third session adapting home to the needs of older … · technologies – casa@adatta” has this...

CIB Working Group 84 “Building Comfortable Environments for All”

Meeting ACCESSIBILITY AND SAFETY FOR ALL PTE-Expo Verona, Italy

22 March 2006

THIRD SESSION ADAPTING HOME TO THE NEEDS OF OLDER PEOPLE BY THE AID OF TECHNOLOGIES Giuseppe Ceresi, Regional Institute of Studies and Social Research of Trento, [email protected] Michela Chiogna, CunEdI, University of Trento, [email protected] Key words: method, assistive technologies, smart home technologies, architectural barriers Abstract The number of persons with motor, cognitive or sensitive disabilities is increasing in Trentino as in Italy. This fact is associated with the constant growth of the persons with an age over 65. This trend induces the welfare state and social policies to respond promptly to the challenge of the demographic ageing. Smart home and information and communication technology (ICT) is expected to assist growing groups of senior citizens if help is required for independent living at home. The project “Adapting the home to the needs of old people by the aid of the technologies – Casa@adatta” has this general goal: the experimentation of smart and assistive technologies to improve the home living, the autonomy possibilities and the level of life quality for the elderly people living in their home. The design of assistive and smart home technologies may provide a new set of circumstances in order to adopt use-related methods and tools, i.e. specifically interdisciplinary requirement user analysis and the user involvement (Participatory design). Research focused on the user-related methods and tools for smart home design is still in progress. This model should be adopted in the future. The elderly people requires do not fit only their own needs but also the needs of the people that have a family relationship with them, or take care of them. This paper will summarise the results of few case. Introduction The XXI century is characterized by a progressive ageing of the population and by the change of the age structure, both at an European level (the 65-years-old should pass from the 14.7% in 2000 to the 19.4% in 2020) and at a national level (in Italy we should pass from the actual 18.2% to the 33.% previewed for the 2041). The demographic structure evolution of the population in Trentino Alto Adige keeps up with the same progression. In this context we set the new experimentations in progress in order to improve the safety, the security, the autonomy and the social inclusion of disabled and elderly people through new and differentiated applications of smart home technologies. The adaptation of the dwellings to the needs of elderly and disabled people through an



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integrated and unitary design, represents a measure to support the live at home. This praxis is still in an experimental and validation phase. This approach should be mostly improved and it is added to other measures already practiced: the education of care givers, the develop of day-care services and of the medical territorial services, and so on. At a national context, the Trentino region is putting itself up for the realisation and the experimentation of innovative solutions in the field of telecare and of the ambient assisted living. In these last years the ICT (Information and Communication Technology) has been identified by the Autonomous Province of Trento as one of the possible instrument for the public spending reduction in the sector of assistant services. Therefore the public administration is rewarding with public funding these projects. In this context we set Casa@datta, a project promoted e coordinated by the Regional Institute of Studies and Social Research of Trento. The committee of the project was the Autonomous Province of Trento, through the Servizio Rapporti Comunitari 1 METHOD The experimentation is founded on a bio-psycho-social model, indicated by OMS (World Health Oranization) in the International Classification of Functioning (ICF). It is characterized by a socio-technical approach, i.e. oriented to the consideration of the social and technical factors in a integrated way. It means that human factors (persons, family net, care givers), technical factors (dwelling, technologies, devices, instruments, etc.) and organizational issues (social services, sanitary services, etc.) play together a role in the processes and in the phenomena of the project. The operative model is based on the development of a clinic-ethnographic method. It will be able to stress the project requirements that come out from the point of view and the real live conditions of the users. In this way the appropriate comprehension of the final users needs and preferences will be possible. In order to gather useful information for the project, documentary and cultural probes are used such as: medical diagnosis, clinic prescriptions (capacities analysis according to the clinical diagnosis), analysis and evaluation documents according to the social context (family net, mapping of domestic roles, to apply assistive technologies, rehabilitation services, day-care, treatments, economic resources, legislative procedures, etc.), indication about activity daily living analysis and domestic practices (people way of life, conditions and material context, usual activities at home, participation in the social live), dwelling plans, system plans, pictures. Their information is completed trough domiciliary visits, direct observations, qualitative demonstrations and contextual interviews. The designers take part in these steps. This process is useful in order to clarify the disability and ageing level, i.e. the effective context where it is realized. The method includes also the users collaboration, in order to explain the meaning that the project could and should give to their life. The users themselves are encouraged to



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consider and to think over their personal and family situation, as well as their daily living conditions. In this way it will be possible to identify preferences, needs and aspirations in order to support the designers and the project. Each report (texts, pictures, users considerations) is a resource for the staff that analyze it together. The discussion, the comparison of different opinions and the dialog enable the project ideas, suggestions and improvements about the plan and the installation of technological devices. The members of the staff can express freely, intuitively and without restrictions the contribution of their sensibility, creativity and professional experience. The roles, the tasks and the competences are assigned during these discussions. In particular, the case manager is designated according to the personal attitudes and/or the previous relationship with the user. The case manager plays the role of mediation and reference point between the user and the designers/researchers of the staff.



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Figure 1. Cultural and documentary probes of the staff The emergent needs and the local preferences are selected on the basis of these considerations in order to share project goals and to individuate actions and technological devices, appropriate for the context of the users. The dialog and the negotiation are essential and indispensable to the project process to make arrangements for the first version of the project (project hypothesis)



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Figure 2: meeting of the interdisciplinary staff The first version of the project is presented and discussed after the staff work with the final users in future meetings. They are organized and led by the case manager, that is previously identified for each single user. The main goal of the meetings is the co-definition of the project solution in order to fit the aspirations and the needs of the user ( shared project hypothesis). The project model introduction becomes an additional adaptation tool for the next meeting. The reports, structured in graphic or descriptive/written form, and also the result of the conversation with the user are examined in order to adapt the home (technical re-analysis).



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Figure 3. Plan of final project including technical device, assistive technologies and barrier free solutions This phase is necessary to define what’s to preserve, what’s to include or to modify in the final project solution. This final version is formalized with a contract signed by the user. 2 RESULTS The experimentation focused in particular on the realisation of five case studies. These projects are based on the needs analysis of disabled and elderly people. The 5 developed cases have been selected from a shortlist of 30 potential users, indicated by the social services of the district (they were included already in the assistant net), and by the local medical services (medical officer and district medical services). Each of the 30 cases has been examined with the cultural and documentary probes. These tools have been used to verify the compatibility of the project goals. The different criteria of the selection, discussed during the work steps, have been gathered in a guideline report. The 5 cases study of the experimentation will be described in the following chapters. They stress also the fragility of the elderly users. Case 5 Two sisters, that are over 90, live together in the same dwelling autonomously. They have hypoacusis problems and they assist one other in the daily life. One is born deaf,



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therefore she is 100 percent disabled. The other became deaf during the ageing, but her illness is not so serious as the one of the sister. A son live with his family in another apartment of the same building. The project focused on the safety and security of the house with reference to the deaf of the elderly women. In order to communicate with the outside world, technical devices have been installed (visual signals to indicate the sound of the outdoor bell and of the telephone ring). Moreover a visual alarm has been used also to warn up the users in case of danger. In order to communicate failure or equipment malfunction detected in the dwelling, different alarm systems have been located in each room according to the functional. In the kitchen there are different alarms visible on the television screen. In the bathroom there is an alarm light, in the bedroom light signal adapt to be sensed also during the sleep is installed. Moreover in order to warn of the alarm situations the son who lives in the upper dwelling, an emergency call system has been projected to open the communication between the two apartments. This system enables to speak in-person from each room, in which the disable is. This solution improves the family net. Other solutions added in the project are the external lighting improvement and the external architectural barriers elimination.

Figure 4. Architectural barrier in bathroom, at storage door, at entrance door Case 6 The specific characteristic of this case study is connected basically to the motor disabilities of the final user, that is a woman who lives alone in her dwelling. Different solutions to design a barrier-free apartment have been found. As first, in order to make able the woman to go out autonomously, a suitable technical solution has been installed: it is an external elevator. In order to make accessible and usable the garden, additional solutions have been introduced, such as flowerbeds lifted form the ground. In order to aid the upper limbs weakness, the taps and cooker have been changed.



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At last, in order to adapt the house to the woman remaining abilities, assistive technologies and smart devices have been installed: the shatters have been regulated automatically by the bus system (by command buttons or remote control); the entry-phone images have been visualized on the television screen supporting the partially blindness; specific detectors have been installed in every room detecting equipment malfunction. Also for this case study, the commissioning of a communication and alarm system has been programmed, with the aim to connect the relatives living in the same building with each room of the disable woman dwelling. Case 7 This family unit is composed by three persons: a woman, 70 years old, 75 per cent disable, affected by asthma and arthrosis (she is limited in the daily activities and in the mobility into the dwelling); her husband, always present at home, able to support the woman for the house management and for her personal hygiene; the partially signed son, who would live autonomously with the girl friend in an independent dwelling. After a careful analysis, the staff did not evaluate this case adequate for the project criteria requirements, so that they did not proceed in the project development. The main cause was the transitory pathology of the woman, the secondary the constant husband presence, who has not any health problem. Caso 10 Marina is 75 years old and she is affected by linfedema from a long time. This pathology influences the upper limbs motion and causes deambulation problems. Marina can not go up and down the stairs and can not have an upright bearing continuously as well. She can have only a partially autonomous life. Her husband assisted the woman to do almost every daily needs, even if he was over 75. On that basis the staff designed a specific project hypothesis, focused to aid the assistance relationship between the husband, introducing smart technology solutions and assistive technologies. In first place was considered the need of the woman to go out autonomously. For this reason a stair lift has been adopted. The living room re-functionality has been designed using safety devices and changing only in the least the present furniture (a chair-bed, a touch panel usable from the chair-bed to control entry-phone, lights, in-person communication and connection with social service). The staff was about to start the project realisation, when the husband suddenly had a serious ill, so that he can no more help his wife. She has been moved to a nursing home for elderly people. In this institution the woman receives the assistance and the care that were given before by her husband at home. Because of the aggravation of the husband sickness and his subsequent death, the life condition of the family has been changed completely and irreparably. In this new social and familiar context, adapting the home would be no more an efficient solution to support the woman autonomous living in her dwelling.



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Figure 5. Stove and electrical cooker, inaccessible stair, heavy shutters Case 14 This family context is very complex because of the different illness problems of two members of the family: the grandmother, over 80, confused and no more clear-headed because of the Alzheimer; her daughter, with serious scoliosis problems, always bedridden and completely dependent on the artificial ventilation. Her son and an assistant live in the same dwelling. The first project goal was to improve the safety and security systems of the house, in order to prevent improper and dangerous uses of domestic appliances by the old woman. Therefore a security system inside and outside has been installed (double camera to verify the guest identity both at the building outdoor and the apartment entrance door; the possibility to open the entrance door from the bed with a remote control system). In order to aid the autonomy of the disable women in the bed, other smart devices have been included in particular in her bedroom: speakers to communicate with every room, touch panel accessible from the bed to control telephone, shatter, guest identification, entrance door, social service and lights, with also cromo-therapy function.



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Figure 6. Smoke and gas detector Discussion and conclusions In addition to the technological solutions explained above, an operative method has been developed. In particular an interdisciplinary and participatory design method has been adopted both in the analysis phase of use needs and in the evaluation phase of technical solutions. An experts staff has been constituted, with medical, social, technological and building competences. At the moment the experimentation can not be considered concluded, because the projects have been realized only recently. The impact on the daily life of the final users (not only the elderly people, but also care givers and social and medical operators) should be still evaluated as well. The main user need is to reduce the architectural barriers for his independent living at home. This proves that is absolutely necessary to adopt architectural barrier free solutions and ergonomic solutions in order to guarantee spaces and objects usability. In order to stress the meaningful aspects of the research, the auto evaluation carried out up to now is useful. • The multi-professional and inter-professional staff work is necessary , to have a better overview of the elderly or disable people condition and more resources for the design complexity. Furthermore the staff work integrates different solutions (building, technological, medical, psycho-social solutions) to improve the ambient living availability. • The understanding of elderly and disable people domestic needs is still limited and design that take these needs into account is not as wide spread as it should be. • The research about user-related methods and tools for smart home design is recent and must be undertaken in the future, including the involving users in the development of the process of design



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• Older people requires design to fit not only their own needs but also the needs of those who are close to, or take care of them. The project solutions should enhance the quality of life, not only for the older or disable persons, but also it has to be considered an improvement of the care processes not an alternative proposal. • The frailty of the elderly people and of his family can be a risk factor, even a crack risk, for the final design solutions. That means that the requirements and the aims project should be changeable and flexible. • The staff felt the need to have available dwelling prototypes and centres of technical aids, as learning and demonstrative tools. In fact the project itself is a learning and empowerment process. • Formal or informal care services, architectural and technological issues are essential to appropriate design. Nevertheless, older people are a wide and heterogeneous group and design must be always person centred. • Safety and security devices adopted in the project solutions must be integrated into a broader community alarm services, involving various aspects of social or medical support. Concluding, in order to pass the experimental character of the project and to reach a institutional model of integrated design for vulnerable older or disable people in the community, it is necessary an interdisciplinary staff work directly provided by local authorities or other formal service agencies.

third session adapting home to the needs of older … · technologies – casa@adatta” has this...

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