Ebook: Advances in Home Care Technologies

The ageing world population is already bringing pressure on social care and health care services. As the percentage of older people continues to rise, the situation is likely to get worse. Many governments have recognised the challenge and are already responding. A key element in national strategies is the development and deployment of computer-based technologies to support care at home.

Telecare and telehealth use technology with the aim of supporting home care in a cost-effective manner. Human involvement in care will continue to be central, but home care technologies can offer reassurance and can support routine aspects. This will benefit those being cared for, their care professionals, and the families and friends who provide informal care.

The aim of this book is to provide an up-to-date overview of key advances in relevant technology. The target readership includes researchers and practitioners in the fields of telecare and telehealth, policy makers in these areas, and providers of social and health care with an interest in technology. The book is designed for self-study.

The contributors are experts in their field, and offer an in-depth look at the latest research in various home care technologies. Although the contributors have provided technically detailed information, they have balanced this with explanatory material to help practitioners in understanding the work, its applications, and its implications.

The book focuses on telecare and, to some extent, telehealth. Given the strong international interest in these fields, the book is particularly timely. Although the book mostly discusses the results of the MATCH project (Mobilising Advanced Technologies for Care at Home), it also includes work on related projects. The book will therefore be useful for gaining a wider perspective on home care technologies in general.

The editorthe book contributors have been actively involved in the MATCH project since its inception. The whole team is grateful to the Scottish Funding Council and to the Universities of Dundee, Edinburgh, Glasgow and Stirling who have financially supported the work. We hope you enjoy reading about the fruits of our efforts.

Kenneth J. Turner

In response to the world-wide ageing population, telehealth and telecare have been introduced to support remote delivery of care to the home. Standards for both are gradually emerging, but are relatively immature in the case of telecare. Home care systems are computer-based solutions to support home care delivery. MATCH (Mobilising Advanced Technologies for Care at Home) was a large-scale project that researched and developed flexible home care solutions. The objectives and achievements of MATCH are discussed. MATCH components and services for home care are presented. The chapter concludes with a summary of the MATCH context and a brief overview of the remainder of the book.

This chapter introduces the MATCH home care system. The nature of a home care system is introduced, along with its context. The background to this topic is given, dealing with aspects such as home networks, component frameworks, home automation and home care. The architecture of the MATCH system and the flow of data through it are explained at a high level. Key aspects of the system are then outlined. It is seen how sensor and actuator data can be combined. Rules can be defined for home care in the form of high-level goals and lower-level policies. The system supports dynamic configuration so that the best combination of capabilities can be selected for the current circumstances. Multimodal interaction allows the system to communicate with users in convenient and acceptable ways. It is also explained how the MATCH system design has inspired new projects. The chapter concludes with a summary of the system, an assessment of the approach, and pointers to future work.

Since home care systems require a high degree of autonomy, it is desirable to have automated rules that manage their operation. Home care systems also require flexibility and adaptability, but modifying their technology normally needs expert intervention. Policy-based management has been developed as a higher-level, user-friendly way of supporting home care. High-level goals are automatically realised using policies that are executed dynamically. Sample goals and policies are given to illustrate how the system handles a typical scenario. This gives confidence that the approach offers flexibility and practicality in making home care systems more adaptable.

Future homecare networks will consist of a very wide range of embedded services and software that will often rely on numerous other components to achieve their tasks. They will rarely operate in a self sufficient manner. The ability to discover and use services is not however a trivial task. Services may provide raw data, such as temperature readings, or higher contextual data, such as user activity and availability. Networks may change over time and may not be subject to a single management regime, implying the need for a great deal of self-reliance for any software component seeking services from elsewhere within the network. This chapter describes work carried out at the University of Stirling to improve service discovery and allow it to operate effectively in networks with a significant turnover in services. Simple syntactical keyword lookups are insufficient, and so semantics are introduced into the discovery process by using ontologies. However ontologies are known to grow and change over time and so maintaining them can be difficult and error-prone. The described approach employs a hierarchical approach that fosters re-use and sharing of ontologies to alleviate some of the more acute problems of building and maintaining large ontologies.

Many who suffer from Bipolar Disorder are keen to control their disease with as little external medical intervention as possible. Self help through websites, meetings, and questionnaires are commonly employed approaches. The PAM project has worked to help this process. It has endeavoured to form an ambient system of monitoring to provide objective feedback to bipolar sufferers. Particular effort has been made to allow the system network of sensors to be personalised and ambient, and operate without the need for a centralised resource. So a sensor system that embeds the processing of the sensor data has been developed. It allows the processing to be changed at run-time to allow personalisation and for changes in behaviour over time. This chapter describes the current status of the project; in particular it describes the rule-based system that the project developed, and an initial technical trial and its outcomes. The rule-based approach and the trial description should be of general interest to both technical developers and practitioners. The latter part of the chapter however is aimed more at the technical developer and focuses on the technical outcomes from the trial with a focus on the programmability aspects and addresses consistency issues that arise with such a flexible programming environment.

This chapter addresses the challenge of the configuration of modern interactive systems (ubiquitous, context-sensitive, mobile et al.) where it is difficult or impossible to predict the resources available for evolution, the criteria for judging the success of the evolution, and the degree to which human judgements must be involved in the evaluation process used to determine the configuration. A conceptual model of interactive system configuration over time is presented (known as interaction evolution) which relies upon the following steps; (i) identification of opportunities for change in a system, (ii) reflection on the available configuration alternatives, (iii) decision-making and (iv) implementation, and finally iteration of the process. This conceptual model underpins the development of a dynamic evolution environment based on a notion of configuration evaluation functions (here-after referred to as evaluation functions) that provides greater flexibility than current solutions and, when supported by appropriate tools, can provide a richer set of evaluation techniques and features that are difficult or impossible to implement in current systems. Specifically this approach has support for changes to the approach, style or mode of use for configuration. These features may result in more effective systems, less effort involved to configure them, and a greater degree of control for the user.

This chapter argues that computer based messages delivered in the home (such as the status of your house or reminders to take your medication) should be available in multiple sensory modalities (visual, auditory, tactile and olfactory) in order to increase the usability and acceptability of home care technologies and make them accessible to a wider range of users. We present an overview of ‘multimodal interaction’ and how it can be enable the delivery of information to the user in a way that is more appropriate to the user's needs, the devices available in the home, and the physical and social environment that the person is in when they receive a message. We conclude with some general guidelines and lessons on how to design personalisable multimodal assisted and independent living technologies for the home.

Although speech is a highly natural mode of communication, building robust and usable speech-based interfaces is still a challenge, even if the target user group is restricted to younger users. When designing for older users, there are added complications due to cognitive, physiological, and anatomical ageing. Users may also find it difficult to adapt to the interaction style required by the speech interface. In this chapter, we summarise the work on spoken dialogue interfaces that was carried out during the MATCH project. After a brief overview of relevant aspects of ageing and previous work on spoken dialogue interfaces for older people, we summarise our work on managing spoken interactions (dialogue management), understanding older people's speech (speech recognition), and generating spoken messages that older people can understand (speech synthesis). We conclude with suggestions for design guidelines that have emerged from our work and suggest directions for future research.

This chapter argues that user centred design and evaluation of home care technologies is fundamental for their success. Designing technologies that work and that are acceptable to users is a significant challenge. Including users in the process of design and development increases the likelihood for products that result in good usability and positive user experiences. This in turn should lead to increased uptake and success of assisted living technologies in the homes of users. This chapter provides a brief overview of user centred design methods and presents several examples of how these have been used in the MATCH project in the design of technologies to support care at home. We also present some emerging guidelines for the design of home care technologies.

The chapter describes work done in MATCH on using forum theatre to facilitate the process of eliciting requirements from users and stakeholders concerning care technology for the domestic environment. Interactive theatre has been developed previously for requirements gathering purposes and this chapter describes how an interactive theatre exercise was developed for use with a diverse range of user groups and stakeholders. The piece was devised and produced by theatre professionals in collaboration with computer professionals with a focus on the development of home care technology to support older and disabled people. The chapter describes background to the use of theatre in this role and then, using script examples, it explains how the forum theatre exercise was used within MATCH.

Research in MATCH led to interest in developing ways of enhancing the Dialogue of Care between stakeholders, in particular between carers and those in their care. In order to inform this dialogue, different stakeholders require different information according to their different perspectives on care. This information then needs to be presented to the stakeholders in appropriate levels of detail and granularity through interfaces that are suitable for each stakeholder. This chapter reports on various discrete studies within that overall process. Investigation was conducted into ways of looking for patterns in the life of a person, through modelling of the “busyness” of activity in their dwelling. The use of on-line analytical processing (OLAP) and data mining was interesting in this context because of the possibility of exploring, detecting and predicting changes in the level of activity that might reflect change in personal well-being. An investigation was conducted into the use of business intelligence techniques and visualisation to illustrate activity from sensor data from a trial project run in a domestic context. This was followed by development of a domestic well-being indicator system (DWIS) to present information to stakeholders and a model instrumented house for use as a demonstrator to promote understanding among stakeholders regarding home care technology.

The context of home care technologies is briefly reviewed. The achievements of MATCH are presented through a brief summary of the book contents. Future developments in telecare and telehealth are discussed in the areas of usability, reusability, integration, technology, services and awareness.