Wired and retired: assisted living; residents go online. (Feature Article).

Joan Gloe is a resident of Country Meadows' Leader Heights Campus, an assisted living facility in central Pennsylvania. She's a retired math teacher with no prior experience with computers. Nerve damage to her hand makes her unable to use a keyboard. All of her children and three of her grandchildren use computers, and Ms. Gloe says her family "stays in touch constantly through e-mail." Until recently, Ms. Gloe was the only family member who could not participate in these e-mail conversations.

Joan Gloe's story is not unique. Residents of senior living communities are among those who have the lowest Internet usage rate of any demographic in America, with the possible exception of people living in prisons. A recent study by the U.S. Department of Commerce shows that Internet usage is highest among the young, with nearly 95% of American 16-year-olds online.

Seventy percent of adults aged 20 to 50 use the Internet. But connectivity drops off dramatically for seniors, with only an estimated 40% of 65-year-olds connected, 20% of 75-year-olds, and fewer than 10% of the "oldest old" (age 85+). (Figure 1)

There are no reliable usage statistics for senior living residents, but our own informal surveys have led us to conclude that 5% of assisted living residents and fewer than 2% of residents of skilled nursing facilities use the Internet. These low numbers are not surprising, given that many seniors feel like "strangers in a strange land" when they sit down to use a computer. To them, the Internet often seems like a clubhouse created by 20-year-olds for other 20-year-olds, with an "Old folks not welcome" sign posted out front.

This antisenior bias appears in many ways. Designers of software and Web sites assume their users have good vision and want to see a lot at once, so they pack lots of small text, cryptic icons and complex graphics onto a page. They assume that their users can discriminate between program content and banner ads, so they scatter flashing ads all over the screen. And, of course, they assume that their users can type, can handle a mouse and are familiar with Web conventions such as underlined hyperlinks, forward and back buttons, and multiple overlapping windows.

The result of all this is, not surprisingly, a frustrating computer experience for older users, especially those who are coping with age-related disabilities such as dementia, short-term memory loss, low vision or arthritis, or who are simply unfamiliar with computers and the Web.

Beyond these barriers are other, more subtle impediments. The Internet culture is edgy, hip, going in a thousand directions at once. For an elderly resident raised in a culture of Norman Rockwell, Gary Cooper and Radio City Music Hall, the "MTV look" of most software and Web sites is confusing and disturbing.

So, in those senior living communities that have computers for residents to use, the equipment generally ends up gathering dust. The computers are used by occasional hobbyists, by staff in their off-hours and by visiting family members (often kids) who surf the Web when they come to visit.

A New Approach

In late summer 2001, an assisted living provider called Country Meadows decided to do something about this. Senior managers at this family-owned company, with 12 locations in Pennsylvania and Maryland, decided to find a partner that could help them transform the Internet from a "young people only" medium to one that could provide real value for residents, families and staff. They wanted their residents to have an improved quality of life, as well as the competitive edge that could come from being a truly wired retirement community.

In July 2001, they contacted ElderVision, a Pittsburgh-area-based software company that was just beginning a complete redesign of its Touchtown software product to meet the needs of long-term care providers and residents. ElderVision had formed a consortium of senior living providers, called the Senior ConnectPartnership, toward this end. CountryMeadows joined the Partnership and soon became one of its most active members.

For several months CraigDieck, Country Meadows' Manager of Information Technology, participated in weekly Partnership conference calls and worked with ElderVision's design staff to help create the new software product. The design phase was completed in October, then ElderVision's programmers and graphic artists took over, and in May 2002 the finished product was ready to use.

Its design is worth describing because it illustrates the special challenge of creating art Internet-friendly system for the residents of assisted living.

The product's most important feature is a powerful, voice-enabled e-mail system that residents can use to successfully exchange e-mail even if they cannot type or if they suffer from poor vision, arthritis, dementia or short-term memory loss.

The program also provides a scrapbook for handling e-mail attachments, a message board system for discussion topics ranging from soap operas to current events and a simplified Web browser to give residents easy access to billions of Web pages around the world. The system also provides a range of business-related features, including integration with intranets and other proprietary software applications, integration with census systems, automatically managed e-mail distribution lists, and message boards and notices that can be tailored to the needs of residents in specific campuses and buildings.

Country Meadows first introduced the system at its Leader Heights and Allentown assisted living facilities. Key to their success was a commitment by top management. CFO Ted Janeczek personally shared with employees, vendors and residents his company's commitment to the project's success. The project also had a highly skilled and dedicated manager, Patty Marrero, the company's director of technology training. Each facility's activities director was given ultimate responsibility for the project's success within the facility.

Here are the six steps that Country Meadows followed in implementing the project:

Brief the staff. A corporate team gave each facility's management team a complete project briefing-an overview of the project's objectives, its potential benefits in marketing and quality of life, and the specific details of the rollout process itself. The meeting was chaired by Janeczek and Marrero, and was attended by the facility's administrator and directors of activities, wellness, marketing and maintenance, and even the dining services supervisors.

Create the infrastructure. As staff briefings continued, the company's IT staff was getting the computers, furniture and locations ready. "We wanted to make sure we had good computer equipment," says Marrero, "so we invested in touch-screen monitors, telephone handsets instead of microphones and nice furniture." (Figure 2) Location was a key consideration, as the team tried to strike a balance between high visibility to encourage use, and enough privacy so that residents could use the system without being distracted. At Leader Heights they placed the system in an alcove just outside the chapel, a high-traffic area that would ensure that every resident would see the system often.

Build the coaching team. Since resident training was to be done primarily by other residents instead of staff, the next key step was to identify the Resident Coaches. Marrero and the facility's activity director sought residents who were already involved in other activities, had been living at the facility for at least two years and (if possible) already had some computer experience. They decided on a ratio of one coach for every seven users. Coaches received their own Touchtown accounts free of charge, and agreed to work with their assigned residents to get them up to speed. Marrero trained the coaches herself, using ElderVision's multimedia training materials over five 45-minute sessions.

Promote the system. To make sure there was enough excitement in advance of the rollout, Country Meadows sent letters to residents, letting them know that "Touchtown is coming" and what it would mean to them. They also sent letters to families, letting them know that their loved ones would soon be able to stay in touch via e-mail. Both sets of letters went out in May, a full two months before the kickoff reception.

Launch it. The system was launched at a wine and cheese reception on a Saturday afternoon. Attendees heard brief speeches from the administrator, the corporate training staff and the president of ElderVision. Then everyone got a chance to sit down at a computer, log in and send an e-mail by just speaking into a handset. Signup sheets were handed out at the reception.

Grow it. After the launch, responsibility for continued resident access and use shifted to the Resident Coaches. Each coach was given the names of several residents who had signed up for accounts, and worked with them for several weeks. The goal was to make sure that residents could walk up to a computer, log in to their account and check their e-mail, Marrero also plans to start monthly classes--one for existing members and another for people who are not yet members but are interested in learning more about computers and the Internet.

Status Report

A month after the kickoff receptions, computer usage was growing steadily at the two Country Meadows facilities. In the first month, 20 residents logged in a total of 402 times. They sent 128 e-mail messages, 58 of them dictated into a handset. They received 425 e-mail messages from friends and family, including 52 voice messages they listened to through their computer speakers. Nine of the residents accessed the system's "seniors-only" message board system--and a few of them have even ventured out for the first time onto the World Wide Web.

One of the most active members is Joan Gloe, the retired math teacher mentioned earlier in this article. Now a Resident Coach, Ms. Gloe spends five hours a week coaching fellow residents. It's true that she still can't use a keyboard, but that's riot a problem anymore--she sends e-mail regularly by just dictating it. "My children are very impressed that they can hear my voice," she says.

"Five or ten years from now," says Country Meadows' Janeczek, "what we are doing at Country Meadows will be commonplace. This is just one more way for us to help seniors experience a higher quality of life."

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Jeff Pepper is the founder and president of ElderVision, Oakmont, Pennsylvania, provider of Touchtown. For further information, visit ElderVision's Web site at www.eldervision.net; to try Touchtown, visit www.touchtown.org. To comment on this article, please send e-mail to [e-mail].