with colonel john petkosek. caller: good morning, sir. i would like to know how this urban training conflicts with the posse, taught us act. i will take my answer out there. guest: thank you very much for your call. it does not conflict with the posse cometatus act. the army does not engage in law enforcement activities. we do operate in environments where there are civil years and soldiers operating together. to answer your question directly, it does not. but it really does is provide us with an opportunity to become accustomed to operating in areas where civilians and from these are operating.

it's a makes them able to better perform their mission. as a justin sapp talked about, there is a number of basic skills that we want our soldiers to be able to do. we want them to able to shoot and hit a target. they want them to be able to maneuver in environments. those are the essentials of any military operation. when you overlay that on top of the complex world we live in, we want our soldiers to be able to operate and decide it is not whether you're going to hit the target, it is whether you should shoot or not shoot. the able to make decisions rapidly in a complex environment. that is what we are trying to achieve. host: you talked about civilian and military together. one of the replicas here is a metro station. why is it important to have that and how do you account for civilian -- dealing with civilians in the sky situations? guest: our soldiers have to be able to operate in all kinds of environments. what you saw it on their looks like a metro station and we've used it in the past for other things. we blow a better cars and of role in a flatbed railcar and it is a hidden gun that are said -- our soldiers a going to go after.

the next a we put tanks on it and chemical weapons that are soldiers what to go after. we are able to tailor it to the mission set we're going to face. when you look at underground rail systems, those are probably in most major cities today. i cannot think of another place where i can train where i would have the opportunity to understand what would happen if i encountered a facility like that. what decisions to we want our soldiers to make? when you good on their and you turn off the lights and it's filled with smoke and you're trying to recover somewhat that might be injured or trying to fight her through it, let us do that here at fort ap hill and provider soldiers with that kind of complex environment for they have to do it elsewhere. host: rhonda for massachusetts. caller: thank you. i came across police officers training of a closed store at the mall.

my question is what terminologies like one world government and the patriot act being in place and barack o is using the rustic terrorism, is there a time this asymmetrical army can be used in the united states against the people? guest: the short answer is no. there is not an asymmetrical army per se. you see training in a facility where they have to close off a mall so they can train and what are they going to do if they have to react to an incident by what happened in kenya just a short time ago. instead of shutting down the mall for law-enforcement to train on those things, what you ring them here or they can replicated here and exley get those techniques down so we can do what we are going to ask them

to do without being annexed or imposition on the environment we live in. when you talk about the metro station, that is another great example. we have a commute to work each day. i would be pretty disappointed if the measure was not working on time because someone else was training there. we can do the kind of thing here and not inconvenience our day-to-day lives. host: talking about training taking place in international areas, is there and it's -- a plan for if an incident happens in the united states? guest: one of the missions of the national guard is to react in case of a national emergency. if there was an emergency but we had have soldier sent in to provide relief as they have a numerous occasions when number of floods or hurricanes, this is the kind of thing they could do. they could get an opportunity to do this kind of tasks. i know with the recent hurricane we had a few years ago in new york, there were metro stations that were flooded. is the be the kind of place for you can figure out those

techniques if the military is a recalled on. you want to make sure they are adadadf luxury when we are called on. we are expected to be there and be ready to do whatever we are asked to do. if the army is called on to help but in a situation, one would not effect is to be ready to's -- disable be ready in a few weeks. now, when the american people: the military to perform a mission we expect them to be ready. we are able to look at some of these unconventional things that we might ask our soldiers to do and make them ready for this. host: david from texas. caller: i am retired and the late 80's we did some training at fort hood at some all caps stations. me being an armored crew member and thank you matter, it helped

our troops to actually learn how to fight in urban warfare so when we went overseas we do it to do. everybody knew they had to do. as a tanker, you never get off your tankless you have to. now if something cap us your vehicle if you're on foot you know what to do to help out the infantry or the medics or whoever to survive. and the training itself is worth it. all of our soldiers and airmen and marine corps need to go to some kind of training like this because they need when they go overseas. guest: i really appreciate that comment. i myself served in a number of types of units. a few years ago when everyone -- >> this hearing will come to order. good afternoon. this afternoon's hearing will explore the potential of new technologies to help seniors

safely and to retain their independence. 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, are the fastest-growing segment of our population. this is the very population most at risk of multiple and

interacting health problems that could lead to disability and the need for long-term care. at the very time our population is growing older the need for care and support increasing. the population of professional and informal caregivers is declining. today, there are seven potential caregivers for each person over age 80 and at the highest risk of reclaiming long-term care. by the year 2030, there will be four. i've year 2050, the numbers drop to fewer than three. as a consequence in the future, more and more people will have to rely on your and fewer caregivers. as people age they naturally

want to remain active and independent for a long as possible. the ability to live in one's own home and communityy independently, and comfortably regardless of age or ability level. surveys taken consistently reflect the fact that aging in place is the preferred option for seniors who want to continue living independently and avoiding nursing homes and other institutionalized care fssible. today's hearing will examine some of the recent advances in technology provide a new options allowing seniors to remain in their homes longer by monitoring their health status, detecting emergency situations such as debilitating falls, and

notifying health-care care providers of potential changes in health status form urgencies. while it is not a replacement for professional care or personal attention from family members, technology can help to bridge the care gap and extend the amount and length of time a person is able to live independently. technology can also help to reduce isolation and enrich the lives of seniors by keeping them engaged and connected to their families and their communities. we will also hear this afternoon about technologies that can make the lives of family caregivers easier by giving them the tools they need to support their loved ones as they age in place. we will finally here from the veterans administration, a real

pioneer in health, which has used technologies such as videoconferencing and smart monitors to reduce hospital admissions and to shorten hospital stays. this has resulted in lower costs and also allowed 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 cannot get up." that phrase was an advertisement for a medical alert system. while many seniors still rely on this device, breakthroughs in modern technology has brought us a long way. providing many new options for seniors and their families.

caps off solutions can be cost-effective and tailored to meet specific needs of a senior and his or her living situation. companies developing these technologies are starting to realize that not only is there a growing need to design products that meet seniors needs, but also that there are many seniors who want technology and devices that look just like those used by younger generations. for example this phone is an over -- older generation device specifically designed for seniors to be easy to use. it has large numbers, for example. this new generation version of the phone is a smart phone that still has the same ease-of-use

as the old version of the jitterbug phone but looks like the smart phone that people's children and grandchildren use. much more important than its appearance however, this new generation device also includes technologies that help seniors maintain independence. for example, it has features to help with medication, provide 24/7 access to medical emergency operators, as well as an app the family caregiver can download to keep them up to date on their loved one's well-being. we will also explore the challenges posed by these technological advances, such as privacy concerns and the unequal access to the internet that exists across the country. before i turn to senator

mccaskill for her opening statement, i want to give a special welcome today to dr. carol kim, the vice president for research at the university of maine. dr. cam overseas -- dr. kim overseas the sail program. aging and thriving, in place movement that will benefit significantly from the development of new technologies and devices. i look forward to hearing not only from her, but all of our witnesses this afternoon. senator mccaskill. senator mccaskill: thank you. helping our seniors age with dignity is an important issue and a top priority of this committee. you have assembled a great panel today i look forward to hearing

about exciting innovations that could help seniors and their families. there is a disconnect between the number of seniors who say they want to stay in their homes and communities and the number of seniors who end up having to move into nursing facilities. a recent aarp study found that 87% of older adults would prefer to remain in their own communities as they age. it may not be possible for every person depending on risk factors to remain in their homes for many of us, it is possible. it is preferable in terms of quality of life and financial reasons. providing new options for these seniors and their families to allow them to remain home for longer by monitoring home status, and notifying health care providers about changes in health -- help staff. this can make the caregiver life easier by providing tools to support left once -- loved ones

and giving them peace of mind. seniors are much happier keeping their routines, families can make sure the love ones are safe and society as a whole benefits from significantly reduce health care and long-term costs. many of these technologies are already on the market. even health communications companies -- of connected home systems that can keep seniors secure in their home. developers are creating senior specific monitoring devices such as beds and toilet that could monitor activity in the home. the sensors are so simple in nature and can prevent tragic accidents by making sure seniors are not mixing medications or taking too many pills. wearable devices are also popular for helping to prevent falls. falls are the leading cause of

injuries in older adults, with one out of every three senior falling each year. some of the newer monitoring devices do not even require the push of a button. they detect when a person has fallen. technology has been critical to the growth and helpful to seniors in particular who, by using the services, can have their health monitored from the comfort of their home rather than the doctor's office. these technologies are being developed by researchers across the country, one of whom is with us here today. i am so pleased and proud to introduce dr. marjorie, the director of senator for -- eldercare at my university, the university of missouri. the center has created a living advisement.

the doctor and her team have found a way to use radar and 3-d sensors are i look forward to learning more about this and other things from dr. skubic:'s testimony. we also want to make sure we are looking out for their safety. i know privacy techniques, such as using only silhouettes on video monitors that could help ease privacy concerns of older adults, the challenge for those who develop these technologies is to find ways to maximize safety with minimal invasion of privacy. thank you to chairman collins and witnesses for taken the time to be here today and i look forward to listening and learning from your testimony.

>> thank you very much for that excellent statement to want to note we have been joined by senator purdue, senator kaine and i am very pleased you could join us this afternoon. we will now turn to our panel. we will first hear from lori, a tech industry founder of technology watch. i understand she also has the will is just the wisdom to have a summer home in the state of maine. i have already introduced dr. carol kam, the vice president for research at the university of maine.

our next witness is dr. marine mccarthy at the department of veterans affairs, the active chief consultant for health services. we will discuss the v.a.'s health program, which, by many measures, has been a success and has helped to reduced costs. -- to reduce costs. artie introduced from missouri by the committing's ranking member, and finally, i would like to welcome strickler to today's hearing and mr. strickler knows well the challenges for caring and he will share his personal story with us and how he has used technology to assist in the care of his mother and mother-in-law.

>> thank you. i want to thank you for the opportunity to testify today for the requirement for technology innovation to help older adults age in place. evie ahead -- as you have noted, demographics make these essential. these categories will help make it feasible for older adults meet their needs as they age. nearly 90% of adults aged 65 want to remain in their own homes. in fact today, they actually are remaining in their own homes. the ability to do things for myself, feel safe, and have good health. aging in place, therefore, is the ability to successfully age in your home of choice. aging in place products and services, including technology provide a useful underpinning and the enhancement of the quality of life for seniors as they age in place. we have talked about demographics.

i want to add a couple of things we already heard. we know 46 million adults 65 or older today, 24 million of those are 75 or older. 46% of women aged 75 plus today are living alone. society of actuaries recently updated life expectancy at age 65 to reflect a new reality that women aged 65 can now expect to live on average to be 88.8. .5% of them living to 90 or more. men at 65 are going to live on average 286.6. the average one-year cost will be $61,000 per year by 2020 and in northeast chicago, and most units, the number has already been reached and exceeded. seniors know this and are deferring move-in to assisted-living facilities until they reach mid 80's p or most of them still remain at home.

so let's talk about categories of technologies for aging in place. if you could bring up that slide. thank you. they are best represented by what i describe as interlocking pieces of a puzzle. the puzzle paradigm is used to show if you leave out any one piece of the puzzle, people are at the risk of depression, isolation, undetected illnesses and all kinds of competitions in their lives. older adults benefit from innovations and particularly related training and how to benefit from them that adjust their ability to connect with other people, opportunities, they engage in their communities, be safe and manage health and well-being. looking at each category, starting with the upper left puzzle piece, let's admit -- examine them one at a time. in the communication and engagement technologies, while devices may change over time and have changed significantly, as you showed by your example, the

purpose remains the same. they help older adults connect with others through e-mail and video chat, playing games, fining people with shared interests, and fining services and resources to meet their needs. with video, they can be used to monitor it also to engage people with social connections with family and friends are while 629% of the population have access to the internet and 27% have smartphones both percentages drop off noticeably at age 75. the second category, the most important aspect is a home alarm system that can monitor and alert about fire, temperature, and moisture in the home. without it the other

technologies are just nice to have their other uses of technologies listed here include emergency response, which we have artie talked about, and safety watches. falling to tetris in the home, motion sensors, and activity monitors that could now monitor absence of activity and decline over time. increasingly, information from various devices can be combined to detect changes in tatters over time -- in patterns over time. health and wellness technologies in the bottom right, that includes health as we heard, but also wearables, smart phone apps, as people acquire smartphones, that may be useful, and online health information. new tools are being developed all the time to help with dementia care, and help home care workers. a variety of these new devices can assist with people with low vision and able with hearing impairment. the bottom left-hand corner is

about learning and contribution and how we stay engaged in our society as we continue to learn new things, which is how we remain content with our lives and interested and help keep our minds sharp. tools that help people tell and record their life story, for example, online sites that enable them to volunteer, enable them to find work. 20% of people after age 65 these days are actually working. many of them full-time. people can learn new skills. they can learn new skills that are leisure and work-related and all of this online training is free. these are the times we live in now. it is free. forums are developed -- are available to ask questions. the biggest problem we have is that multiple device data plants today average 60 to $80 per month and wi-fi access is typically being used by people in coffee shops and libraries because having a high-speed internet connection to the home can be quite costly. $60 a month or more.

that is limitations on access for a lot of folks. as people age, all of the four categories are enhanced by inclusion of the role of the formal and informal caregiver , which you can see in the middle. that includes a professional giver, new technologies not only track time and attention of caregivers but also committed kate care status. that is, -- communicate care status. that is, mobility, eating, and cognitive function. the future market potential of this market is greater than the availability of smartphone features, technologies, and will move into robotics. it has been sized at the low end of $20 billion by 2020. in the future, you will see fewer offerings for seniors. more examples of standard -- standard hardware and device platforms with customizable software that will meet the

specific needs of the user so we do not have to put in vent special-purpose technology for everything. that concept can be seen today in the customizable features in your car your tablets smartphones, television, and consumer electronics. design once, customized for the individual. i hope the overview has been helpful for you and i hope -- and thank you very much for your time. chairman collins: thank you for your testimony. dr. kim. dr. kim: good afternoon, distinguished members of the senate committee on aging. my name is dr. carol kim and i appreciate the opportunity to share with you technologies the university is developing allowing older individuals to age and thrive in place. it could not be timelier. we are convinced the aging and thriving movement is destined to benefit greatly from the rapid deployment of technologies products, and devices that

maximize human performance improve mobility, navigation home environment and intelligent living. improve emergency detection and mitigation and response. older, and response. the university of maine has launched a cross campus initiative in partnership with community agencies and has established a research incubator from social work to kent -- to engineering to disability studies responding to major public health issues that affect aging americans. in the area of home safety optimization and falls prevention, we are developing technology to promote mobility, increase contrast sensitivity and improved balance. one of the common challenges that occurs is loss of contrast

a sensitivity. this can be dangerous for older adults as it turns low contrast features, such as cement stairs, curbs, or benches into falling hazards. our goal is to reduce falling. to do this, we are exploring the use of computer vision as a means to detect low contrast edges and improve visibility. the technology will likely reduce the falling problem because it is optimized. all, crutches, and canes have been available. these are minimally functional for exercise. in this movie, the assistive jogger was created to fill an

unmet need for populations who would be less likely or unwilling to participate in ambulatory exercise. it is convenient foldable, three wheeled standard support device. it is fitted with biofeedback and load sensing technology and is in the early phase of commercialization. in the area of falls mitigation we are developing advanced energy absorbing clothing technology. a team at the university of maine is working to develop protective gear to mitigate injury for individuals at risk for falls. the main company has developed an impact resistant material system and offers headgear for

older adults that can be integrated into fashionable headwear and provide protection against injury. it is lightweight and can be incorporated into cap's, scarves, and hats. it has potential for reducing head injury. in 2013, 200 thousand people were admitted for treatment for hip fracture. researchers are collaborating to design departments in a changeable shell that will be worn by elders at risk for falling. i have samples of the material here. in the areas of fall response, we are developing wireless

networking technologies with wireless detection to assist first responders. loss of sensory, cognitive and motor function that occurs as people age can lead to many safety risks. we have re-created a typical apartment setting for testing a new, sensible system that makes use of low-cost technology. rfid tags can be embedded into the physical structure of an apartment. the reading device is small and designed to be worn comfortably. the system tracks the user's location and sends an alert that there is a problem. the system will help reduce in-home falls and improve safety, efficiency, and independence. i would like to thank the

committee for the opportunity to describe the exciting and necessary technologies that researchers are pursuing to improve the quality of life for our older population. senator collins: thank you. >> thank you for the ability to speak. joining me today is the chief consultant for geriatric and long-term services. she is recognized as a world leader in the development of telehealth services.

they are one of the major transformational initiatives aimed at ensuring care is convenient, accessible and patient centered. it increases access to high-quality services. it provides health services when the patient and practitioner are separated. it allows 12.6% of our enrolled veterans to receive care through telehealth. this amounts to over 2 million episodes of telehealth care. it is available in over 45 specialty care areas. we use three telehealth modalities to ensure excellence in health care delivery.

clinical video telehealth is the use of real-time conferencing. sometimes, with the support of peripheral technologies. home telehealth is a program for veterans that applies care and case management principles to coordinate principles. lastly telehealth is the use of technology to acquire and store clinical information that is forwarded or retrieved by a provider at a nether location for clinical evaluation. home-based primary care provides long-term primary medical care to veterans and their homes under the coordination of an interdisciplinary treatment team.

telehealth support can include recording the weight of the patient, sending reminders about medication taking medication asking key symptoms that indicate the need for intervention. it also allows the patient to send pictures to a nurse or doctor to advise on what additional care is needed. it can act as an educational cool and -- an educational tool and support system p or to who might be overwhelmed is provided with knowledge and skills and access to emotional support. we have increased access to primary care and consultations. it results in reduced utilization of inpatient care.

in fiscal year 14, when we stuttered -- when we studied veterans those enrolled veterans had a 54% decrease in bed days of care and a 32% decrease in hospital admissions when they were compared to themselves in the year prior to their enrollment. veterans receiving mental health services, what we called tele-mental health led to reduced psychiatric care. in addition, they reduce the necessity for veterans to travel to facilities for care. home telehealth has decreased costs for v.a. and non-v.a. care.

most importantly, veteran satisfaction scores have rated high with approval for these types of modalities. for many veterans and their loved ones, travel can be a complicated and arduous task. travel time is time away from work or family. the telehealth services programs revolutionizes the time challenged by changing the location where health care services are provided. it helps veterans take a more active role in the management of their health and well-being. i am prepared to answer any

questions you or other members may have. dr. skubic: thank you for allowing me to be here. i want to tell you a story about eva. the senior housing facility with 54 apartments. residents can stay there. if they need extra help, services are delivered to them. a private corporation built it and clinical operations are handled by the nursing school. a nursing professor set up tiger place to investigate new ways to investigate --.

eva had a history of congestive heart failure and a cycle of hospitalization as her condition worsened and got better and worsened again. we installed a motion bed and chair centers in her apartment. the sensor system detected changes in her patterns. she knew her health was worsening. if we did not act now, she would have to go back to the hospital. in this case, it meant changing her medication. her doctor was resistant to the request because she had not gained enough weight to satisfy his protocol. his one-size-fits-all protocol did not work for eva. she needed to change now. maryland convinced the doctor to change her medications and she

never went back to the hospital again. this broke the cycle of rehospitalization. the sensors pick up subtle changes before eva or her doctor noticed it. since then, we have developed a support system with automated health alerts sent to nursing staff. it has a fall detection system and a walking gait analysis system. sensors are mounted in the environment and operated without the sensor having -- the operator having to wear anything or do anything special. two sensors can be installed in the same bed for couples. to respect privacy, no surveillance cameras are used. we use depth images that produce

silhouettes. it learns patterns and send alerts to clinical staff when there are signs of health problems. we have good signs of pneumonia pain delirium, hypoglycemia. we were able to recognize changes in walking speeds and stride length of the husband in the home that corresponded to his early dementia. even when his wife was living there and they had many visitors coming into the home. in the case of a fall, alerts are sent to staff. they can see what happened leading up to the fall. residents get help immediately. pictures and links are included in my testimony.

i would be happy to show them to anybody. i carry all of my slides with me. i have another story about my mother-in-law, who did not have this technology. she got up in the middle of the night, sell down, broke her shoulder. my father-in-law was sleeping without his hearing aid, so he did not hear her call. the next morning, he found her but the damage had been done. with her damaged shoulder, her mobility was limited. she could not cook or bake anymore. the constant pain was age rain. i can imagine a different outcome if she had sensors in

her home and had gotten help immediately. seniors with sensors have a longer stay in independent apartments in tiger place compared to those without sensors. many of my colleagues -- to help seniors. the potential for proactive health care is significant. detecting health problems early so that early treatment can be offered is more effective and less expensive than the current approach and will keep seniors healthier so they can stay in their homes. we have seen this work in missouri. i would like to see this so others can benefit.

senator collins: thank you for your testimony. mr. strickler. mr. strickler: thank you. on behalf of caregivers, thank you for the opportunities to testify. my wife and i have -- it has been a challenge to stay in tune with their state of mind and respecting their spirit of independency and privacy. my mother is independent. she is active in her community and continues to enjoy gardening. she can remain independent.

she can someone for help at the touch of a button. it works wherever she goes. she is diligent about wearing her pendant. my mother-in-law aging experience is one such case. we needed to have her closer to us. we modified a cottage next to our home by incorporating a walk-in tub. she moved in september 2012.

we tried several different products. it would not respond to the voice in the box. the products are ineffective. we worked to find a company to install sensors. incorporated with the existing door and motion sensors it enabled her to have independence and privacy and get alerts when patterns changed or when issues arose and she required assistance. bed sensors facilitated tracking sleep patterns. the refrigerator sensor helped recognize when she would forget to eat.

the system provides many of the alerts based on individual sensors, but provides a wellness overview including data summary overviews that make it easier to see trends and patterns. the graphics make it easy to understand what is changing. the system has enabled us to know when to layer in additional care and assistance. matching it to her state of health as her capabilities changed. my wife and her twin sister are the two primary caregivers. the system provides a tremendous piece of mind, ensuring mom is safe, allowing us to check on her. the technology is a priceless gift enabling us to honor her request to stay at home and live as independently as her capabilities allow. financially, it has been a

relief to preserve resources, allowing us to provide the best possible one-on-one care. had we moved her into assisted living, the cost would have been significant. moving into an average virginian nursing home as $223,000 plus $104,000 for services. the cost of our system was $2200 plus a $59 monthly fee. we still need to supplement our efforts with contracted home care support, the investment in technology has provided cost savings and a higher standard of care. the company we are working with continues to innovate and our system has more capabilities. a sensor alerting when the stove is left on over a prolonged period.

motion sensors activating lights. alert pendants which can unlock the doors. aging in place technologies are not a magic solution. from our experience, they can be an interval part of the solution. these technologies can be tools that can help difficult conversations, prolonged independence, and guide assistance in a cost-effective and nonintrusive manner. affording caregivers and their loved ones excellent lifestyle choices. senator collins: thank you for sharing with the committee. dr. kam, as i watch the technology that you illustrated for us today, i could not help but think i could have fought

for years and never come up with the assisted jogger. i realize that there is a certain stigma that is associated with walkers. seniors are eager to avoid those. how do you come up with the technologies and products that you are developing at the university of maine? dr. kim: in terms of the assisted jogger, that started with two faculty members in disability studies. one faculty member has walking and balance issues and wanted to develop some kind of system so she could exercise outside and remain active and part of the community. her goal was to participate in a 5k.

she developed this jogger. she would be able to complete a 5k. even though the technology was originally designed for someone with walking issues, you could see this jogger would be a great piece of equipment for someone aging or someone who has had a knee or hip replacement. there are sensors included in the assisted jogger so you can make sure you are not putting too much weight on a joint. lots of technology can come from this originally technology -- this original technology that can be tracked to the aging population. >> do you survey seniors and see

what their biggest problems -- to your reach out to health care providers? home health agencies? dr. kim: all of the above. even with a small group of students going to the local assisted living facility, it is right there. students in engineering met with residents at this facility and in one hour, they were asked what can we design that would help you in your daily lives. in one area -- in one hour, they came up with 50 designs. senator collins: that shows there is a need for these innovative devices. i read an article in which you were quoted as aging in place

does not imply watching us age. i understand the concern. how can we make sure we are striking the right balance between maximizing safety, so people can stay in their homes and not making them feel that they brother, not big brother the adult child, who is watching them? dr. kim: the use of any monitoring technology is the concept of opting in and giving permission that you are willing.

a lot of implementations of monitoring technology have been done under the basis of threats, if you do not let me put this in your home, i will have to help -- i will have to have you moved to assisted living. i would call that the loving threat. the loving threat has worked in many cases, but it is important people and what their opting into. it is not necessarily into having their every move watched. people who design technology properly designed the absence of activity in a particular window of time, or the absence of going near the refrigerator, the presence of a cat or a dog that may jump by the sensors, there

are the sensors saying you are not moving, but you are away for several weeks. when configured properly, they can work well. senator mccaskill: i would like to talk about taking things to scale. what are the cost savings you can attribute to some of these advancements as it relates? we have tried to stress, many people out there, who are not directly involved, they do not under and a huge proportion of medicaid dollars are not spent on struggling families. rather, they are spent on our seniors, who are in nursing

homes. the high proportion of medicaid beds makes this an important hearing for our deficit. if we can figure this out, the cost savings and the implication of the cost savings are dramatic to the problem we have with the demographic double that is represented with my generation going into medicare and not having sufficient money saved. what kind of savings can you actually quantify at this point that we might be able to realize that if we embrace these monitors in people's homes, these sensors. professor skubniic: we are looking

for early signs of health changes and declined. when we started working with the nurses, they talked about the trajectory of aging and functional decline in a stairstep fashion where you will go on a plateau until something dramatic happens and you get dropped down to the next level very quickly until the next dramatic thing happens. our premise was, if we can recognize the beginning of the decline so and intervention could be offered, we can keep people at the top of the level and some people call it squaring the life curve. i am hoping this is what happens to my parents. to all of us. that we would end up being very functionally active until the end.

trying to quantify that in terms of cost savings is hard. we have not done the study that quantifies the effectiveness in those terms, in economic terms of the technology alone. we are involved in in any -- an nih control funded and we are hoping to have some economic cost savings figures associated with this. i can tell you my collaborator has looked at the economic impact of using nursing care coordination. that is what they are doing an entire place as well. it is how they do the nursing care and how you add the technology on top of it. they have shown a dramatic

potential associated with what they have been able to do, just to organize and coordinate it we have seen the standard level of care at tiger place with those -- between those who have sensors and those that do not. we see improved health outcomes and a longer stay in independent living. i am extrapolating. i do not have the numbers for you. isis backed they are significant. i -- i suspect they are significant. this one statement in here comes from maryland -- marilyn's work about 10 million people need long-term care in the united

states of the 4.6 million older than 65 and live in the community. these represent a potential 89 billion in class savings. senator mccaskill: we would love to get the numbers. tiger place is more expensive than some of the other facilities in the area in terms of care, but it is small and you are doing research. we have got to start monetizing the savings as quickly as possible. the more quickly we can monetize, the more quickly we can adopt them. that would have a huge impact on

their availability to most people. dr. skubic: it is not too much more expensive than other facilities. senator mccaskill: i am a big fan of what you're doing. i want to deliver this to as many people as possible. it helps us struggling with how we are going to make sure our grandchildren are not inheriting debt they cannot swallow. thank you. senator perdue: there is an old terrier motive. we want the best care we can for our parents. the second is, i am hearing an opportunity to deal with one of the largest cost items we have coming at us. like several of you, i have a personal experience with this.

contrary to political opponents, i have a mother. she is 89. she is tech savvy. this aging in place is a new phrase for me. she is living it out. my wife's mother is a bit younger. she has been diagnosed with alzheimer's disease. we have a different trajectory to deal with. dr. mccarthy, i am excited about what you are doing with those the a -- doing with the v.a. you have a perfect laboratory. you have patients who are sometimes in denial about need and you have a medical staff that might be less them receptive to some of these new technologies, or not. maybe it is a perfect lab to develop these.

give us a general sense of cost, acceptability with the patients and also with the medical staff. dr. mccarthy: we have an example of a device that would be placed in the veteran's home. this would monitor the blood pressure or the weight or the temperature or something of the veteran. we provide those devices. the cost about $350 and can be repurposed. the cost of using a device like that are about $1600 a year. when i talk about cost savings i did not translate the cost of -- into savings. patients last year had a 54%

decrease in bed days of care. they had a 32% decrease in the number of admissions. it is important to know the devices do not exist alone. they are part of a system. for us, we have home telehealth coordinators. for every 100 veterans enrolled, it needs to be the right population. forever -- for about every 100 we have one care coordinator. people have published about this data. we having prairies. -- we have inquiries from all over the world. some of the problems people in other countries have experienced is not having the care coordinator available or

electing the wrong group of patients. there are four disease conditions for which this is helpful. congestive heart failure means the heart is not functioning as strongly or effectively as it used to. congested because the fluids back up. you see things like weight gain. weight is an incredibly important sensor for someone with congestive heart failure is starting to deteriorate, because of their diet or some other condition. that is a very important piece of information, to notice the trend. another, lung disease, what people sometimes called emphysema. sensors are attached that can detect oxygen saturation.

the veteran and the caregiver do not have to get in the car and travel. the intervention can be made. i also wanted to mention ptsd would is a very important condition for us, where people can track their moves and symptoms. the fourth one is diabetes, where blood sugars can be monitored. the care coordinator serves a crucial role in trending the data and communicating with the patient and the health care team to make sure the interventions happen appropriately. senator perdue: thank you. senator blumenthal: thank you for holding this hearing. i want to focus on an aspect of security, which has not been

mentioned so far. the security of the data. the information that is collected. perhaps begin with you, ms. orlov. if you can tell us what steps have been taken and what more has to be done to make sure that the personal information confidential medical and other information can be kept secure. ms. orlov: we are in the midst of a data crisis. you know about the records that were stolen and the identity theft associated with that. it has created a heightened awareness of all of the players that are in the continuum of care for older adults and for everyone.

that includes insurance companies, for which the state -- but also includes health care providers and their management of electronic medical records. awareness has been dramatically heightened in the past four to six months. >> it should have been heightened years ago. anthem's data was not encrypted. is yours? ms. orlov: i do not have any data. senator blumenthal: should it be encrypt to through this kind of program? >> we recommend protection and privacy. our journey started around the early 2000 decade. the technology available to ensure answer your he has changed.

some of the rules and requirement reflect what was required then. there are newer means to conduct those kinds of visits and we are migrating our technology that way. senator blumenthal: as you know, we have an ongoing controversy about the 40 mile rule, whether it should apply to clinics, to the clinics that can provide the care that the veteran may need.

they are able to go to a private health provider. what i am wondering is, whether the telehealth program from hospitals, the 100 plus hospitals that there are would fill a gap that would enable more vets to go to clinics to get the care they need. how much of that have we explored and fulfilled? i hope my question is comprehensible. ms. orlov: thank you. -- miss mccarthy: thank you. a lot of folks are familiar with

skype or facebook -- not facebook -- facetime. that is the technology people are familiar with that represents what goes on with telehealth. those clinical visits can happen from one of our parent hospitals to the community-based outpatient clinics. they can help -- they can happen from one outpatient clinic to another. they also happen into the patient's home. we are looking at exploring ways for the provider to not have to take up the space of a medical center to provide this kind of care. we have about 12.7% of our patients engaged in clinical video telehealth.

there is a large opportunity for expansion. we are working down the barriers that we see in expanding this as an option. someone wrote in the mid-1990's that the biggest barriers to the extension of telehealth are not the technologies. they are the administrative burdens. what we often refer to is the fact that our nation has a health care system that is excellent, but it is a bricks and mortar based health care system. there is not a system of hospitals. it is our goal to get to the point where the care can be provided timely.

not clunky. it will be easy for the provider and the veteran to be able to have that care. senator blumenthal: you said 12 to 20%? dr. mccarthy: i said 12.7%. senator blumenthal: thank you for your excellent work. senator collins: senator cotton. senator cotton: dr. mccarthy, i would like to continue along the lines that the senator is discussing. in a state like arkansas, we

face a couple of challenges. in east arkansas, we have low population density. and what you have experienced at the v.a., how much of the challenges do you think are going to revolve around that kind of infrastructure limitation how much will revolve around the novelty of it or the resistance to change that we all have is a natural human instinct? dr. mccarthy: there is a requirement for buy-in on multiple part. we can tell stories of elderly patients that have coached our younger providers through their first telehealth visit in a way that has been positive for

everybody engaged. technology is an issue. we have three kinds of technology that we use. we use device connection, the interactive voice response is and the web browsers. the voice responses is how a lot of people used to do their banking, put in their number in the phone and what they want to do. you can do that by pushing buttons or by voice recognition. the device connections can be through the telephone system. it is some times called the "pots" or plain old telephone system. we have some devices rolling out that have built-in cellular antenna that allow for that kind

of connection. it has been my experience that grandchildren at a distance are becoming more familiar with facetime and skype. they are faced with the incredible -- they are not faced with the incredible inconvenience of moving around the medical centers and so forth. the whole process has been well received. they are very positive about it. senator cotton: have you worked on the challenges on one hand and consumer preferences and habits on the other?

>> one of the things we have not talked about is boosting conductivity for older adults. there have been pilot programs to provide discounts. at this point, there is not a standard program across the carriers in the united states that would make internet access affordable for many people of lower income. that is an opportunity that it seems we could do more with. the average plan is around $60 a month. an internet service plan at $60 month now means you are out $120 a month. that is beyond the means of many people of lower income. there is an opportunity to work with the carriers and come up

with a better idea. senator cotton another importance of broadband. the savings we can achieve through the government and medicare, or in our society as a whole are no doubt that sancho. building on some of the work you have done, i have no doubt they are strong incentives in the market given that senate -- seniors are a rapidly growing population. they are generally some of the most athletic editions in our country. there is a strong incentive, but there are strong legal barriers. >> looking at the physical environment, which is the home looking at building code and the

way new housing for older adults is being designed, there is no code that would make homes modestly accessible. nothing that requires smooth thresholds or wide doorways for bathrooms. nothing that requires singh kites to be accessed if you are in a wheelchair. if you want to think about something that can be done to enable people to age longer in their home, it would be to talk to organizations and look at what are the barriers. there are probably barriers at the state level. that will enable use of standards. even if you move into the home and you're able body, it's your home able to age with you? senator cotton: thank you again. senator collins: senator cotton

thank you. i am glad you brought up the issue of rural broadband. that is an issue in my state as well. it would not work in some parts in the state of maine. it is something we need to do more work on. i have a couple of other questions. i noticed you did do the cost comparison that all of us are interested in. you have talked about the cost of the set up. if my math is right, when you look over the two point five years, if you had nursing homes plus help, is over $300,000. i think this has important cost

implications for us. one of the issues i think congress needs to work with the administration on is what is involved for health care providers under the medicare-medicaid program. it will pay for the consequences of unchecked diabetes, but we will not pay for the ongoing prevention -- the ongoing prevention that prevents a person from having the complication. that is something we need to look at as well. in your testimony, you mentioned your mother-in-law did not want to wear the emergency alert pendant. how did you find out about the alternative ways of keeping her safe by use of sensors.

i do not think most people would even know where to begin. how did you get the advice you needed on what you should purchase for her and what was available? >> we tried to find a trusted advisor. we started groping in the dark and explored a couple of things that were not successful and visited with people who found solutions that did work and said let's find some money that knows technology. my advice would be to find a trusted advisor and they can

identify which technologies are appropriate. different technologies are appropriate in different circumstances. in our case, we reached out to our home security folks and they helped us zero in on things that spoke to the needs that my mother-in-law had. having the sensors be able to identify if she was up and about and did not reach point a or point b in a timely fashion, it would send cellular alerts to let us know hey, you need to check on her if something is amiss. that was helpful to be able to reach out and have that resource. senator collins: thank you. my final question is for dr. mccarthy. you mentioned you were doing

telemedicine from 900 sites. is that correct? dr. mccarthy: i believe that is the correct figure. senator collins: is this happening from the community-based clinics and your va hospital? it is not individual, outside providers that you are contracting with. dr. mccarthy eight could include that, but that is primarily v.a. driven. some of the sites where the care is provided with the other clinics or other parts across the country. as a network we are supporting one another. also, -- at home as much as possible, too. senator collins: the cost to savings you have quoted, you star multiplying that, you get into real numbers very quickly.

this has been an interesting hearing. i want to call on senator mccaskill for any final questions. senator mccaskill: i think we need to go back and look and see how we began distributing scooters with reckless abandon out one point in time in the medicare program. when i began talking about scooters, we found a couple of -- one woman worked in my office, her grandmother had three. the lift chairs and all of those things in many cases, they are needed, but how do we get approval for all of those to be paid for by the medicare program and what do we need to instead of paying for those, pay for sensors? they can monitor things that will allow us to intervene in a way that is cost effective and healthy and allow seniors to age in place. the more weekly the

entrepreneurial free market in this country comes with products that can be brought to scale they can present to the medicare system for possible reimbursement that would result in the savings. the more quickly we can turn this thing. i encourage you to reach out in the public-private partnerships that many of you are engaged in with your companies at the university of maine and with your partners at the university of missouri. the v.a. has a lot of martial partners. the more quickly we can give us technology to the point you do not have to have, most of us do not have a trusted tech advisor. therein lies the problem. most americans do not know where to find a trusted tech advisor. if you look online for a trusted tech advisor, you are likely to not get someone that is a

trusted tech advisor. the more quickly we can do that, the more quickly we can make progress. i appreciate this hearing. i learned a lot. i think all of us are motivated to the if we cannot push this envelope. i thank you for your work. thank you, chairman, for a really good hearing. senator collins: thank you. i think your comments are well taken. we want to make sure that as we start promoting this kind of new technology that can give peace of mind to caregivers that we are not opening a whole new avenue for con artists out there who will exploit any possible opening as we have found