People are affected by their surroundings and, especially, by the condition of their homes. When people are healthy, a less than ideal setting may amount to little more than irritation; but when people are elderly and/or in poor health, conditions in the home can have a significant impact. Poor building conditions lead to poor health; conversely, good conditions can promote good health.
The starting point for telecare is a healthy building into which can be introduced medical and ancillary equipment to allow people to be treated and cared for in their own homes. There are sound economic as well as medical arguments for treating people in their own homes. However, this cannot take place without serious investment in both housing to suit and technology to enable medical care to be correctly received. Inevitably, this will mean that new buildings will have to be produced with such features and then maintained properly.
Rethinking design for inclusivity
Retrofitting of the existing housing stock is also possible, but success is more likely when homes have been designed to take these features into account. Since an individual’s needs are likely to be different to any other, a strategy for delivering technologically enhanced real estate is needed. The adaptation of homes to accept a range of support functions and care regimes will call for a rethink of how dwellings can be equipped or re-equipped to deal effectively with these challenges. One concern, amongst others, will be to minimise the impact upon the occupant/patient arising from changes to the original layout, functionality and appearance of the home. Furthermore, changes will need to be reversible if it is subsequently shown that an alternative arrangement is better suited.
The design of all-inclusive buildings and other facilities is a developing field, as opposed to an exact science in which all parameters are known. In addition to the provision of medical support, there is likely to be the need for homes that are responsive and which, as underscored above, do not adversely affect health. Many of the arguments and recommended solutions advanced for affordable, healthy homes would apply here, particularly in the context of enabling technology against the background of mass customised products that are economical, defect free and of a decent quality.
ICT to the rescue
Homes equipped with ICT and medical apparatus could provide care, monitoring and education to patients who would otherwise have to be admitted to hospitals or other care facilities. Medical practitioners would be able to maintain continual contact with patients, enabling them to be treated in their own home and avoiding the trauma and expense of hospitalisation. The problem is one of designing and delivering both a home and a care environment – through the provision of modern, highly-serviced, ICT-enabled housing – that can accommodate the equipment required for home telemedicine. Given the right kind of setting and conditions, there is no reason why medical equipment that was previously found in health care centres and hospitals could not be adequately installed, protected and maintained in a person’s home.
The development of mobile technology provides an important element in the provision of telecare services, especially since mobility in the home is likely to be a key issue and one where the occupant/patient might face restrictions on movement. Another aspect of concern is coping with an ageing population and one where the proportion of older people will become increasingly significant in the coming years. The approach advocated offers a realistic alternative to moving people from their homes to health care centres and hospitals and then back again, and repeating the cycle many times over. The economic and social arguments are powerful, and there is sufficient technology to ensure this can be achieved. However, the latter has to be placed within a process that is purposely designed for telecare purposes. It is not enough to graft it on to existing practices for procuring buildings that will house the elderly and/or people in poor health.
Research and development project
The primary aim of such a project is to develop a range of innovative housing products that can provide a secure and safe environment into which telecare services can be introduced. The specific objectives are to:
- define users’ needs (i.e. housing developers, owner-occupiers, tenants and medical practitioners) as a basis for developing inclusive environments and support systems);
- develop housing solutions, based on high levels of service provision, low energy consumption and re-configurable, adaptable space;
- specify the characteristics of the indoor environment in terms of function, amenities, climate and support for medical and ancillary equipment; and
- create branded products that are acceptable to national health departments and the medical professions and demonstrate this to all stakeholders, not least the elderly and infirm.
The research necessitates extensive investigation of the means for delivering medical care in the home. It is not enough to scale down the facilities of a professional health care facility or to simply modify existing housing products. A detailed investigation of how elderly or infirm persons can be properly supported in their homes has to be undertaken. Questions of mobility and dependency will need to be addressed if housing solutions are to be real solutions to the needs of a growing proportion of the population. The interaction between such occupants and their surroundings needs careful examination so that workable solutions arise. It goes without saying that people should not be prisoners in their own home. The technical feasibility of the overall concept will need to be fully explored and this will extend to modularisation, methods of assembly, fixing and disassembly. Special attention will need to be paid to the added complexity arising from the incorporation of medical and ancillary equipment.
The growing proportion of the population and, hence, the housing market that serves (or should serve) the elderly or infirm is in need of radical overhaul. Attempts to provide health care regimes for people in their own homes are, in many countries, generally limited to the well-off with little commercial interest in extending this to the social and mass housing sector. A concerted effort that would bring together the many interests, bodies and disciplines in this area is needed. The success of telecare in the long run will depend largely upon how effective housing solutions are at catering for the needs of their occupants. This will require that the research results are adequately demonstrated so that practical solutions, as well as the concepts, can be replicated. Important too is that proprietary rights are not allowed to prevent the maximum penetration of telecare housing products into the marketplace.
The areas of competence required for this research include, but are not restricted to:
- design of inclusive environments
- telecare concepts
- sensors and controls
- telemedicine – equipment and communications
- mobile technology.