Telecare Call Centre Work and Ageing in Place

We report findings from a study of call centre staff working to deliver a telecare service designed to enable older people to ‘age in place’. We show the steps they routinely take to produce a care system on behalf of their clients and their families that is both workable within the constraints of available resources and fit-for-purpose. In doing so, we have seen how call centre staff share with one another their experiences and solutions to problems, carry out liaison work with networks of lay carers, and generally act as the ‘glue’ providing the all-important link between otherwise fragmented services. We conclude with some thoughts on the significant technical and organizational challenges if the ‘ageing in place’ vision is to be realized in a practical, secure, dependable and cost-effective way.     

Developing a pragmatic evaluation of ICTs for older adults with cognitive impairment at scale: the IN LIFE experience

Implementing information and communications technology (ICT) at scale requires evaluation processes to capture the impact on users as well as the infrastructure into which it is being introduced. For older adults living with cognitive impairment, this requires evaluation that can accommodate different levels of cognitive impairment, alongside input from family and formal caregivers, plus stakeholder organisations. The European Horizon 2020 project INdependent LIving support Functions for the Elderly (IN LIFE) set out to integrate 17 technologies into a single digital platform for older people living with cognitive impairment plus their families, care providers and stakeholders. The IN LIFE evaluation took place across six national pilot sites to examine a number of variables including impact on the users, user acceptance of the individual services and the overall platform, plus the economic case for the IN LIFE platform. The results confirmed the interest and need among older adults, family caregivers, formal caregivers and stakeholders, for information and communications technology (ICT). Relative to the baseline, quality of life improved and cognition stabilised; however, there was an overall reluctance to pay for the platform. The findings provide insights into existing barriers and challenges for adoption of ICT for older people living with cognitive impairment.

     

Marginalised Care: Migrant Workers Caring for Older People in Ireland

Older adult care in Ireland is a mix of public, private, voluntary and family provision. This model is characterised by deficient funding and support structures for both care recipients and carers, leading ultimately to fragmented service delivery, both in the community and in residential care. Against this backdrop, there has been a significant and rapid growth in the number of migrant registered nurses and care assistants providing care to Irish older people. With two potentially marginalised groups now at the centre of the caring relationship, questions arise regarding the sustainability of quality of care and quality of life for both providers and recipients of care. This research study draws on the perspectives of the older person, the migrant carer and the employer to develop an understanding of migrant worker care provision within the disadvantaged ageing sector in Ireland. The paper will frame migrant care workers’ experiences within the perspective of a marginalised sector, whose central consumers, older people, are not prioritised in policy or practice. Providing evidence of disadvantage for older adults and migrant carers, the research findings demonstrate that it is necessary to improve caring experiences and conditions for both groups if quality of care is to be enhanced.     

Self-Care Technologies and Collaboration

The self-management of a chronic condition is a collaborative activity, performed by patients and carers. However, to date, self-care technologies have been mostly designed for individual use. This article uses a case study of people living with Parkinson’s disease to (a) illustrate how patients and carers collaborate in self-management, (b) discuss the reasons why self-care technology is designed for individual use, and (c) explore the implications of recognizing collaborations for the design of self-care technologies. This work is based on a qualitative study with interviews and observations with people living with Parkinson’s. The analysis illustrates how people living with Parkinson’s collaborate in self-care to build a good life. In particular, it exemplifies how the complex interplay of actions and of patients and carers enables the different self-care activities to take place. To further integrate self-care technology in everyday life, designers need to consider collaborations when studying the context, conceptualizing a technology, and planning an evaluation.     

Innovation as Improvisation ‘In The Shadow’

In this article, we explore processes of innovation – which are inherently uncertain – from a complexity perspective, in which they are understood as new patterns of experiences as they emerge in human conversational interaction. We reflect on local interactions between people involved in emerging processes of innovation, with a particular emphasis on the improvisational nature of interaction. Through an abductive approach, by iterating actual experiences and our understanding of them, we show that such processes are collective efforts that take place as informal, highly improvised conversations — happening ‘below the radar’ — which may unpredictably offer windows of opportunity to enable change. We show that innovation often emerges as ‘shadow themes’, experienced as subversive by those involved in the moments of interaction. While these themes are embedded in informal conversations and processes, they can be induced by invitations – conscious or unconscious moves that encourage those involved to make spontaneous moves together in a mutually improvised context. Our experience shows that the emergence of shadow themes can have a long‐term impact on the organization and the people involved, and that managers may be ‘in charge but not in control’ of such innovation processes.     

Lessons learned in deploying independent living technologies to older adults’ homes

Independent living technologies are fast gaining interest within both academia and industry, amid the realization that the world’s population is ageing. Technology can increase the quality of life of older people, allowing them to age-in-place and helping them to remain physically, cognitively and socially engaged with their environment. However, little research in this area is applied. The paper argues for the necessity of moving such technology out of the research laboratory and into the home, where its real impact on the lives of older adults can be assessed. Moreover, a series of recommendations are outlined, encompassing the life cycle of independent living technologies, from ethnographic assessment, through to design, deployment and evaluation. This work is based on lessons learned in deploying such technologies to older people in over 200 homes. This paper can act as a guide for other researchers interested in developing technologies with older people.     

‘I Work With my Heart’: Experiences of Migrant Care Workers in a Northern,Rural Context

In Norway, long-term care needs are rising rapidly. Due to the dual-earner family model and the fact that many people live far away from frail parents and other dependent family members, the growing care needs may not be met through informal care. Through the Nordic welfare system, formal care services are provided to all citizens in need of care, regardless of their age, income or family relations. Since the 1990s, however, Norway has experienced a shortage of healthcare personnel. In this ‘care deficit’ situation, skilled immigrants play an increasingly important role. To date, the international literature has examined the experiences of the professional migrant care workers in a limited way. In particular, there is a lack of knowledge of this issue in rural contexts where recruitment challenges may be even more pronounced than in urban areas. This article addresses this knowledge gap by examining the spatial and relational experiences of skilled migrants working in the healthcare sector in Finnmark, northernmost Norway. In this study, the informants share largely positive experiences, stating that their care services are highly valued and that caring provides them with a sense of joy and mastery. Moreover, they talk about the importance of establishing trust in the relationship with their users and note that some patients end up becoming almost like family members. The migrants’ relationships with colleagues and management at the workplace are also defined by mainly positive feelings, trust and respect. Caring is hence perceived by the migrants as an inherently sense-making practice.     

Respite and the Internet: Accessing care for older adults in the 21st Century

Contrary to popular belief, fewer numbers of older adults today are living in extended care facilities (ECFs) and other institutional settings. Rather, adult children, adult grandchildren, and aged spouses prefer the home setting as the environment in which to provide care to older adult family members. Benefits exist with regard to the provision of care within the home setting; however, tremendous stress may be placed upon these informal caregiving systems as family members find themselves with little time for activities other than those related to the provision of care. Respite care is invaluable in alleviating and preventing the physical and psychological depletion associated with caregiving by granting family members the opportunity to relinquish temporarily the demands of providing care for someone on a continual basis. As a means of connecting family members to sources of respite care and related services, the Internet possesses significant potential. Without ever leaving the home environment and the older adult care recipient(s), family members can utilize the Internet to access information about respite care services.     

Evaluating the Use of Daily Care Notes Software for Older People with Dementia

There has been little research to investigate the impact of software to support the care for older people with dementia care. This article reports the evaluation of software adapted to support one key person-centered task for the care of older residents with dementia – recording and sharing daily care notes. The evaluation on the dementia wing of 1 residential home for over 6 months revealed that use of the software on mobile devices carried by the carers increased the number and volume of daily care notes recorded, but only for the types of content that were already being recorded by carers. Carers reported more advantages that resulted from daily care notes once in digital form than from the documenting task, as well as barriers to the use of mobile digital software to record daily care notes.     

Active Ageing,Pensions and Retirement in the UK

The ageing population has led to increasing concerns about pensions and their future sustainability. Much of the dominant policy discourse around ageing and pension provision over the last decade has focussed on postponing retirement and prolonging employment. These measures are central to productive notions of ‘active ageing’. Initially the paper briefly sets out the pension developments in the UK. Then it introduces active ageing and active ageing policy, exploring its implications for UK pension provision. It demonstrates that a more comprehensive active ageing framework, which incorporates a life-course perspective, has the potential to assist the UK to respond to the challenges of an ageing population. In doing so it needs to highlight older people as an economic and social resource, and reduce barriers to older people’s participation in society.     

Between Elderly Parents and Grandchildren—Geographic Proximity and Trends in Four-Generation Families

In an ageing society, families may have an important role in the caretaking and well-being of the elderly. Demographic changes have an impact on the size and structure of families; one aspect is how intergenerational support is distributed when there is a need for support to both older and younger generations at the same time. Another vital aspect of the provision of care for the elderly is geographic proximity. This study is oriented towards the potential “both-end carers” i.e. persons who have grandchildren in potential need of care while still having living ageing parents. The incidence of having grandchildren and having living parents at age 55 and the proximity between generations is described using Swedish register data. The results show that the share of 55-year-olds who are grandparents decreased dramatically from 70% to 35% between 1990 and 2005. As expected, more 55-year-olds have living parents—a proportion that increased from 37% to 47% during this period. As a result of delayed childbearing among the children of these cohorts, the likelihood of belonging to a four-generation family among 55-year-olds has not increased, despite increased longevity. Furthermore, most individuals live within daily reach of their kin and no evidence was found of a trend of increasing geographic distances between generations.     

Awareness and handoffs in home care: coordination among informal caregivers

Informal caregivers, such as family members and friends, are important for maintaining the health and wellness of the elderly and the chronically ill. However, the complexity of informal caregiving has been under-studied in prior research. In this study, we attempt to answer two main questions – what makes the coordination of patient care so difficult among multiple informal caregivers, and what are the challenges that should be considered in designing technologies to facilitate informal care coordination? To answer these questions, we conducted a qualitative interview study with 15 individuals with caregiving experience. The findings of the study identified the main challenges faced by caregivers in maintaining awareness, coordinating handoffs among informal caregivers, and easing tensions among caregivers and patients. These findings revealed considerations unique for informal caregiver coordination, and helped inform the design of technologies to support the care coordination.     

RFID-based indoor location tracking to ensure the safety of the elderly in smart home environments

In recent years, the number of elderly people living alone has grown rapidly. This increases the need for indoor healthcare services that help elderly residents live a safe and independent life. There has been increasing interest in indoor ubiquitous healthcare (U-Healthcare) applications that monitor the elderly unobtrusively via sensors and that warn them or healthcare providers of abnormal conditions. In U-Healthcare applications, automatically locating and tracking users who move around a building is a fundamental feature. Outdoor location sensing technologies such as the global positioning systems are not suitable for use in indoor environments, such as “smart home” applications, because their indoor-based location sensing lacks accuracy. This paper proposes an indoor U-Healthcare system that uses radio-frequency identification technology to accurately locate and track the elderly. The proposed system provides real-time monitoring of elderly people’s whereabouts. In addition, it analyzes their locations in association with time slots and the length of time they stay in the same place, thus inferring information such as movement patterns, ranges, and frequencies. This information is used to determine elderly people’s well-being and to warn family or healthcare workers of any potential problems. The proposed indoor U-Healthcare system improves the quality and convenience of care delivered to elderly people.     

Informal learning recognition through a cloud ecosystem

Learning and teaching processes, like all human activities, can be mediated through the use of tools. Information and communication technologies are now widespread within education. Their use in the daily life of teachers and learners affords engagement with educational activities at any place and time and not necessarily linked to an institution or a certificate. In the absence of formal certification, learning under these circumstances is known as informal learning. Despite the lack of certification, learning with technology in this way presents opportunities to gather information about and present new ways of exploiting an individual’s learning. Cloud technologies provide ways to achieve this through new architectures, methodologies, and workflows that facilitate semantic tagging, recognition, and acknowledgment of informal learning activities. The transparency and accessibility of cloud services mean that institutions and learners can exploit existing knowledge to their mutual benefit. The TRAILER project facilitates this aim by providing a technological framework using cloud services, a workflow, and a methodology. The services facilitate the exchange of information and knowledge associated with informal learning activities ranging from the use of social software through widgets, computer gaming, and remote laboratory experiments. Data from these activities are shared among institutions, learners, and workers. The project demonstrates the possibility of gathering information related to informal learning activities independently of the context or tools used to carry them out.     

Measuring and Managing Bodies in the Later Life Course

With increasing longevity and the medicalization of the life course in countries with developed health and welfare systems, measurements have become more important for managing ageing bodies. This review article emphasizes the importance of the ‘meso-level’of social interaction, where people are involved with others in using numbers to deal with older bodies. It considers three kinds of measurement: the quantification of biological values for purposes of treatment; the assessment of functionality in order to determine the need for care services and training; and the use of measuring devices to track and manage health at home. Ethnographic methods are well suited for exploring the social uses of numbers and to the appreciation of diversity in those uses. They show that the overall trend towards increasing quantification takes different forms for different people and purposes. Because they abstract and objectify, numbers can facilitate reflection and communication. In practice, they may be interpreted differently by different actors. The review concludes with suggestions for further research on the uses of measurement for managing bodies and people in the later life course.     

Remote electronic voting systems: an exploration of voters' perceptions and intention to use

Coupling telephone and web interfaces with computers for balloting outside the polling place, remote electronic voting systems (REVS) give the voter a choice: polling booth, absentee ballot, or remote voting. Not only does this e-Government technology raises issues such as security, voter participation, and accessibility, REVS technologies themselves differ in features and enabling conditions. How users (voters) perceive REVS's availability, mobility, accuracy, privacy protection, and ease of use, is likely to affect their use intention. Intention to use or not to use a voting technology can translate into a decision to vote or not – and there are no ‘do-overs’. We develop a model and report on a survey of potential voters – people waiting to be impaneled on a jury – in regard to the impact of REVS characteristics on voting intentions and how the two most discussed REVS technologies of telephone- and web-based interfaces are perceived.     

Little brother: could and should wearable computing technologies be applied to reducing older people’s fear of crime?

This paper considers whether emerging wearable computing technologies could and should be applied to reducing older people’s fear of crime. The paper begins by exploring the sociological and criminological literature, which debates why older people are most likely to fear crime, even though they are least likely to be victims. It goes on to report findings from ethnographic studies of key care and social service professionals in an English city. This field work reflects the ways in which assistive technologies for older people can function as signs of vulnerability, and also reports the uses of relatively simple information and communication technologies in providing critical backup and reassurance for elderly users. The fear of crime is then considered as an information problem centring on three questions: what’s going on, what can I do about it and can I get help? Possible applications of emerging wearable surveillance technologies are then explored through a design concept called the Cambadge. This is a wearable, wireless webcam for older people to broadcast video and audio data to police or community Web sites. This concept is situated with reference to a company developing a similar technology and to related fields. It is argued that the design problems of such surveillance technology are inherently political. The case is made with reference to the history and philosophy of surveillance and the massive demographic shifts of the ageing population. It is argued that utopian visions of the uses of such technology under-theorise power and accountability. The paper concludes that technological innovations will not adequately address older people’s fear of crime without accompanying social and cultural change.     

Ageing, Demand for Care and the Role of Migrant Care Workers in the UK

In recent decades, rapid population ageing has dramatically increased the need for older adult care provision in the UK. A prominent role in meeting the care needs of the older population has been played by migrant workers. The aim of this paper is to explore the characteristics of the UK social care system that shape demand for migrant labour, the conditions under which migrant care workers are employed, and older people’s and migrant care workers’ experiences of the quality of care. Our analysis draws on the findings of a survey of providers of social care for older people, in-depth interviews with migrant care workers, and focus groups with older people. The findings show that the underfunding of social care and interrelated workforce shortages are largely responsible for the extensive reliance on migrant workers among social care providers, and raise concerns for workforce inequalities and for the quality of care.     

“What do they snapchat about?” Patterns of use in time-limited instant messaging service

The use of Snapchat – a time-limited instant messaging service – has been rapidly rising amongst adolescents. However, the exact nature of Snapchat use remains difficult to examine due to the self-destructive nature of content sent and received via this service. We report an online survey conducted with the use of a memory sampling method to enquire about the specific details of the very last image or video each participant sent and received via Snapchat. We found that users mainly share ‘selfies’, typically embed text and ‘doodles’ with photos they share, use it mostly at home, and primarily for communication with close friends and family as an ‘easier and funnier’ alternative to other instant messaging services. We also found that high intensity of Snapchat use was more associated with bonding rather than bridging social capital. We discuss those findings in the context of existing studies on the use of instant messaging services and social networking sites.     

Mobile manipulators for assisted living in residential settings

We describe a methodology for creating new technologies for assisted living in residential environments. The number of eldercare clients is expected to grow dramatically over the next decade as the baby boom generation approaches 65 years of age. The UMass/Smith ASSIST framework aims to alleviate the strain on centralized medical providers and community services as their clientele grow, reduce the delays in service, support independent living, and therefore, improve the quality of life for the up-coming elder population. We propose a closed loop methodology wherein innovative technical systems are field tested in assisted care facilities and analyzed by social scientists to create and refine residential systems for independent living. Our goal is to create technology that is embraced by clients, supports efficient delivery of support services, and facilitates social interactions with family and friends. We introduce a series of technologies that are currently under evaluation based on a distributed sensor network and a unique mobile manipulator (MM) concept. The mobile manipulator provides client services and serves as an embodied interface for remote service providers. As a result, a wide range of cost-effective eldercare applications can be devised, several of which are introduced in this paper. We illustrate tools for social interfaces, interfaces for community service and medical providers, and the capacity for autonomous assistance in the activities of daily living. These projects and others are being considered for field testing in the next cycle of ASSIST technology development.