Senate asks industry for aging in place technology cost savings data

By Jonah Comstock
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Senator Claire McCaskillThe Senate Special Committee on Aging held a hearing yesterday to learn about the potential of aging in place technologies, including sensors and wearables. Aging In Place Technology Watch lead Laurie Orlov and VA Deputy Chief Patient Care Services Officer Maureen McCarthy testified, along with academics Marjorie Skubic from the University of Missouri and Carol Kim from the University of Maine. Charles Strickler spoke as well, as a representative example of a caregiver with an aging parent.

"Recent advances in technology are providing new options for seniors and their families that can allow them to remain at home for longer by monitoring health status, detecting emergency situations and notifying health care providers about any changes in health status," Senator Claire McCaskill (D-Missouri), the ranking member of the committee, said in her opening statement. "These technologies can also make family members’ and caregivers’ lives easier by providing them with tools to support their loved ones and giving them peace of mind. This really is a win-win situation, seniors are much happier continuing their normal routines and social activities where they feel comfortable, family members can make sure their loved ones are safe, and society as a whole benefits from significantly reduced healthcare and long-term care costs."

McCarthy shared a lot of data at the hearing about the VA's use of telehealth, much of which supports aging seniors.

"In fiscal year 2014, VA provided care to more than 717,000 patients (12.6 percent of our enrolled veterans) through telehealth modalities," she said. "This amounted to over 2,123,000 telehealth episodes of care. Forty-five percent (45 percent) of these veterans lived in rural areas and may otherwise have had limited access to VA health care services. In fiscal year 2014, telehealth was implemented in over 900 sites of care and is available for over 45 specialty areas of care. The number of veterans receiving care via VA’s telehealth services grew approximately 18 percent in 2014 and is anticipated to grow by approximately 28 percent in fiscal year 2015."

Skubic's work at the University of Missouri includes overseeing TigerPlace, an assisted living facility that uses Microsoft Kinect cameras and other sensors to monitor seniors and facilitate early detection of gait problems or other health risks. An NIH study that's currently underway will give the University a sense of the cost savings potential of these sensors, Skubic said.

Kim shared a number of interesting innovations in progress at the University of Maine including augmented reality software for helping seniors detect ledges and steps, and thus avoid falls, an "assistive jogger" that allows less stable seniors continue to exercise, and a sensor-laden mattress that could detect cognitive decay early based on sleep movement. Kim said that University of Maine students spent an hour at a local nursing home and came back with 50 workable ideas for improving the lives of seniors.

But the panelists stressed that aging in place technology was unlikely to come down to a single silver bullet. Orlov made it clear that any solution involving invasive monitoring needed to be truly opt-in for seniors and protect their privacy however possible.

"A lot of implementations of monitoring technology have been implemented on the basis of threats," she said during the Q&A. "If we don't monitor you, I’m going to have you move to assisted living because I’m too nervous about your wellbeing to leave you living alone. I would call that sort of the loving threat. That’s worked in many cases, but it’s very important that people understand what they’re opting into. They’re not opting into having their every move watched."

Strickler spoke about his experiences caring for his mother and mother-in-law, who required very different technology from one another. While his mother was "diligent about wearing" a personal emergency response pendant, his mother-in-law refused to, like many seniors.

"We know PERS systems have been ineffective for the vast majority of users for many reasons," he said in his testimony. "The reasons include: not wearing the pendant, responding that things are OK even when they really need help, fall detection not activating an emergency response, drained batteries, and seniors worried that emergency responders will knock their door down if the resident cannot get to the door to open it, as well as a variety other reasons. We had first hand experiences like these with my mother-in-law, but her biggest complaint, aside from not wanting to wear a pendant, was that she simply didn't want to 'talk to an unfamiliar voice in a box.'"

McCaskill urged the panelists to focus on demonstrating cost savings if they wanted legislative support for their technologies.

"One of the things we’ve tried to stress in this committee that I think many people out there don’t understand is that a huge percentage of the Medicaid dollars that are spent in this country are not spent on struggling families who are not working, but rather are spent on our seniors who are in nursing homes," she said. "The high proportion of nursing home beds that are Medicaid beds makes this a really important hearing for our debt and our deficit. Because if we can figure this out, the cost savings are dramatic to the longterm problem we have with the demographic bubble that is represented with my generation going into Medicare."

"We've got to start monetizing these savings as quickly as possible," she added later. "The more quickly we can monetize them, the more quickly we can begin adopting them as part of public policy preferences, which would have a huge impact on their availability."