Technology and Aging -- AAHSA and CAST Meetings

With people staying alive longer, more of them are reaching their 80s, 90s and even 100s. One day, if we're lucky, "them" will be "us"! What does that have to do with technology and broadband? What effect can we and our companies have on our own future well being and that of our parents and loved ones?

To learn more about these issues and the technologies under development, we attended the AAHSA "Future of Aging Services Conference" and CAST "Solutions to the Aging Services Crisis" meetings on March 15-17 in Washington, DC.

Last July, we published a guest article by Eric Dishman "Repurposing Broadband: Home Health Technologies for the Worldwide Age Wave". His article described some of Intel's research in this area, and mentioned the formation of a new organization called CAST (Center for Aging Services Technologies), focused on using technology to help provide aging services, of which Eric is the Chair.

The subject struck a resonant chord for us. We've experienced the traumas of aging parents. We also believe that broadband can be a tool for linking people in their homes with outside people and organizations, in ways that help both those involved and society. We've called these the "tele-social" applications. In our view, this category includes tele-education, telecommuting, telemedicine and tele-care (and more). Each of these links people in their homes with people and companies/institutions/organizations which are located at a distance. And each seems to be an application for which an always-on, high bandwidth connection (i.e., broadband) could be an enabler.

AAHSA and CAST Actions

The organization sponsoring the CAST program is the American Association of Homes and Services for the Aging (AAHSA). Its members are not-for-profit nursing homes, continuing care retirement communities, assisted living and senior housing facilities, and home and community-based service providers. CAST was formed a year ago with the mission (in Eric Dishman's words) "to put the age wave challenge--and the opportunity for new technologies to help with this challenge--on the national agenda".

Last week, AAHSA held its spring conference, focused largely on technology. During one afternoon, CAST hosted a demonstration of technology applications which might be part of the future of elder care; it was held on Capitol Hill at the Dirksen Senate Office Building with members of Congress and their staffers invited. CAST called on Congress and federal agencies to support the development and application of technologies to meet the needs of older adults.

For a relatively new organization, CAST did a great job of getting attention and support. Companies participating in the demonstrations included Intel, GE Security, H-P, Honeywell, Motorola, Philips and Comcast. Numerous university research groups such as Georgia Tech and MIT were also heavily involved. The first sign that the initiative succeeded in getting attention is that the Senate Special Committee on Aging has scheduled a 10 a.m. hearing on April 6, 2004 to examine assistive technology’s role in aging services.

Health Concerns of the Aging and Technologies that Can Help

Here's a brief overview of some of the health concerns of the aging and their families that we learned about at the AAHSA conference. Many of these apply to people living in their own homes as well as to those living with some level of assistance.

• Being fearful of falling and not getting quick assistance
• Social isolation
• Having to keep track of too many medications
• Sleep disorders
• Cognitive impairments
• Unrecognized changes in health status

We saw and heard about a wide variety of technologies to address these concerns. A presentation by Honeywell on ILSA (Independent Lifestyle Assistant), and another by the University of Virginia, helped us categorize some of the functions that are useful in addressing these concerns.

The vision for ILSA is to recognize changes in routine daily behaviors as potential predictors of a change in health status. The four steps they described include:

• Gathering information. This information can be assembled into patterns that help determine what is routine or normal for a given individual. Various sensor technologies were the most common method by which information was gathered; most attendees agreed that the best sensors were passive and minimally intrusive. Sensors described during the conference included fall detectors; gait detectors; sensors under a mattress which could indicate restlessness and measure weight, pulse and respiration; RFID tags to judge what tasks had been completed, including medication compliance.
• Assessing the need for assistance. Inference engines and algorithmic work are important ingredients in technologies that help decide whether something abnormal has happened and assistance is required. Processing power is another technology ingredient here.
• Responding by providing assistance. Generally communication technologies are a part of what is required here, including both wireless technologies and always-on connections. This may include reminders of the need to take medications or other health related activities.
• Sharing health and status information with those who need to know. This may include direct caregivers, family members and very importantly aging adults themselves, as people become more responsible for their own health maintenance.

Some Big Issues

Some of the issues we heard about repeatedly during the conference concerned regulation, liability and financing. Because a significant portion of care for the aging is paid for through government programs, regulations which were once appropriate may no longer be in everyone's best interests.

• For example, certain reimbursements now apply for institutional care but not for home care. This is a problem, since home care is often better, less disruptive and less expensive.
• Reimbursement policies often cover only face-to-face visits with doctors--yet in rural areas, telemedicine may provide better, more efficient and less expensive care overall.

Since sensor technologies provide detailed information about what a person is doing, their use raises significant privacy questions. However, many installations of technology resulted in significantly more concern on the part of the caregiver than by the aging adult, as long as the client had access to the information about themselves.

Because many of the technologies relate not just to lifestyle and wellness but to medical conditions, fear of legal liability is an issue for some companies which have technologies which could be applied to this market.

...And Also Some Success Stories

Despite the issues which must be addressed, it was reassuring to hear some real world success stories. One of these was presented by Bridget Gallagher, representing Lifecare Services by The Jewish Home & Hospital. Her organization is focused on home care and addresses a population of over 800 seniors, 90% of whom live below the poverty level. Their data on Home Care patients revealed that the number one cause of acute care hospitalization was Congestive Heart Failure (CHF).

By providing Health Buddy--a simple telecare technology--to 111 CHF patients and remotely monitoring to promote self care, early intervention and medication adherence, they found that patient outcomes were improved and hospitalization rates were significantly decreased. Bridget's conclusion was that "all home care agencies need to improve patient outcomes while containing fiscal expenditures. It is unlikely that agencies will continue to meet these goals if they do not include Telecare, in some shape or form, as part of their care planning process."

A Work In Process

CAST has just launched an updated Website that includes a clearinghouse to provide "a place to learn what's happening in aging services technologies". It includes four content areas in which technology companies and research organizations can find or post information related to Products, Pilot Projects, Research and Development and Emerging Technologies.

Although many of the technologies we saw in Washington are not ready for deployment today, we are pleased that these companies are forward-looking enough to understand that some of the same infrastructure being put in place now for entertainment and other applications--including broadband connections, home networking and new consumer electronics devices--could play a future role in promoting and maintaining our health. Pursuing this market of wellness and health care for the aging population is not only good for society, it also promises large amounts of money which will be spent by individuals, institutions and governments as the "baby boomers" reach and pass retirement age.

Postscript to our non-US readers

From some of the non-US projects we are aware of, we suspect the application of technology to the health concerns of the aging and their families may be an area in which the US is behind some other countries. One of our previous articles concerned Telefonica's Pilot on Home Health Services. We would be interested in hearing from our readers about other projects in which broadband, home networking and home gateways are being applied to home health care, either for the aging or more generally.

( www.agingtech.org ) ( www.aahsa.org )