statement will open doors, not slam shut. i think it is too early to tell whether it all in tokyo will make progress on the issues that divide them, but what seems clear at this point is in the aftermath of the abe statement thanks to what i believe is president pac is wise, prudent statement like reaction to it, the two sides prepared to try. ..

thank you very much. thanks for inviting us and thank you for coming. i would associate myself completely with the excellent textual analysis and i would agree with evan's prediction that this could add some momentum, not a lot, but some momentum in their relations and also the relations and also the prescription about what the u.s. government could do. i never had any expectation or should anyone have any expectation that this would resolve this issue within japan were korea or china or the u.s. for that matter. they famously said in the 70s it would take three generations to resolve this issue.

around the same time they said we leave this issue to the next generation which would be wise. apparently that wasn't the case. in some ways it's gotten harder. but i start with this premise it was never intended or have any chance of resulting the history issue. a lot of the criticism is promised on the need to resolve this and i just would put it to you that that was never for any prime minister a realistic prospect. could you stop the reverse backwards movement or forward momentum and on balance even though he is right there were flaws in the statement with the public of korea i balance it modestly and we will see that it modestly would add some momentum. on the politics within japan i think they aimed for the center,

not the right, but the center. the poll has 45% in the more recent 48%, 56% who said they were satisfied with the statement. the question on the policy cited if you aggregate people don't like what he said about the apology and there was no need to mention the policy so i think they aim for the center and generally within japan hit the target. for those that were not happy with the statement, let's not assume that they were all reading liberals. that includes right-wing and conservative people that are not happy with the prime minister's expressions of b. morse. as said as recently as a month ago, the word inside the content

in the prime minister's office is the statement would be more or less with the prime ministers said the joint session in the u.s. congress which was less than we heard on august 14 through things shifted. i'm speculating but i think there were several reasons for that. what was the intellectual journey they spent a lot of time talking to scholars and multiple sessions with the drafters. he personally redrafted most of it i'm told by one factor. the second is the meaning coalition partner. this was a cabinet statement, and as many of you know he has a strong pacifist grassroots organization in the cabinet. cabinet. so come he needed and wanted to get him on board, and he did. maybe that was important for his political standing where the legislation in the - which i will come to in a moment. third, i believe that he was

taken by many of the debates and the special commission that he established to look at how japan should approach the second anniversary. and if you examine who was on the commission they were mostly center-right. these are not right-wing liberals but they are center-right and was maybe one person on the list to consider more to the right. so the group explored multiple dimensions if you saw the report on this issue and the one that had the biggest influence is the idea that japan and orbis mistakes can be anonymous suffering into the japanese people didn't happen because of some original sin. it happened in the context of global history and in germany the recent historiography is critical of the idea that german

treatment of the past focus on the idea that somehow there was an original sin in germany and things happened and now germany in the postwar period put that original sin in a box. and i think the prime minister was keen not to perpetuate that japan is a permanent outpatient. a permanent sinner. and geopolitically for good reasons. so the global history context mattered and as a matter of history come accurate history, the structural factors would have been the natural system kept edward particularly if you are going to learn something about how to prevent that from happening again in the future and that makes it what japan has done to make the national system more just. so i didn't have a problem with that. i thought it was accurate and made it possible for the prime minister to be more forthcoming

in terms of the reflection than the previous ministers had although he did not offer his personal apologies as mentioned. the u.s. and australia moved within about two hours to issue statements. and the spokesman welcomed the statement. i thought perhaps it would be a caveat welcome. the white house put out a signal early to point out that they welcomed this and wanted the movement. and so did the paymaster spokesman. i don't know this for the fact i will mention anything that was coordinated the u.s. and australia have an interest in moving forward but ignoring the past and freeing japan from the need to continue working on this issue particularly korea.

and i thought frankly the statements were very influential it is of course a democracy and ally in the u.s. and australia. the administration here has been a little bit confused over the map on this issue. but that was an effective way to set the tone. in china peoples of the response was harsh but if you follow what they say about this issue it was actually fairly moderate. some of you may have noticed that the english language chinese statement said japan should have apologized and should have done this and should have done that. whereas the chinese statement said japan must apologize. so, i don't think that this is an absurd comment. i think they were playing multiple audiences and for the washington response in particular. since november last year when

they had their summit, both leaders although there is continuing geostrategic rivalry between japan and china because they tried to stabilize the situation for their own domestic political and economic reasons. i thought the paymaster's initial statement, because something had to be said initially that the actions are more important than words was well done. i thought it was appropriate in the japan and korea context and i don't think that a minister expected, probably that there would be an apology. and probably was ready for this and came out quickly and set up at action matters and i think that is appropriate because the piece of this is not resolved as everyone said. and i thought that the president's statement was also well crafted as both evans said. from the u.s. national interest perspective, this is the toughest knot are the most important piece. japan in some folds - let me

read gallup for example. 80% of the japanese do not trust korea. and my own discussions with the leaders we are not just talking about the right-wing politicians. we are not just talking about the conservatives. we are talking about liberals in the korean actions with respect to the court cases opening up in the 1965 normalization treaties and another statement. and that doesn't mean that japan should in any way be absolved from response body from making progress in building trust with korea on the most sensitive issues, but it is a bad dynamic. it is a bad bad - dynamic. the first target was the japanese public. the second was the u.s. and australia and what line did - like-minded. if you look at it i agree with

evan. this is a strategic mistake. korea is critical. other leaders going back centuries understood that the korean peninsula with the heart of japan and i think that we would have a more rational debate in japan because i hope what happens when i went with a few predictions and if i'm wrong don't invite me back. i don't think that the japanese ministers will apologize anymore. it is possible that you will have a liberal centerleft politician come back in. i wouldn't expect in the next four or five years that anyone on the 75th anniversary or other occasions i think abe probably succeeded in putting that in the past as he wanted.

i think that he did himself a favor in terms of the legislation on security which has hit a lot more headwind in the public then the government expected because it was explained poorly in part because of the 75th anniversary. so the path to the fact that his support rate had gone up since the statement. they put 80 or 90% now and i think a good ten, 20% bump in the production comes from the statement. i understood correctly some momentum at least reduces the headwind further progress towards the trilateral meeting. i agree if they could do the trilateral meeting on the margin of the september commemorations

in china but on the day that they prayed the shock in the weaponry but maybe the next morning. it's very risky for him to go in the same new cycle to have the entire chinese be about shock and awe and intimidation of japan. but i would bet against it. there will be a statement in korea that there will be more momentum towards addressing the bilateral allocation issues. and it's obviously not the hardest one. will those be resolved, i don't know. there should be progress on them.

but i take away from the overall dynamics of this issue will not begin relations anymore. it will be a critically important issue but based on the merits of the federal relations and cooperation there will be a momentum towards the tramadol summit. but i hope from the perspective of japan's interest if there is progress on this issue going forward. >> i hope the audience is eager to get into questions but i want to exercise my prerogative and toss one or two out. i think generally we have a positive response with a lot of caveats and things he could have done. i think that generally the positive response from the panel that reflects the sort of overall u.s. expert community. are we grading them on the curve and curb and should be graded them on the curb in the sense that given the expectations even a week ago as you pointed out in the specialty of a year ago then

the predictions whether they were always wrong that he will never say apology or embrace the statements, etc.. so is it like a student that you have low expectations that you give them a higher grade because of the good effort and is that right? and are they grading him on a reverse curve had been issued by the time mr. derringer tenure - during their tenure. so the curve and the reverse. >> i'm happy to. it's a great question. we are grading them on a curve to be fair. but there's two pieces of the puzzle all of us have talked about the bible put it together again. is that statement now reflecting the national policy and the

decision to make it a cabinet decision and the intellectual journey that mike talked about and the debate inside the yes and no and which piece of which language. we are not just grading the prime minister abe. we are looking at how the opinion is changing so i wouldn't underestimate the impact. we can talk about that i'm sure. so how we grade ham is one piece but it's not just grading abe's performance but recognizing the trend forming inside of japan and it isn't a movement to the right it is a generational transformation looking at the way that the question continues to be part of the diplomacy. the reverse critics i was neither a praising the statement that we ought to take it in the term frankly. i wasn't a fan of the semantics. i think the debate sidesteps the

core issue which is how does the reconciliation take away and as the domestic leadership in both countries going to be able to overcome some of the domestic differences that are emerging in a society lacks is that a direct answer to the question? >> i think that sheila's take is pretty much my own. i think implicit in my analyst is of the statement that i provided earlier is that you cite is grading them on a curve but more importantly, it is the analysis that we have to look at. and my take away from the statement over the weekend is that somehow he has passed an important test.

i thought you were going asked what grade i did give him. i would give him decent three marks for effort but incomplete and send them home to do a little bit more homework. they were reading between the lines for some of what she had said. so i think the jury is still out so i'm optimistic that it has been open just a crack. whether the reverse curve exists and whether the government or would have issued such a statement, i think putting the two together side-by-side i think that there was a much more intense level of what the right word, emotion and sincerity.

it wasn't to criticize what they had done. i think that he has come a long way and deserves credit for that despite the incomplete grade i've given him and the homework that he needs to do. >> so, i will say everything that he said except for the apology part and more. so, it matters. and those that would curve would say this is better than we expected, which is most experts doing that because of past statements. and those that say that it's not enough forces here are saying that because of his past statements but if you do a thought experiment and say what if you had exactly the statement issued by and i will thought some prime ministers. if any of them issued the same statement we would say that's about right. so that is pretty much at the center. he's the 1955 system postwar

socialist bipolar cold war context. i don't think it is just generational it is a structural politic but the statement could have been issued by almost any perspective in japan who is on the horizon. i can think of a few exceptions but most of the mainstream people come if he was abducted tomorrow one of these guys would be the prime minister in the same statement would have been completely expected. >> but would it have gotten the same positive grade or criticism? >> in both cases in the context of the statement by the socialist feminist or who in

1995 brought the socialist party to the statement including opposition to the defense or the u.s. and things like that. so the political context set the generation of politicians against and it wasn't really about korea or china. it was about the ideological battle of whether japan has the right to be a normal nation or not. and of those politics colored the way that many in a cabinet viewed those because it wasn't just the words in the apology. it was all about the package that was in the socialist party with it. it was premature the mainstream print to mainstream print mr. would have said. >> i'm going to open the floor to questions and i will start with the usual housekeeping once i recognize you, please wait for the microphone to come to you and state your name and your

affiliation. keep it short as a question rather than a speech. but even more so given these issues which are very highly controversial. in the context of analytical questions as opposed to very strong remarks. thanks for continuing. what has been a rich discussion on some of these things just since late last week. there's about 50 pages of comments so far and now we have support. some of the feedback i've been getting wasn't printable on the request. a lot of our great friends are

feeling sandbagged on this. we want to move things forward and we want to front so therefore it would be good if you did, too mac. he certainly came through on that. it is worrisome. does that keep us from having this we leaned on them to be positive. we need him to take up the parts at specifically what you think of the print mr. one of the things last night from an anonymous contributor was abe absolutely must reach out and once and for all resolve this and that is what he took up.

do you agree with that but they have incurred an additional burden to be positive here and if so how does that play out? does anyone want to jump in? >> there has been a lot of meaning in both directions and lots going on in the background of the appropriate concerns expressed in both directions while a lot of it may not be public but behind the scenes there has been a lot of very helpful i wouldn't call it leaning more pressing but there has been good advice offered including from those of us here. they somehow feel sandbagged by this. if you look at the statements coming out about what they wanted and needed, one of the

fundamental requirements was a reaffirmation by all previous japanese government statements. there've been plenty of editorials written suggesting that he was trying to undercut the statements and reject them and rewrite them etc.. it's been quite the opposite. he'd reaffirmed them and they are now part of his legacy since he signed onto them and so i think that it is a little unfair to suggest that somehow it was sandbagged in all of this. i think that as i suggested in my opening remarks it's been interesting going on and they've kind of keep up the environment with the country that they now find themselves in. there has been a gradual turning down of the rhetoric that we have heard and the hope and

future oriented remarks as i am a lot less cynical than the sum of your unnamed correspondence. it's important for the united states to continue to do quietly but it has been doing to quiet the dialogue in tokyo and encourage them to do precisely what is going on right now to move things in a better direction and take advantage of the opening. in the white house knowing how the office works and knowing again they would have been responsible for this, i am very confident that the government and the ministry was in dalia conversations as was japan about

how this will play so i doubt they were surprised. and i think that the statement is well-crafted for knowledge about how this would play. >> that phone call to the counterpart also helped keep this up in a very good fashion. the statement is a product of the internal debate in the japanese domestic politics about how has the japanese history read and it seems that investigate how the national

right is out. my question is about 80% of the public on the pole but covers a split of the political views who say they don't trust korea. how does that play into the dynamics and the dimension of the response to it. what is the attitude in japan to words. so they don't care very much for korea. >> i will take a stab at that since i missed the last round. i think all of us are aware. when we go to tokyo and talk to friends on both sides of the political drum of just

government officials and policymakers the attitude towards korea are troubling. the deepening mistrust and antagonism and discrimination against them is a difficult history for both countries. i will hold both of them accountable for this because i think that the diplomatic estrangement between tokyo could have been a different story and the domestic entities could have been much less harsh i suspect on both sides. when they decide that they are not going to speak to each other because their publics don't like it. they are also creating opportunity inside of their own domestic societies with the kind of antibodies that we are seeing again on both sides are not just on the japanese side. so, there is responsibility and diplomacy in large part and that

is one of the pieces of the puzzle but again i'm not singling out one leader or the other this is a story that's been on folding. it is inherited in one way the dissidents but they are the only ones at the moment that try to fix it. for the koreans and japanese why is the future so interdependent or why should the future be interdependent? so that isn't a complete answer about why that 80% exists is plenty of reasons we can come up with in terms of more memory, etc.. but how does it get fixed and i think that 80% will shift and atvs come others may take issue with this but it's movable. it's not just a diplomacy.

it's trying to advocate for and demonstrate that the relationship is in japan's interest. he needs a partner to do that and i think that is an important piece of the puzzle. >> a quick additional word and i agree with all of that. there's not only fatigue in tokyo but there's japan and korea traveling back and forth between the two capitals in recent years. this is how they perceive the other side. it is a fact that it's been insufficient leadership exercised on both sides to be very frank i have tremendous love and respect for both countries and i've served in both for many years. it's true that the two leaders who are in power now inherited a lot of dissidents from their

predecessors but on their respective watches it got worse. and the good news coming out of all of this is that in recent months it has become increasingly obvious that responsible people in both capitals right up to the top have looked at this deterioration of relations between the two. the two countries that have so much in common in terms of as i said in iran are the shared values and concerns and threats of things have gotten so bad that it was time to arrest what some have described as a freefall in the relationships. and i wouldn't point to them as having turned the corner in the relationship i think that we've actually sent months ago we began to turn the corner as the two sides recognized that something needed to be done and the point i want to leave you with today is the event

reaffirmed both sides need to have a sense that things should not be allowed to get any worse and that there is a prospect that things might get better and we might be able to get that number back in better territory. >> that is a great question. i would characterize the first part of the comment. i'm not sure that the right wing lost. either the statements were synthesized and brought the centerleft and center-right together and some of them like that but on the question of japan and korea, i agree it's about leadership. i don't think that was about malicious intent. but feminists are made his own speech in 2013 and i moderated the discussion and told my friend the minister's office i

was going to call to ask other relations so they would be ready and set a positive tone and she's having glad you asked that question. he was the most pro- japanese leader in history which was sincere and positive but not the right message and he also did things particularly with dongxiang that were not done with the message in mind that both sides have leadership. too much familiarity.

i don't think they have an anti-japanese feeling. famously it was very well. it was the politics in part because they thought they were so familiar with conservatives with each other. and if you look at where i once was an exchange student and go from time to time to the hot springs. there is a hill where the first korean pilot to cross the ocean of shopping and between japan and korea as there was a memorial and in 2000, the feminist or went and built the villa and put up a huge stone forever plunging the relations.

you don't see that now. so it's setting the right tone. little gestures like when the feminist or went to the embassy - prime minister went to the embassy. going to the embassy that's good but it's not her thing. it's not imaginative so part of this would be to get past that grumpiness around the leaders and start thinking creatively now and i think the statement wasn't a home run to think of the kind of gestures that would create the kind of environment which in my view has to precede it to some extent that we are addressing. it will have to be every bit and hopefully there will be some of the more imaginative creative thinking that both capitals do.

>> i would like to ask about the september 3 has been discussed already. i'm sorry i can't offer whether or not the ministries going and i thought the speculation by doctor green that he might if there is a trail after a meeting my question is what do you think because there's been no reports that the chinese government is pushing hard to come and the

u.s. government is expressing some reservations. so i would like to tear your prediction or speculation and also how would they treat this? >> i'm not with the government anymore. that's why i smile so much and i'm not going to speak for washington may or may not be doing. i have - i will separate. if the feminist or abe is to visit, no problem. the military parade is a

different issue quite frankly. not that anybody has asked me to provide a device but if i were there with the be a number of factors i want to consider before approving the notion of the visit to beijing. one of which would be the notion to the counterpart from tokyo. that is a pretty important factor] the second it legitimizes the whole thing. reflecting on the government's position on a number of issues dealing with peace and stability in northeast asia if the goal is peace and cooperation and reconciliation in east asia which is obviously a goal of the government, does her presence at a military parade added, i think

not. so that would be one factor that i would consider speaking very frankly how appropriate would be at a military parade if that is an option that is hosted by the last country to have invaded korea, speaking very bluntly. the participation in the military parade is separate from the part being there at the military parade risks buying into the chinese communist party's mythology about world war ii and the resistance to japan that is or the brunt of the battle of the fight etc. and i think that is problematic and it's also, i don't need to

remind anybody in this room but the government in beijing did not come into existence until four years after the end of the war. so why are they celebrating? what are they commemorating an commemorating independent result of the symbology of the tanks and troops rolling down the streets for everybody that remembers i would say let's think twice for this. let's keep the issues as possible if they can be done by both leaders separate from the whole briefing i don't know how this has been to play out but once again if i were asked for my advice those are the factors that i would provide to my boss. >> i agree there's the optics of participating understanding and tian an men square for any democratic leader would be difficult frankly, and i think that's why the european leaders are having a difficult time making decisions about how they

want to to think up a moment. on the other hand, i think there is an opportunity here, and it's a big one. if the prime minister abe wants to take it and that is that they do step up and in a separate capacity to talk about peace and stability in the region. again in my opening remarks that might be too much of a dream. but i think it is an option that should be fully discussed and coordinated and considered. if it is greatly difficult to do then of course maybe another occasion but if it is possible to conceive of coming together for the sake in the region and for the demonstration in that ambition. we would applaud that and i would applaud it. i would ask for a little bit of body and to the importance of the trilateral relationship. i think there is one danger that i see and i do not see for the government at all that one of

the damages of the trilateral forum is that it allows china and south korea to build trust and also to problem solve the regional level so when they begin the trilateral everybody thought it was going to be about economics or cross-border issues and very quickly turned into a conversation with was a comfort level. the promise of the trilateral venue is very important and even more important today and i would urge both leaders in tokyo but to allow the relationship again to be at the axis of that relationship that they must offer for defining that ownership. if you allow it to be separated and speaking here to people that are thinking if you allow south korea to be separated from its diplomacy from japan then you

have lost your own initiative over the trilateral dialogue. but you also begin yourself over the long run into the same goes with tokyo if you only focus on china then you have weakened your latitude going forward. so i hope that this trilateral occasion if we can see it happen in a constructive way september 3 or the morning of the fourth i think all of us in this panel would be delighted but at least don't allow the separation to continue in a way that is going to make trilateral is on either imported or not possible at all. >> many of you probably followed the senate last spring which brought together the continental leaders with a summit by

kazakhstan but they hosted at last it last year and got chinese hosts pressed all of the participating countries to sign onto the joint statement opposing the blocks which is an amended u.s. attack on the u.s. alliances and calling for the new security system every liter and participants signed onto the allies like turkey and israel. korea was the only one end is a good ally of the united states. at the time we asked friends if they are concerned that beijing thought korea would sign on in the first place and it got people thinking. they've been a little bit cautious about allowing a good

relationship which is a good thing. it's going to be a continental system that korea is moving towards. i don't believe it is true in that is true in its position that i know a lot of people who do. it's very eloquently explained. it's risky for her to go on the margin. it's better to go after them before. i recommend going the day before. it's less risky as we have been saying if she does it in the trilateral. it's been to participate in the

commemoration at the end of the war. extremely risky for him though because the ministry which is who tokyo talked to what end wouldn't control the spin on the parade. and i think it is almost certain that it will be a very militarized. for a whole host of reasons in the chinese decision-making and dust at politics agnostic politics but it's a lot less risky to be after. so i haven't thought about this but if you think about the logic, we should all be pushing this and pushed into 50% because it would make a lot of sense. >> thanks to the panel, great discussion. i have two questions.

one is bureaucratic. is there any reason that the u.s. reaction came from the spokesperson rather than the ambassador with a secretary of state or wherever i think after the visit it came from the ambassador, so wondering about that and the other thing is i'm struck by the prediction that the prime ministers will apologize anymore. and if that is the case if you can look back at this as a narrative where abe successfully lowered the bar on what you have to do grading on the curve and clear the bar but within a sort of martyr for the future leaders of japan and is that a bad thing or a good thing? >> i can't tell who's a smirk is bigger. the shadow panelists chris nelson - [laughter]

>> [inaudible] you realize you are out touting him on television. [laughter] [inaudible] [laughter] does anybody want to ask a question of chris? [laughter] >> i ensure that the government wanted - they didn't want to come from the embassy or the department of the unified message because the stature.

it wasn't a white house statement. now i'm being very bureaucratic. that could have been because getting a white house statement in that system takes more than two hours unless it is like an attack on the homeland or something and so as a practical matter they needed to get it up quickly and i think the spokesman is easier than getting it through the statement. on the apology? you asking my own personal opinions? i'm not big on apologies. there are times they are appropriate but i don't think that any country anywhere for anything is perpetual apologies area there have been 50 pending how you count in japan. i think working on the apologies are extremely political.

even the way that you apologize and so forth establishes hierarchy and places they merited about whether asia is defined by the norms of japan created on standby and things that have been 70, 80, 90 years ago. if we want all of asia to be moving towards the norms that we in japan and korea stand by then we ought to be focusing on that. so for those reasons i personally, not just in this case but in general, i am not big on apologies and so i think it is appropriate and a good thing. but this is something kind of like marriage my view is i shouldn't always have to apologize but i used that one. >> can i ask you a question would you draw the distinction between the future apologies or the lack thereof in japan and future statements that would

include some of the things that the prime minister touched upon on friday the remorse and regret and reflection. so i don't think that they will apologize but i do think they might do what was with much notice to talk about specifics, get into the more specific references to any previous statement by any prime minister or foreign minister and i think that that is the trend and future ministers and japanese politicians and ambassadors will talk more about more specific things coming out of that to me is much more fruitful in terms of repairing and healing dan an apology which is so political and so hierarchical and so much about power and legitimacy in the time and the focus on legitimacy should be building norms that make it a more prosperous place. >> i ask the question for a number of reasons the most

important of which if you look back at the statement from the prime minister, one of the building blocks in that statement is the notion of the future generations lessons that we have learned and i think that you will probably continue to hear that in the future. >> a footnote we use the word martyr and thought you will be here. i won't be here in the 80th anniversary or some of the on the panel anyway. but i think it is hard to project forward whether the next statement would come with context they will be looking either diplomatically or at home and i think that speaks to how much change we have seen. look at what was going on even back it up to what im and the domestic politics aside work at what they were looking out at and where we are today. and i think that context fast forward ten years from now, we

don't know. so that will shape whether or not a statement and what kind of statement is given. but again i'm not usually here supporting mr. abe but i am finding myself in a position today. in a press conference after the statement, he said something important. first cut in the statement he said we should never forget history. there is a clear statement and it was their obligation not to forget. in the conference after he said what mike was the looting to and that is key was trying to bring the most that he could together under his statement so he is trying to bridge this difference in the definition of what was right and what was wrong wrong that he is also enlisting them a little bit in the education in the future generation but this is something that we can't all come together as a common purpose that we can teach and we can make it possible that he did take it on as the generations

responsibility. and he was on the morning after the statement. he said our generation is responsible for making this happen. so that wasn't i'm not going to apologize anymore. he did sort of assumed that his generation, and i suspect this generation potentially chinese baby we are - maybe we are going to work this problem and that is given when we started the panel that dongxiang statement about the future etc. it was a statement of ownership that i thought again rocked over a little bit and i'm not sure that that's how he interprets this insult that it wasn't a martyr like he was doing it for the right wing cause. i think that he felt a little bit more invested in making it possible. i am not a historian but the international politics after you have the war, you have the treaty. and the historians still write today about the treaty that ended world war i and the

punitive piece that peace that have been imposed. but it was a treaty followed reparations. generations have to pay back those that they had used force against. and after world war ii in the sessions the costs are that heavy burden on the future generation was fully discussed and when it came time to think about the reparations in san francisco. so i think today we are looking at this other question of history now that we do not have the treaty that is full of reparations in germany or japan at least i'll have this sort of sentiment of unfinished business. again bilateral, south korea, japan and china for those that were not in the san francisco peace treaty table but the basic understanding was japan would be welcomed back into the postwar peace without punishment. and here we still sit today

talking about apology and i don't want to say that is the answer to that question and i know that the japanese governnt get a lot of criticism, some of it is justifiable that they are being legalistic and in the thinking of what needs to happen but you are talking about the two-tiered phenomenon especially for japan and south korea and especially for the women that suffered on the battlefield. those women deserve justice. whether the treaty needs to be renegotiated or not i don't think anybody is going to want to open up again. i think again both leaders on both sides have to figure out how the treaty language and of the state to state relationship perhaps differ from what is fundamentally at this particular moment in time if they've been in there for 57 of them - 51 coming and we lost in the last several months we lost several more but those women deserve attention with or without the

legalisms and with or without fighting about in terms of who is more or less sorry and i think that is the piece of the puzzle that's going to be very difficult politically but again go back to the leadership it shouldn't be dismissed. >> doctor smith talked about the possibility of holding the bilateral summit between the two countries. i think it is important to hold bilateral talks, and more importantly what kind of agenda should be discussed? because if it is on a summit and something bad happens, it will be different. what do you think of that? >> i'm sure everybody else has an opinion on that. i think the poetic disasters are part of the risk.

i will let him talk about how whiskey the diplomacy can be but you don't solve problems without the risk frankly especially difficult problems. i thought that was interesting about the relations, so cause of this is taking us a little step back. but many of us thought that the summit, but kind of conditionality would suffice. the diplomats found a way around that. but he went to beijing before the summit and it forced - it was hosted by beijing but they came up with four points of agreement with a precondition. we all know that they created a foundation for both of the leaders to be able to sit in the same room together. we all saw the picture. .. it to

decline in the face of reality. what we have, thanks to reflection on part of the japanese leader, and some basically helpful comments he made on friday, as well as the korean president remarks on surveillance transparency act our two leaders who recognize the risk and the need to arrest what had been a free fall in bilateral relation and turn things around and move them in a better direction. i have a lot of confidence the two leaders having given their blessing to try one more time to move relations in a good

direction having seen that happen and heard the leaders spoken i am very cautiously optimistic perhaps we are on our way to turning a corner here. >> i know we have more question but i promised the panelist we would finish by 11:30. please join me in thanking the este esteemed panel. [applause] >> congress is on break today. starting at 8:00 eastern, we have the book why library matter more than over in the age of google. and the dark net: inside the digital underworld. and how music got free, the end

of the industry, the return of the embassy and the return of pira piracy. it all starts here on c-span2. >> our road the to white house to the presidential candidate continues from the iowa state fair. as the candidates walk the fairground and speak at the candidate soap box. on friday morning at 11 a.m. eastern it is senator ted cruz and on saturday republican governors chris christie at noon and bobby jindel at one. c-span's campaign 2016 taking you on the road to the white house. the senate aging committee is looking into ways to help seniors maintain independent living. they talked to academics and

experts about some of the advances in telehealth, electronic devices and health alerts. this meeting is about 90 minutes. >> this hearing will come to order. good afternoon. this afternoon's hearing will explore the potential of new technologies to help seniors age in place, safely and to retain their independence. the u.s. population is aging. according to census bureau projections, 21% of our population will be age 65 and older by the year 2040.

that is up from just under 14% in 2012. every day 10,000 baby boomers turn 65. as many as 90% of them have one or more chronic health conditions. americans age 85 and older, our oldest old, are the fastest growing segment of our population. and this is the very population that is most at-risk of multiple and interacting health problems that can lead to disability and the need for long-term care. at the very time that our population is growing older, the need for care and support is increasing. the population of professional and informal caregivers is

however the declining. today there are seven potential caregivers for each person over the age of 80 and at the highest risk of requiring long-term care. by the year 2030 there wile be four and by 2050 the drops to viewer than three. as consequence in the future, more and more people will have to rely on fewer and fewer caregivers. as people age, they naturally want to remain active and independent for as long as possible. aging in place is the ability to live in one's own home and communities safely, independently, and comfortably regardless of age.

surveys taken by aarp consistent reflect the fact that aging in place is the preferred option for seniors who want to continue livi living independently and avoiding nursing homes and other institutionalized care for as long as possible. today's hearing will examine some of the recent advances in technology that are providing new options to allow seniors to remain in their homes longer by monitoring their statue and detecting situations like debilitating falls and notifying family members and health care providers of changes in health care status or emergency. it is not a replacement for professional care or personal attention from family members, technology can help to bridge

the care gap and expend the amount and length of time a person is able to live independently. technology can help to reduce isolation and enrich the lives of seniors by keeping them engaged and connected to their families and their communities. we will also hear this afternoon about technologies that can make the lives of family caregivers easier by giving them the tools they need to support their loved ones as they age in place. finally, we will hear from the veteran's administration, a real pioneer in telehealth, which has used technologies such as video conferencing, and smart monitors to reduce hospital admissions and shorten hospital stays. this has resulted in lower cost and has also allowed some of our

older veterans with chronic health conditions to live independently at home right where they want to be. many of us are familiar with the decades old and well known phrase i have fallen and i can't get up. that phrase of course was an advertisement for a medical alert system. while many seniors still rely on this device, breakthroughs in modern technology brought us a long way providing new options for seniors and their families. technology solutions can be cost-effective and tailored to meet the specific need of a senior and his or her living situation. companies that develop these technologies are starting to realize not only is there a growing need to design products

that meet senior's needs but also there are many seniors who want technology and devices that look just like those used by younger generations. for example, this phone is an older generation device that is specifically designed for seniors to be easy to use. it has large numbers, for example. this new generation version of the phone is the smart phone that still has the same ease of use but looks like the smart phone people's children and grandchildren use. much more important than appearan appearance, however, this new generation device includes technology that helps maintain

seniors maintain their independence. it has features to help with medication adherence and provide 24 hour service to medical operators and an app that the family caregiver can download to keep them up to date on their loved one's wellbeing. we will explore the challenges by the technology advances such as privacy concern and the unequal access it the internet across the country. before turning to senator mccaskill for her opening station i want to give a special welcome to dr. kim who oversees the successful initiative for

living and travelled to washington to tell us about maine's aging and thriving in place movement that will benefit from the dwevelopment of new technologies, products and devices. i look forward to hearing from her and all of the witnesses this afternoon. senator mccaskill. >> thank you, chairman collins. i am looking for forward to learning about the devices that can help seniors and families. there is a number of disconnect from the number of seniors who want to stay in their home and the number that have to move into facilities. 87% of older adults were found

to prefer to remain in their own communities as they age. it may not be possible for every person depending on a number of factors but for many of us with the right support it is possible and preferable in terms of quality of life and financial implications. recent advances in technology are providing new options for seniors and families that can allow them to remain their home longer. these technologies can also make family members and caregiver's life easier by providing them with tools to support their loved ones and giving them peace of mind. this is a win-win situation. seni seniors are happier, family members make sure their loved ones are safe and society as a whole benefits from significantly reduced health

care and long-term care cost. many assisted technologies are on the market. home improvement stores and other stores tell versions of connected system that can keep seniors secure. they are developing senior specific monitoring devices like bed, toilet and pill box sensors. pill box sensors are so simple but can prevent tragic instances. wearable devices are poplar for tracking physical activity and helping to prevent falls. falls are the leading cause of injuries in older adults with 1-3 seniors falling each year. some of the new devices don't even require the push of a button. they can detect when a person has fallen using a meter. technology has been cite critical to the growth of

telehealth and for seniors who by using telehealth have their health monitored from the comfort of their home rather than the doctor's office. this technology is being developed by researchers all over the country one of whom is with us today. i am pleased and proud to introduce marjorie skubic who is the director at my university, the university of missouri. the center in partnership with america care created tiger play. a continued care living environment that utilizes it. i look forward to learning more about this and other technologies from dr. skubic. i know there is concern for

security for seniors and using webcams and such might prevent challenges. we want to insure the privacy of seniors and their dignity using this technology but we want to look out for their safety. i know university the missouri is using techniques like only silhouettes on the monitors. the challenge for those who develop the technologies is to find ways to maximize safety with the minimal invasion of privacy. thank you chairman collins and the witnesses for being here today. >> thank you very much for that excellent statement. i want to note we have been joined by senator perdue, senator cane, senator sase and senator casey. we will turn to the panel and

first hear from laurie orlav who is the founder of aging in place technology watch. i understand she also has the wisdom to have a summer home in the state of maine on fire island. that for me sealed it as far as inviting you to testify today. i introducet carol kim who is the vice president of research at the university of maine. our next witness is dr. maureen mccarthy from the department of veterans affairs. she is the acting chief consultant for telehealth services and will discuss the va's telehealth program which has been a success and reduced cost.

professor marjorie skubic from the university of missouri has been introduced by the committee's ranking member and finally i would like to welcome charles strickler to today's hearing. mr. strickler, who is from virginia, knows all too well the challenges of caring for seniors who have a desire to age in place and we will share his personal story with us and how he has used technology to assist in the care of his mother and mother-in-law. first we will start with ms. orlov. >> i want to thank you for the opportunity to testify today about the potential and requirement for technology innovation to help older adults age in place. as you have noted, demographics make this technology markets essential. these categories of enabling

technology will help make it feasible for older adults to meet needs as they age. as we noted, nearly 90 of adults age 65 want to remain in their own homes and are remaining in their own homes. successful aging is described as the ability to do things for myself, feel safe and have good health. aging in place is therefore the ability to successfully age in your home of choice and aging in place products and services including technology provide help with this. we talked a bit about demographics. i want to add a couple refinements. we know 46 million adults are 65 and older and 20 million are 75 and older. 46% of women aged 75 plus are

living alone. life expectancy at 65 and reflecting that women at age 65 can expect to live on average to be 88.8. with 25% of them living to 90 or more. men at 65 are going to live on average to 86.6. the average one-year cost of assisted living in the united states is $50,000 by 2020 and into the northeast, san francisco, chicago and other areas that number has been reached and succeeded. seniors are defering live in to assisted living communities until mid-80s but most remain at home. let's talk about the categories of technology for aging in place. if you could bring up that slide. thank you. they are bet represented by what i describe as interlocking pieces of a puzzle and the puzzle is used to show if you

leave out any piece of puzzle people are at the risk of depression, isolation, and undetected illnesses and all kinds of complications in their lives. older adults benefit from innovations and particularly related training in how to benefit from them that address their ability to connect with other people and opportunities; stay engaged in communities, be safe, and manage their health and wellbeing. starting with the upper left puzzle piece let's examine. in the category of communication and engagement technology, while the devices change over time and have changed as you showed by your example of phone, the purpose remains the same. they help older adults stay connected through e-mail, online text, and video chat, searching the internet, playing games, finding people with shared interest and finding services and resources that meet their changing need.

and in particular with video, it can be used to monitor but can be used to engage people in some social connections with their families and friends. today while 59% of the 65 plus population have access to the internet and 27% have smart phones both percentages drop off at age 75. the second category on the right upper corner is had safety and security category. the most important is the home alarm system that that can monitor about fire, temperature and excessive moisture in the home. without it the other technologies are just nice to have. other useful technologies listed are personal response attendance which we talked about and safety watches. fall detectors in the home. home-based motion sensors and activity monitors that can now monitor absence of activity and decline over time. increasing information from

various devices will be combined and we are hoping changes or signs that indicate a risk in falling. at the bottom we have telehealth and wearables, smart phone apps as people acquire smart phones that maybe useful and online health information. there are new tools being helped with dementia care, support care coordination and help find home care workers. and they can assist with people of low vision and people are hearing impairment. bottom left hand corner is about learning and contribution and staying engaged in society, continue to learn now things, which is how we remain content with our lives and helps keep our minds sharp. tools that help people tell and record their life story for example, online starts that enable them to volunteer and

work. 20% of people after the age of 65 these days are work many of them full-time. people can learn new skills that are leisure and work related. and all of this online training is free. this is the time we live in now. it is free. forums are available for expertise and ask question. mobile plans average between $60-$80 and wi-fi access is being used by people in coffee shops and libraries because having a high-speed internet connection to the home could be $50 a month and that is a limitation of access. as people age, all four roles are enhanced from the role of the formal and informal care fp giver you can see in the middle. and that can include the professional caregiver. newer technologies track time

and attendance of caregivers but communicate care status. what is going on with activities of daily living, mobility, eating and cognitive function. it has been sized at the low end add a $20 billion industry by 2020 but in the future you will see few were special purpose offerings for seniors and more examples of standard hardware with customized software that will meet the user. that concept is called design for all and can be scene today in your car, tablets, phones, televisions, and consumer electronics. design once, customize for the

individual. i hope this overview has been helpful and i want to thank you for your time. >> thank you for your testimony. dr. kim. >> good afternoon, chairman collins, ranking member mccaskill, and the members of the committee. my name is dr. carol kim and i am happy to share with you the technology the university of maine is developing to help older individuals thrive in place. we are convinced the aging in place movement is invested to benefit greatly from products and devices that maximum human performance, improve navigation, home environment and living and contribute to older adult falls, prevention and response. the university of maine launched

a campus wide initiative to investigate this and established a research incubator from social work to engineering to disability studies that is responding to major public health issues that affect aging americans. in the area of fall prevention we are developing technologies to promote mobility, avoid falling, increased contrast sensitivity, promote outdoor exercise and improve balance. one of the most common challenges that occur with age is lost of visual contrast sensitivity and this can be dangerous for older adults as it turns common place low contrast features like stairs, benches and curbs into falling hazard. our goal is to improve safety and reduce falling via a cost-efficient solution that can be implemented without

infrastructure build out. we are exploring the use of computer vision as a means to detect low contrast edges in the environment and improve disability. this technology is likely to reduce the falling problem because it optimizes to address known perception changes that occur with ages. walkers and canes are minimal function for out side environments. the assisted jogger is feeling the unmet population that without adequate support would be less likely or unwilling to participate in the exercise. the assisted jogger is a three-wheel standing support device that includes balance and

it is fitted with biofeedback. we are developing energy absorbing clothing technology. a team at the university of maine is working to develop protective gear to mitigate injuries of individuals at risk of fall. the main company, a maine corporate partner, developed a hi highly effective system and offers head gear that can be fashionable and provide protection against head injury. it is light weight and can be incorporated into hats, scarves and other things. 258,000 people over the age of

65 were admitted for treatment of hip fracture. the hip project expands our project work with head gear to innovative wearable hip protection for elders. researchers are collaborating to design hip protection consisting of undergarments and a changeable shell that will be worn by elders at risk for falling. i have samples of the material here if anyone is interested in looking at that. in areas of fall response we are developing wireless network with detection and vital sign sensors to assist first responders. loss of sensory, cognitive and motor function can lead to safety risk for older adults living independently. current responses are instillation of expensive video

monitoring. we are testing a new system making use of minute and low-cost technology such as micropad and rf-id pads. rf-id pads can be put in the carpet and behind the paint. it is small and designed to be worn comfortablely by an individual. the system tracks the user's location as they move about and sends an alert if there is a problem. i would like to thank the committee to describe the exciting and necessary technologies that the researchers at the university of maine are pursuing to improve the quality of life for our older population. >> thank you very much, dr. kim. dr. mccarthy. >> thank you.

chairwoman collins, and ranking member mccaskill, and members of the committee thank you for allowing us to discuss the high level of care that the veterans health association and telehealth care programs are privileged to provide. dr. richard almand is joining me and ms. catherine voss national home telehealth lead and analyst for telehealth services. she is from richmond, senator cane. telehealth services are mission critical to the future direction of va care for veterans and one of the major initiatives aiming that care is convenient, accessible and patient centered. it increases access to high quality care services by utilizing secure information and telecommunication technologies to provide health services when

the patient and practitioner are separated by geographical distance. in fiscal year 2014, va telehealth occurred in over 900 sites of care allowing more than 717,000 patients, that would be 12.6 enrolled veterans to receive care from telehealth. this amounted to two million episodes of care. it is currently available in over 45 speciality areas. we use three areas to insure delivery. clinical video health is the use of real-time conference sometimes with support of proof full technology to assess, treat and provide care remotely. home telehealth is a program for veterans that applies care and case management principles to

coordinate care using disease management protocols and technology such as in-home and mobile monitoring, messaging and video technologies. lastly, store health is the use of technologies to acquire and store clinical information that is then forwarded or retrieved by a provider at another location for clinical evaluation. home based primary care starts in 1970 and provides long-term care to clinically ill veterans up their hominid under the care of the team. it can provide the weight of the patient, regular reminders about medication, asking key symptoms that indicate the need for particular intervention. it also allows the patient to send pictures of healing wounds to a nurse or doctor who can

then advise on what additional care is needed. in addition, telehealth can act as an educational tool and support system for a caregiver. for example, a spouse who might be overwhelmed by the complexity of caring for a loved one is provided with the needed knowledge and skills as well as access to emotional support. va telehealth services has delivered positive outcomes. we have increased care and specialties leading to reduced wait times. we have improved outcomes resulting in reduced utilizing this care. when we surveyed in the beginning, those enrolled veterans had a 54% decrease in va days in bed and 32% increase

in va hospital admissions compared to the year prior. veterans receiving mental health services, what we call telemental health has a 35% reduction in acute care. it reduces the necessary for veterans to travel to va facilities for care. clinical telehealth has been shown to result in an average cost saving of $35-$40 per patient per consultation. it has been shown to decrease va net patient cost by $2,000 per veteran receiving nelt. and the most importantly the stat

status -- satisfaction rate is high. the va is transforming to being veteran centric. for many veterans, travel to the centers can be complicated and argerous. travel time is time away from the veteran's work or family. va's telehealth care revolutionize the travel challenges by changing the locations where health care service is provided, improving access and helping the veterans take a more active role in the management of their health and wellbeing. this concludes my testimony and i am please today answer questions you or other members of the committee may have. >> thank you. dr. skubic. >> thank you for allowing me to be here between the senators and visitors. i want to tell you about eva who lived at tiger place.

the aging in place senior housing facility in columbia, missouri with 54 independent apartments. residents can stay there through the end of life. if they need extra help services are delivered to them. a private corporation, ameri-care built tiger place and clinical operations are handled through the nursing school at the university of missouri. a nursing professor set-up tiger place to investigate new ways to help seniors age in place. we started testing technology there in 2005. back to my story, eva had a history of congestive heart failure and a cycle as her condition worsened, got better and worsened again. she israel volunteered in our

study and we installed sensors that detected in marilyn's -- eva's pattern. when marilyn saw this she knew eva was going to relapse soon. it meant changing her medication. her doctor was resistant to this because it didn't meet his protocol but the one-size-fits-all protocol didn't work for eva and she needed the change now. the nurse convinced the doctor of changing the medicine and it broke the cycle of rehospitalization. the sensors picked up subtle changes before eva or her doctor noticed it. we have developed a system with

automatic notes including a bed censor capturing restlessness, a fall system and walking gate system. sensors are discreetly in the environment and operate without the person required to wear anything or do anything special. the bed sensors is installed under the bed mattress. two sensors installed in the same bed for couples. to respect the privacy, no surveillance cameras are used. instead we use depth images that product shadow silhouettes and observes the seniors and learns their patterns and sends alerts to staff when there are signs of health problems. we are detected early signs of

pain, hypo glycemic behavior and in one case we were able to recognize changes in walking speeds and strive lengths of a husband in the home that corresponded to his early dementia even when his wife was living there and they had many visitors coming into the home. in the case of a fall, alerts are sent to staff with a link to the depth video so they can see what happened leading up to the fall. residents get help immediately. pictures, i don't have a presentati presentation, but pictures and links are included in my written testimony so you can see them. as a professor, i carry all of my slides with me. i have another story about my mother-in-law, yvette, who didn't have the technology. she got up in the middle of the

night and fell and broke a shoulder. my father-in-law was sleeping without a hearing aid and didn't hear her call for help. he found her the next day but her shoulder never healed and she was in constant pain the rest of her life. her mobility was limited. she could not cook, bake or pick up her great grandchildren and the constant pain was a drain. her quality of life was dimin h diminished. i can imagine a different outcome if she had gotten help immediately. the in-home health alert system works. seniors have better health outcomes and a longer stay in independent apartments at tiger place compared to those without

sensors by nearly two years longer. we have a commercial partner bringing this technology to seniors. many colleagues at other universities have decided exciting technology to help seniors such as we heard today. the potential for proactive health care is significant. detecting health problems early so that early treatment can be offered is more effective and less expensive than the current approach and will help keep seniors healthier so they can stay in their own homes. we have seen this work in missouri. i mind like to see it used throughout our country so others can benefit including my mom and dad in south dakota and your loved ones, too. >> thank you very much for your testimony. mr. strickler. >> good afternoon, chairman collins, ranking member mccaskill, and members of the committee. on behalf of caregivers in aging

parents thank you for the opportunity to testify before you. it has been a difficult process to find the right assistive technology to help our parents age in a home environment. my wife and i have mothers who are 85 and 86 respectively and both desired to live at home as long as possible. it has been a challenge to stay in tune with state of mind, safety and wellbeing while respecting their privacy and living several hours apart makes it more challenge. my mother is activity in her community and enjoys gardening. she uses a pendant so she is independent but enables her to help at the touch of a bottom or automatic if she is incapacitated. unlike most customers, she is diligent about wearing her pendant but we know they are not effective for the vast majority.

my mother-in-law's aging experience is one such case. she has experienced a different aging scenario. she has a dementia. after arriving at her home and seeing a toaster oven was on for 24 hours we saw she needed to be closer. we modified a cottage and moved in full-time in september of 2012. our existing home security system alerted us to doors open and detect motion in each of the four rooms of the cottage so we knew when she was active. as the dementia progressed we were concerned about falls and tried several products but she refused to wear the pendant. in short these products were in effective and failed for our concerns. we worked with a home security company to find and install alternative technologies including a bed sensors, chair

sensors, refrigerator sensors and a censor for help. we monitored her schedule and got alerts when patterns changed or issues required immediately assistance and we set parameters to be alerted to cell phones by potential falls or wandering alerts so we could immediately check on her. bed sensors facilitated in tracking sleep patterns. a censor on the fridge helped recognize if she would forget to eat. the system provides many of alerts that provide overview including data summary tools making it easier to see trends and patterns the user-friendly graphics made it easy to see

what is changing in her life allowing us to know when to layer in additional care and standards. my wife and her twin sister are the two primary caregivers tell you the three balanced benefit system is the breadth and solution. the system provides a peace of mind assuring us mom is safe and allowing us to check on her when we are not in her cottage. the technology is a priceless gift enabling the request to live at home independently. it has been a relief allowing us to preserve resources and providing the one-on-one care. in significant living the cost of two and a half cares would have been $223,000 plus an

additional $104,000 for homemaker and health services. our system was about $2200 plus a $59 monthly fee. we need to supplement our own caregiving effort with contracted support, phenomenal technology has provided a huge cost saving and high standard of care in a more comfortable environment. the company we are working with has continued to innovate and now our system has more capabilities that would have been useful for our family before. remote control of the thermostat, lights and locks, motion sensors, activating lights, aging in place technologies are not a magic solution that will solve all of our problems of cost effectively caring for the aging population but from our experience, they

can be part of the solution. these technologies can be objective tools that can help with typical conversations, prolong independence and help guide assistance, intervention, all at a cost effective and non intrusive manner affording caregivers and aging love ones great choices. thank you. >> thank you for your first hand experience and chairing with the committee. -- sharing -- dr. kim, as i watch the technology that you illustrated for us today, i could not help but think that i could have thought for years and never came up with the assisted jogger. i realize there is a certain stigma that is associated with walkers. for example in that seniors are eager to avoid those. but how do you come up with the

technologies and products you are developing at the university of maine? >> so in terms of that assisted jogger, for instance, that started with true faculty members and disability studies and one of the faculty members has walking and balance issues and wanted to develop some kind of system so that she could exercise outside and remain active and part of the community. her goal was to participate in a 5-k. she partnered with a professor in mechanical engineering and students as well and developed the assisted jogger and was able to complete a 5-k. the technology was designed for someone with walking issues and had disabilities you could easily see this assisted jogger

would be a great piece of equipment for someone who was aging, someone who had a knee or hip replacement and going through a rehabilitation. there are sensors including in the assisted jogger so you can make sure you are not putting too much weight on the joint if you are rehabbing. lots of technology coming from the original technology that can be transforward to -- transferred. >> do they survey seniors to see what their biggest problems are? do you reach out to health care providers? home health agencies? >> all of the above. as an example, you know, even with a small group of students going to the local assisted

living facility in orno, so it is right there, the students in engineering met with residents at this facility and in a one-hour period of time the residents were asked what could we design that would help you in your daily lives and they came up with 50 items in a one hour period. >> that is incredible. that shows there is such a need for this innovative devices. ms. orlav, let's look at the other side of the issue. i read an article in which you were quoted and surserving that quote aging in place does not imply watching us age. end quote. i do understand the concerns about privacy that some of these

ton technologies may raise particular web cams, implanted devices even. how can we make sure we are striking the right balance between maximizing safety, so that people can stay in their own homes, and yet not making them feel that big brother or maybe actually not big brother but maybe the adult child who is watching them? >> the first think i would like to say about the use of monitoring technology. there is a concept of opting-in and giving permission that you are willing basically. and i know a lot of implementation of monitoring technology has been done on a bases of threat. if you don't let me put this technology in your home i am going to have to have you moved to assisted living because i am

too nervous about your wellbeing. that is called the loving threat. the loving threat has worked in many cases. but it is very important that people understand what they are opting into. they are not opting in to have their every move watch. people that design properly design for alerts to show the absence of activity in a particular time or the absence of going near the refrigerator. the presence of a cat or dog may jump by the sensors. the idea you may go on vacation and your sensors are saying you are not moving but you are really away for several weeks. i mean a lot of thought has to go into the how they are setup and configured. >> thank you. senator mccaskill. >> thank you. i would like to talk a little bit about cost-savings and the

financial implications of all this and taking things to scale. professor skubic, what are the costsavings that you can attribute to some of these advancements as it relates -- one thing we tried to stress in this committee that i think many out there, not directly involved, don't understand a huge part of the medicare dollars are not spent on struggling families who are not working, but rather are spent on our seniors who are in nursing homes. and that is a high proportion of medicaid beds in the nursing home makes this an important hearing for our debt and deficit because if we can figure this out the cost savings and the implications of those cost savings are dramatic to the

long-term product we have with the demographic bubble represented with my generation going into the medicare and ultimately not having sufficient money saved in a medicare nursing home bed. what kind of saving can you actually quantify at this point that we might be able to realize if we started embracing the monitors in people's home? these sensors? >> well, first i want to clarify something. you know, i am talking about a relatively narrow aspect of this technology rather than the broad array that laurie mentioned. but in the context of what we are doing is we are specifically looking for signs of early health changes and functional decline. when we started working the nurses they talked about the trajectory of aging and

degrading and you will be dropped to the next level quickly until the next dramatic thing happens. oh sour premise was if we can recognize the beginning of that decline so an intervention could be offered we can keep people at the top of the level. and some people call this squaring the life curve where you go along for some period of time and then there is a sharp drop off and then you die. i am hoping this is what happens to my parents and to all of us. yes, to all of us. that we would end up being very functionally active until the end. trying to quantify that in terms of cost savings is really hard. we have not yet done the study that really quantifies the effectiveness in those economic terms of the technology alone. we are involved in a nih rand

randomized controlled study that scaled up the work behind tiger place and we are hoping to have economic cost saving figures associated with this. i can tell you that my collaborator marilyn rant has looked at the economic impact or the cost savings of using nursing care coordination in this context, which is what they are doing at tiger place as well, it is how they do nursing care and add the technology part on top of that. and they have shown dramatic potential of cost saving associated with what they have been able to do with just the organize and coordinated chair. and we have seen, as we compared the standard level of care at tiger place between those who have sensors and those who do not, we see a much-improved

health outcome and longer stay in independent living. i am extrapolating and saying i don't have the quthe quainnatat numbers for you. but i did include dramatic numbers in there. this one statement that is in here coming from marilyn's work that about 10 million people need long-term care in the united states of these 4.6 million are older than 65 and live in the community. these 4.5 million recognize $89 billion in cost saving if everyone had access and participated in the intervention that has been tested at the

university of missouri. that is huge. >> we would love to get the details of that survey. as soon as the academic community can put numbers on the advancement. i know tiger place is more expensive than the other facilities in the area in terms of care but i understand it is small and you guys are doing a lot of research and i understand all of that. but i think we have to start monetizing these savings as quickly as possible. the most quickly we can monetize them the more quickly we can begin adopting them as part of public policy preferences which has a huge impact on their availability to most people. ...