The lift chairs and all of those things, in many cases, they are needed, but how do we get approval for all of those to be paid for by the Medicare Program and what do we need to instead of paying for those, pay for sensors . They can monitor things that will allow us to intervene in a way that is Cost Effective and healthy and allow seniors to age in place. The more weekly the quickly the entrepreneurial free market in this country comes with products that can be brought to scale, they can present to the medicare system for possible reimbursement that would result in the savings. The more quickly we can turn this thing. I encourage you to reach out in the publicprivate partnerships that many of you are engaged in with your companies at the university of maine and with your partners at the university of missouri. The v. A. Has a lot of commercial partners. The more quickly we can give Us Technology to the point you do not have to have, most of us do not have a trusted tech advisor. Therein lies the problem. Most americans do not know where to find a trusted tech advisor. If you look online for a trusted tech advisor, you are likely to not get someone that is a trusted tech advisor. The more quickly we can do that, the more quickly we can make progress. I appreciate this hearing. I learned a lot. I think all of us are motivated at this point to see if we cant push this envelope. Thank you, chairman, for a really good hearing. Senator collins thank you. I think your comments are well taken. We want to make sure that as we start promoting this kind of new technology that can give peace of mind to caregivers, 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. Dr. Kim, i love the fact that you are involving the students at the university of maine. And taking them to talk with seniors. It is incredible that there are 50 different ideas that should keep them busy for quite some time. Each of our witnesses has contributed to our understanding of this issue. I thank you for taking the time to testify for us today. Committee members will have until friday, may 22 to submit questions to our witnesses or additional materials for the record. I want to thank senator mccaskill and members of our committee who participated as well as the committee staffs. Most of all, thank you to our witnesses. This hearing is now adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2015] [indiscernible] the house and senate are both in session this week. The sun is back for general speeches tomorrow and will vote on a resolution on the policy of the u. S. On the release of your citizens in iran. On tuesday they will vote on whether to advance trade commodity trade authority promotion. The new congressional directory is a handy guide to the 114th congress with color photos of every member and bio and Contact Information as well as twitter handles district maps, a look at the capitol hill, and it look at congressional committees the president s, federal agencies, and state governors. Order online today. It is it is 13. 95 at www. Cspan. Org. Tonight on cspans q a. Kate Anderson Brower on the world of the white house through the eyes of the people who work there, from the kennedys through the obamas. Who are the thick lens thicklands