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Aging Digitally

Oregon Business Magazine
September 2005
By Mitchell Hartman

Roger Kolaks, a tall frail man in a comfy-looking wool cap, smiles affably and raises his voice to be heard above the "stomp, stomp, clap" of an enthusiastic crowd at PGE Park in Portland.

"I played baseball for the Air Force," he says proudly. "Pitcher and infield. I was in the Air Force. Now I'm retired. That was a long time ago."

Kolaks' caregivers from Oatfield Estates in Milwaukie one of the premier long-term care facilities in Oregon, have brought him and eight other residents to the stadium. With the score tied in the top of the ninth, Beth Pearce, a director at Oatfield who regularly logs 12-hour days working with her charges, whispers, "I hope it doesn't go into extra innings!" There's nothing easy about shepherding a group of elderly people — with their wheelchairs and walkers — to a Beavers game on a sweltering mid-summer day.

How old is Kolaks? "Eighty-six," he says. "Eighty-nine," says the health aide standing beside him. "Shame on you," Kolaks shoots back with a sly wink. But when asked: "How long ago did you play baseball?" Kolaks looks confused. Ask some of the other residents how long they've lived at Oatfield, and they don't have a clue.   

When an elderly person lies about their age, it can seem quaint. When they don't know how long they've been in long-term care, it can be upsetting. When they call a son or daughter 12 times a day because they don't remember the conversation they just had, it's anxiety-provoking. When they stop answering the door because they no longer recognize familiar faces, it can result in clinical depression and rapid physical and mental decline. And when they don't remember that they already took their morning dose of Coumadin and swallow another one, it can lead to stroke, incapacitation or even death.

In a lab in Hillsboro, Oregon Eric Dishman is working on cutting-edge research that could make life easier and safer for the ever-growing population of frail elderly. The group of scientists he supervises at Intel includes gerontologists, anthropologists and software engineers. Their goal is to develop medical monitors and software programs to help elders "age in place," to keep them well-fed, well-rested, physically active, emotionally engaged and properly medicated, even as their faculties diminish. The new technology tries to prevent, as much as possible, the repeated end-of-life moves — home to retirement community to assisted living facility to nursing home to hospital — that often contribute to disorientation, depression and premature death.

As Intel's research moves forward — in close collaboration with local institutions such as Oregon Health & Science University, Pacific Retirement Services (operator of Rogue Valley Manor in Medford and Holiday Park Plaza in Portland) and Oatfield Estates — the company is helping to create a hub of local expertise, innovation and, eventually, profitable medical device companies.

"Oregon invented the notion of a continuing care retirement center and also of hospice," Dishman says. "Partly it's a function of Oregon 's liberal use of Medicare money to experiment. While that's gotten worse with the state's recent budget cuts, Oregoncan be a leader in the nation and the world, setting the pace for treating the problems of aging."

There have been some hopeful signs recently. U.S. Sen. Gordon Smith now chairs the Senate Special Committee on Aging. Portland is home to cutting-edge initiatives such as CareWheels, which trains disabled working-age people to monitor and support the frail elderly in their homes. And later this year, Intel, OHSU and Oatfield Estates will be among approximately 25 exhibitors demonstrating their innovative technologies at a once-per-decade White House Conference on Aging.

DISHMAN'S TEAM HAS ALREADY PRODUCED and tested several promising systems that are awaiting large-scale clinical trials and commercial development. The systems use wireless micro-sensors and Internet connectivity to assist elderly people with routine tasks, and to help family members and caregivers monitor their condition — from across the room or across the country.

The sensors can provide continuous detailed information on such diverse data points as: a person's weight, activity level, heart rate, food and liquid intake; how well they're sleeping; where they are at any given moment; who they've spoken with or seen recently and what they talked about; and, perhaps most important, whether they're taking their medication at the proper dosage and on time.

Carol Baird, medical director of the Providence Center on Aging in Portland, says that in the future, to keep people healthier and save money, more of the aging population will be cared for in the home or in a home-like assisted living facility. "We want to modify the environment to make them successful," she says. "And that's where high tech comes in."

Take the example of falls in the home, a primary reason older people are forced to give up independent living. Baird says many patients don't report minor falls because they're afraid of being institutionalized. But, she asks, "What if there was a way to know whether they're falling?" Sensors attached to clothing, kitchen utensils, furniture, floors or walls could gather data on a patient's movements over an extended period and display the information graphically. "Once we know the patient's prone to falling," Baird says, "we get rid of stuff that trips them, install railings, put in automatic lights so they don't have to fumble for a switch." Dishman's group at Intel is pushing the envelope even further. Among the devices being tested in hundreds of households in Oregon, Nevada and other research locations are:

  • A "social solar system" that displays visually on a computer screen next to the telephone, showing the faces of people who regularly phone, visit or e-mail, and the content of recent conversations, helping the elderly person stay socially connected.
  • A notification system with an indicator light that alerts an elder that one of her caregivers, such as a son or daughter, is at home. This can ease anxiety and cut down on repeated calls by a forgetful or disoriented person.
  • Radio-frequency sensors attached to prescription medicine bottles thatmonitor when medications have been taken and in what quantity.

ONE PLACE WHERE NEW TECHNOLOGY for aging in place gets field-tested is Oatfield Estates in Milwaukie. The private facility consists of six two-story Craftsman-style group homes perched on about six acres of organic gardens with stunning views of Mt.Hood. Each house has a spacious living room, kitchen and dining room; residents live in efficiency apartments with a bed and bathroom. Pets are welcome, visitors knock on the front door to enter (just like in a private home), and there are no locked wards to keep the residents from wandering off on their own.

Oatfield was conceived by Lydia Lundberg, a native of Germany, and her husband,
Portland real estate developer Bill Reed, as an alternative to traditional assisted living. Under the brand name Elite Care, Reed and Lundberg are developing two new facilities in Tigard. They plan to expand across the
United States and in Europe in coming years.

Lundberg describes the philosophy as high-touch and high-tech. Caregivers are encouraged to hold hands, pat reassuringly — whatever it takes to create emotional connection. There are weekly house meetings where residents suggest menu items, plan field trips and complain about what's shown on movie night ("All that cussing!"). At many conventional facilities, residents are limited to sitting in front of a television or being walked around the grounds. At Oatfield, even people with severe Alzheimer's disease garden and prepare flower arrangements for the county fair. "Most places train people in disability, to be in a wheelchair," says Reed. "We train them in independence, to walk" — alone if they can, with help if they need it.

Oatfield is also hands-down the most wired elder care facility in Oregon (Intel tests its prototypes at Oatfield, among other places). Bed and chair monitors track residents' sleep habits, weight and daily movement. Radio-frequency tags (RFIDs) attached to their clothing track their location 24/7; those prone to wandering are gently urged away from the property's front driveway by a motion-activated sprinkler system, rather than a fence or alarm. Family members anywhere in the world can log onto a "family portal" website and check on their loved one's health and daily movements.

Staff members' movements are similarly tracked, and Reed freely admits that managers use the system to crack down on inefficient work habits and loafing. But he says the benefit of monitoring elders' health outweighs any privacy concerns. And he stresses that patients have the final say. One resident recently decided to deny some of his relatives access to the family portal after they harassed him about eating better and getting more exercise.

"We're not here to fix them," says Reed. "We're here to give them an opportunity to live safely and be the boss."

CAN THIS TYPE OF HIGH-TECH CARE be replicated? Let's hope so. By 2040, 22% of Oregonians will be over 65, compared to just 13% today. In some counties — Curry, Wheeler, Tillamook, Sherman and Josephine — the senior population already exceeds 20%, and the number of elderly people continues to climb in Southern, coastal and Central Oregon, which routinely rank among the best places in America to retire.

Places such as Oatfield Estates can be part of the solution, though at a cost of $4,300 per month, it's out of the question for many lower-income elderly. Oatfield doesn't accept Medicaid because, Lundberg says, reimbursement rates are too low.

Still, telehealth technologies will likely be key to keeping down overall medical costs for the aging. "In every nation of the world we'll have double, triple, quadruple the number of seniors," says Dishman. "The number of nurses and doctors is declining every year, and throwing more of them at the problem isn't going to get us out of this demographic catastrophe."

Intel conducts its research on aging all over the world, and Dishman says the United States is starting to fall behind Europe and Asia in product development because of inadequate federal research funding and runaway legal liability for medical device-makers. Byzantine reimbursement rules for Medicare, Medicaid and private insurance, meanwhile, keep potentially money-saving inventions from ever seeing the light of day. Devices that prevent the elderly from falling or identify blood-sugar imbalances in diabetics, for instance, are unlikely to be widely adopted if they aren't covered.

"We could reduce cost, capture disease early and improve quality of care," Dishman says. "Policy barriers are keeping America behind in the age-wave marketplace."

Copyright 2005 Oregon Business magazine

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