Design makes a place a prison or a home. Turning ‘human-centred’ vision for aged care into reality

Posted on April 16, 2021April 16, 2021 by Joanna Sun

Jan Golembiewski, University of Technology Sydney

The Royal Commission into Aged Care left organisations that provide housing for aged care wondering how they will put its recommendations into effect. Most of these recommendations relate to the models of care and levels of staffing in homes. Put simply, in the architectural rabbit warrens that typify aged-care facilities, there can never be enough staff to manage every nook.

Models of care are also difficult to change when the architecture is obsolete. Yet these difficulties aren’t detailed in the report. It barely mentions architecture. Only two of the 148 recommendations relate specifically to architecture, numbers 45 and 46: to improve the design of residential care accommodation; and to provide “small household” models of accommodation.

But don’t be mistaken. Architecture has a profound impact on how we live our lives, work and respond socially.

If architects are able to work with some basic design rules – to design to a vision, with simplicity and a non-institutional design language – architecture can play a role in implementing the bulk of the recommendations. But, if the importance of design is neglected, obsolete architectural models will undermine the best efforts to reform the models of care.

We can design to remove restraint

Architecture is a critical element of “embedding a human rights-based and human-centred approach to care”, the focus of chapter 3 of the royal commission’s report. To understand the relationship between architecture and human rights, consider how human rights are taken away: look at prisons, detention centres, mental health facilities and even the residences where we care for our elderly citizens. Invariably, it’s architecture that stifles the freedom of movement, the dignity, the freedom of association, choice and other rights.

The commission estimates architectural solutions to seclusion and other forms of physical restraint are used on 25-50% of all residents of high-care residences. These restraints can look innocuous – including “seating residents in chairs with deep seats, or rockers and recliners, that the resident cannot stand up from”. But for residents who can’t get up on their own, deep seats restrict their freedom of movement and ability to make their own choices about as much as handcuffs do.

old women being helped to get out of a chair — When a person can’t get up from a seat unaided, it becomes a form of restraint. Shutterstock

The forms of restraint (including in high-care aged-care residences) are increasingly disguised, but a locked door remains impenetrable even if it’s made of clear glass. Along with fences and high walls, such features are designed to keep some people in and others out.

Or we can design for quality of life

If people fail to see how the design of a prison is the primary instrument for imprisonment, then it’s also hard to comprehend just how much good architecture improves people’s circumstances and well-being. But a well-designed aged-care building is replete with wholesome invitations to do such things as explore gardens without putting residents at undue risk.

In turn, spending time outdoors helps prevent “sundowning” – people with dementia may become more confused, restless or insecure late in the afternoon or early evening. It also improves the resident’s experience (personal well-being and satisfaction). Recent unpublished data (in review) shows time outdoors even protects against viral flu-like infections.

And that’s just one example of the benefits of good design. All good architectural choices have similarly positive effects.

3 principles for human-centred design in aged care

Principle 1: projects are driven by a vision that maintains and enables human dignity, even for people with cognitive impairment.

A vision includes a single, well-articulated concept that cannot be dismissed or ignored. The vision creates a hierarchy in which important things are valued more than anything else. A vision that makes human dignity a priority ensures other functional or pragmatic concerns do not lead to human rights being deprioritised.

A good vision isn’t just words or intentions. It involves concrete decisions that are armed with bravery and honesty. Bravery because a good vision always aspires beyond known benchmarks and guidelines. Honesty, because a good vision isn’t shy about speaking the truth.

The diagram below shows an example of a vision in which high-care aged-care residences were to be incorporated into a new precinct for the University of Wollongong. The vision prioritised human centredness – a human-centred workplace, a student-centred learning environment, patient-centred aged-care residences and a person-centred environment overall.

The above vision led to this conceptual diagram.

The conceptual diagram was developed as a masterplan.

In this concept, the educational, residential (non-aged-care) and health facilities make natural walls around a shared village. Car-free streets, cafes, shops, parklands and a distributed residential aged-care facility create a pleasant and safe environment for everybody. The exterior buildings are accessible from both sides for students and staff, but not for high-care residents unless they are accompanied.

Principle 2: keep it simple.

As cognitive abilities decline, this reduces people’s capacity to deal with complexity. So keep design simple, with destinations that are visible and clear.

Think about turning all bedrooms inwards to provide immediate access to common spaces, activities and gardens. The reception, all offices and commercial facilities can face outwards, and be invisible to residents.

Simplifying the layout also aids staff. Hidden spaces and doors to unsafe places cause anxiety for residents and staff alike, adding to the staffing burden.

Simple design doesn’t mean plain. It means keeping plans simple – especially for the residents, who have all they might need (and all they want) immediately visible. All no-go areas are hidden.

Principle 3: Residential means non-institutional.

Much as they assist with routines of care, residences are residences. They are ruined by staff stations and institutional touches like vinyl flooring, strip lighting and furniture lined up against the walls.

Residents’ bedrooms must be customisable – meaning people should be able to hang their own art, listen to their own music, and have their own furniture and belongings. After all, these rooms are where people live. And how can people feel at home, unless they are allowed to feel at home with their surroundings?

The left image shows a relatively typical scene in an Australian residential-care facility. The details are institutional – the windows, the lighting, the residents lined up along a wall. The opposite (right) is a residential milieu. Which one would you choose?

Jan Golembiewski, Researcher, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why some nursing homes are better than others at protecting residents and staff from COVID-19

Posted on June 12, 2020June 12, 2020 by Joanna Sun

Life Care Center in Washington state was at the center of the U.S. outbreak back in early March.Photo/Ted S. Warren, CC BY

Anna Amirkhanyan, American University School of Public Affairs; Austin McCrea, American University, and Kenneth J Meier, American University

The coronavirus pandemic has posed a serious threat to the U.S. long-term care industry. A third of all deaths have been nursing home residents or workers – in some states it’s more than half.

Yet some long-term care facilities have managed to keep the virus at bay. For example, veterans’ homes in California have seen only a handful of cases among roughly 2,100 residents. And preliminary results of our research on COVID-19 cases and deaths in nursing homes also support the idea that some homes are doing better than others at protecting clients and staff from COVID-19.

Why might this be?

As scholars of public management, we have found that three factors likely play the biggest role in determining how well a nursing home responds to a disease outbreak: whether it operates for profit, the degree of government regulation and the quality of management.

Profit versus quality care

More than 15,000 nursing homes currently operate in the U.S. Most of them are for-profit facilities backed by private investors, but a small share are operated by nonprofits or government.

For-profit companies selling the same product or service typically perform optimally in what’s known as a perfect market in which there’s plenty of competition and consumers have comprehensive information. More importantly, consumers are able to act on the information.

The nursing home industry, however, is far from a perfect market. Residents – who require constant assistance due to serious physical and cognitive limitations – are often unable to differentiate between good and bad care, advocate for themselves or choose a better facility. Their care is often arranged and paid by others.

As a result, for-profit homes, which are motivated to keep costs low and profits high, tend to be understaffed and, on average, provide lower-quality care compared with public and nonprofit homes.

In contrast, nonprofit and public homes tend to put higher emphasis on patient-centered care and reinvest their profits into better physical spaces, equipment and responsiveness to clients’ needs.

The numbers back this up. Our ongoing research shows that government inspection of for-profit homes found nine violations in an average regulatory inspection cycle, compared with 6.4 at nonprofit homes and 6.8 at government homes. These trends have largely remained constant during the past two decades.

As we examine the data on COVID-19 cases in nursing homes reported by states in real time and link them to the federal data on regulatory violations, we are observing more COVID-19 cases per capita in for-profit than nonprofit or public homes. So far, we’ve looked at homes in Illinois, Nevada, Colorado, South Carolina, Oklahoma and Oregon.

While it is too early to draw firm conclusions, it appears likely that fewer regulatory violations will correlate with success in managing the outbreak.

Government regulation is critical

Federal and state government regulation aimed at protecting residents is another critical factor that influences nursing homes’ ability to combat infection.

All nursing homes that accept Medicare or Medicaid must comply with federal regulations, while states are able to set their own rules for all facilities in addition to the federal minimums. A closer look at the variation among states offers strong evidence that more stringent regulation leads to better care quality.

That is a key finding of our recent study on a voluntary federal program that provides biometric criminal background checks of front-line care workers such as nurses and health care aides. About half of U.S. states have signed on to the National Background Check Program. Nursing homes in those states have fewer deficiencies and higher 5-star ratings.

Staffing requirements in nursing homes are regulated too. We looked at the impact of having more high-skilled nurses on the quality of care in counties hit hard by Hurricane Katrina in 2005. Facilities with a higher share of registered nurses on staff experienced little to no impact on residents’ health outcomes, such as mobility or personal hygiene, as well as on the number of regulatory violations, while most that witnessed significant evacuations saw a large increase in violations and deteriorating health.

The federal government sets a minimum requirement of one registered nurse on staff at least eight hours a day. States are allowed to set their own higher standards – yet even these are considered insufficient by experts.

One key problem is that many state regulations emphasize staffing levels, rather than staffing mix, which means there is little incentive for homes to hire more skilled and expensive personnel. While federal rules issued in 2016 would have strengthened staffing requirements, including one that required homes to have an infection specialist on staff, they have yet to take effect, and the Trump administration has taken steps to weaken them.

Better management

Our research also suggests that management plays a critical role in determining the level of care quality – and ultimately a facility’s ability to withstand COVID-19. Specifically, we have identified several key factors that make a meaningful difference and are certainly worth considering by those looking for a home for their loved one.

For example, nursing home administrators who are more innovative and constantly looking for new ideas tend to run better homes, keep costs lower and address organizational flaws. In addition, homes with managers who have been around for longer periods of time usually deliver better quality of care because this makes it easier to buffer external threats – such as a disease outbreak.

We’ve also found that homes that engage residents and their families and apply their feedback in decision-making boast higher ratings and fewer health violations.

Understanding the pitfalls

Billionaire investor and philanthropist Warren Buffet is credited with saying that it is only when the tide goes out that you discover who has been swimming naked.

COVID-19 seems to be having this kind of effect on nursing homes, exposing which ones were in a better position to handle a pandemic. And that’s why it’s essential for more states that are not publicly sharing their COVID-19 cases or deaths in nursing homes – such as Alaska, Hawaii and Idaho – to begin doing so.

This will allow more research to be done and ensure that the U.S. nursing home industry is adequately prepared for the next pandemic when it inevitably comes.

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Anna Amirkhanyan, Associate Professor of Public Administration and Policy, American University School of Public Affairs; Austin McCrea, Ph.D. Student, American University, and Kenneth J Meier, Distinguished Scholar in Residence Department of Public Administration and Policy, American University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Built Environment

Better design could make mobile devices easier for seniors to use

Posted on April 5, 2020 by Joanna Sun

If all of these devices really work together, they can be a bigger help than any one of them alone. Pro Image Content/Shutterstock.com

Edward Henry Steinfeld, University at Buffalo, The State University of New York

A loud “bing” sounded as we drove onto the highway access ramp. I didn’t see a message on our car’s screen. Was it my phone or my wife’s? Was it a calendar alert, or did one of us receive a text message? Was it the low battery warning on one of our hearing aids? Was it our home security system? Maybe the car needed an oil change or lost tire pressure? Should we stop in heavy traffic or ignore it?

Younger people may take this kind of thing in stride, but it often frustrates us older folks. It’s not our fault, though. The problem is really that these systems require people to adapt to them – rather than adjusting themselves to accommodate what people need and want. And when products share information with each other, they often create unexpected and indecipherable events.

Many current hearing aids can connect to smartphones with Bluetooth. Africa Studio/Shutterstock.com

These situations are particularly interesting to me because I am a design researcher and gerontologist who likes to try out new technologies. Over the past two years, I have used two smartwatches, a mobile phone, two sets of Bluetooth-enabled hearing aids and several Bluetooth-enabled cars. I have found that these devices bring huge benefits that can help compensate for age-related health and function issues. One smartwatch app, for example, can detect if I fall or have an irregular heart rhythm; it may even one day save my life.

Each device is complex in its own right, and trying to use them together in many different settings makes things even more complicated. If technology designers paid more attention to how these gadgets work with each other, they could help customers of all ages – but particularly older people – explore and enjoy greater benefits of mobile computing. They could also help to reduce seniors’ reluctance to purchase new devices that could benefit them.

A litany of confusing encounters

That experience driving with my wife is far from my only confusion about how my many devices are supposed to interact. Other technophiles likely have similar stories, too.

When I got my second smartwatch, which had built-in mobile service, one of the first things I did was try to answer a call. I read the instructions and tried three times, but it didn’t work. When I called the support line, I learned that I had somehow inadvertently activated a “Theater Mode” that turned off call notifications. A tiny blurry icon on my watch face was supposed to alert me that this mode was on, but I’d had no idea what it meant or whether it was important. And, I could barely see it.

The ‘Theater’ mode icon on the watch face, at left, is too small to see with aging eyes. A larger icon, at right, would be better. Screenshot by Edward Henry Steinfeld, CC BY-ND

As a bicycle commuter, I sometimes get phone calls about work while riding. To answer the call on my watch, I would need to release my right-hand grip on the handlebars, reach across and press the “answer call” icon, while looking at the watch to make sure I don’t press cancel by mistake. Then I’d need to regrip the handlebars with my right hand and hold my left wrist close to my head to talk and listen. It is not a good idea to do all this while trying to avoid potholes in an urban street.

I can route phone audio to my hearing aids. This avoids having to hold the phone close to my ear to hear, but it works only when it is relatively quiet around me. When there is lots of background noise, my hearing aids amplify the noise and drown out the phone’s audio signal.

If I get a phone call while driving, there are four places I can direct the call: my car, my smartwatch, my hearing aids or the phone itself. But the phone seems to default to my hearing aids – even my millennial-aged hearing aid supplier cannot figure out why. That choice doesn’t activate the car microphone, though, so I still can’t talk without taking my hands off the steering wheel. I can turn off the hearing aid option, but it requires drilling down six levels on my phone.

The setting controlling which device receives the audio is buried six levels deep in the phone interface. Screenshots by Edward Henry Steinfeld, CC BY-ND

Handling complexity with design

In many ways, advanced technology is inherently complicated: If users want devices that can do incredible things, they need to deal with the complexity required to deliver those services. But the interfaces designers create often make it difficult to manage that complexity well, which confuses and frustrates users, and may even drive some to give up in despair of ever getting the darn things to work right.

Older users may be particularly prone to finding their gadgets exceeding their limits of agility, vision, hearing and cognitive capacity. All the mobile devices I use are reasonably usable by themselves and have accessibility features like interfaces with hearing aids and text magnification. But they’re not really designed to be easily used together.

My vehicle infotainment display shows only the status of the phone, not of other connected devices. Background images and reflections create perceptual clutter. Edward Henry Steinfeld, CC BY-ND

It would be helpful if designers in the mobile technology industry thought broadly about how their devices might be used by a more diverse population, including those with mobility and sensory limits. My co-author and I explored this prospect, and its significance, in a book called “Universal Design, Creating Inclusive Environments.”

Overall, the mobile computing industry could adapt key principles of universal design, a philosophy that seeks to empower all users and enhance all users’ experiences. The best news is that our research shows that designs that work for older people will work that much better for everyone else.

Based on our knowledge, I’d recommend the mobile technology industry improve user experiences by ensuring every connected device with a screen has a personalized dashboard with direct access to all settings. Mobile devices should use a combination of easy-to-perceive icons, text and sound cues (which are coming to be called “earcons”) to give users clear information not just when they are standing still in the middle of the day, but also when they’re outdoors, at night, driving or bicycling.

They should also design accessories to be integrated with other equipment, such as microphones for talking on hearing-aid devices and touch-sensitive controls that could be mounted on walkers, canes and bicycles to avoid the need to release hand grips or divert attention from the path ahead. In addition, device makers should use their gadgets’ sensors to detect when the user is moving and automatically activate hands-free use, including canceling, answering and terminating telephone calls. With manufacturers’ help, more seniors could enjoy the benefits of advanced technology, without the frustrations.

Edward Henry Steinfeld, SUNY Distinguished Professor of Architecture, University at Buffalo, The State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Caregiving, The Built Environment

Green roofs improve the urban environment – so why don’t all buildings have them?

Posted on October 17, 2019October 10, 2019 by Joanna Sun

Green roofs improve the urban environment – so why don’t all buildings have them?

Michael Hardman, University of Salford and Nick Davies, University of Salford

Rooftops covered with grass, vegetable gardens and lush foliage are now a common sight in many cities around the world. More and more private companies and city authorities are investing in green roofs, drawn to their wide-ranging benefits which include savings on energy costs, mitigating the risk from floods, creating habitats for urban wildlife, tackling air pollution and urban heat and even producing food.

A recent report in the UK suggested that the green roof market there is expanding at a rate of 17% each year. The world’s largest rooftop farm will open in Paris in 2020, superseding similar schemes in New York City and Chicago. Stuttgart, in Germany, is thought of as “the green roof capital of Europe”, while Singapore is even installing green roofs on buses.

These increasingly radical urban designs can help cities adapt to the monumental challenges they face, such as access to resources and a lack of green space due to development. But buy-in from city authorities, businesses and other institutions is crucial to ensuring their success – as is research investigating different options to suit the variety of rooftop spaces found in cities.

A growing trend

The UK is relatively new to developing green roofs, and governments and institutions are playing a major role in spreading the practice. London is home to much of the UK’s green roof market, mainly due to forward-thinking policies such as the 2008 London Plan, which paved the way to more than double the area of green roofs in the capital.

Although London has led the way, there are now “living labs” at the Universities of Sheffield and Salford which are helping to establish the precedent elsewhere. The IGNITION project – led by the Greater Manchester Combined Authority – involves the development of a living lab at the University of Salford, with the aim of uncovering ways to convince developers and investors to adopt green roofs.

Ongoing research is showcasing how green roofs can integrate with living walls and sustainable drainage systems on the ground, such as street trees, to better manage water and make the built environment more sustainable.

Research is also demonstrating the social value of green roofs. Doctors are increasingly prescribing time spent gardening outdoors for patients dealiong with anxiety and depression. And research has found that access to even the most basic green spaces can provide a better quality of life for dementia sufferers and help prevent obesity.

An edible roof at Fenway Park, stadium of the Boston Red Sox.
Michael Hardman, Author provided

In North America, green roofs have become mainstream, with a wide array of expansive, accessible and food-producing roofs installed in buildings. Again, city leaders and authorities have helped push the movement forward – only recently, San Francisco created a policy requiring new buildings to have green roofs. Toronto has policies dating from the 1990s, encouraging the development of urban farms on rooftops.

These countries also benefit from having newer buildings, which make it easier to install green roofs. Being able to store and distribute water right across the rooftop is crucial to maintaining the plants on any green roof – especially on “edible roofs” which farm fruit and vegetables. And it’s much easier to create this capacity in newer buildings, which can typically hold greater weight, than retro-fit old ones. Having a stronger roof also makes it easier to grow a greater variety of plants, since the soil can be deeper.

The new normal?

For green roofs to become the norm for new developments, there needs to be buy-in from public authorities and private actors. Those responsible for maintaining buildings may have to acquire new skills, such as landscaping, and in some cases volunteers may be needed to help out. Other considerations include installing drainage paths, meeting health and safety requirements and perhaps allowing access for the public, as well as planning restrictions and disruption from regular ativities in and around the buildings during installation.

To convince investors and developers that installing green roofs is worthwhile, economic arguments are still the most important. The term “natural capital” has been developed to explain the economic value of nature; for example, measuring the money saved by installing natural solutions to protect against flood damage, adapt to climate change or help people lead healthier and happier lives.

As the expertise about green roofs grows, official standards have been developed to ensure that they are designed, built and maintained properly, and function well. Improvements in the science and technology underpinning green roof development have also led to new variations on the concept.

For example, “blue roofs” increase the capacity of buildings to hold water over longer periods of time, rather than drain away quickly – crucial in times of heavier rainfall. There are also combinations of green roofs with solar panels, and “brown roofs” which are wilder in nature and maximise biodiversity.

If the trend continues, it could create new jobs and a more vibrant and sustainable local food economy – alongside many other benefits. There are still barriers to overcome, but the evidence so far indicates that green roofs have the potential to transform cities and help them function sustainably long into the future. The success stories need to be studied and replicated elsewhere, to make green, blue, brown and food-producing roofs the norm in cities around the world.

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Michael Hardman, Senior Lecturer in Urban Geography, University of Salford and Nick Davies, Research Fellow, University of Salford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Caregiving, International Campaigns, Research & Best Practice, The Built Environment

Nursing homes for all: why aged care needs to reflect multicultural Australia

Posted on October 10, 2019October 10, 2019 by Joanna Sun

Do nursing home staff know and respect your cultural background or language? Here’s why that’s important.
from www.shutterstock.com

Helen Rawson, Deakin University

This week, the aged care royal commission looks at diversity in aged care, an issue becoming increasingly relevant to both residents and the staff who care for them.

Diversity includes gender, sexual orientation, religion and social background. The issue is important because if we aim to offer older people and families choice and control in aged care, we must meet the diverse needs of all older people.

Australia’s rich diversity is reflected in its older population. In 2016, more than one-third (37%) of Australians aged 65 and over were born overseas and one-fifth (20%) were born in a non-English speaking country.

These figures have increased continually since 1981, when one-quarter (25%) of older people were born overseas.

Diversity within diversity: culture and language

Culture is important for every person. It indicates a way of life based on customs, beliefs, language and experiences shared with family and a wider community or group.

According to the Federation of Ethnic Communities’ Councils of Australia, many people from culturally and linguistically diverse backgrounds don’t want to move to a nursing home. This is for a number of reasons.

They may not want to be away from family and community, they might speak a different language to staff and other residents, and homes may not understand or meet their individual cultural needs.

Our previous research showed living in an aged care facility could make some older people feel disempowered. Language and cultural diversity can further add to that disempowerment. For the older people we studied, communication, companionship, and staff knowing them as individuals was very important.

Language is particularly important for older people’s physical health and well-being. Many culturally and linguistically diverse older people say they speak English well. However, with age and cognitive decline, they may lose the ability to communicate in English and revert to their first language.

And as more than half of nursing home residents have dementia, with the associated deterioration in language and cognition, communication can be more difficult still.

Appreciating someone’s cultural background can help residents make friends.
from www.shutterstock.com

Being aware of their peer’s culture and language can help residents build relationships with each other, family and staff.

Different cultural expectations and language barriers can create misunderstanding and resident and family dissatisfaction. This can affect residents’ care and quality of life.

How can we support appropriate care?

Aged care needs to be responsive, inclusive and sensitive to a person’s culture, language and spiritual needs. So it is important for nursing homes to understand those needs.

For those who are culturally diverse, government-funded support and culturally specific nursing homes can help. These include services for Greek, Italian, Dutch, Jewish and Chinese older people, reflecting post-war migration.

However, organisations like these cannot meet everyone’s needs. So all residents need care that respects cultural and social differences, works with older people and family, and supports choice.

What might appropriate care look like?

Staff need ongoing cultural competence training to deliver appropriate and supportive care.

Staff cannot know everything about the many cultural and language groups in Australia. They can, however, practise in way that is culturally appropriate, by:

never making assumptions about someone’s culture, heritage, language or individual needs. No two people are the same, even if they are from the same culture and language background
talking to the resident with an interpreter, if needed
learning what is important to the resident. For example, staff could ask family members or close friends to bring in photos or mementos important to the older person
talking with family of residents who are unable to communicate in English to make a list of key words or phrases for staff. This could include how to say “hello”, or how to ask “are you comfortable?”, or “are you in pain?”
making sure the older person isn’t isolated in the nursing home. This could involve working with the local community of the person’s culture, and asking for volunteers who could come and visit the older person.

Family members can be a huge help to staff in understanding the resident’s language, culture and preferences.
Nadya Chetah/Shutterstock

Appropriate and respectful aged care is a human right

Culture and language diversity in aged care is a fundamental human right. Embedding diversity in all aspects of aged care is also recognised by government, and in how the quality of aged care is assessed.

New aged care quality standards, which came into effect this July, include being treated with dignity and respect, with identity, culture and diversity valued, and all residents able to make informed choices about the care and services they receive.

If the outcomes of this royal commission are to benefit Australians now and especially in the future, older people from culturally and linguistically diverse backgrounds must not be an afterthought in the aged care discussion. They must be part of the planning.

Helen Rawson, Senior Research Fellow, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ageing & Culture, Caregiving, International Policies, Research & Best Practice, The Built Environment

Truly smart homes could help dementia patients live independently

Posted on September 26, 2019November 1, 2019 by Joanna Sun

PixOfPop/Shutterstock

Dorothy Monekosso, Leeds Beckett University

You might already have what’s often called a “smart home”, with your lights or music connected to voice-controlled technology such as Alexa or Siri. But when researchers talk about smart homes, we usually mean technologies that use artificial intelligence to learn your habits and automatically adjust your home in response to them. Perhaps the most obvious example of this are thermostats that learn when you are likely to be home and what temperature you prefer, and adjust themselves accordingly without you needing to change the settings.

My colleagues and I are interested in how this kind of true smart home technology could help people with dementia. We hope it could learn to recognise the different domestic activities a dementia sufferer carries out throughout the day and help them with each one. This could even lead up to the introduction of household robots to automatically assist with chores.

The growing number of people with dementia is encouraging care providers to look to technology as a way of supporting human carers and improving patients’ quality of life. In particular, we want to use technology to help people with dementia live more independently for as long as possible.

Dementia affects people’s cognitive abilities (things like perception, learning, memory and problem-solving skills). There are many ways that smart home technology can help with this. It can improve safety by automatically closing doors if they are left open or turning off cookers if they are left unattended. Bed and chair sensors or wearable devices can detect how well someone is sleeping or if they have been inactive for an unusual amount of time.

Lights, TVs and phones can be controlled by voice-activated technology or a pictorial interface for people with memory problems. Appliances such as kettles, fridges and washing machines can be controlled remotely.

People with dementia can also become disoriented, wander and get lost. Sophisticated monitoring systems using radiowaves inside and GPS outside can track people’s movements and raise an alert if they travel outside a certain area.

All of the data from these devices could be fed in to complex artificial intelligence that would automatically learn the typical things people do in the house. This is the classic AI problem of pattern matching (looking for and learning patterns from lots of data). To start with, the computer would build a coarse model of the inhabitants’ daily routines and would then be able to detect when something unusual is happening, such as not getting up or eating at the usual time.

A finer model could then represent the steps in a particular activity such as washing hands or making a cup of tea. Monitoring what the person is doing step by step means that, if they forget halfway through, the system can remind them and help them continue.

The more general model of the daily routine could use innocuous sensors such as those in beds or doors. But for the software to have a more detailed understanding of what is happening in the house you would need cameras and video processing that would be able to detect specific actions such as someone falling over. The downside to these improved models is a loss of privacy.

Future smart homes could include robot carers.
Miriam Doerr Martin Frommherz/Shutterstock

The smart home of the future could also come equipped with a humanoid robot to help with chores. Research in this area is moving at a steady, albeit slow, pace, with Japan taking the lead with nurse robots.

The biggest challenge with robots in the home or care home is that of operating in an unstructured environment. Factory robots can operate with speed and precision because they perform specific, pre-programmed tasks in a purpose-designed space. But the average home is less structured and changes frequently as furniture, objects and people move around. This is a key problem which researchers are investigating using artificial intelligence techniques, such as capturing data from images (computer vision).

Robots don’t just have the potential to help with physical labour either. While most smart home technologies focus on mobility, strength and other physical characteristics, emotional well-being is equally important. A good example is the PARO robot, which looks like a cute toy seal but is designed to provide therapeutic emotional support and comfort.

Understanding interaction

The real smartness in all this technology comes from automatically discovering how the person interacts with their environment in order to provide support at the right moment. If we just built technology to do everything for people then it would actually reduced their independence.

For example, emotion-recognition software could judge someone’s feelings from their expression could adjust the house or suggest activities in response, for example by changing the lighting or encouraging the patient to take some exercise. As the inhabitant’s physical and cognitive decline increases, the smart house would adapt to provide more appropriate support.

There are still many challenges to overcome, from improving the reliability and robustness of sensors, to preventing annoying or disturbing alarms, to making sure the technology is safe from cybercriminals. And for all the technology, there will always be a need for a human in the loop. The technology is intended to complement human carers and must be adapted to individual users. But the potential is there for genuine smart homes to help people with dementia live richer, fuller and hopefully longer lives.

Dorothy Monekosso, Professor of Computer Science, Leeds Beckett University

This article is republished from The Conversation under a Creative Commons license. Read the original article.