Dr. John Huth

Overcomomg Boredom and Loneliness in Long Term Care Facilities

This BLOG will focus on experiments to define practical ways to brighten the lives of residents of Long Term Carte Facilities (LTCFs) such as nursing and assisted living homes. At the same time it will address opportunities for making the vast pool of experience representeed by such people available to the public at large, and particularly to young people of high school age.

ANY ONE INTERESTED IN THE QUALITY OF LIFE FOR RESIDENTS OF LONG TERM CARE FACILITIES IS URGED TO COMMENT.

We've all seen them: bored and lonely elders asleep in front of an LTCF television, or clustered around the front door hoping to meet a smiling face with a willingness to stop and chat. And these observations seem to hold true regardless of whether the LTCF is modestly priced (are there any?) or expensive.

What are the causes of this problem?

Can you suggest some possibilities for improving the situation?

Let us hear from you

Thanks,

John H. Huth, PhD, PE

Using Sketchbook in Nursing Homes

The bladder cancer has gotten me down to a much greater extent than either the previous breast or prostate cancer.  However I've been able to make progress in the use of my new Toshiba tablet, and in fact believe I now understand how to really introduce it into a nursing home.  The trick is to make use of layers with my Alias Sketchbook software.  The procedure is as follows: first I sketch the outline of a figure on a "backgrouind" layer, and then let a Nursing Home resident "dress it" on a transparent second layer.  The second layer can then be erased or changed as much as the resident wants without in any way modifying the background layer.  Then when the resident is finished, I can print out a fusion of the two layers.  This of course lends itself to a setting up a competition between residents; after the first resident is finished, I merely print out his painting, erase everything on the second layer and let the next resident start to work on a new "dressing" of exactly the same sketch on the background layer.  And once they are accustomed to working on a tablet, there is then the possibility of connectring them with students at tablet equipped schools.   

Virtual Volunteering Through The Elder Wisdom Circle

I've discovered The Elder Wisdom Circle. It was founded as a non-profit in California by Douglas Meckelson and attempts to pair online advice seekers with a nationwide network of volunteer seniors, 60 to 97, who share their know-how and accumulated wisdom.  These circles, composed of volunteers, answer letters of the "Dear Abby" type (letters to newspapers seeking advice for dealing with problems such as custody of children, and their answers are published in some newspapers. I've been in contact with him, and have found that he pushes his circles pretty hard. Meckelson says that so far 250 elders have responded to over 30,000 requests for advice.

I doubt that many nursing residents could keep up the pace that he demands.  However one could read "Dear Abby" letters to residents, hold a discussion of possible answers and then let them in on the actual answer as published.  That in itself might perk them up. 

   

We of course need money, and so I've approached the Mary Washington University concerning a joint proposal covering the acquisition of technology (e.g.-tablets) which should ease access to the Internet for seniors, an evaluation of acceptance and needed modifications, and a long-term study of the impact of such technology on resident quality of life.  The University would provide competence in psychology, Etc. while the home would provide a test-bed.  I would view my role as a kind of "integrater."

If this does't fly, I think I'll just stay home and try to write a brief booklet on the subject.

This Blog Mentioned By AARP

Gabe Goldberg writes in a "Life Online" column on the AARP web site: "let's visit a few interesting blogs, and along the way you'll learn the ways in which you can continue to explore the "blogosphere" (the world-wide and ever-growing collection of blogs).

"Hosted on a colleague's Web site, Dr.John Huth's blog highlights his personal crusade to reduce senior citizens' isolation through computers. Recent posts include "Video-Conferencing: the Killer Application to Reduce Isolation and Depression Among the Elderly" and "Bedside Computers in Hospitals."

Digital Signature Software

Sue Ovall of Wacom has sent a list of inexpensive annotation software for use with Tablet PCs:

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http://www.cic.com/

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http://www.dailytoast.com/

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http://office.microsoft.com/en-us/assistance/HA010451251033.aspx

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http://office.microsoft.com/en-us/FX010858031033.aspx

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http://www.openoffice.org/

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http://www.phatware.com/

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http://www.ritemail.net/

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http://www.evernote.com/en/products/evernote/user-stories.php

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Hope this helps.

REgards,

Sue Ovall

Customer Service

800.922.6613 ext 173

Blog By Email

Dear Dr. Huth,

Just to let you know you can now blog by email. I'm sending this message to your blog by email.

Regards,

Jim Buie

Video-Conferencing: the Killer Application to Reduce Isolation and Depression Among the Elderly

Here's a screen shot of a video session I initiated with Jim Buie. (Click on it to see full size.) Imagine the possibilities of this technology to reduce isolation and depression among senior citizens. If a teenager, volunteer, nurse or other assistant learns to set up the equipment, an elderly person with impaired cognitive abilities, who has little hope of mastering a computer doesn't even need to type. He or she can simply look into the camera, watch the screen and enjoy visits with their adult children, grandchildren, great-grandchildren, or far-flung friends and relatives -- even if they live thousands of miles away. Anyone with a high-speed Internet connection can learn to set up crisp and unlimited video and audio connections for free or at minimal cost.

Instead of staring for hours at boring television shows, senior citizens should have the opportunity to interact with real friends and family members in real time. As I visit warehouses for senior citizens, I think they should DEMAND the right to this video-conferencing technology. They have been warehoused for far too long!

Jim Buie and I, as well as other members of our virtual team around the U.S. are available to train you, your family, friends or caregivers to utilize these connections, to enhance relationshps between parents and adult children or grandchildren. Contact us. If you live outside the U.S. and would like to become part of our network, contact us as well!

Improving the Quality of Life for Residents of Long-Term Care Facilities

Approximately 33 years ago, Dr. Jaber Gubrium (now a Professor of Sociology at the University of Missouri) spent several months as a participant-observer in the “Murray Manor” (a pseudonym) nursing home and published his observations in a book entitled “Living and Dying at Murray Manor.”

Surprisingly, many of his observations that senior citizens just sit around with nothing to do)for most of the day are just as relevant today as they were then.  The advent of TV has done little to improve the situation, and if anything contacts between nursing home residents and relatives and/or young people have decreased.  Everyone seems to have become too busy for such niceties.

And yet young people and senior citizens are natural allies, as William H. Thomas, MD, point out in his book, “What are Old People For? How Elders Will Save the World.” Each group is, of necessity, searching for a new lifestyle and each group has something to offer the other.

Fortunately, however, modern technology, such as tablet computers and the Internet, offers real hope for remedying the situation.  And while capitalizing on this fact, we do not intend to ignore the inner strengths of those individuals who successfully transition from their former life styles of freedom and self-responsibility to life in an institution where freedoms are curtailed in exchange for transferring responsibilities to others. 

Our approach will rely heavily on Dr. Gubrium’s work on techniques of interviewing (“Handbook of Interview Research; Context and Method”), although we do not intend to follow his approach slavishly.  Our goal is somewhat different from his in that we intend to distill the elements of successful transitions such that they may be used to assist later arrivals as they attempt to adjust to Institutional life. 

In addition, we expect to be assisted by Humanities honor students from Wootton High School.

Bedside Computers in Hospitals

"Lahey Clinic in Burlington has just installed 274 bedside computers, one in each hospital room. Patients use them to watch television, search the Internet and send e-mails. Within the coming year, doctors and nurses will also be able to use them to access the patient's medical records and scan bar codes on medication. " -- Newburyport, MA Daily News (posted by Jim Buie)

Beaumont Foundation Buys Computers for Schools, Community Groups

John, the Beaumont Foundation offers grants to schools and community groups for laptop and wireless computers. They might be a great resource. Check out the link. They funded a program to connect students in South Dakota with the elderly.

An article on the web site of a South Dakota school says Roslyn SD superintendent Allan Crane "while thinking of ways to tie in the community he thought about who may not be acquainted with computers and thought of seniors and others in the community who have computer phobias. He also decided to work with students on the project." He involved students who were required to do projects for Family Career, Community, Leadership of America (FCCLA), and Future Homemakers of America.  The students are working with Strand-Kjosvig Rest Home.

"Senior citizens would be given the opportunity to use e-mail to communicate with family members, with FCCLA students providing assistance.

"Within the school, a mobile lab will enable students to do projects with other classrooms anywhere in the world. A pen pal type electronic project with students from another state or country would be a priority. The mobile lab would enable classes to have increased access and expand learning experiences outside the classroom.

“The interaction of students with local senior citizens will be a learning experience for everyone.” Crane said.

Regards,

Jim Buie

Innovative New Hardware and Software Present Opportunities for Senior Citizens

Several new hardware and software innovations make our mission easier. As we illustrated, Tablet PCs translate handwriting to text. You just scribble on a tablet with a special pen and the tablet will transform handwritten letters to typed letters.

Voice recognition software translates speech to text. You just speak into a microphone, and with practice, the software will "learn" your accent and learn to translate your spoken words into written words.

Other innovations include low-cost web cameras, video email, live video-conferencing over high-speed broadband connections, and low-cost laptops that connect to the Internet over a wireless hub.

These technologies are likely to interest residents who otherwise might be "computer-phobic." If all they have to do is look into a camera and speak, with the assistance of a volunteer, the stress of learning how to use a complex computer disappears.

With these technologies, even residents with speech impediments, arthritic hands, or the inability to speak or to hear can now access the outside world with relative ease...especially if assisted by a computer-savvy high school student. 

Lure Members of Community to Routinely Visit Long-Term Care Facilities

We are most anxious to have citizens join the effort to routinely visit long-term care facilities. Senior citizens. especially, have something to offer. We “old fogies” can readily establish rapport with residents. Community acceptance is absolutely essential before proceeding to steps two and three, and will only be granted when residents are convinced that any newcomer has a real interest in them.

But we also want high school students to visit, for two reasons:

1) they will bring vitality and many are real “computer geeks”; and

2) they can learn about possible careers, and at the same time satisfy their “community service” requirements.

By developing family-like relationships with one or two residents at a time, one can help them break out of a depressed and lonely frame of mind.

For example, two amiable ladies in one nursing home expressed to me an interest in learning to type. They never gained much speed, but they eagerly awaited each session, and before long other residents (even including some nursing aides) who had been remote at best suddenly wanted to participate!

One of the ladies lived as a young girl in a neighborhood of immigrant Italians. She can speak from first-hand knowledge of their reactions when we went to war with Italy during WWII. Such historical information should be of interest to both high school and junior college students, and should lead to on-line discussions and perhaps even face-to-face visits.

'I've personally visited many long-term care facilities...Residents are lonely, feel abandoned, and like worthless burdens on society.'

Today, as we all know, the US is aging and our family structures no longer accommodate the caring of elderly parents or grandparents at home. 

With the inexorable increase in the number of elderly, both as a percentage of the population and in absolute numbers, and the rise in chronic diseases, researchers have hypothesized that Medicare and Medicaid will be bankrupt in a few years. One physician told me that if no cure if found for Alzheimer's, it alone could bankrupt the long-term care system.

There are approximately 200 long-term care facilities -- nursing homes, assisted living centers, etc.-- within about 25 miles of the nation's capitol.  I’ve personally visited many of them. One invariably finds many residents who are lonely, feel abandoned and have come to regard themselves as simply worthless burdens on society. As one psychologist has put it, “They need to shift their attention from themselves to the outside world.” 

I do not accept the inevitability of such a fate, and have a three part plan to attempt to improve the quality of life for seniors cocooned in such facilities. I outline the plan in my next blog.

Disabled Citizens Hunger for Meaningful Work

Many of you know the academic axion, “publish or perish.” As a Beltway Bandit, the axiom is, “get a contract or perish.”

Somewhat to my surprise, I was successful, and in quick order won contracts from the Departments of Education and Agriculture. Both dealt with finding employment for adults with disabilities.

That was the beginning of my current interest in our growing population of seniors in long-term care facilities, assisted living centers, and nursing homes.

One of my contracts called for me to help West Virginians with disabilities find employment. This project taught me two things:

1) there is real hunger for work among those who generally are regarded as unemployable, and

2) local politicians and small colleges are capable of absolutely treacherous behavior in blocking disabled people who seek work from getting it.

However, with the assistance of Senator Robert Byrd (D-WVA), we did find employment in a major computer project, Year 2000 computer compliance, for many of our disabled West Virginian citizens.

From the Forrestal to Vietnam

At first, my job with the Navy Department was a very good job. I could spend a lot of time out with our fleets during their exercises. I had a chance to work with many flag rank officers including Jerry Tuttle, who just missed becoming CNO because he made a politically incorrect comment. Ultimately, following the USS Forrestal tragedy, I became very involved in carrier survivability including training of damage control crews, ship design, etc.   

Unfortunately, my time at sea, which included time ashore in Vietnam, ultimately led me to question Washington priorities, so as retirement neared anyway, I resigned and entered the world of "Beltway Bandits".  From what I saw in Vietnam, I pray that we will never again try to fight a war micromanaged from Washington.

Career Highlights, with Hotlinks to History, Great Projects and Great Institutions

Now, my story:

For 13 years, I worked at the Rand Corporation as a researcher. Rand has an international reputation for addressing difficult challenges throughout the globe, for anticipating emerging issues, establishing new angles of inquiry, and mapping the territory for responses by government, business, and society.

I believe the same sort of technological faith we had at Rand, which helped put a man on the moon and win the Cold War should now be applied to the problems of senior citizens.

Recalling my early career:

I left “The Farm” (Stanford for you non-Californians) with a shiny new PhD in Engineering in 1950, and went directly to RAND where I was housed over a bicycle shop on Third Street, along with the rest of the Missiles Division. My first assignment was to study "flow over flat-bottomed bodies," a topic which the administrative assistant somehow suspected of being pornographic! Actually I was trying to cast the problem in a form which the math department could run on their computer.

Back then, to run something through a computer meant using punch cards, and getting the results back in about a week if you were lucky.

Subsequently I moved on to study the possibilities for an ICBM Defense based on high-speed impact with clouds of small particles. While we did successfully model the impact phenomenon, we never claimed (as was reported in a now defunct magazine, the Coronet) to have solved the problem forever! However, our computer model is, I believe, still in use today.

At that point, I wrote two chapters for Bob Buchheim's book on Space Flight One of my chapters was on power sources for space vehicles.  This caught the eye of NASA and led to my being appointed to one of their Research Advisory Committees. 

Finally I became involved in the development and application of fuel cells, a topic which DARPA had just decided to fund through Project Lorraine. DARPA in time asked Rand to loan me to them for one year, which would necessitate a move to Washington. My late wife and I were excited to move to the nation's capital.

As might have been expected, one year became three, and by then my wife had developed a full-fledged case of "Potomac Fever." So I left Rand to accept a position in the Navy Department.

Internet Blogs and Hotlinks Can Enrich Lives of Senior Citizens, and Others' Appreciation of Them

Let me tell a little bit of my own story, to illustrate two things:

(1) how a blog like this can give voice to any senior citizen, to let them tell their stories, so that when they enter a longterm care facility, they won't be just an anonymous face without a past, but indeed a person with a rich history. I would like to see volunteers, particularly high school students, assist every senior citizen in telling his/her story online. Everyone has a story to tell, a life of interest, something to share and teach young people about the past. By posting biographies, photos, audio and video clips, senior citizens also achieve a bit of "digital immortality."   

(2) how hotlinks to Google and other web sites help me and other senior citizens to discover new things about our past, about subjects we are interested in. Internet biograghies with hotlinks can also help to connect individuals to larger events in history, to great institutions, projects and causes.

Internet searches are a heck of a lot more interesting than television soap operas and a lot better for keeping the brain sharp than sitting dazed and dozing in front of a blarring television!

Art Lessons with TabletPC Are Rewarding to Residents

Since our last BLOG, we are happy to report that we've conducted art lessons with several residents of the Hebrew Home using the Tablet PC. With the tablet, creating art is not messy, and does not require setting up a table, setting aside a particular space, or protecting carpet or clothing from potentially spilled paint. A resident can set the TabletPC on his or her lap and "paint" very creatively. See the remarkable work that Helena Gottlieb did last week.

Art lessons, in almost any form, have been shown to be beneficial for improving the mood of LTC residents.  However, the use of a tablet, which allows erasures, the flexibility of changing colors after the sketch has been done, and instant e-mail and web display of the finished product, seems to be of particular interest to residents.

Don't Know How To Type? You Can Still Send Email

Senior citizens and residents of LTC facilities who do not type can prepare typed documents and email without knowing how to type, using a Tablet PC. The tablet can convert their handwriting to text, as long as it is legible. In the Windows Journal application, once the citizen has scribbled a note, use the lasso command to circle the text...

Then under the "Actions" tab at the top, select either "convert to email" or "convert to text." Voila!

-- posted by Jim Buie

Was Long-term Care Neglected in Dartmouth Study?

Dartmouth/Health Affairs researchers have released a study dealing with variations in Hospital Care and Outcomes for the Chronically Ill.

What I found curious is that despite the fact that more than half of all health care beds are in long-term care facilies, no mentioin was made of them.