Tag Archives: assistive living

Virtual reality cuts costs and increases satisfaction

Put on your 3-D glasses
The following appeared in HME News, the publication for the home medical industry, on July 26, 2011. This year and last, I asked the residents of Addison Court, the low-income apartment for disabled and elderly in State College where I live, to attend a demonstration at the Immersive Construction Lab, described here. One of the participants was Lilian Hutchison, who celebrated her 87th birthday in January. No one can say for sure whether Lilian would have fallen several times in her apartment if this kind of technology were in place. However, the hope is that the future will be kinder to those of us who can benefit from design which residents are able to modify in advance. 

The projectors behind the three, 8-foot screens show a virtual reality world that can improve the environment where home medical equipment HME is used. Professor John I. Messner’s Immersive Construction (ICon) Laboratory at Penn States Architectural Engineering Department is a dark, windowless room where the healthcare facilities being viewed seem so real there is a special world for it: immersion.

When Kaiser-Permanente began constructing a medical building in downtown Washington, D.C., pharmacists traveled 140 miles to State College to see how their workplace would appear. Among their suggestions: a partition so when two patients are served simultaneously, their privacy is insured.

There is substantial growth in constructing healthcare facilities from hospitals to housing for the elderly. Previously, a model of how a building would look required physical materials like wood and nails. By comparison, virtual reality offers interactive models early in the design process. The resulting efficiency and cost savings (making changes to a building before it is built) are creating a boom in the use of virtual reality in the architectural, engineering and construction (AEC) industry. Expectations exceed the ability of the AEC industry to have virtual reality applications ready as quickly as desired.

 

Gala with residents of Addison Court at the Immersive Construction Lab


Sonali Kumar, a graduate research assistant at Penn State, is developing a 3-D model for an independent living facility for elderly and disabled individuals based on the concept of experience-based design. Experience-based design often refers to a body of academic literature, primarily health-care related. Designers are urged to consider the perspective of the individuals who build, maintain, work and reside in the facility, including patients and residents. A common example is the decision of a Philadelphia hospital to build its bathrooms closer to patients beds.

My perspective on Sonali’s effort comes from my status as a disabled resident of a primarily elderly independent living facility. For example, I look at an early version of Sonali’s model showing a bathtub in the bathroom and say, No. There should be a roll-in shower here. I show an early prototype to Travis Barr, co-owner of T & B Medical here in State College. While fixing my scooter, Travis says, “There should not be cabinet doors in the kitchen. Doors are a nuisance for people with disabilities.”

Sonali’s model is based on a Blue Roof Technologies cottage in McKeesport, Pa. Pennsylvania has a larger number of elderly people in its population than any other state except Florida. The need for elderly housing is acute. In McKeesport, where the factory for steel pipes closed down leaving a near-ghost town and an elderly population of more than 20%, Robert Walters, a retired Penn State professor, created Blueroof. The cottages are constructed of pre-fabricated housing and have special sensors inserted in the walls to remind residents when to take their medicine (the walls talk) and to call 911 if a resident falls and does not get up in a timely fashion.

Sonali’s model of a Blue Roof cottage makes use of interaction, the most significant new development in virtual reality. Look at the screen shot Sonali took of the power chair inside the kitchen of her model cottage. For those readers who have not spent their productive hours playing video games, an avatar is a virtual reality representation of an actor functioning in a 3-D environment. The avatar in the Sonali’s kitchen is a power chair. The power chair makes coffee and toast, opening the refrigerator door to get eggs and milk, and scrambles eggs on a stove the avatar has just turned on. Interactivity is key to understanding how practical people in the construction industry have come to use 3-D technology for practical purposes.

Interactivity is arrived at slowly as Sonali experiments with a wide range of software. I suggested that Sonali replace the 3-D power chair with a scooter. In my experience, a scooter is more mobile and less likely to damage walls and take bathroom doors off their hinges. I ask a manufacturer to provide a 3-D scooter file, but for reasons I cannot explain (because I do not understand), the file does not yet open. Sonali explains, “We are in the process of integrating the computer model obtained from Amigo Mobility.” Keep your 3-D glasses on and await future developments.

Joel Solkoff writes about disability issues from a customer perspective. He is an adjunct research assistant at the Department of Architectural Engineering at The Pennsylvania State University.

 

 

Saving Medicare billions: Trying too hard can get in the way

Memorial Note: November 13, 2011, Jack Seidner aged 93, my neighbor and friend at Addison Court, State College. PA, died while talking to his son who had called from Israel. He died at Centre Crest, an assistive care facility in Bellefonte, PA, 11 miles from Addison Court.
Jack was a veteran of World War II and was a monthly calendar boy on the Jewish War Veterans calendar last year  He will be buried beside his wife in Harrisburg at a private funeral.

 

Jack was a wonderful man. He was basically an intellectual although he hid it as much as possible. When I wrote a story about home medical oxygen, oxygen which he received to stay alive, he refused to be photographed saying, “I have been studied enough.”
His sense of humor was ever-present, sometimes to the point of reciting bawdy limericks to the residents of Addison Court. I will miss him. He died at Centre Crest. The article below, originally published in HME News on September 27, 2011, is dedicated to his memory. In these days of turmoil at Penn State University, the need to care for the real needs of this community should be apparent.+++
Saving Medicare billions: 
Trying too hard can get in the way 
The money saved as a consequence of concentrating on what is right will astonish the body politic
“I have saved up enough pills to kill myself,” a neighbor told me, “if I ever have to go to Centre Crest.”

I live in an independent housing apartment building in downtown State College, Pa. The nearly 100 residents of Addison Court are disabled or elderly. Most of us are poor–the more affluent are on Social Security or Social Security Disability and Medicare.

At least once a week, the ambulance stops by my window and a resident goes off to the hospital. The lucky return. The not-so-lucky move on to Centre Crest, the default public nursing home about 11 miles away, where assisted living means expensive round-the-clock care, diaper changes, attachment to machines that keep the biological aspects of life going, medical personnel who make sure medications are taken correctly, and a world view that echoes Dante’s inscription over Hell: “Abandon hope, ye who enter here.”

Last year, Pennsylvania’s Department of Aging estimated it costs Medicare $40,000 extra each year for a resident to move from an independent living to an assistive living facility. The loss of dignity to the individual is incalculable.

The French philosopher Jean Paul Sartre observed that when one tries especially hard to listen, often the trying gets in the way of hearing. Medicare is trying too hard to do the wrong thing. Medicare‘s purpose is not to save money, but to provide health care in a way that concentrates on improving the quality of life. Recent evidence on the brain’s adaptive capacity provides hope that not only can individuals resume physical capacity from the devastation of a variety of afflictions that affect us at Addison Court, but also we can regain our talents to improve this society, not simply take from it.

“The Brain that Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science,” by Columbia University’s Norman Doidge, M.D., points to the brain’s ability to recover from strokes and other disorders with rehabilitation and concern.

“Traditional rehabilitation,” Doidge writes, “typically ended after a few weeks when a patient stopped improving, or ‘plateaued.’ And doctors lost the motivation to continue.  But…these learning plateaus were temporary…Though there was no apparent progress in the consolidation stage, biological changes were happening internally, as new skills became more automatic and refined.”

The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare‘s frequent citations of the Congressional Budget Office’s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out-of-state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.

Medicare is discouraging the necessary alliance between rehabilitation therapists and medical suppliers. This alliance will help restore the ability of my fellow residents to function and contribute to society.

“Individuals with disabilities remain one of our nation’s greatest untapped resources,” said Rep Jim Langevin, D-R.I., the only quadriplegic in Congress. To release the untapped resources of the elderly and disabled, Medicare must stop thinking about saving money and start thinking about improving health. The money saved as a consequence of concentrating on what is right will astonish the body politic. Providers of durable medical equipment require the support of consumers like me. Providers and rehabilitation therapists have been slow to recognize that in unity there is strength. Together they must spread the word that when an individual becomes old or disabled, science is rapidly increasing the ability to regain talent and good health.
Joel Solkoff is the author of “Learning to Live Again, My Triumph over Cancer” and is adjunct research assistant at Penn State’s Department of Architectural Engineering.

“Individuals with Disabilities Remain One of Our Nation’s Greatest Untapped Resources”

“Individuals with Disabilities Remain One of Our Nation’s Greatest Untapped Resources”

A shot from the revolver of the Rhode Island policeman went off by mistake. The bullet hit Jim Langevin, a 16-year-old boy, who was a police cadet in a Boy Scout Explorer Program. It hit Langevin’s spine and kept going. The damage made him a quadriplegic (paralysis of both arms and both legs).

Rep. Langevin is the first quadriplegic to serve in the U.S. House of Representatives. To enter the House chamber 10 years ago, when he was first elected, the maintenance crew made the chamber wheelchair accessible and removed two fixed seats in the front row so Langevin could maneuver his power chair and effectively address his fellow colleagues. Langevin has made his reputation in Congress as an expert in terrorism, computer security, and biological warfare.

This column comes to you at an awkward time. This column will appear in early December, before the seasonal gloom causes you to cheer up others with presents. This December/January issue of Voices stays on the stands until Jan. 31, by which time you will have already broken the New Year’s resolutions you have not made yet.

More to the point, for those of us who care more about politics than football, December marks the end of the lame duck Congress, controlled in the House by the Democrats and is succeeded in January by a new 112th Congress with a large majority of Republicans (63) new members) and not enough Democrats in the Senate to break a filibuster, but enough to sustain a presidential veto.

In short, the next two years promises to be a period when NOTHING will get done. Since Congress controls spending, it is possible that legislation that was dear to the president’s heart will find itself without the money to implement. For those of you so inclined, Gloom is a gift that will not go out of style, especially between now, February first, and beyond.

This column focuses on the problems and opportunities of the elderly and disabled here in Centre County. I chose to interview and profile Langevin because of a letter he signed at the end of the summer, just as the vacuous senate race in Pennsylvania was beginning to heat up. The other signer was Glenn Thompson who represents us here in State College. Langevin is a liberal Democratic; Thompson a conservative Republican. Langevin voted for Obama’s health care reform bill; Thompson voted against it. Why are these two unlikely representatives working for the same cause?

The cause is the fight to keep local medical suppliers in business. This is a cause that affects me personally because without a battery-operated wheelchair I would not be able to go from my bed to the bathroom, or to the kitchen to make dinner, or outside to work and make a life for myself. Previous attempts to reduce costs by giving large corporations, some outside the Commonwealth, contracts to provide wheel chairs, scooters, power chairs and oxygen, have resulted in companies with unsavory reputations receiving the lowest bid and raising the likelihood that poor and middle class individuals who are unable to walk face long waits for equipment delivery, maintenance and repairs. The consequence of these waits are likely to be accidents of the kind that would force independent people with disabilities to move to assistive living resulting in cost increases many times greater than Obama’s penny pitching savings on medical equipment.

Langevin and Thompson agree to end competitive bidding and (the subject of the end-of-summer letter) to halt Medicare’s requirement that customers be given the option of renting their chairs for a 13 months, rather than buying them—through Medicare–in the first month. Power chairs are custom designed to the needs of individual patients, and forcing medical suppliers to pay for them in advance will badly damage a business that is already strapped for cash.

Langevin’s exclusive written interview of over 1,700 words is available on my blog at voicesweb.org. Thompson and Sen. Robert Casey, Jr. have expressed the desire to give you their points of view. Stay tuned.

The big issue, of course, is money. Does our country have enough money to invest in the talent of those of us who are disabled and elderly? Langevin maintains, “Individuals with disabilities remain one of our nation’s greatest untapped resources, and they continue to face challenges in accessing employment, transportation, housing and even health care.”

–Joel Solkoff, author of The Politics of Food. Contact him at [email protected] or at voicesweb.org.

USED TO BE ONLY THE GOP TRIED TO DESTROY MEDICARE

[MY FEBRUARY 2010 COLUMN FROM VOICES OF CENTRAL PENNSYLVANIA]
From Where I Sit

“…Dr. [Margaret] Pfanstiehl…said her goal was to engage the sight-deprived to‘live a 20/20 existence without 20/20 vision.’”

                            –from The Washington Post.

Dr. Pfanstiehl, mourned last month in a Maryland ceremony, was blind and promoted audio description technology to the point where a blind patron can hear audio description of dance.

From where I sit on my $5,000 power chair, two issues come to mind immediately. First, President Obama, the man I supported to be president, plans to reduce the Medicare budget by nearly half a trillion dollars. These cuts, intended to help pay for health care reform, have come on top of procedures that hurt me and others who are elderly or disabled. The argument is that current and future cuts will reduce “fraud
and abuse.” Attorney General Eric H. Holder, Jr.’s fraud and abuse prosecutions are notable for their relative insignificance.

The second issue that comes to mind is when elderly and disabled voters are organized,
they constitute an effective voting bloc. As I write this column in Addison Court in State College, I note that Addison Court has about 90 residents who are 55 or older or who have disabilities or impairments.

Most of us are registered and vote even in low-turnout elections. Addison Court now has a tradition of iinviting candidates to inform our residents about the issues. To date, residents (eating
Elaine Mede-Wilgusr donated food from Webster’s Café) have heard R e p r e s e n t a t i v e
Glenn (GW) Thompson, his challenger Mark C. McCracken (currently a Clearfield County commissioner),
Assemblyman Scott Conklin, State College Mayor Elizabeth Goreham, and four State
College Borough Council candidates representing both major parties.

When George Bush was president, he attacked Medicare, creating barriers that
made it more difficult for eligible citizens to obtain medical oxygen for homecare,
wheelchairs, power chairs and scooters.

To take me as an example, in March 2008 a power chair was prescribed for me after (in-patient
hospitalization at Health South). I received a thorough evaluation from physical and
occupational therapy. My physician, Dr Colin McCaul, a specialist in rehabilitation,
prescribed the chair because he said it would be useful for me to have more support
for my right arm, helping to avoid surgery.

It would also be useful teaching my left arm how to perform functions previously
done by my right. The chair’s controls are on my left causing much trouble
before I finally learned how to drive lefthanded.

Medicare required that I go through an hour-and-a-half test with a rehabilitation
specialist. After passing the test, I saw Dr. McCaul in the hallway. The rehabilitation specialist
emphasized the importance of the doctor scheduling a one-on-one appointment devoted strictly to why I need a power chair and to be followed by a paper prescription with the magic words on top “after a one-on-one appointment.”
Since I had seen Dr. McCaul immediately before the test, he said it wasn’t necessary
to meet again. He would take care of it.  Medicare, which has been consistently negligent in explaining the rules to physicians rejected the prescription and would not pay. The prescription was not written in keeping with Medicare regulations. [How I obtained payment from an agency other than Medicare
 is a story for another time.]

When Obama became president I thought he would reverse those policies. He has
made things worse. Especially distressing is that while Obama has been busy with health
care reform in which Medicare was a significant factor, he had not named a director of
Medicare, the largest health insurance company in the United States. Assistive technology
(which gets me from bed to the bathroom reliably) generally helps the disabled
avoid assistive living (which costs Medicare more than $40,000 extra per person
per year than independent living. Also, independent living
allows a greater sense of independence and helping to improve morale.

I said in my last column that I would discuss John Wayne’s comment that after
cancer surgery he did not feel sorry forhimself, despite the temptation. Wayne
proved it by getting back to work, filming a movie only two weeks after surgery.
For those of us who are disabled, not feeling sorry means having the equipment to
get a job, equipment suc as that listed above.

Assistive technology for the blind especially have resulted in
very exciting developments Disgracefully, technology that is very
useful to help individuals who are blind gain indepence
is not paid by Medicare. We also need technology for those who cannot
hear—only some of which is paid for, including controversial cochlear implants.

The most effective message to the Democratic Party is the creation of a bloc
within the party that will vote strictly on disability and aged concerns—a bloc which
will flirt with the Republicans if it does any good. [It should go without saying that this
bloc would include disabled veterans, but all too often veterans are neglected even
when intentions are best.]

—Joel Solkoff, author of “The Politics of
Food.” Contact him at [email protected]