10 PERVASIVEcomputing 1536-1268/02/$17.00 © 2002 IEEE

A s an example of an early applica-tion that puts pervasive comput-

ing technologies directly in the serv-ice of improved quality of life for theelderly and that is “gracefully inte-grated with human users,” this inau-gural installment looks at the assistedliving complex constructed by EliteCare (www. elite-care.com). By build-ing pervasive computing into the envi-ronment, Elite Care’s Oatfield EstatesCluster (Milwaukie, Oregon) givesresidents as much autonomy and evenresponsibility for themselves and theirenvironment as possible. The com-pany focuses on creating a personal-ized environment that avoids the tra-ditional institutional care model usedin nursing homes for the elderly who

can no longer live unassisted. From the physical setting (see Figure

1), to the language used to set expecta-tions, to the pervasive computing envi-ronment, everything about the envi-ronment is arranged to serve this goal.Elite Care based the residential setting’slayout on an apartment complex ratherthan a hospital with its hallways androoms. By using a social care modelthat has the staff making house callsrather than doctors making rounds, theresidents continue to live as normallyas they can. In this scheme, pervasivesensors and staff assist residents inmaintaining their independence, offer-ing assistance as necessary and usingpervasive sensors to monitor vital signsand health indicators.

DEVELOPING THETECHNOLOGY

Founders Bill Reed and Lydia Lund-berg established Elite Care to improvehousing and health care for the elderly,evolving the project from their researchon elder-care facilities and issues sur-rounding aging. Experience with theirown aging parents helped motivatetheir efforts. Elite Care, a small, fam-ily-owned business, developed allaspects of the technology, includingconstruction, care giving, and pervasivecomputing, without venture fundingand on a limited budget. Design goalsincluded low-cost integration of tech-nologies, unobtrusiveness, and an elder-friendly software interface. The com-pany’s advisory committee includedrepresentatives from the Mayo Clinic,Harvard University, Providence HealthSystem, Intel, University of Michigan,University of Wisconsin, OregonHealth Sciences University, EindhovenUniversity of Technology, and SandiaNational Laboratory.

Six primary stakeholder groups atElite Care, each with its own set ofneeds and responsibilities, use the com-puting environments:

• The elderly residents• Families of the residents • Physicians and health care providers • Staff caregivers • The Elite Care management team

that monitors the staff and residents • A community of researchers who are

Using Pervasive Computingto Deliver Elder CareVince Stanford

Editor: Vince Stanford � vince-stanford@users.sourceforge.net

Applications

Satya, our Editor in Chief, has characterized pervasive computing as “the creation of envi-

ronments saturated with computing and wireless communication, yet gracefully integrated

with human users.” While very much to the point, this high-level statement covers a lot of

ground. Many constituent technologies must come together to transform it from dream to

usable and productive reality.

Barriers to wider deployment abound, especially in physical and network security, authenti-

cation, wireless bandwidth management, multiresolution data rendering, distributed multide-

vice interfaces, and multimodal user input modes, including speech and pen—problems

enough to keep the available engineering talent in the IEEE Computer Society busy for years

to come, it would seem.

In each issue of IEEE Pervasive Computing, this column will address basic pervasive technical

issues in light of case studies of deployed pervasive systems. We’ll also explore significant

issues that block organizations from deploying pervasive computing applications. Contact me

if you have suggestions for future installments. —Vince Stanford

EDITOR’S INTRO

JANUARY–MARCH 2002 PERVASIVEcomputing 11

engaged in determining how to bestuse the pervasive computing envi-ronment to improve the quality andefficiency of care delivery.

The facility’s networked sensors letstaff identify residents who might needimmediate care. Databases that moni-tor trends over time also reduce stresson staff members who must track thedetails of vital signs and medication sta-tus in delivering quality care. These sen-sors and databases also help residentsintegrate into the cluster’s social en-vironment. The environment includesactuators that can respond to the activ-ities and whereabouts of residents,lighting the way to the bathroom ifsomeone gets out of bed late at nightand recording the period of wakeful-ness for the staff to interpret later, forexample.

FRONT-LINE DELIVERYAccording to Connie Easter, the clus-

ter’s general manager, pervasive com-puting technologies help her staff pro-vide enhanced residential care in avariety of ways. Easter, who managesthe day-to-day delivery of care to theseniors, points especially to the positiveimpact pervasive computing has had onher staff’s ability to respond to the sen-iors’ care needs (see the “Locator Sys-tem Resolves a Crisis” sidebar).

In particular, the sensors and perva-sive computing infrastructure help staffidentify when seniors actually needassistance, such as when one becomesdisoriented and starts to wonder offcampus or is experiencing an unusuallyrestless or wakeful night. This way, staffcan concentrate their efforts where theyare needed, and the resulting customcare delivery lets the company avoidregimenting the residents according toinstitutional needs while allocatingcaregiver resources efficiently. Inte-grated databases relieve caregivers fromextensive manual record keeping, let-ting them concentrate on person-to-person care delivery, thus increasingoverall efficiency.

The sensors and infrastructure alsoallow easy trend monitoring for each res-ident, according to Easter. For example,if a resident’s blood pressure or weight

changes, the resident’s physician mightneed to be called. The same databaseslet the staff clearly communicate with theresident’s adult children about changes

Figure 1. Gardens of the Oatfield residential cluster with pervasive but unobtrusivesensors.

As an example of the type of advantage pervasive computing technologies can offer in an

elder care setting, Elite Care’s Connie Easter cites a case of a resident with early Alzheimer’s

who was becoming disoriented at times and beginning to wander. Easter described the wan-

dering as the person’s way of searching for “a time and place where memory and life were still

whole.”

Because the resident was well-oriented most of the time, Elite Care could rely on the locator

badge, or bracelet, to trigger an alarm if he started to leave the facility. One day, he wandered

to the entrance where he encountered a stop sign. He stopped and waited for a moment to

decide what to do. In that brief interval, the sensor net detected his elopement. Alerted by an

alarm, staff came to his assistance and brought him safely back home.

Assisted living that uses the social model of care is becoming increasingly popular as our

population ages. To give residents maximum autonomy, Elite Care uses a pervasive comput-

ing solution called Creating an Autonomy-Risk Equilibrium, which includes a network of sen-

sors wired unobtrusively into homes and common areas that gathers information on residents

in real time. Some sensors use an infrared, radio frequency badge worn by residents, while

others, such as motion sensors do not require the badge. Information gathered falls in three

care categories:

• Health vitals

• Inputs/outputs

• Movement

This data offers efficient care allocation and prolongs more independent living for the

residents.

THE LOCATOR SYSTEM RESOLVES A CRISIS

in condition such as weight loss, periodsof disorientation, or wandering.

Staff quality of life improves as well,dramatically reducing turnover rates inan industry where it can go over 80 per-cent per year. The facility’s residentialscale and design attracts many of the staffto live on campus, enabling them to bet-ter monitor status using the pervasivecomputer network from their own apart-ments. Elite Care supports and encour-ages this kind of staff living arrangementbecause it increases familiarity betweencaregivers and residents and improves thestaff’s ability to respond rapidly duringcrucial care situations.

PERVASIVE COMPUTINGTECHNOLOGIES

According to Lundberg and Bill Pas-coe, a systems engineer, Elite built per-vasive computing into the units fromthe ground up, using up to 30 miles ofwiring, 300 or more control relays, 20control boxes, gigabit Ethernet, andnumerous computers and databaseservers, as well as environmental andpersonal sensors. Elite Care makes mul-tiple uses of the sensor data streamscoming from the apartments and theresidence’s common areas to maximizethe benefits obtained.

Locator badgesResidents each carry a dual-channel

infrared radio frequency locator tagthat acts as their apartment key and

emits periodic IR pulses to the sensorsin each room and in the common areas(see Figure 2a). The pulses are uniqueto individual badges and support real-time updating of personal locationdatabases. Status bits let residents sum-mon immediate assistance by pressingthe proper button and automaticallyalert the staff when the battery chargegets low (see Figure 2b). The RF com-ponent enables location tracking toabout a 90-foot radius when a badge isout of sight of an IR sensor, such aswhen the person wanders.

If triggered, elopement alarms alertstaff if a resident prone to disorientationstarts to leave the campus. Motion sen-sors in the rooms enable energy man-agement or convenience functions suchas turning on the lights when peopleenter a space. The locator badge can bedeployed in a wristwatch form factorfor those who might be prone to mis-placing their badges.

Embedded weight sensorsEach apartment bed has a built-in

weight sensor. As with locator badges,the pervasive computing infrastructuremakes many uses of the signatures ob-tained from these sensors. For example,a daily weight measurement is taken, buttransients during sleep periods can alsoindicate tossing and turning, whichmight imply wakefulness, perhaps dueto pain or stress caused by illness. Fre-quent trips to the bathroom might indi-

cate a urinary tract infection, alertingstaff to arrange for a checkup. Doctorsreceive notification of any sudden weightloss, but because some residents mightbe sensitive about their weight, they canopt out of this measurement.

In-apartment computersEach apartment has a networked

computer with a touch screen interfacethat provides access to a standard suiteof applications residents use to com-municate with families and friends.Tools include email, word processing,audio for speech recognition, and videoconferencing using Webcams. The appli-cations suite defaults to large fonts for easier viewing. Residents can alsocommunicate with their neighbors andsummon staff assistance. Staff can usethe consoles in their apartments to moni-tor the status of residents in their care aswell as for personal use. These systemsconnect to the wired network infra-structure extending across the cluster.

Personalized databasesElite Care maintains individualized

resident databases that enhance caredelivery, for example, by documentingvital signs—such as weight and bloodpressure changes over time—and activ-ity logs. The caregivers use this data tocall for qualified medical attention whenneeded. Medicine delivery databases letstaff know if the residents are currenton their prescription medications.

Managers use the databases to moni-tor staff performance in timely deliveryof services and communicate with theresidents’ adult children. Residents alsouse the personal histories in the data-bases to foster social relationships withothers who have common points of his-tory, such as having attended the samecollege or high school.

Most residents do not view thesedatabases as an invasion of privacy andare willing to contribute their data forresearch in facilitating the design ofmore effective residential care tech-niques. Web-based front ends for thedatabases that will allow staff access

12 PERVASIVEcomputing http://computer.org/pervasive

APPLICATIONS EDUCATION STANDARDS WEARABLE COMPUTING

A P P L I C A T I O N S

Figure 2. Locator badges: (a) infrared and radio frequency sensors for locator badgesreside throughout the Elite Care environment; (b) residents use badges as apartmentkeys and to locate service or summon help.

(a) (b)

JANUARY–MARCH 2002 PERVASIVEcomputing 13

APPLICATIONS

from multiple locations are currentlyunder development.

As we’ve seen, the Elite Care infor-mation technology group has de-

ployed a system with many elements ofpervasive computing, including port-able and wearable devices and wire-less networking, to create intelligentand responsive work and livingspaces. It has harnessed the technol-ogy in direct and important ways toconstruct a more humane and humanworld for its residents and staff.Founders Reed and Lundberg recentlyreceived a 2001 Computerworld 21st-Century Achievement Award for theirwork.

To give readers a quick summary of the deployment discussed in the

column, I offer a Pervasiveness Report on each major application. By

their nature, pervasive systems are closely integrated to both human

activities and conventional systems infrastructure, so they must be char-

acterized along many axes. Table A shows my initial take. I hope to con-

duct a discussion with our readers on refining this rating report. I would

rate systems with an average pervasiveness index of medium or above

as significantly pervasive. Smaller, more isolated systems and devices

might not address all these axes, but might still be highly pervasive in

nature. By contrast, whole systems that facilitate service delivery in the

real world will usually score on many or most of the axes. A high rating

for a category means that the function is broadly defused or central to

the application, while a low rating means that either the function is not

present, or is not fully integrated into the application.

Overall, the Elite Care Pervasive Computing Environment seems

highly and successfully integrated into the work processes at the Oat-

field Cluster, allowing new efficiencies and innovative approaches for

meeting the enterprise’s mission.

ELITE CARE PERVASIVENESS REPORT

TABLE APervasiveness Report.

Category Function Rating

Computing infrastructure Apartment consoles, personalized databases, database Highand Web servers

Mobile computing devices Personal badge locators with help functions used by all residents Medium

Wireless networking RF and IR locators Medium

Device discovery Static configuration Low

Service discovery Static configuration Low

Multimodal user interfaces Environmental sensors for location, weight, and speech recognition Highat apartment consoles

Pervasive databases Personalized databases for status and history High

User authentication Statically configured Low

Secure networking Short range transmission of limited data, relying on the Lowfacility’s physical security.

Vincent Stanford is the lead engineer for the NIST Smart Space Laboratory, project manager for the

NIST Smart Space project, and a founding member of IEEE Pervasive Computing magazine. Contact

him at vince-stanford@users.sourceforge.net.

COMING NEXTPervasive Computing in Health CareIn the US, the Health Insurance Portability and Accountability Act of1996 makes it a felony to be negligent in protecting medical historydata. Health care is a huge potential market for pervasive solutions,but these legal concerns create a significant barrier to deployment.In our next installment, we’ll talk to Brent Lowensohn of Kaiser Permanente Research as well as representatives from leadingcomputer software and hardware manufacturers attempting todevelop systems to improve health care.

COMING NEXT