The human touch keeps the elderly and disabled technology-connected

Ever-evolving technology brings regular, robust, and reliable communication with the outside world to individuals with physical limitations.

By Brian Dipert, Technical Editor -- EDN, December 17, 2004

AT A GLANCE Broadband-Internet access with communications hardware and software enables housebound individuals to keep in touch. Computers are increasingly user-friendly but may be overkill featurewise. IP (Internet Protocol) telephony is fiscally attractive but cannot yet meet most users' reliability and emergency-response needs. Videoconferencing has especially demanding upstream-bandwidth requirements. Internet videocameras and tracking devices enable you to monitor an individual's location and condition at any time from anywhere. Sidebars: A personal perspective Wardriving for dial tone Consider the caregiver

The most recent every-10-year US census, in 2000, produced some interesting geriatric results with significant short- and long-term implications for the electronics industry. The number of Americans aged 65 and older climbed to more than 34.6 million in 1999, compared with 3.1 million in 1900 (Reference 1). Over the same time, the ratio of 65-and-older Americans to the total population increased from 1 in 25 to 1 in eight. Plummeting birth-rates, coupled with dramatic improvements in health care (and, consequently, life expectancy) are the primary factors driving the trend.The aging population isn't a phenomenon only in the United States. Census Bureau estimates suggest that the world's 65 and older population is growing at a rate of 800,000 individuals per month, that the United States ranks only 32nd on a list of countries with high proportions of 65 and older individuals, and that more than three-quarters of the world's elderly population gain from 1999 to 2000 occurred in developing countries (Reference 2). And the trend shows no sign of reversing course or even of slowing down; between 1990 and 2020, the population of individuals aged 65 to 74 is forecasted to grow 74%.People may be, on average, living longer, but their physical capabilities will inevitably decline and render them increasingly housebound. Moreover, limited mobility isn't restricted to the elderly; comparatively young persons with debilitating diseases also experience this same restriction (see sidebar "A personal perspective"). Virtual interaction with the outside world, in lieu of face-to-face contact, is necessary for maintaining these otherwise-isolated individuals' morale.

If you're nearing, at, or beyond retirement age, the topic of this article will be of direct relevance to you. Or, perhaps you have a friend or family member who is or will soon be housebound and for whom you select and maintain communications technology. The mobility of the modern US family inevitably scatters many of you around the country and across the globe to the extent that regular face-to-face interaction with home-confined people isn't feasible (see sidebar "Consider the caregiver"). Electronics technology can provide rich communication facilities, but it must be intuitive to use and require little to no maintenance.

In other words, the reason for using it must outweigh the barriers. Still, areas such as telemedicine, for instance, have in the past few years made big strides, sometimes eliminating expensive and difficult trips to a physician's office. For instance, North Shore Elder Services (Danvers, MA), nearby Beverly Hospital Health Disease Management Services (Beverly, MA), and ATI (American TeleCare Inc) (Eden Prairie, MN), have jointly created systems that allow physicians to remotely monitor the weight, blood pressure, and heart rate of housebound patients.

Last summer, telemedicine allowed a wounded Marine at the National Naval Medical Center (Bethesda, MD) to watch his child's birth 400 miles away. Companies are also deploying telemedicine in rural areas, where the long distances patients must travel to see a doctor or visit a hospital guarantees that they'll receive substandard care.

Sometimes, such systems require little more than a phone line and modem. But as such applications evolve and become more demanding, a sophisticated home-IT infrastructure will become necessary. How and when an aging population will embrace such an infrastructure is unknown. For instance, with homebound individuals' finances often limited and prioritized toward health-care expenses, cost is always a critical concern.

The network is the crux

Given the cost considerations, the advocacy of a broadband Internet connection may at first glance seem counter-intuitive. Happily, though, today's approximately 20% broadband penetration in US homes—or, looking at the situation in another way, today's greater-than-50% broadband penetration among US Internet users—has occurred in lock step with decreasing broadband rates (references 3and 4). It's common, for example, to find cable and DSL prices lower than $20 per month in major metropolitan areas. Downstream-bandwidth capability, servicing download-centric applications such as e-mail, file transfer, and multimedia streaming, usually receives primary consideration in a broadband-purchase decision. In this case, however, you should focus equal or greater attention on the upstream bandwidth the service delivers, because many of the applications this article covers are symmetric—that is, bidirectional—in their data-transfer nature.

Keep in mind that older homes' telephone wiring may prove to be an unfriendly environment for DSL. In most communities, it's also impossible to activate DSL unless you also have traditional POTS (plain-old-telephone service) enabled at home; this "bundling" requirement runs counter to a VoIP (voice-over-Internet Protocol) telephony approach. Cable-Internet service sometimes has similar bundling requirements with cable television, but, because many home-confined individuals already watch a lot of TV, this broadband option may be your best bet.

Once you have a high-speed Internet connection flowing into the home, how do you distribute it to various network peripherals and connect them to each other? Power-line networking has, to date, a spotty reliability track record and, like DSL, is prone to problems with older homes' ac-wiring setups (Reference 5). Wireless networks provide ease of installation and cosmetic benefits, but their reliability is equally nebulous, especially when a home contains attenuating and blocking materials or interfering broadcast sources, such as cordless phones, microwave ovens, neighbors' wireless-access points, and the like. Unsightly but dependable Category 5 cable is probably your best bet—that is, if you can convince your elderly or disabled ally to let you route it around the house.

Remember to consider long-term maintenance when selecting and setting up the network, especially if you live far away from the housebound individual and frequent on-site visits are therefore infeasible. The router-setup screens should be robustly password-protected but ultimately accessible, often through HTTP (Hypertext Transfer Protocol) or Telnet, from the WAN connection. Set up the necessary firewall "holes" that'll also let you monitor and reconfigure LAN clients from the WAN. And don't underestimate the value of a UPS (uninterruptible power supply), especially in areas of the country that frequently experience brownouts and blackouts, such as Florida with its daily, fierce, afternoon thunderstorms in the summertime (Figure 1).

PCs are getting easier to use with each incremental generation of applications and operating systems, exemplified by Microsoft Windows XP and Apple OS X, versus their predecessors. No-cost Linux is also a possibility if you do the initial setup, if the user's need to subsequently tweak his or her software environment is minimal, and if you're available to do the tweaking. And, although AMD and Intel might not like to hear this, unless your housebound comrade is into high-definition video editing or playing the latest generation of shoot-'em-up games at high resolutions and frame rates, almost any computer now available will fit the bill in speed and features. Voice recognition is one application that does have stringent CPU-performance expectations, as well as requiring abundant RAM and available hard-disk-drive capacity. ScanSoft, which also resells IBM's ViaVoice software, offers Dragon NaturallySpeaking, a common selection for Windows systems. The latest generation of Microsoft Office suites also includes voice-recognition capabilities, and MacSpeech's iListen is an oft-suggested product for Macintosh systems.

Voice recognition might seem at first glance to be an ideal navigation and data-entry method for individuals who, due to physical limitations, find it difficult to use a mouse and a keyboard. But think twice before you suggest it, unless it's the only feasible computer-interaction method. Voice-recognition technology is still too inaccurate for many users, even after abundant training. Older persons may lack the patience to endure those lengthy setup sessions, anyway. And day-to-day variability in voice strength and other qualities, along with inevitable overall voice weakening with advancing debilitation, further decrease accuracy. If you try out voice recognition, invest in a robust microphone to give the program the best possible chance of doing a good job. A headset with a microphone in close proximity to the mouth is a much better option than a cheap boom or monitor-housed microphone. Better yet, from companies such as Andrea Electronics, is an array microphone that can automatically detect and subtract background ambient noise and doesn't require the user to struggle with a headset (Figure 2). If the PC lacks a two-channel microphone input, as most do, you need to supplement the array microphone with a USB adapter, such as Andrea's USBD-2A.

The ability to monitor, control, and configure the housebound individual's LAN setup should extend to any computers on that network. Windows XP Professional supports the no-additional-cost Remote Desktop server; free client programs let you control the PC from a computer running any Microsoft OS version from Windows 95 onward, along with any Apple OS X-based computer. Otherwise, freeware VNC (virtual-network-computer) software is probably your best bet. RealVNC, a descendant of AT&T Labs' original VNC work, is the most operating-system-generic approach, albeit the slowest, because, in effect, it transfers information from the server to the client a screen's worth of pixels at a time. Proprietary variants of VNC, such as TIghtVNC and UltraVNC, rely on graphics subsystem-specific hooks to boost performance but, as a result, don't work with all hardware and software configurations.

Before you invest or encourage your housebound friend to invest in a full-blown computer, however, consider what things that individual needs to do with the system. E-mail and Web browsing are probably necessities, of course, but if the list doesn't extend much beyond those basics, a potentially problem-plagued PC is probably overkill. Instead, consider a configuration with fewer and more dedicated functions, such as Microsoft's MSN TV (formerly, WebTV) set-top-box system (Figure 3). Don't assume that the housebound individual will be a PC power user; a simpler setup may in the long run be the better approach.

Telephony

Sometimes, the simplest communications enhancements, intuitively obvious to the tech-savvy but not necessarily to the person for whom you're advocating, are the best. A cordless telephone, replacing a traditional wired unit, can provide reassurance to someone who prefers to keep his communications device within arm's length in case of an emergency. Spend $20 on a Plantronics headset for that phone, and someone who previously had to cut conversations short because of fatigue from holding the phone handset can now talk for a much longer time. And preprogram the phone with commonly used numbers, and someone whose eye-to-hand coordination has deteriorated faces less frustrating dialing.

For housebound individuals on a tight budget, IP telephony promises significant fiscal relief, particularly now that the Federal Communications Commission has ruled that states cannot tax or otherwise regulate it. Proceed with caution and first visit www.testyourvoip.com to determine whether it's even an option. Computer-based services, such as Skype, are the least costly, and hands-on testing under Windows delivered impressive voice quality and minimal latency. (Macintosh and Pocket PC variants of Skype were still in beta at press time.) However, Skype interfered with some other sound-centric programs on the PC, such as High Criteria's Total Recorder—even if Total Recorder were installed but disabled. Skype users can call other Skype-equipped PCs for free and, using SkypeOut, can also call other phone users. But conventional-phone users cannot reverse this process and call Skype accounts. Skype also employs proprietary protocols and audio codecs that hinder its interoperability with other PC-based Internet-telephony products, although the company recently announced that it was releasing its software's API for free nonprofit and paid commercial use.

Fully functioning SIP (Session Initiation Protocol)-based VoIP services also deliver impressive audio quality with little to no delay, and, unlike Skype, they fully interoperate with conventional telephones. Deltathree and BroadVoice, for example, generally produced positive results, when testing them from and to numerous geographic locations, at various times of day and week, with various broadband-Internet-connection methods and providers. They even worked well when other LAN and WAN activities, such as file transfers between PCs, downloads from HTTP and FTP servers, e-mail and Web browsing, occurred in parallel. BroadVoice's service is especially economical, at $19.95 per month for unlimited calls within the United States and to 20 foreign countries. Occasionally, however, initiating a phone call would produce only silence—no ring tones—until the person or answering machine on the other end of the connection picked up the call. Audio during the first few seconds of almost all BroadVoice-hosted calls made during the testing period was also distorted.

These inevitable startup glitches are common for any technology that's still in beta and are likely to be fixed over time (see sidebar "Wardriving for dial tone"). Even if you overlook these minor problems, though, other more-difficult-to-resolve issues burden VoIP use for elderly or invalid individuals. Whenever something severs the LAN connection between the router and the phone or the WAN connection between the router and the Internet, the phone stops functioning. Equally ominous is the absence of robust 911 emergency service with VoIP, due to a lack of precise geographical correlation to any IP address. The dynamic IP-address allocation common with most cable- and DSL-Internet accounts further complicates this void.

A cumbersome Band-Aid near-term approach involves the VoIP customer's service system keeping track of the IP-address assigned to an account and transferring the account owner's address on file to relevant emergency-services personnel when a 911 call comes in. Many routers can also automatically send updated IP-address info when dynamic allocation results in a change, a feature that's also useful for domain-name services, such as DynDNS. ZyXel offers an alternative approach with its P-2002L VoIP adapter (Figure 4). If the VoIP connection goes down for any reason or if you want to route your 911 or other service call directly to support personnel without a VoIP middleman, you can set up the P-2002L to forward your outgoing calls to a redundant PSTN (public-switched-telephone-network) line, which, in a basic configuration without long-distance service or boutique features, is inexpensive.

Several other VoIP limitations may preclude the technology's use in your situation. VoIP lacks support for TTY (text telephony), also known as TDD (telecommunication device for the deaf). The White Pages and other print and online directories do not include VoIP accounts' phone numbers, and VoIP doesn't work with dial-up home-security or satellite-TV systems.

Videoconferencing

"A picture is worth a thousand words," and for a housebound person, a video image on a computer screen is the next best thing to seeing others' real-life faces. A modern, advanced Internet videocamera, such as Creative Labs' WebCam NX Ultra provides an ideal platform for testing the videoconferencing concept (Picture). It includes an interpolating digital-zoom function that also supports automatic face tracking, thereby not requiring the user to remain frozen in place during operation. It includes a headset for audio, though it's cumbersome to attach to a user's ear; an array microphone in combination with PC speakers may be a better alternative. It also automatically senses and adjusts its frame rate and size according to the system-side USB connection: 12 Mbps for Version 1.1 or 480 Mbps for Version 2.

The high video bandwidth exiting the camera may be great for use within a LAN, but, for folks interacting across the Internet, their respective upstream network-connection speeds are the bottlenecks. ADSL services typically cap upstream bandwidth at 128 kbps. Consider that the data flowing from the user's PC contains both audio and video information, along with error detection and correction, framing, and other protocol-overhead bits, and you'll soon realize that, even with a broadband-Internet link, you'll be restricted either to postage-stamp-sized video or slow frame rates. Cable-Internet uploading speeds depend on the number of users connected to each node-aggregation point and typically range from 128 to 512 kbps; at the upper end of that range, a passable large-frame videoconferencing experience becomes possible, but only if both participants are on cable connections.

The Windows Messenger program that comes with Windows XP produces good videoconferencing results, but its multistep authorization process is confusing; you need to first establish a bidirectional audio or chat connection, and then each user needs to enable video. Windows Messenger also doesn't videoconference with MSN Messenger clients on other Windows OS platforms; Windows XP users need to install MSN Messenger on their systems, too. The Macintosh equivalent to Messenger, not tested for this article, is iChat AV. D-Link and other suppliers offer dedicated videophone systems for implementing videoconferencing when using a PC isn't an option.

Monitoring

Ailing individuals are notorious for not revealing the full story of their situations in telephone conversations, especially the ones they initiate. And, after all, how much information can you discern from a low-resolution Web-camera view of someone's face? If you'd like to discreetly keep more regular and spontaneous tabs on your housebound friend or family member, consider installing an IP-based videocamera that you can monitor from your Web browser. D-Link, for example, offers an extensive family of units, in both wired and wireless 802.11b and 802.11g variants. Latest generation models, such as the DCS-5300 family, even support remote control of pan, tilt, and zoom functions (Figure 5)! The housebound individual might reject the IP videocamera installation offer if its only intended use is for you to "spy" on him; the added security that this surveillance capability provides may be a more compelling sales strategy.

Because you probably won't be able to install enough cameras to cover the entire house, how else can you determine where your friend or family member is at any point in time? The GPS capabilities in many cell phones, along with proximity to a given cell tower (so-called Enhanced 911), can help you and public-service personnel locate the individual on the rare occasions when he leaves the home. But this strategy works only if the phone is on and with the person. Companies such as Wherify, with its GPS Locators, strip out the cell phone's voice-communications capabilities to reduce cost but still employ the 1900-MHz CDMA (code-division, multiple-access) cellular network to track owners' location and pass along pushbutton emergency-response requests to company operators.

RFID and Bluetooth offer ranges too short to be of practical use (Reference 6). Apple co-founder Steve Wozniak's latest venture, Wheels of Zeus, takes a different tack: Instead of relying on expensive and power-hungry communications-centric cellular networks to track individuals' whereabouts, the company plans to roll out a proprietary wOzNet low-speed, low-power wireless network, with each hot spot able to cover approximately 3 km. Although Wozniak's GPS-enabled vision may be solid, his implementation is questionable, particularly considering past proprietary-network failures, such as Ricochet, the steadily increasing web of public Wi-Fi nodes, and the promise of up-and-coming WiMax (Reference 7).

References

www.usinfo.pl/aboutusa/society/demographics.htm. www.census.gov/PressRelease/www/releases/archives/aging_population/000370. html.  www.ntia.doc.gov/reports/anol. www.websiteoptimization.com/bw/0411. Dipert, Brian, “A man, a LAN, a plan,” EDN, Aug 19, 2004, pg 22. Dipert, Brian, “Reading between the lines: RFIDs confront the venerable bar code,” EDN, Oct 14, 2004, pg 48. Dipert, Brian, “Wireless network’s fast, on-the-go access makes waves,” EDN, Nov 8, 2001, pg 49.