Byte, Byte, Against the Dying of the Light
A new senior-care facility e-monitors every move
Whenever Harold Taylor rolls his wheelchair into his bedroom or crosses his two-room suite to take another wistful look at the photograph of his deceased wife, Elsie, his movements are tracked as though he were a radio-collared elk or a prisoner on house arrest. A badge the size of a credit card, pinned to the lapel of Taylor's shirt, transmits an infrared signal to sensors on the ceiling and walls. The sensors send information to a central computer in his rest home—Oatfield Estates, a new managed-care facility just outside Portland, Oregon—and by touching the Where Is Everyone? icon on her screen a caregiver can detect that Taylor has moved.
With a few more taps on the screen the caregiver can also ascertain what time Taylor tucks in for the evening, exactly how much he weighs lying in bed (a load cell sits under each bedpost), and whether he's resting peacefully or twisting and turning. She can take his temperature by means of infrared, keep track of how often he rolls in and out of his bedroom, and create graphs documenting changes in his patterns of movement and in his heart rate and blood pressure. And if Taylor, a former steel-company repairman who is still sharp-witted at the age of ninety-one, should ever develop Alzheimer's, the Oatfield staff need not worry that he'll absentmindedly burn himself on the stove down the hall: the infrared sensors would recognize that he had entered the kitchen, and the burners would lose power at once.
Surveillance has, of course, become part of everyday life in America. Many employers now monitor their employees' telephone conversations. The police plant video cameras on street corners, and direct marketers keep close tabs on where we go on the Web. But each of these activities accounts for only a slice of our existence. Oatfield aims to capture the whole pie. It is the nation's highest-tech senior home and perhaps the first facility of any kind to e-monitor its residents around the clock. And it is continually fine-tuning its surveillance. When I toured Oatfield recently, Bill Pascoe, the architect of the facility's computer system, speculated that Oatfield might soon begin to monitor residents' breathing. "One way to do this is to hang a long, thin microphone over where the person sits, to pick up his sounds," he said. "You'd use a broad, multi-directional mike to pick up the ambient noise, and then you'd subtract the ambient noise and ..." I felt as though I'd entered the world of that ominous Jim Carrey film The Truman Show.
But I felt, too, as though I'd entered a homey small town. Opened last fall and still under construction, Oatfield will consist of a cluster of ten wooden bungalows, each containing fifteen suites, situated in the Portland suburb of Milwaukie, on a six-acre hilltop that was once an apple orchard. Each bungalow is designed to serve as an "extended family residence," a multi-generational home that will welcome seniors and allow them to "age in place"—and to garden and cook—while living alongside their caregivers and those caregivers' families.
Oatfield had only two residents when I visited, but still it had a family feel. In the central kitchen in Harold Taylor's bungalow Connie Cooper, a "live-in facilitator," whipped up some sandwiches for lunch. Her sixteen-year-old son, Tim, slouched on a nearby sofa, playing a video game called Perfect Dark; Taylor surveyed the scene in stately silence while he nibbled at some ham. After lunch his daughter dropped by, accompanied by Taylor's beloved Shetland sheepdog, Mandy. Mandy, who is fifteen years old and blind, lolled on a blanket in Taylor's living room. Oatfield's founder, Bill Reed, soon meandered in, wearing jeans and a sweater; he looked at Mandy and grinned.
Reed, who is fifty-two, is a powerfully built, balding Portland developer. He told me that his inspiration for Oatfield was his sprawling childhood home in Connecticut, where he lived with his parents, four brothers, a grandmother, and a great-grandmother. "My grandmother baby-sat for us," Reed recalled. "At night one of my brothers and I would help lift my great-grandmother's feet for her as she climbed the stairs to bed." The old women were frail, Reed said, but his mother managed their health deftly. "She had intimate knowledge of them. She knew that if my great-grandmother didn't, say, eat dessert two nights in a row, something was wrong. In the past forty years, as people have stopped living near their parents, we've lost that sort of family memory."
A few years ago Reed decided that he wanted it back. And so, in October of 1998, Oatfield's omniscient computer system, Daughter I, was born. (It was later rechristened CARE, for Creating an Autonomy-Rich Equilibrium.) During the subsequent eighteen months Bill Pascoe, a former systems integrator for a company that makes wastewater-treatment equipment, headed a team that designed ten computer programs that, collectively, enable 180 gigabytes of electronic data—a plethora of personal health stories, an epic detailing seniors' moment-by-moment physical ups and downs—to flow daily over Oatfield's network, which contains some 360 miles of copper wiring.
Reed and Pascoe's undertaking was not only vast; it was also unprecedented. Academics across the country are just now starting to consider electronic monitoring for the elderly. For example, at Carnegie Mellon University and the University of Pittsburgh psychiatrists and computer scientists are seeking funds for a project that would videotape sixty dementia patients nonstop for several months. A computer would then select "disruptive vocalizations"—aggressive outbursts and cries for help—for researchers to examine, in part in the hope of finding clues about how dementia works. At the Georgia Institute of Technology computer scientists have built an "Aware Home," in which sensors can monitor residents' movements and conversations. Computers can then digitize the data and send reports about seniors' physical and social conditions to family members off-site. Such technology might allow seniors to delay moving to a residential-care facility. The project's coordinators will move small groups of senior citizens into the Aware Home for short stays beginning in June.
Reed is not the sort to trifle with such preliminaries. Ever since he graduated from Columbia University, in 1971, he has made a career of following odd, optimistic instincts all over metropolitan Portland. In 1973 he opened one of the nation's first self-service garages, where customers rented repair bays and tools for three dollars an hour. In the 1980s he made millions of dollars by buying 160 abandoned houses in a gang-ridden neighborhood that, as he'd been betting, made a comeback. In 1999 he finished converting an old dairy into a sort of village—a hip warren of apartments adjoining a restaurant and bar, some art galleries, some studios, and an "e-mat" (a laundromat-cum-cybercafé).
Reed has always been a hands-on developer, someone who likes wrenches and bandsaws, and what he most wanted to show me at Oatfield was the "brains room" in Taylor's bungalow—a stark basement closet where more than a thousand colored wires converge amid a few sheets of raw plywood. He extolled the virtues of the control board there, and then explained how the relay switches operate. "The computer basically takes the place of a daughter," he said. "It creates baselines on residents. It can tell caregivers, 'Hey, something's wrong—go check it out,' and it can act as a cognitive crutch. Say we find out that someone with dementia always gets up to go to the bathroom at two in the morning. We can tell the computer to turn on the fan in the bathroom then, to remind him why he got up." Reed cut the lights in the brains room, and we stepped outside into an Oregon drizzle. "The computer allows the elderly a new way to be independent," he said.
It is easy to shudder at Reed's equation of surveillance with freedom. The skeptic in me wonders whether we will all one day be tracked around the clock by infrared, and whether the details of our wanderings will be made available to the marketing department at Wal-Mart.
The seniors' advocates I spoke with share some of my dread. But they are also hopeful, with Reed, that smart technology will afford old people new freedoms. Roy Green, a lobbyist for AARP, formerly known as the American Association of Retired Persons, foresees a day when many seniors can stay in their own homes longer by "telecommuting." "You could set up motion detectors at home, and doctors could monitor you remotely," Green says.
Tim Fuller, the executive director of the Gray Panthers, says, "The thought of being watched gives me chills, but if someone has Alzheimer's, maybe they need electronic monitoring along with care from the family. You can't say that technology is purely good or purely bad. The question is, Are we expanding it ethically and humanely? Currently we don't have any philosophers who are specifically addressing that question. Health care needs to develop a new ethical analysis, a new base."
In the meantime, Harold Taylor will remain at Oatfield, sleeping an average of 9.65 hours a night and thoroughly enjoying life. When I stepped into his living room late in the afternoon and found him tipped back in his easy chair, Taylor told me that Oatfield was by far the best of the four managed-care facilities he has inhabited. "The meals!" he rhapsodized, his voice soft and a bit scratchy. "The people! The view!"
"But what's your favorite thing?" I asked.
Taylor pointed a quavering finger at his locator badge, which bears a black "help" button, and I thought for a moment that he was going to sing the praises of Oatfield's electronic surveillance. "The service," he said.