Smart Home Tech to Support People’s Needs

I had the pleasure of chairing the fifth in The Institution of Engineering and Technology’s (IET) series on Healthy Living and Housing.  The focus for this session was on smart home tech to support people’s needs.

You can access the session by clicking the link here and registering to watch on demand.

Speakers for this session included:

• Alisa Frik, Research Scientist, International Computer Science Institute; Postdoctoral Fellow for Berkeley Laboratory for Usable and Experimental Security
• Nuno Almeida, Founder, Nourish Care
• Philip Shelton, Principal Advisor (Commercial), Eastern Academic Health Science Network

Perspectives on privacy and security

Alisa discussed older people’s perspectives on privacy and security. This included reference to how older people make decisions about privacy and security with respect to smart home devices.

What we know is that at present, much of the adoption of smart home tech is driven by older people’s children, and care providers, to support care needs. And it remains the case that a high proportion of older adults don’t have access to the internet.

Alisa noted that older people often express concerns about privacy and security in relation to technology. It’s important to note that privacy preferences are unique to individuals and vary widely. A challenge can be that while older adults are concerned about privacy and security, they can be less aware and more at risk from privacy and security threats. Despite this, older adults are underrepresented in security research. For Alisa, the goal here needs to be to design effective systems that empower older adults to make informed decisions about privacy, security and information sharing; to have better control over their personal data; and to maintain better security practices.

It was also pointed out that some older people also have misconceptions about data flows. This is a particular concern given the use of smart phones and growing usage of sensor-based and AI technologies. For example, as one respondent noted, ‘I don’t see my phone capturing my data, unless—what I enter.’ What this points to is the real need for data collection, storing, and sharing, to be made clear and transparent for tech users.

Tech also needs to be considered as specific to needs, including those who may have experienced declining physical and/or cognitive abilities. For example, some may have issues with remembering strong passwords, others with reading small privacy text, or identifying phishing attacks. Key here is to improve accessibility and usability of systems through engaging a range of older adults in usability research. Insights gained can benefit older people as well as other tech users.

It is also important to consider that older adults can sometimes face difficult trade-offs between privacy, safety, and autonomy. For example, while monitoring of health conditions can support ‘ageing in place’, there can be a trade-off between care, safety, privacy and independence.  This is why it is crucial to design systems that respect older adults’ privacy, preferences, and choices regarding information collection, sharing, and use, and for these to be considered as context dependent.  Alisa is in the process of developing and testing a set of prompts, for example cards, to be used in workshops and assessments of prototypes by designers and developers.

Creating an operating system for care teams

Nuno’s background is in engineering. He began by discussing what brought him into the care sector and to establish Nourish Care. Nourish is a software system that records data at the point of care and can save time and support more accurate notetaking. It also provides live information that ensures managers are kept up-to-date and can make informed decisions.

The ageing population is the most important demographic trend. From 2007 to 2032, it’s expected that there will be an 86% increase in the numbers of people in care homes. In line with this we’re seeing baseline growth every year. But here we also have an incredibly diverse population.

Care is a highly regulated sector with an array of offerings, from residential care homes, dementia care, in home support and so on. With this comes a high level of scrutiny with the expectation that every evaluation, every plan, every decision taken, is recorded and logged for demonstrating good practice and reporting and supporting audits. And this needs to be done in compliance with information governance rules for personal information.

Funding is secured through a variety of sources – NHS England for clinical commissioning, from local authorities for social care funding, and funding provided by individuals themselves. And it’s a critical sector that is under considerable financial pressure. The increases pressures and costs in other areas including to the NHS. Between 2012 and 2016, there was a 70% increase in beds needed in acute care settings largely due to the challenges with social care funding.

During volunteering in the care sector, Nuno identified a key challenge where tech can play an integral role – in supporting care workers and improving the quality of care through accurate record keeping. For individuals or families managing care, it can be dauntingly complex. Nuno looked at how this could be improved, namely through a focus on the user, including carers as users of tech.

Through research, the team found that the lack of user centred design was the main barrier to the adoption of tech in the care sector. And this remains a problem. Eighty percent of care homes still use paper based systems which can lead to poor outcomes.

To develop the product, they used an open process of expressing what they were trying to achieve and inviting people to become part of that journey. Co-production continues with a strong focus on user experience.

Smart home tech and healthy ageing

Philip spoke about healthy ageing and the importance of ensuring solutions are contextualised. He currently works at the Eastern Academic Health Science Network (EAHSN) ). Their focus is on turning great ideas into positive impact. They work with local innovators and across the system, bringing together NHS England, Public Health England, NHS providers and others. The EAHSN is part of a wider national network across England.

The focus of much of the work of the EAHSN is on mental health, cancers, rare diseases and personalised medicines, underpinned by a focus on living and ageing well. This point about ageing well has become more prominent, driven very much by the needs of the ageing population.

On smart home tech, the key to successful delivery is setting up an ecosystem within the specific context. Factors to be considered include health needs, healthy ageing, the wider determinants of wellbeing, and health inequalities; and what’s going to work effectively in a particular system.

When he was at Philip’s, he got involved in the healthy ageing challenge and related pilots in Manchester. And the scale of the challenge? There is a significant need to meet the needs of an ageing population – currently over 75s are about 1 in 12 of the population, with this rising to 1 in 7 by 2040. With this comes challenges to the delivery of health services. But there is also a real opportunity for businesses and researchers to come together to address this.

The ambition of the Ageing Grand Challenge is for people to have an additional five years of healthy living, enable people to work for longer, and to narrow health inequalities. What is clear is that the model for ageing has changed – with people working longer and different models for retirement. The system needs to support and enable this to happen.

In Manchester they looked at this challenge from a number of different angles and put together a value based system. They brought together a multidisciplinary team at a Population Health Management (PHM) level. Using a PHM approach made it possible to direct programmes and interventions where they were most needed. Underlying this was the value based care model which allowed the continuous measurement of outcomes and to monitor systems. This allows for earlier intervention through health and care services.

Engineers and technologists have a critical role to play. In Manchester, housing and infrastructure specialists were involved, as well as design specialists focused on developing digital systems to capture data. The other key factor is to take a system wide approach and focus on outcome based measurements.

Key discussion points

It there an issue with engineers, tech users etc using different conceptual models in terms of how they think and talk about tech?

• It’s a significant issue and there continues to be a disconnect between engineers, technologists, and users.
• It’s important to consider the role of training in user research and design.

How do we get better at engaging older people in conversations about tech design, security and privacy?

• Understand that older people aren’t an homogenous group. They have different needs and expectations and views.
• Engage positively and proactively with active tech users through to non-tech users; from a range of different settings.
• Use language that people understand and engage on a human level.
• Not to focus on the tech per se, but rather on the need, and how tech enables users to address that need.

What is the role of 5G and Internet of Things (IoT) in supporting the delivery of health and social care in the future?

• 5G and IoT will become part of many solutions. But it’s important to look at context. At present, there continue to be care teams that struggle with bandwith an access to technologies.
• We are starting to see greater maturity of IoT products for deployment in smart environments. This includes in care homes, in homes where people have care needs, and more generally.
• IoT with 5G has the potential to reduce the cost of installation. With this it’s likely we’ll see a new wave of technology such as sleep monitoring or medicine dispensing. It is also likely that these technologies will be cheaper and easier to use.

What could we do in the next 6 months to deliver smart home tech?

• Look to provide internet access to homes where there is none. In addition, training to be provided including on privacy and security.
• Build on current momentum on acceptance of tech in supporting people in health and care by embedding solutions that work, and ensure solutions are interoperable.

As part of The IET’s series on Responding to COVID-19: Healthy Living and the home

1. Healthy living and housing
2. Community care and care homes
3. Monitoring vulnerable patients and remote diagnostics
4. Reducing social isolation and loneliness
5. Smart home tech to support people’s needs
6. The future of Intelligent homes to support health