[Senate Hearing 116-547]
[From the U.S. Government Publishing Office]
S. Hrg. 116-547
AGING AND DISABILITY IN THE
21ST CENTURY: HOW TECHNOLOGY
CAN HELP MAINTAIN HEALTH
AND QUALITY OF LIFE
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
MAY 22, 2019
__________
Serial No. 116-07
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-419 PDF WASHINGTON : 2022
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SPECIAL COMMITTEE ON AGING
SUSAN M. COLLINS, Maine, Chairman
TIM SCOTT, South Carolina ROBERT P. CASEY, JR., Pennsylvania
RICHARD BURR, North Carolina KIRSTEN E. GILLIBRAND, New York
MARTHA McSALLY, Arizona RICHARD BLUMENTHAL, Connecticut
MARCO RUBIO, Florida ELIZABETH WARREN, Massachusetts
JOSH HAWLEY, Missouri DOUG JONES, Alabama
MIKE BRAUN, Indiana KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida JACKY ROSEN, Nevada
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Sarah Khasawinah, Majority Acting Staff Director
Kathryn Mevis, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Susan M. Collins, Chairman.......... 1
Opening Statement of Senator Robert P. Casey, Jr., Ranking Member 3
PANEL OF WITNESSES
Joseph F. Coughlin, Ph.D., Director, Agelab, Massachusetts
Institute of Technology, Cambridge, Massachusetts.............. 5
Cara McCarty, Director Curatorial, Cooper Hewitt, Smithsonian
Design Museum, New York, New York.............................. 8
Brenda Gallant, RN, Executive Director, Maine Long-Term Care
Ombudsman Program, Augusta, Maine.............................. 10
Robert Mecca, Executive, Life and Independence for Today (LIFT),
St. Marys, Pennsylvania........................................ 11
APPENDIX
Prepared Witness Statements
Joseph F. Coughlin, Ph.D., Director, Agelab, Massachusetts
Institute of Technology, Cambridge, Massachusetts.............. 29
Cara McCarty, Director Curatorial, Cooper Hewitt, Smithsonian
Design Museum, New York, New York.............................. 42
Brenda Gallant, RN, Executive Director, Maine Long-Term Care
Ombudsman Program, Augusta, Maine.............................. 46
Robert Mecca, Executive, Life and Independence for Today (LIFT),
St. Marys, Pennsylvania........................................ 49
Statements for the Record
Testimony of Audrey Busch, Association of Assistive Technology
Act Program.................................................... 55
Testimony of Mary Lee Fay, National Association of State
Directors of Development Disabilities Services................. 60
Testimony of Betsy Beaumon, Benetech Organization................ 72
AGING AND DISABILITY IN THE
21ST CENTURY: HOW TECHNOLOGY
CAN HELP MAINTAIN HEALTH
AND QUALITY OF LIFE
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WEDNESDAY, MAY 22, 2019
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., in
Room 562, Dirksen Senate Office Building, Hon. Susan Collins
(Chairman of the Committee) presiding.
Present: Senators Collins, Tim Scott, Braun, Casey, Sinema,
and Rosen.
OPENING STATEMENT OF SENATOR
SUSAN M. COLLINS, CHAIRMAN
The Chairman. The hearing will come to order.
Good morning. Today we will explore how 21st century
technology is improving the quality of life for older Americans
and those with disabilities. We have on display an array of
devices that are available today. I want to show you a few of
them from up here on the dais.
This pen, for example, is the PenFriend 2. It allows one to
put stickers on various items and then record voice labels in
order to identify them later. This is particularly helpful for
people with limited vision.
For example, let us say that there are a number of cans in
your kitchen cabinet. One might be pears, one might be corn,
one might be peaches. They are all about the same size, and it
can be difficult for someone with limited vision to be able to
discern which is which.
Well, when the cans of corn, peaches, and pears are bought,
each would have one of these yellow stickers put on them, and
then using this device, you would record what the item is.
Later on, when the person with limited vision is trying to
select the right can, he or she can simply touch the pen to the
yellow stickie, and it will tell him or her what it is. That is
just one of the many examples.
Another are spoons that make it easier for people who have
Parkinson's, for example, to continue to feed themselves. Or
there are other mobility issues, this intriguing spoon, if I
can make it work here, will bend to come to the right level of
your mouth, so there is so much that is exciting out there.
These days, most of us carry in our pocket at least one
device, such as my iPhone. This phone, while still used for
making telephone calls, today offers so much more potential. A
typical smartphone can track health measures like daily steps
or blood sugar and can pair with other devices to predict the
risk of falls or diabetic episodes.
From the everyday technologies that we all use to assistive
technologies that help seniors and those with disabilities
improve function, these devices are poised to change the future
of aging. Survey after survey indicates that seniors envision
themselves living independently at home in their own community
for as long as possible and living their lives to the fullest.
Technology can help make that possible.
With 10,000 Americans turning 65 every day and one out of
five Americans set to join this group by 2035, we are in the
midst of a major demographic shift. The fastest-growing segment
of our population are Americans age 85 and older. While aging
brings opportunity, it also comes with increased risk of
multiple and interacting health conditions that can lead to
disability, at times requiring long-term care, and making it
more difficult to age at home.
As our population is aging, the need for care and support
is increasing. In 2010, there were approximately seven
potential caregivers for each person over age 80. By 2030,
there will be only four, and by 2050, the number drops to fewer
than three, so more people will have to rely on fewer
caregivers--opening the door for technology to help fill that
gap.
Advances in technology are working to bridge this ``care
gap,'' improving function in activities of daily living,
helping to manage multiple chronic conditions, reducing the
risk of hazards, and making homes safer for seniors. Not only
has technology allowed seniors to age in place, but also it is
making it possible for individuals to move out of nursing homes
or other institutionalized settings back into the privacy,
security, and comfort of their very own homes.
Through tools and technologies, Maine's Homeward Bound
program, for example, has helped to transition seniors as well
as others with disabilities back into their communities, and we
will hear more about that this morning.
One particularly promising avenue for new technologies is
in the prevention of falls. Falls are a leading cause of both
fatal and nonfatal injuries among seniors and are projected to
cost our Nation $67 billion in the coming year alone. Falls-
related injuries can have a devastating impact, requiring
round-the-clock institutional care, but new technologies can
reduce the risk of falls, as well as contact emergency services
for help as soon as a fall happens. I am excited about an
innovative approach now being developed by the University of
Maine, which is a pair of smart glasses that can detect edges,
such as stairs or curbs, to help prevent falls, particularly
for those seniors with limited mobility and limited eyesight.
Another area where technology holds great potential is in
reducing social isolation. Social media and video chat on
tablets and smartphones help to reduce isolation and loneliness
and enrich seniors' lives by keeping them connected to their
loved ones. We have had previous hearings on the health impact
of prolonged isolation, and they are substantial, on physical,
emotional, and mental health and well-being. In fact, according
to researchers, prolonged isolation is comparable to smoking 15
cigarettes a day. That is how profound the impact on health is.
While not a substitute for interacting directly with people,
technology can help bring people together.
It is important that older Americans have a key role in
developing these technologies. That will increase utilization,
reduce stigma, and ultimately makes for a better product.
Older Americans also have helped companies realize that
they want technology devices that look just like those that are
used by younger generations. For example, many of us are
familiar with hearing on television that old phrase, ``I have
fallen, and I cannot get up.'' Well, that was an advertisement
for a medical alert system that, for many years, was considered
among the most advanced technologies to help seniors age in
place. While many seniors still successfully rely on this
device, breakthroughs in modern technology have brought new
options that are far more versatile.
Technology is opening the doors for older Americans and
those with disabilities to live the way they prefer, and that
really is what this is all about--accommodating the individual
preferences as we grow older. From better managing health and
mobility to increasing connectivity and community involvement,
technologies on the market today and those on the horizon for
tomorrow promise to usher in a new era of aging.
I look forward to hearing our excellent witnesses today,
and I now will turn to our Ranking Member for his opening
statement. Senator Casey.
OPENING STATEMENT OF SENATOR
ROBERT P. CASEY, JR., RANKING MEMBER
Senator Casey. Chairman Collins, thank you for your
testimony, and also thank you for this hearing.
Assistive technology provides an opportunity for millions
of individuals to live independently. It can improve the lives
of older Americans and people with disabilities, and today we
will hear how assistive technology can help members of these
communities enjoy the same rights as any individual. We will
hear how it gives everyone the right to learn. We know that
assistive technology makes it possible for students with
disabilities to fully participate in their education.
We will hear how it gives everyone the opportunity to work,
and we know that assistive technology can break down barriers
to employment and allow individuals to remain in the workforce
as long as they choose to. We will hear how it gives everyone
the right to live independently. Assistive technology provides
the opportunity for older adults to live and thrive in their
own homes and communities, and as a previous witness who
testified before this committee, Rick Creech from Pennsylvania,
explained, assistive technology gives everyone the right to be
heard.
As Chairman Collins and others will recall, Rick testified
before the Committee with the assistance of an alternative
communication device. Without that communication device,
someone like Rick might have used a spelling board or may not
have been able to communicate much at all. He told the
Committee at that time, ``living without being able to
communicate was like being behind four glass walls.''
This hearing will examine how assistive technology can
break down those walls. We hope to raise awareness about the
availability of assistive technology for those who could
benefit and highlight that far too many people with
disabilities and older adults still need access to assistive
technology.
I also hope this hearing will jump-start a conversation in
Congress about updating the Assistive Technology Act, a law
passed way back in 2004 that needs an update. Technology looked
a lot different than it does today. Just think of our
smartphones--kind of mini computers that we all carry around.
Certainly older adults never imagined the ability of Fitbits or
smartwatches to promote healthy living. None of us could have
imagined that.
People who are blind or have limited vision--as Chairman
Collins pointed out--did not imagine they could wear glasses,
literally wear glasses that were connected by Wi-Fi to someone
who can see what is around that person and communicate the way
to get to a restaurant, a theater, or a grocery store. Every
week there are new advances that we must harness so that every
American who requires assistance can, in fact, benefit.
It is for this reason that Senator Collins and I will be
introducing the 21st Century Assistive Technology Act when we
return from recess, a bill that can, quite literally, bring
assistive technology into the 21st century. This legislation
will update the Assistive Technology Act to provide more
resources to State assistive technology programs that would
expand access for older adults and individuals with
disabilities.
I will also introduce the Access to Freedom of Speech for
All Act that will increase access to information about
alternative communication devices for those who have speech and
written language disabilities, areas that often limit an
individual's access to education and employment.
These bills are designed to ensure assistive technology and
alternative communication devices are available to those who
need it so they can be full participants in every aspect of
their lives, and to help us make the case, I am pleased that we
can showcase here today, in the back of the room, the types of
assistive technology that we want to get into the hands, or in
some cases be the hands, of seniors and people with
disabilities.
So, again, I want to thank our witnesses and thank Chairman
Collins for agreeing to hold this hearing today. We look
forward to the testimony of our witnesses.
Thank you.
The Chairman. Thank you very much, Senator. I want to
welcome Senator Rosen, who is here today, and I am sure there
will be other Senators in and out, which is pretty typical of
our hearings.
I have asked the staff to also put out some more of the
technology in front of us that I referred to in my opening
statement, and I would invite people after the hearing to come
up and take a look at it, supplementing what Senator Casey
said.
We are delighted now to turn to our distinguished panel of
witnesses.
First we will hear from Dr. Joseph Coughlin. Dr. Coughlin
is the founder and Director of the AgeLab at the Massachusetts
Institute of Technology. He studies the role of technology in
the lives of the 50-plus population, and what better place to
do that than at MIT. He is also author of the ``Longevity
Economy: Inside the World's Fastest-Growing, Most Misunderstood
Market.''
Next we will hear from Cara McCarty. Ms. McCarty is the
director at the Cooper Hewitt, Smithsonian Design Museum, which
houses exhibits featuring an array of assistive technologies
for older adults and those with disabilities. We welcome you as
well.
I am, of course, particularly pleased to introduce our
third witness, Brenda Gallant from Maine, the great State of
Maine. Brenda is the executive director of Maine's Long-Term
Care Ombudsman Program, and she directs the Homeward Bound
program that I mentioned in my opening statement. Sponsored by
Maine's Money Follows the Person, this program provides
participants with the tools and technologies necessary to
transfer from living at a nursing home or other
institutionalized setting back into their own communities and
their own homes.
Finally, I am delighted to turn to our Ranking Member to
introduce our final witness.
Senator Casey. Thank you, Chairman Collins.
I am here to introduce today Bob Mecca from St. Marys,
Pennsylvania, Elk County, which is a pretty good drive from
here, as we were talking before the hearing about the drive he
had. He drove down, and his wife, Dawn, did some driving when
she got here. I guess it is up for grabs who is driving home,
right? But we are grateful you are here, and Bob will be able
to speak personally about the importance of assistive
technology. He is one of the millions of people in our country
who use assistive technology every day in order to maintain
their independence. Not only is Bob a user of assistive
technology, he helps provide assistive technology to
individuals in some of the most rural counties in Pennsylvania.
Bob is the executive director of Life and Independence for
Today, an organization that serves the needs of Pennsylvanians
with disabilities in Cameron, Clearfield, Elk, Jefferson,
McKean, and Potter counties, and take my word for it, that is a
lot of territory in just those counties, and as I mentioned,
his wife, Dawn, is with him. We are thankful they are here and
that they made the journey here, I guess about 4-1/2 hours one
way, so we are grateful for that effort that you have made and
look forward to your testimony.
Thanks.
The Chairman. Thank you very much.
Dr. Coughlin, we will start with you. Thank you.
STATEMENT OF JOSEPH F. COUGHLIN, PH.D.,
DIRECTOR, AGELAB, MASSACHUSETTS INSTITUTE
OF TECHNOLOGY, CAMBRIDGE, MASSACHUSETTS
Dr. Coughlin. Thank you so much, Chair Collins, Ranking
Member Casey, and Committee members for the opportunity to
discuss how technology will not just improve aging and quality
of life for older adults and their families, but it is actually
a new opportunity to redefine how we age in the future.
While I am also privileged to serve on the National Board
of AARP, I am here today as a private citizen and as a research
scientist and director of the MIT AgeLab. I have collaborated
for decades with researchers around the world, and it is on
their shoulders that I make a few of these remarks, and
particularly enjoy the fact that this is Older Americans Month
that you chose to have this hearing.
Senator Casey, I want to start with a resident of
Pennsylvania that you may recall to set my remarks. Sarah
Knauss lived to 119 years old in Pennsylvania, and she was
asked, if you can believe this, on her 115th birthday, ``Why do
you enjoy living so long?'' That took a lot of chutzpah, I must
add, by a journalist, but she came back with an answer better
than any scientist, any engineer, any policymaker: ``I enjoy my
life because I have my health and I can do things.''
Members of the Committee, technology is not just to help
people age. We have an opportunity now to set a new longevity
economy, to change how we age, to change how we live.
Unfortunately, we are constrained by a short story.
Unfortunately, the short story is that old age is about
frailty. It is about what we cannot do. It is about poverty. It
is about poor health, and that is absolutely true for a very
large number of people, but it is also a time for us to think
of something else. It is no longer the aging ticking time bomb
as many have described it.
Unfortunately, that story has permeated the consciousness
of technology makers, so where we have companies where the
average age is in their 30's and in some cases their 20's, they
see someone in their 40's as being old, but more importantly,
the story that they see is the only thing you do in older age
starting at age 50, 60, 70, and 80 is to be reminded to take
your medications.
So as a result, with all the great technology and promise
that we have there, we have technologies that may be
functional, but they are big, they are beige, and they are
boring, so they lead to stigma, if you will, by anyone who
chooses to use them when, in fact, we do not want TV remotes
that are large enough to be a self-defense device; we simply
wish to age by stealth.
Senator Collins, your remarks on bringing, if you will,
older adults into the process, absolutely required. We do that
at the AgeLab, and many other researchers around the world do
that as well. However, I caution those who believe that putting
the consumer in the system alone will lead to innovation.
Consumers do not know the power of what technology can do. They
do not know the power of new design, so we have created the Age
Gain Now Empathy System, AGNES, that allows my students,
marketers, engineers, designers, shall we say, to feel the
friction, the fatigue, and often the frustration of disability
and aging, because they know how the technology can be used and
are less likely to edit the fact that they feel that friction
or are too embarrassed often to voice it.
On that note, yes, there are amazing technologies that are
out there. Many of them are assistive, but we are also
forgetting one other user. Fundamentally the consumer of an
aging society are women. The future is female. The majority of
them will live longer. They are the majority of caregivers and,
by the way, make the majority of household consumption
decisions. If we do not frame around what she sees as a
consumer, we will be confusing the user with the actual
influencer and buyer, so, yes, there are many technologies out
there. Your house, your toilet, your toaster, and refrigerator
will be talking to each other about your nutrition. Your spoons
and your forks will not just be accessible; they will be
smarter. Robots will keep you company, remind you to take your
meds, answer the door. One, in fact, will tell you a joke or
insult you once or twice a day to keep you cognitively well.
Your home will become a service platform, not necessarily just
a place, and yes, I would be remiss that my own department of
the Center for Transportation Logistics, the driverless car is
coming, offering great promise, but I caution all of you not to
be overly exuberant. Think of that first 50 feet of getting
into the car and the last 50 feet of getting out of the car.
Think of the system, not the technology itself.
In the spirit of Sarah Knauss, however, I ask you to think
about how technology will help us work, stay engaged, and I
dare say the ``F'' word--fun--as we think about the future of
aging.
Let me close my remarks with some serious policy
considerations, and, Senator Collins, you touched on a few of
them.
One, affordability. How do we actually get this so that
others can afford this?
Second, smart buyer. Where do I learn about these systems?
How do I know which to use? And how do I get them into my life
and into my home? And given that they change faster than your
cell phone, how will I make sure that I stay on top of what is
possible for my family?
Senator Collins, I speak to you particularly personally as
a fellow New Englander. Rural accessibility. We are now looking
on Capitol Hill about the discussion of infrastructure.
Pavements and pipelines alone are not infrastructure. Digital
access is a requirement for participation in the United States.
It is no longer simply a luxury.
Last, if I can close on this: I want you to think of the
longevity economy as not just a matter of policy and markets
doing what is fair, doing what is nice. The fact of the matter
is the fastest-growing part of the population worldwide and in
the United States is the 50 and 60 plus. This is another
particular to create an entirely new lifestyle, an entirely new
economy, new products, services, and experiences to improve the
citizens and residents of the United States, but also something
that the U.S. can export.
To date, unfortunately, there is not a single place in the
Federal Government where there is a podium to talk about
technology, aging, and innovation on a positive note--not just
about pills, not just about assistive devices, but how do we
turn long life into a dividend to be cashed in to make life
better?
My closing remark: Vannevar Bush was a professor at MIT,
science adviser to FDR, and the dean of engineering at the
time. He said that science and technology was an endless
frontier. Members of the Committee, I want to put in front of
you the following: that longevity and the longevity dividend,
in the 30-plus years that we have gained since the year 1900 is
a new frontier to use science, technology, and commerce to
chart not just how to live longer but how to live better.
Thank you, Chair Collins, Committee, and I stand by for
questions and look forward to helping you in the future. Thank
you.
The Chairman. Thank you very much for your excellent
testimony.
Ms. McCarty.
STATEMENT OF CARA McCARTY, DIRECTOR
CURATORIAL, COOPER HEWITT, SMITHSONIAN
DESIGN MUSEUM, NEW YORK, NEW YORK
Ms. McCarty. Thank you, Chairman Collins, Ranking Member
Casey, and Committee members. It is an honor to share with you
several examples of the beneficial ways design and technology
are transforming the lives of people with physical, cognitive,
and sensory disabilities. They are from two exhibits I
organized--one in 2018 at Cooper Hewitt, Smithsonian Design
Museum, and the other featured earlier this year at the World
Economic Forum in Davos.
Senator Casey, I am delighted to inform you that in 2 weeks
the exhibition opens at the Carnegie Museum of Art in
Pittsburgh.
The goal of both exhibitions was to illuminate the
innovative designs developed during the past decade for people
with various disabilities to improve their quality of life,
expanding their options and their ability to engage more fully
in life.
Design plays a powerful role in shaping our lives. When
applying design sensibilities to people with physical and
cognitive challenges, the shortcomings of existing products and
environments, as well as societal barriers and social stigmas,
are magnified. Until recently, products looked clinical,
perpetuating psychological barriers and how we stigmatize the
user.
By addressing the needs of individuals with significant
challenges, many others benefit. Curb cuts in sidewalks are a
prime example whose mandated purpose and function have extended
well beyond the original intended users.
I would like to illustrate a few examples of low-and high-
tech solutions, several of which would have included what you
showed, Senator Collins, which I included in the exhibition.
Mobility. May I have the slides, please? Thank you. Making
canes stylish and objects of pride empowers the user with
confidence and dignity. Today there is considerable redesigning
of walking sticks. They function better. They have non-slip
handles. They can illuminate at night to help prevent falls,
and interchangeable handles and tips and joyous colors let the
user personalize them. It means people now have choice, which
will continue to expand as digital technologies are integrated
into canes.
Next slide. Walkers, wheelchairs, scooters for older adults
often lack elegance or grace, which stigmatizes the user. They
are seen as medical equipment. Consequently, individuals often
resist using them, and they do not venture outdoors, but as
demonstrated by the Afari Mobility Aid, an all-terrain
``walker'' designed by two older adults with mobility
challenges--two adults from Maine, by the way--but who want to
remain active and independent, these mobility aids are both
useful as well as stylish. In use, it appears like walking a
bicycle .
Connecting and communication. Digital technologies--next
slide, please--are undeniable game changers for many
individuals with disabilities. They fill a void that is vital
to maintaining a fulfilling life. Many counteract isolation, as
has been noted.
A poignant example are Tobii Dynavox's portable, eye-gazing
devices that support access to communication for those not able
to speak or who require hands-free communication to express
themselves, their thoughts and ideas in ways and at speeds
previously unimaginable. In addition to the product's speech-
generating capabilities, eye-tracking enables an individual to
use their eyes as pointers to move symbols, or to type and send
emails, or to edit images and films.
Daily needs of bathing, dressing, eating are essential.
Next slide, please. A man with Parkinson's disease had
difficulty buttoning his shirt. His wife saw a design
opportunity, not an obstacle. She was inspired by the magnetic
covers of iPads and transferred that innovation to invisible
magnetic buttons. It is a prime example of inclusive design. It
looks like a regular shirt and can easily be marketed to
individuals with limited manual dexterity.
Next slide, please. I am excited about the recent
legislation deregulating hearing aids. Everyone experiences
moments of decreased hearing, a noisy restaurant, crowds of
people. In earlier generations, concealing disability was a
priority, but this is changing as awareness is growing, and we
see people embrace their disability. These customized, low-
cost, over-the-counter hearing aids are not dissimilar to
eyeglasses, which were traditionally called ``medical
appliances'' until fashion designers got a hold of them And we
see what happened. Why not glam them up?
Next slide, please. Particularly striking examples of this
shift toward outward expression are these prosthetic leg
covers--snap-on tattoos that are intricately patterned and
available in a variety of patterns and colors. With these, the
conversations turn to the appealing prosthetic rather than what
happened to you. The positive reaction gives confidence to the
wearer.
My last slide, how do we design transportation for
everyone? In the U.S. 30 percent of individuals with
disabilities have difficulties accessing transportation.
Cities, streets, buses, subways, and other public spaces are
not universally accessible, but as has been noted, as we plan
for the future and upgrade infrastructure, we have tremendous
opportunities. This Accessible Olli is a prototype autonomous
shuttle bus, accessible to people with physical and cognitive
disabilities, with a retractable wheelchair ramp, software that
can process sign language and display other simplified
information.
In conclusion, design matters. What distinguishes many of
these products is that they were designed with the user at the
center. By focusing on the user and designing with the user not
just for the user, we cannot only understand the needs better,
the product better, but we humanize design. What is needed is a
mindset change. We speak about the aging population or people
with disabilities as having the problem, but isn't the real
problem that many of our designs on all scales create barriers?
By placing those who have been traditionally excluded central
to the work of design, we not only value their ways of being,
but we also reconstruct notions of inclusivity and exclusivity.
As August de los Reyes, who is quadriplegic, said,
``Disability is a mismatch between my own abilities and the
world around me. Disability is a design opportunity.''
Thank you.
The Chairman. Thank you very much. Your slides are
absolutely fascinating.
Ms. McCarty. Thank you.
The Chairman. Creative and encouraging. Thank you.
Ms. Gallant, welcome.
STATEMENT OF BRENDA GALLANT, RN,
EXECUTIVE DIRECTOR, MAINE LONG-TERM
CARE OMBUDSMAN PROGRAM, AUGUSTA, MAINE
Ms. Gallant. Good morning, Chair Collins, Ranking Member
Casey, Committee members. My name is Brenda Gallant, and I am
the Maine State Long-Term Care Ombudsman. Thank you for
inviting me to provide testimony regarding the essential role
of assistive technology in supporting older adults and adults
with disabilities to live independently in the community.
We have observed the vital importance of this technology
through our work with Maine's Homeward Bound program, the CMS-
funded Money Follows the Person Demonstration Program. Maine
implemented this program in 2012. Since then, with the
resources this program provides, 141 nursing home residents and
hospital patients have been able to transition back to the
community. MFP serves Medicaid beneficiaries who have been in a
nursing home or hospital for at least 90 days.
In our experience, older adults and adults with
disabilities want to live in their own home whenever possible.
MFP assesses the needs of each participant and develops an
individualized care plan to provide the services and supports
needed for a successful transition back to the community. A key
part of the planning includes an assistive technology
assessment.
Here are some examples of how assistive technology has
enabled MFP participants to gain the independence necessary to
return to living in the community.
A 58-year-old woman with a diagnosis of muscular dystrophy
resided in a nursing home for 17 months. She uses a motorized
wheelchair, and her muscular dystrophy has impacted her ability
to use her arms and affected her ability to communicate. She
expressed her wish to leave the nursing home, but was
discouraged by her physician, who felt that her needs could not
be met in the community. However, she was determined to be in
her own apartment. A critical part of her planning was access
to assistive technology. An assessment recommended an eye-gaze
system that enables her to use her computer with her eyes to
communicate through email and have access to the Internet, as
well as remote access monitoring that provides motion detectors
and notifies caregivers if her routine is not followed.
Additionally, a remote door entry button that she keeps with
her allows her to enter and exit her home independently.
Despite the initial skepticism, she has been successful in
living on her own for 6 years.
A 49-year-old woman, also with a diagnosis of muscular
dystrophy, resided in a nursing home for 5 years prior to her
transition to her own apartment. She uses a motorized
wheelchair for mobility. MFP funded a ceiling track lift to
enable transfers to be done safely, requiring only one
caregiver to be present; a smartphone and iPad allow her to
access the camera installed outside her door so that she can
see who is there and is able to operate an automatic door
opener with her hand. She also utilizes an emergency response
system that has GPS tracking so that when she is away from her
apartment, the system will continue to operate, and she can
call for help if needed.
A 94-year-old woman transitioned from a nursing home back
to her own home after falling and fracturing her hip. She has
macular degeneration and arthritis. MFP funded a reacher to
assist in picking up, an assistive device for administering eye
drops due to arthritis in her hands, an electric lift chair to
help her stand and sit, and automatic door opener to allow her
time to enter and exit the house safely. Additionally, she uses
an Echo Plus through voice command to control ceiling fans,
lights, and the thermostat. She never imagined she would be
using this type of technology; however, she has embraced it and
has been successful living in her own home.
MFP, and the access it provides to assistive technology,
has enabled these participants to reside independently instead
of in a more costly institution. MFP has enabled States to
rebalance Medicaid dollars from institutions back to home and
community-based services, complying with the 1999 Olmstead
decision mandating States to provide individuals with
disabilities the opportunity to live in the least restrictive,
most integrated setting possible.
In closing, despite these successes, we are concerned that
the provision of assistive technology and other services
accessed through MFP is at risk. We have seen firsthand how it
has transformed the lives of Maine people who have utilized its
services to regain their independence. The EMPOWER Care Act, S.
548, and its companion legislation, H.R. 1342, extends funding
for MFP for 5 years. We urge members of the Committee to
support the EMPOWER Care Act so MFP can continue to make a
dramatic difference in the lives of Maine people and thousands
around the country.
Again, thank you very much for inviting me here today.
The Chairman. Thank you for your testimony. Great examples,
too.
Mr. Mecca.
STATEMENT OF ROBERT MECCA, EXECUTIVE,
LIFE AND INDEPENDENCE FOR TODAY (LIFT),
ST. MARYS, PENNSYLVANIA
Mr. Mecca. Chairman Collins, Ranking Member Casey, and
members of the Committee, thank you for inviting me to testify
today. I am honored to be here on behalf of people with
disabilities who need assistive technology to live the
independent lifestyle that so many people take for granted. My
name is Bob Mecca. I will be married for 29 years this year. My
wife, Dawn, is here to support me.
I was born with spina bifida, and I use assistive
technology every day to live independently, work, and be an
active part of my community. I have been working in the
independent living field for almost 30 years with over 20 years
as executive director of Life and Independence for Today.
I use both high-tech and low-tech devices. I use a
wheelchair for mobility and portable hand controls, which I
have with me today. I can fit these hand controls in and out of
any automatic vehicle within 5 minutes. I am currently looking
for funding for an all-terrain tracked wheelchair, as I am an
avid deer hunter. This outdoor wheelchair would allow me to go
into the woods where I would not otherwise be able to go.
One low-tech device I use is a reacher to get things out of
high places. A few years ago I had shoulder surgery, and I had
to use a wheelchair and a transfer board. The transfer board
was a little bit different than the normal transfer board, as
it had a seat on it that slid back and forth, which made it
very easy to use. I acquired the transfer board from Life and
Independence for Today, LIFT's reuse program, and I got the
wheelchair from the Saint Marys Pharmacy Home Health, which is
a durable medical equipment provider in my home town. If I had
not had access to these priceless pieces of AT, I would have
been stranded in my living room looking at the same four walls
for 3 to 4 months, as I only had the use of one arm. This
example demonstrates that AT is not only important for people
with permanent disabilities, but it is very helpful in
temporary situations to keep people independent and in their
own homes,
LIFT is one of 17 Centers for Independent Living in
Pennsylvania. My center is located in Saint Marys. LIFT serves
arguably the six most rural counties in Pennsylvania: Cameron,
Clearfield, Elk, Jefferson, McKean, and Potter counties. This
is an area of over 5,000 square miles, and we serve this huge
geographical area with a staff of only six. We provide services
to assist individuals with disabilities to live independently
in the community. Currently, LIFT has 366 open consumers. We
also receive hundreds of I&Rs, Information and Referral
requests every year.
LIFT is a regional center for TechOWL, Pennsylvania's
Assistive Technology Act program. As a State AT Act program,
TechOWL and LIFT work together to ensure people with
disabilities have access to and acquisition of the assistive
technology and services they need to live in their communities.
Under the umbrella of TechOWL, LIFT provides services through
the Assistive Technology Lending Library, ATLL, which is a free
service that enables all Pennsylvanians with disabilities,
regardless of age or disability, to try AT devices to see what
best suits them before they buy something. LIFT also
facilitates the Telecommunications Device Distribution Program,
TDDP, for our six counties. The TDDP provides telecommunication
devices to qualified applicants with disabilities. These
devices allow individuals to use telephones independently. LIFT
also has an assistive technology reuse program. We take
donations of lightly used equipment and recycle them to those
with disabilities who would otherwise not have the means of
obtaining them.
As executive director of Life and Independence for Today, I
serve on the board of directors of the statewide Independent
Living Council, which is a Governor-appointed position. I also
serve on the board of the Pennsylvania Council on Independent
Living, PCIL, which is a membership association of Centers for
Independent Living in Pennsylvania. I travel quite a bit for my
job, and when I need overnight accommodations, I always try to
arrange for wheelchair access. For someone with a mobility
disability who is active like myself, things like an accessible
shower, shower chairs, and grab bars are essential to my
independence outside of my home.
In closing, I would just again like to say thank you for
allowing me to represent people with disabilities who use
assistive technology to ensure their independence and become
and remain productive citizens in their communities. I would be
happy to answer any questions. Thank you.
The Chairman. Thank you very much, Mr. Mecca.
Ms. Gallant, could you describe in a little more detail the
process that you use to assess what kinds of technology would
be useful to an individual who looks to be a promising
candidate for transitioning from a long-term-care facility back
to their own home? I am going to ask you to turn on your mic.
Ms. Gallant. I am sorry. Any individual that would be
transitioning would have an assistive technology assessment
performed, and based on that assessment, the individual would
be visited, for example, if they are in a nursing home or a
hospital, so the assessment would begin in the setting that
they are in, and then also include looking at the home that
they are going to move into, and really look at the medical
needs and the functional capabilities of the individual to
develop a very individualized plan, and then the individual
would be given training and support with respect to how to use
the technology and then ongoing support for any questions or
concerns, and there would be followup, so it is a very
individualized and specific assessment for each individual.
The Chairman. Thank you.
Ms. McCarty, as I was listening to that explanation, I
wondered whether it was a hard sell to get seniors to be open
to the new technology. When you had your exhibit, what was the
reaction of people who looked at the wonderful products that
you displayed in your slides?
Ms. McCarty. I would say euphoria, and we just had crowds
of people coming to the galleries, people of all ages, all
abilities, many expertise, and we had people coming looking out
of curiosity. We had people coming to look what they might be
able to get for themselves. We had people looking for friends
or family members. We had doctors. One day I was giving a tour,
and this man latched onto the tour, and he finally came around
a pedestal and confronted me, and he just said--he interrupted
the tour, and he said, ``Can I just say something? This is the
best exhibition I have ever seen. I see many exhibitions, and I
am a doctor. Why don't I know about these products?'' That was
what so many people said, and it really staggered me. In this
day of the Internet, how many people who could benefit from
these products do not know about them? How do we get the
information out? Many people do not even know where to look?
They do not even know that something like this exists.
We have a real education problem from the beginning, and I
would say that even a lot of occupational and physical
therapists, you know, are maybe not imparting some of that
information, so really, I am thrilled that the exhibition is
traveling, and hopefully that will help highlight some of these
wonderful products and thinking.
The Chairman. Maine is the oldest State in the Nation by
median age, so just as soon as you get done in Pennsylvania, I
think you should bring your exhibit----
Ms. McCarty. Give me a place, we are there. Thank you.
The Chairman. I do think you raise a really important
point, that the average person is not at all aware, but even
the medical profession often does not know about it.
Dr. Coughlin, I see you nodding in agreement with that. You
raised a really important point about when we think of
infrastructure, we have got to think of access to the Internet,
broadband, transmission speeds, all of those issues--cellular
service. That is an issue in a lot of rural America, including
some parts of rural Maine, so up front, many of these
technologies, particularly those that require Internet
capability, may still be cost-prohibitive for many families,
and it is ironic because it actually saves so much money over
institutionalized care, which in some cases, if it is
rehabilitative care, Medicare may be paying, or if it is long-
term care, Medicaid is frequently the payer, so we have a sort
of penny-wise, pound-foolish approach to this issue.
Are there alternatives available at different price points
that would at least make some of these technologies available
to individuals and improve their quality of life?
Dr. Coughlin. Yes, Senator. As I provide in greater detail
in my written testimony, one of the greatest challenges we have
is a coming technology inequality gap around affordability, let
alone accessibility, particularly in rural America. The
affordability issue, there are two ways to look at this, at
least. The first one is that, yes, it is expensive, but they
are getting cheaper over time. Many of these devices are coming
down in price, and over time, many technologies, like a
computer, flat-screen TVs, and the like, we have seen them
markedly drop, so that is the good news. The trouble is we need
to support people in the here and now.
The research that we are doing is suggesting that part of
the price problem is we are designing technologies for a
specific market segment, which means market failure. We need to
design technologies that everyone wants, that is cool,
convenient, and provides care. That way we get full market
capability, and by the way, then people want to buy it. We
create a whole new market. The notion that we are pursuing in
Massachusetts is creating a whole new business around longevity
economy clusters to develop, manufacture, and export these
technologies, not just to people in Massachusetts but around
the world, so we get economies of scale, so yes, while there
should be Government support, agenda setting, I think there are
design, policy, and market forces that we can bring it down and
make it accessible to all.
The Chairman. Very exciting.
Senator Casey. Thank you, Chairman Collins.
I will start with Bob Mecca. In your testimony you
discussed the work you do leading LIFT to provide assistive
technology to very large and very rural communities in our
State, and you mentioned those six counties alone are 5,000
square miles, so that is a lot of territory and I am sure on a
limited budget. The bill that Senator Collins and I will
introduce will authorize more funding to support your work and
the work of others.
Here is my question: As someone who provides assistive
technology in that rural part of our State, can you tell us
about how the assistive technology needs of older adults with
disabilities creates a challenge and how additional resources
can help you serve such a rural area?
Mr. Mecca. Yes. First of all, serving older adults with
disabilities has its own challenges because we often run into--
they may call us for assistance or they need a certain device
to help them or they want to look at different devices, and,
you know, when we ask them, OK, what is your disability, ``Oh,
I do not have a disability. I am just old, and I cannot do
things like I used to.'' So that is a challenge in itself,
getting them to identify themselves as a person with a
disability, and then once we get them to see, you know, what a
difference adaptive equipment or assistive technology makes, it
makes a world of difference, and they just are so thankful that
we can provide something to help them, say a bill reader for
someone with a visual disability that can tell them what
denomination their dollar bills are. That is so helpful to a
person to get out into the community and pay for items. Then
they know what they are giving the person at the other end of
the register.
Also, I wanted to point out that it is over 5,000 square
miles that we cover, and with a staff of six, and how we do
that is we go to our consumers directly. We do not have them
come to us, because although we have been blessed to have the
same transportation provider cover the same six counties that
we cover, unfortunately there are not routes that go between
towns and so forth, so that makes it way too expensive for
people with disabilities of any age to come to us, and so we
have to go to them, and as you said, it is on a very limited
budget, so any additional funding there would just be a godsend
for us to help so many people that we have in our area with
disabilities and older Pennsylvanians.
Senator Casey. Well, thanks for that answer, and I also
wanted to followup on the nature of the technology. We have
heard a lot today, and Senator Collins did a great job of
explaining some of the devices we have now, some rather simple
but helpful, but some very complex and also very helpful as
well.
It seems that, like anything in life, the more complicated
the technology, the more expensive it is and, therefore,
sometimes difficult to obtain. Certainly one of the examples of
that might be alternative speaking devices, which we have
learned so much about, which can restore the ability of an
individual to communicate with the world around them. I am
going to be introducing a bill to increase access to those
kinds of devices.
Bob, can you share with the Committee specifically why
accessing this type of technology is both so challenging but
also to share how targeted resources might help those
individuals?
Mr. Mecca. Well, augmentative communication devices that
help people, you know, with speech disabilities are definitely
one of the more advanced technologies. They can be. They can be
as simple as a person one time that I know had a glass board
with numbers and letters on it, and they would look at each
number and spell everything out slowly, to the advanced
communication boards that are very technical and they need to
set them up oftentimes in advance to say a sentence or
whatever, so they are a lot more expensive. The more technical
they are, the more expensive they are.
Also, at LIFT we used to have a program that we called
``Within Your Reach,'' and what we did was we partnered with at
least one library in each of our six counties, and we put
assistive devices in the library in a prominent place where
people could go in there and look at them and use them, and
then if they wanted more information on it, we left our
information there, and the library staff were trained to
contact us, and then we set up appointments for people to help
them. That was like a one-time funding thing, so we no longer
have the funding to do that, although we still have the
equipment at the libraries. It is outdated now because that was
probably about 5 years ago, so the equipment is outdated now,
but it still provides people that go in there with the ability
to look at that equipment and say, ``I could use something like
this,'' and then they contact us, and we can provide them with
the newer equipment, so we still have a lot of equipment out at
the libraries, although it is outdated, and getting funding for
something like that or for adaptive equipment or services to
adaptive equipment would be a godsend to people, especially in
rural areas like my service area, because we call that program
``Within Your Reach'' because people in very rural areas like
that did not have the access that people in large cities have
to different types of adaptive equipment, and we put that
equipment in their back yards essentially, and they were able
to look at that in the libraries in their own communities. That
is priceless.
Senator Casey. Bob, thank you.
The Chairman. Senator Rosen.
Senator Rosen. Thank you. Well, thank you so much for
bringing this. Unfortunately, none of us is getting any
younger. I think there is no glasses--there is no print that is
too big for me anymore, but seriously, I took care of my
parents and in-laws as they aged, so I have been through rehab
and assisted living and all those kinds of things with my
parents and my in-laws.
Myself, I recently broke my wrist and had some challenges,
although they are temporary. My husband had back surgery, so
people do have all kinds of challenges, and as I sit here and
listen to you, the things that I really think of are two really
exciting areas that we could build our economy, build our job
force. I said I see a ``Better Living Through Technology''
store chain out there somewhere that would be a place--you
know, you see ``As Seen on TV,'' or some of those, that would
be a great business venture. Anyone out there listening to
these hearings, I would think this would be something terrific.
The other thing that I really see--and we talk a lot about
the people pipeline, and we talk about creating jobs, and so
you think about all the things--not just that engineers do and
designers, but we think about our physical therapists or
occupational therapists and the people who work in not just
senior facilities, assisted living, or in the care industry,
but there are real places, I believe, that we could probably
help fund and create certifications so then perhaps through
Medicare and Medicaid there would be reimbursements for people
to go into these types of fields that will help us all.
How do you think you might see us adding some kinds of
certifications perhaps, apprenticeships, ways that we can boost
the people working in this area so they have a career that they
would get paid from to do this kind of work that we are going
to need for so many people?
Dr. Coughlin. Senator Rosen, excellent thoughts and
remarks. One of the challenges I think you will find in the
education field is that while the technology, such as the smart
technologies in the home for medicine, education, and the like,
are advancing greatly, a study that we did in the lab showed
that there was very few professionals being trained on actually
how to use these technologies, so I would suggest that
certification is not just a way to get people in the pipeline.
Actually, most of the practitioners out there providing care do
not know how to use the very systems that actually exist out
there to improve our lives.
Senator Rosen. Do you have a suggestion how we could maybe
help our community colleges or what kind of vehicle could we
use to train either people who are looking for new careers or
our young kids wanting to go into a new career? What would you
suggest that we could try to promote or discuss here from our
bully pulpit?
Dr. Coughlin. Just very quickly, and I will yield to my
colleague here. Two things. One is to put it, as you do best,
put it on their agenda. Perhaps funding is one of the things
you can do, but more importantly I think is to actually
highlight aging and life tomorrow as a positive issue. A good
number of us have glasses. We are sitting here talking about
special technologies, but these are the original assistive
technology.
Senator Rosen. Right.
Dr. Coughlin. I put an Italian guy's name on the side, and
suddenly everybody wants to buy these, sell them, and
everything else. They are no longer that special thing. I think
getting the idea that this is a new entire way of living that
is exciting will get young students to want to commit to a
profession that engages all of us in life tomorrow.
Ms. McCarty. I think that is an excellent question. I am so
glad you asked it because I think about this all of the time.
First of all, I just want to say that I think there are a
lot of young people today who are very interested in social
impact design. The museum collaborates with a lot of design
schools, and 30 years ago, when I did my first exhibition on
the topic called ``Designs for Independent Living,'' it was
difficult to find young people interested in this or even
design schools. Today Cooper Hewitt has partnered with a number
of schools and students doing prototype products. We included
some of them in the exhibition, and they said that this has
really impacted what they want to do in their career going
forward, so I think the time is right. There are a lot of young
people just interested in wanting to make a difference in the
world today, unlike I have seen before during my life.
Second of all, I am a caregiver myself, and I think about
this all the time. I have spent several months when my partner
was going through rehab, and my eyes, of course, were looking
at everything and all the equipment. I asked a lot of questions
of the therapist to train me so that when we went home, I would
know how to lift him and do other daily tasks just helping him
dress, et cetera, and that is not something that most people
who are trained in, like a family member, somebody who gets a
disability or somebody is discharged from a hospital, they are
cared for in the hospital. Everybody is--there are high
emotions just tending to the person. They do not know the
questions to even ask when they go home.
Senator Rosen. Would you say expanding this in the home
health care certification----
Ms. McCarty. I think the opportunity is enormous for jobs,
and I am not talking high-level education jobs. It is really--
--
Senator Rosen. That is what I mean, at the certification
community college level.
Ms. McCarty. Exactly, and I think the opportunities are
immense, and I could just rattle off one example after the
next, but it is really about learning how to just take care of
people, their daily needs, so I know this is talking about a
lot of high technology. There are a lot of low-technology
things----
Senator Rosen. Perhaps you might share those with us----
Ms. McCarty [continuing]. that are very important.
Senator Rosen [continuing]. when we talk about education
and people pipeline, these might be some of the things we can
take back to our community colleges and find ways that we can
fund things or certify or ways that we partner a career with
getting paid for that career, right? That is important.
Ms. McCarty. Right. You know, we are doing a lot, we are
paying a lot. We are doing a lot of medical research to keep
people living longer, but that is just going to bring even more
disabilities the longer people remain alive, so it is a big
audience that we could really address.
Senator Rosen. Thank you so much.
The Chairman. Thank you.
I am going to followup on the question that Senator Rosen
just raised and direct it to Brenda, and that is talking about
the challenges that you face and what the biggest challenge is
as you try to do all of this planning.
I know from talking with home health agencies in Maine that
they feel stretched very thin, that there is a shortage of home
health workers, and I would think that, in addition to the
technology, that may be an important element as well. What is
your experience about the biggest challenges?
Ms. Gallant. Okay. Really, the biggest challenge is
initially finding----
The Chairman. I am sorry. I do not think your mic is on.
Ms. Gallant. Yes, so what we are finding is finding
affordable, accessible housing across the State is a real
challenge. Additionally, as you said, the direct care worker
shortage also makes it a challenge to be able to arrange home
care services, which are so critical in terms of the planning.
However, with the team that we have brought together, we are
able to find housing. Usually 3 to 6 months is about the
average time. We do have a housing coordinator through Alpha
One, Maine's Center for Independent Living, that works on the
housing, so really the team comes together to overcome these
barriers, and it takes time, but we really can--as you can see,
the assistive technology is such a critical part of this and
really can supplement in terms of staffing, the remote
monitoring can really help in terms of reducing the need for
staffing, so it is really the team approach and being diligent
in overcoming these barriers, and we found that we can--it may
take some time.
The Chairman. Thank you.
Dr. Coughlin, let me pick up on a point that was just made
about remote sensors. Obviously, this technology has the
potential not only to allow individuals to live fuller lives
and stay in their own homes, but in some cases, it may raise
some privacy issues, and I would be interested in hearing your
comments since you involve seniors on whether or not they are
concerned about having sensors that monitor whether they open
the refrigerator and thus are eating, for example, or cameras
that can see them. Is that an issue that comes up? Or do people
think the tradeoff is worth it?
Dr. Coughlin. There is certainly an issue that comes up
because think about the fact that it is not just your sensors
in the house knowing that you are walking to your refrigerator.
It is also your toilet talking about you as well. Input-output
model is the best way to describe whether you are taking your
medications, you are eating well, whatever, you know, the like.
However, older adults tend to have, believe it or not,
greater levels of trust than younger people in the institutions
that might be so-called watching them, so yes, Senator, we have
to balance dignity with independence, but one of the challenges
that we see that older adults seem to be willing to do, which
is I will give you some of my privacy if you give me some
independence and safety.
I will give you an analogy that many of us can identify
with. How many of us can say we have a credit card in our
pocket? We now know your price for privacy. My American Express
probably knows more about me than my wife of 30-odd years.
The Chairman. Well, anyone who goes online and does a
search and then gets all those ads realizes----
Dr. Coughlin. Yes, that is somewhere between cool and
creepy.
The Chairman. Yes, exactly. I think it tends toward creepy
myself, but thank you. That is really very interesting.
Ms. McCarty, did you want to add anything to that? Were
those issues raised when you did your exhibits?
Ms. McCarty. They were raised, and I got very similar
reactions. Most people were very--the tradeoffs slanted more
toward wanting the technology, but I know that it is definitely
something that will be an issue and something that needs to be
discussed.
One of the products that we featured in the exhibit that
required remote monitoring was pill taking and pill bottles
with chips in them so that maybe a caregiver from afar could
really monitor if somebody took their pills or not, which it is
a real issue, you know, people not taking pills, but I mean, it
is a real reason why many people are not getting better because
they are not taking their pills for various reasons, so there
are tradeoffs, but just like in the rest of society, we need to
just keep talking about this.
The Chairman. I should probably clarify my ``creepy''
comment. When I was talking about that, I was talking about the
fact that when you are doing a search for a particular item on
the Internet, you all of a sudden get all these unsolicited ads
because your data is being sold or distributed. It seems to me
that is very different from sensors that are helping you be
independent, healthier, and live in your own home. I think
there is a big distinction.
Dr. Coughlin. If I may briefly, Senator.
The Chairman. Yes.
Dr. Coughlin. One of the other reasons we saw that the
technology was accepted by older adults despite privacy
concerns, if you can design systems that not only remind you to
take your meds or to eat well on the more, shall we say, lower
end of Maslow's pyramid, but also encourage a connection with
family and friends, so yes, did you take your meds? And oh, by
the way, Mom what was that recipe you used to use for cookies?
So you can use a technology to engage people and reduce social
isolation, and for that they are willing to tradeoff a little
bit of privacy.
The Chairman. Very good point. Thank you all.
Senator Casey. Thanks very much, Chairman Collins.
I will start with Ms. McCarty because you gave Pittsburgh
and Pennsylvania such good publicity here, but I really open it
up to the whole panel. The opportunity that we have when we are
updating a law, sometimes every 5 years but sometimes a lot
longer, like the Assistive Technology Act, in this case 15
years, to give you a chance to, as you have already in one way
or another, but to reiterate maybe in more of lightning round
to say I hope you do the following when you are making changes
to that act.
I guess the basic question is how should we who are putting
together legislation use this opportunity to update the act and
make sure it is capable of making new technologies accessible
for those who can benefit from them. Ms. McCarty, we will start
with you, and anyone else who wants to add your 2 cents.
Ms. McCarty. Well, I think that what is really important in
this is that it be affordable, as has been mentioned, and the
good thing, as we all know, is that a lot of our technology has
been coming down in price. In fact, I think one could buy some
of these devices for what it takes a family to buy groceries
for a month. I mean, it is really quite staggering that it is
so--it is mind-boggling what is in reach with us and what we
can do with the technology.
The other thing is: How do we get the information out that
I mentioned earlier? That was something that just kept being
reiterated over and over again, and I think that we can
continue to be looking for positive ways to utilize the
technology and to really listen to the users. That is where we
are getting some of our best and most important information, is
what the users need, and as I mentioned the example of the curb
cut, a lot of these improvements that we can be making, if we
use people with more challenging needs or complex needs and
look at their needs and try to solve those, we are actually
going to be solving a lot more needs of a lot more people, and
I think that is the goal to really be striving for, is not just
always looking at a targeted group of people. We are all going
to age. We all get a disability at some point in our life, and
rather than separating this group of people from this group, if
we look at everybody together, but the more complex needs, I
think that we are going to be much more inclusive rather than
exclusive in what we are doing.
Senator Casey. Thank you. Anyone else?
Dr. Coughlin. I would chime in as well, Senator. I think
accessibility is absolutely important. To pick up on
accessibility, rural digital infrastructure, again, it should
be part of the larger dialog here on the Hill with respect to
infrastructure. We need to get these things into retail. This
is where solutions are found by shoppers and by families and
the like, so having a website that no one knows about, we need
to solve what we say in Government is the smart buyer problem.
Where is it? How is it? How much does it cost? Should I buy
this one versus another?
Also, I hear a lot about users. I want to introduce a whole
larger discussion on influencers and buyers. Going back to the
discussion, the future is female. The family caregiver, one in
four American families provide upwards of 26 to 29 hours of
care per week to an older adult out there. She is the one
choosing. She is the one buying. She is the one making the
tradeoff between life, work, job, career, and the like.
Then last, if I may, I think that the bill that you are
thinking of sounds like a great opportunity to also aim high.
This is not about more older people requiring more of what we
know about old age. This is an opportunity to have the Federal
Government put a stake in the ground to say longevity is an
opportunity to aim higher, to live longer, better. It is a
market. It is a policy. It is a new vision of an older but
still innovative America.
Senator Casey. Thank you. Bob?
Mr. Mecca. If I could say something as well, every State
has an assistive technology program through the AT Act, and if
you--you were asking what could be added into the new bill. I
think a really good way is to--LIFT, Life and Independence for
Today, as a Center for Independent Living, we are an assistive
technology resource center for TechOWL, and there are several
in Pennsylvania and I am sure across the United States. Every
State has several ATRCs, we call them, and if you go to them
and, you know, maybe they could talk with their consumers and
see what people actually--what the need is out there, and what
improvements they think could be used, that would be a very
good outlet for you to, you know, see what is needed for the
new bill.
Also, Centers for Independent Living also serve people with
disabilities of all ages, and you could go to each Center for
Independent Living in general and ask that, you know, they go
to their consumers with mobility disabilities or assistive
technology needs and, you know, see what their thoughts are on
getting what type of devices they need and so forth.
Senator Casey. Bob, thank you.
He gave me an opportunity to very proudly promote my State
again. Now, what Bob is referring to is TechOWL, the Temple
mascot, Technology for Our Lives, and you cannot see it from a
distance, but all these categories, lending library, free
special phones, used equipment exchange, information and
assistance, emergency plans, so folks can go to TechOWL.pa.org
for that, but it is really interesting what they are doing, and
Bob works with them. Temple being in Philadelphia, you are
hours away from them, but they have got a statewide presence.
Ms. Gallant, I do not know if there is anything you wanted
to add.
Ms. Gallant. I would agree that I think it would be
excellent to make sure that the Area Agencies on Aging and the
Aging and Disability Resource Centers have the resources to
provide information to older people about technology and
perhaps funding to provide that, as well as Maine's Centers for
Independent Living. I think that is a really important way to
get the word out to people.
Also, I just want to make sure that people that are in
nursing homes and hospitals for extended periods of time have
access to technology because we have shown that they can live
independently through the Homeward Bound program. It saves
money. The health outcomes are improved. Quality of life is
improved. We have seen people come out of nursing homes after
15 years, and actually the 141 people that we have served, the
average length of stay in a facility was 2 years. However, we
have had some younger people, 15 years, who went out into the
community, and the people I have described that you would not
think could be in the community but for the technology, along
with the other supports, so to make sure the funding is there
to provide the technology to make this possible, because people
do want to be independent.
Senator Casey. Thank you.
The Chairman. Ms. McCarty?
Ms. McCarty. Thank you. One more thing I would like to add,
because it is something that I hear over and over again from
designers, is that what can we do to incentivize manufacturers
to take this on and produce these products and work with
designers and people to really bring--to produce some--so many
designers recount stories of working on a product, and it is
all tooled up, ready to hit the button to be mass produced, and
then suddenly the brakes are put on for various reasons, and I
have heard that over and over again, where a product goes into
production, has a very, very short life, even though it is a
really good one, and I think that would be really important if
we could find ways to incentivize manufacturers.
A store like Target, just 2 years ago we featured one of
their adaptive clothing items in the exhibition, and Target,
which really is--their products are affordable to many, many
people, they have now a line of adaptive clothing that just
continues to sell out immediately for mostly children at this
moment, children with various types of disabilities, but they
are showing that it really does work.
The Chairman. Thank you very much for adding that.
Ms. Gallant, I am so glad that you told us of the example
of someone who had been in the nursing home for 15 years and
was able to transition due to the excellent planning that your
office did and the use of assistive technology. That is just so
encouraging, and your 2-year average is also impressive because
I must say that when I first learned about your program, I
assumed it was people who were in for less than a year, for
short stays, so that is so encouraging and really underscores
the value of the work that you are doing, so congratulations
for that.
I want to thank all of our witnesses for traveling to
Washington today and increasing our understanding of how
technology is improving the lives of older Americans and those
with disabilities. For me, the bottom line is accommodating
people's preferences and allowing them to live fuller lives,
and in most cases that means staying in the privacy, security,
and comfort of their own home, and I am excited by what I have
learned today, by the array of technology, but I have to say if
a lot of this is new to those of us who serve on the Special
Committee on Aging, I cannot imagine that many of our
constituents realize what is out there, and that is why I think
that the work that is being done at the State level and by Mr.
Mecca's group as well as in the great State of Maine is so
important, but so is the technology development at MIT, the
vision of an economy where we embrace those who are growing
older and improve their lives and look at the job implications
of this that Dr. Coughlin met and, Ms. McCarty, your exhibition
cannot be understated how valuable that is for people to see
it.
At the risk of telling a personal story, but since Senator
Rosen did, I am going to follow. A couple of years ago, I very
badly broke an ankle and had to have surgery, and I have eight
screws and a plate in it, and when they told me they wanted me
to use a walker and I looked at the walker, I would only use it
inside the house because it was---if I had one of those cool
walkers that ironically are developed by the University of
Maine, I would not have felt nearly as self-conscious, and when
I came back--I used a can way before I was supposed to because
I just wanted to get rid of that walker.
Seeing the design options now are so exciting and embracing
it and making the prosthetic limbs almost a fashion statement
is--it is really exciting and I think really makes a difference
to people.
As someone who cosponsored the bill to provide over-the-
counter access to hearing aids, I was very excited to see the
fact that you are embracing the hearing aid and using it as a
fashion statement. That was just so fascinating to me.
I very much look forward to working with Senator Casey on
the 21st Century Assistive Technology Act and to reauthorizing
the EMPOWER Act that has been mentioned as well. We want to
make sure that these technologies reach older Americans and
those with disabilities.
Before I turn to Senator Casey for his closing comments, I
want to pick up on something that Dr. Coughlin said, and that
is the fact that we lack in the Federal Government a central
place that can focus on these technologies in a more
comprehensive way, and that is something I would be very
interested in working further with you on, and perhaps we could
include that in the legislation that we are introducing and
that you have been the lead on. I think that would really help
as well.
Dr. Coughlin. We would be delighted to help. Thank you.
The Chairman. Thank you.
Senator Casey. Thank you, Chairman Collins.
I want to thank the Chairman for holding this hearing on
assistive technology. I obviously want to thank our witnesses
for being here, for your testimony, and for the effort you made
to be here with us and to provide your expertise, experience,
and insight. You have provided us with important examples about
how older adults, people with disabilities, and their
caregivers can benefit from a variety of assistive
technologies, and also how high-and low-tech solutions can be
used to enable people to remain independent and socially
connected to their families and their communities, especially
in rural areas of our State and our country.
I also want to thank the folks in the back who are from
this region, from Maryland, the District, and Virginia, for
bringing assistive technology not only here to the Capitol but
here in this hearing room so that we could see this technology
and see it up close.
I look forward to working with Chairman Collins and other
colleagues in the Senate to make sure that this technology gets
into the hands of those who need it.
I was struck by so much of the testimony today, but I
wanted to point out one line from Bob Mecca's testimony. He
said at the top of page 2, quoting where he was at this point
in his life, he said, ``If I had not had access to these
priceless pieces of [assistive technology], I would have been
stranded in my living room looking at the same four walls for 3
to 4 months, as I only had the use of one arm.''
Many people in our families and our communities throughout
our Nation are often imprisoned by a disability or in some
cases more than one disability. Assistive technology unlocks
them from that prison, and we have got to do everything we can
as we learn about this technology, as we expand the universe of
ideas, to make sure that as we are working on legislation that
we keep in mind those individuals who can be very much isolated
without that technology.
Chairman Collins, thanks for having the hearing, and we are
looking forward to working with--or continuing to work with you
on these issues.
The Chairman. Thank you very much, Senator Casey.
Members of the Committee will have until Friday, May 31st,
to submit additional questions for the record. If we get any,
we will send them your way.
Once again, I want to thank each of our witnesses for being
here today. You really were terrific in enhancing our
understanding, and I also want to thank our staff for their
hard work and insights.
Thank you very much, and this hearing is now adjourned.
[Whereupon, at 11:02 a.m., the Committee was adjourned.]
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APPENDIX
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Prepared Witness Statements
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Statements for the Record
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