Presidential Report on Independence Technology

In a 68-page report issued this week, the President’s Council of Advisors on Science and Technology (PCAST), made several recommendations to address America’s aging population with independence technology. They include:

• mHealth innovation,
• remote patient monitoring,
• telehealth expansion and reimbursement,
• broadband access for seniors,
• more sophisticated wheelchairs, and even
• home designs for sustained independence.

What follows is a highlighted extract from the report’s Executive Summary.

Executive Summary and Recommendations [for Independence Technology]

The U.S. population is getting older, and Americans are living longer, on average, than they ever have before. As they age, people are healthier and more active than the generations before them and have fewer functional limitations such as difficulty walking or blindness. Studies show that people are happier on average as they advance into their later decades and enjoy high levels of accumulated knowledge and experience.

Getting older is a time of social, emotional, mental, and physical change. Retirement might change how a person interacts socially every day, affecting a person’s mood and well-being. Cognitive aging—the normal process of cognitive change as a person gets older—can begin, or a permanent change in physical function may arise. Technology offers a path for people who are navigating these changes potentially to prevent or minimize the risks associated with them and to enhance people’s ability to live their lives fully. We, the President’s Council of Advisors on Science and Technology (PCAST), sought to identify technologies and policies that will maximize the independence, productivity, and engagement of Americans in their later years.

Study Scope

Advances in technology hold great promise for adding to the lives of older adults. Our study focused on four key changes older Americans often experience:

1. hearing loss;
2. loss of social engagement and connectivity;
3. cognitive change; and
4. physical change.

PCAST issued a letter report on technologies for hearing assistance in October 2015. The current report is the second and final report of the study and addresses the three remaining areas. In light of the many promising technologies that exist, this report is selective rather than comprehensive. It considers technologies important to the key areas, rather than specific diseases and situations, and it focuses on technologies that could have an effect broadly and in the near future.

• Chapter 1 introduces the three areas and cross-cutting themes.
• Chapter 2 describes technologies for social connectivity and emotional health.
• Chapter 3 covers technologies to address changes in mental ability.
• Chapter 4 describes technologies to address changes in physical ability.

Although this report is split into chapters, the concepts are inter-related. For example, lack of mobility can affect social engagement that can affect cognitive decline. This means that these areas cannot be addressed successfully independently; rather, a systematic approach is needed for to increase independence. This observation underlies our strong recommendation that the Federal Government create a standing cross-departmental, multi-agency council with responsibility and meaningful authority to address all these issues.

. . . 

Recommendations in Summary

Cross-Cutting Recommendations

Recommendation 1: Integrating Federal Action

Optimizing Federal support for independent aging requires coordinated action in health, housing, transportation, communications, energy, education, environment, and public safety.

1. The Office of Science and Technology Policy (OSTP) should create a one-year Task Force of the National Science and Technology Council that will identify technologies vital to an aging population, focused on enhancing work between agencies.
2. The Department of Health and Human Services (HHS) should support a standing private- public council, with private-sector leaders from industry, academia, and advocacy organizations to advise on sector-wide ways to advance technology in the service of improving quality of life for older people.

Recommendation 2: Engagement and Social Connectivity

Access to Internet communications is essential to health, social engagement, and well-being.

1. The HHS Administration for Community Living (ACL) and the National Telecommunications & Information Administration (NTIA) at the Department of Commerce (DOC) should create a national plan to ensure all older people have broadband Internet access.
2. The Federal Communications Commission (FCC) should ensure that older adults are included, as are school children, in all negotiated agreements for Federal telecommunications approvals.
3. FCC and NTIA should create a plan, including a matching program with private support, to support training centers in accessible distance for all older people.

Recommendation 3: Monitoring Technology for Frail and Vulnerable Elders

Monitoring holds great promise for predicting problems and enhancing safety of people at risk, and the Federal government could promote the needed frameworks and standards to encourage innovation and access to this service.

1. The National Institute of Standards and Technology (NIST), in collaboration with the private sector, should develop guidelines for marketing and instructional materials to ensure that consumers understand the operational requirements, benefits, and risks of various monitoring technologies.
2. NIST, in collaboration with the private sector, should develop guidance to identify privacy and security risks in a way that does not pose undue barriers to innovation and adoption.

Recommendation 4: Research is Needed to Spur Further Innovation

The National Institutes of Health (NIH), HHS Agency for Healthcare Research & Quality (AHRQ), the National Science Foundation (NSF), the Veterans Health Administration (VHA), the Department of Defense (DOD), and the Defense Advanced Research Projects Agency (DARPA) should support interdisciplinary and translational research including robotics, advanced mobility technologies, communications technology with special emphasis on emergency situations, cognitive training, and home monitoring.

Issue-Specific Recommendations

Recommendation 5: Education and Training in Online Technologies

The Administration should support ongoing reauthorization of the Older Americans Act and build on the provisions in Section 415 to ensure access to online services and protection from scams and fraud, tailored to the learning needs of older adults. Corporation for National & Community Services (CNCS) should expand Senior Corps to include older people with literacy and skills in technology use.

Recommendation 6: Emergency Response and Communications

Older people are especially vulnerable in disaster and emergency situations.

1. The Federal Emergency Management Agency (FEMA) at the Department of Homeland Security (DHS) should advance national strategies to create effective communications systems that reach isolated and vulnerable older people.
2. Within HHS, the Office of the Assistant Secretary for Preparedness and Response (ASPR), the Office of the National Coordinator for Health Information Technology (ONC), and the Centers for Medicare & Medicaid Services (CMS) should promote more rapid interoperability of medical information to ensure timely access whenever and wherever a patient may appear.
3. FEMA, ASPR, and CMS should advance policies that make medical device interfaces more consistent and interoperable to ensure timely access to people who depend on these devices.

Recommendation 7: Financial Services

The Federal Government should encourage the banking and financial services sector to offer monitoring services to protect assets from fraud and exploitation.

1. Signatories to the 2013 Interagency Guidance on Privacy Laws and Reporting Financial Abuse of Older Adults should accelerate expectations of banks to offer a range of available protective services.
2. The Executive Office of the President should convene State governors to ensure that reports of suspicious activity are reported to relevant adult protective services agencies.

Recommendation 8: Cognitive Training

The Federal Trade Commission (FTC) should continue to enforce regulatory review and guidelines for commercial cognitive training products.

Recommendation 9: Improve Regulation and Payment to Reflect Innovation in Telehealth

HHS should convene the Federation of State Medical Boards and the National Governors Association to accelerate reciprocal state licensure policies. CMS should use the full capacity of the Innovation Center to advance payment policies that support innovation in telehealth.

Recommendation 10: Home Design to Sustain Independence

HHS should work with the Department of Housing and Urban Development (HUD) to streamline and strengthen regulations and payment policies that govern home accessibility standards in order to promote uniform standards allowing efficient use and changes in technological support systems. This is especially important for retirement communities.

Recommendation 11: Improving Product Design for Older Adults’ Needs

The Consumer Product Safety Commission (CPSC) should work with AARP and other relevant groups to accelerate better design guidelines for senior-friendly packaging, especially of technology and essential products like food and medical supplies. [But it’s less about Independence Technology and more about the Universal Design concept.]

Recommendation 12: Future Role of Assistive and Robotic Technologies

Advances have been made in wheelchairs and other mobility-necessary technologies, but Medicare payment policies inhibit access and market innovation.

1. CMS should examine current payment policies and implement changes that allow people to buy higher-functioning products with some Government support.
2. A multiagency and industry task force led by VHA, DOD, DARPA, and HHS should recommend a ten-year roadmap for improving wheelchair functional capabilities.