Thesis presentation by Anita Woll INF5722, Thursday 28th August 2014

- Participatory design of ICT - supported elderly care trajectories for

municipal health and care services.

07 05 2014

VELFERDSTEKNOLOGI

Challenges in the municipal health and care sector

• Scares health resources • Increased elderly population • Growth of chronical illness

among the general population • Shortfall of health and care

professionals

Gross operating expenses including HVPU 1973 -

1990 Copyright: Borgan 2012, SSB.

07 05 2014

VELFERDSTEKNOLOGI

Policy guidelines

• St.meld. nr. 7 (2008–2009) Et nyskapende og bærekraftig Norge

• NoU 2011:11 Innovasjon i omsorg • Fagrapport om implementering av velferdsteknologi i de

kommunale helse- og omsorgstjenestene 2013-2030 • Omsorgsplan 2015 og 2020

• St.meld. nr. 47 (2008 - 2009) Samhandlingsreformen • St. meld nr. 29. (2012-2013)Morgendagens omsorg • St. meld. nr. 34 (2012-2013) Folkehelsemeldingen. • Seniormelding for Oslo kommune (kommer høst 2014)

07 05 2014

VELFERDSTEKNOLOGI

The Hagen-Committee

divides welfare technology

into four subgroups:

1) Safety and security technology

2) Compensation and wellness technology

3) Technology for social contact

4) Technology for treatment and care.

Welfare technology is defined by the Hagen – committee

(NoU 2011:11) as ”.. technological assistance that improves

the safety, security, social participation, mobility and physical and

cultural activity, and strengthens the ability of individuals to take

care of themselves in everyday life despite illness and social,

mental or physical disability. Welfare technology can also act as

technical support to relatives and otherwise help to improve

availability, resource utilization and quality of services. Welfare

Technological solutions can in many cases prevent the need for

services or institutionalization.” (NOU 2011:11 p. 90)

Definition of welfare technology

Lime green fact box

07 05 2014

VELFERDSTEKNOLOGI

THE CONNECTION OF WELFARE TECHNOLOGY AND OTHER AREAS AND / OR USER GROUPS:

• E-health and telemedicine • Relatives: help to facilitate communication and information access.

• Volunteer Center: to book companion on errands, voluntary visitor

friend or to walk in the park with others.

• Mobile Services – To move the apparatus and not patient, i.e. to move the X-ray apparatus to the patient.

• NAV - Assistive Technologies (Hjelpemiddelsentralen)

• Services within the local community

Field data

• Home care service manager and home care service staff

• 10 –15 elderly residents from Kampen Care+

• Researchers from UiO (seniors, phd, master, bachlor )

• Representatives from the city counsil in Oslo, department for social services

and elderly

• The vendor of the excisting welfare technology implementation

• 24 / 7 staff at Kampen Care+

• Building meetings for tomorrows nursing home (Eid Municipality, Norway)

• Interview with manager - and planned field study at Lyngbakken nursing

home

• Data collected in the collaborative change experiment

Elderly care trajectory for municipal health and care services.

Nursing homes

Primary Care: GP, home care services, physiotherapists, occupational therapists, speech therapists, other licensed health care professional, and institutions such as nursing homes and care homes and service centers.

Secondary Care: Medical specialist healthcare

Q1: How can technology be incorporated into the municipal elderly care work to better support aging seniors in their daily life activities in relation to their care need and living arrangements? Q2: How can elderly care trajectories contribute to a holistic approach to welfare technological assistance in the municipal health and care sector by combined use of active and passive technologies? Q3: How is design of assistive technology for elderly care challenged in the transfer from pilot study to incorporation in work practice?

Care homes

Private homes

Somatic and psychiatric hospitals, other institutions and

ambulance service.

ICT – supported elderly care trajectory: A basic set of technologies + additional ICT to support individual user needs

The elderly care trajectory

• Strauss and co-authors describe a patient’s trajectory as the physiological aspects of a patient's illness, which includes the overall organization of work required to serve a patient’s illness path, as well as the implications this has for the actors involved in the work and organization.

• Strauss and co-authors refer to “trajectory work” as the management of a patient trajectory by the means of different types of work that is required to serve a patient’s trajectory, and the inter-relationships between the various actors involved in this work (Strauss et al, 1982), e.g. research, monitoring, intervening and re-intervening in order to treat or improve the patients' health problems.

Scenarios of work activities by the elderly

• Expecting elderly to work (e.g. self - care, share information about health conditions, drug use or reaction of drugs/treatment)

• Demanding elderly to work (e.g. forcing reluctant elderly to take medicine)

• Inviting elderly to work (e.g. self - monitoring or take active part during a procedure)

• Negotiating elderly to work (e.g. demanding elderly to do daily life activities that they rather want the care givers to do for them)

• Teaching elderly to work (e.g. instructing elderly about procedure, self - care, drug use or self - monitoring)

Visible and invisible technology

Visible - > Active Technology A piece of equipment that the user is aware of, knows its function, and which requires the direct participation of that user to operate, e.g. pressing a button to unlock and open a door.

Invisible -> Passive technology A piece of equipment that the user is either unaware of, and/or which requires no direct participation of that user to operate. The device operates automatically in response to some outside influence, i.e. a triggered smoke alarm may switch off the electricity to a stove or other appliance.

The balance of active and passive technology to support the elderly care trajectories

• Approaching welfare technological assistance as a holistic system aiming to support the elderly care trajectory

• Welfare technology should support the aging seniors’ care trajectories for the continuation of technology usage, regardless of their living arrangement.

• Technological assistance needs to be introduced to younger

elderly in order to support them with technology over time. – Require us to select a basis package of active and passive technology

that can evolve together with the users by adding supplementary technology in relation to individual care needs.

– Set requirements to chosen technology i.e. standalone solutions like sensors from different vendors must "talk together” and be integrated with the main response infrastructure like the nurse call system, the safety alarm system and the patient record system.

Research contribution

• Computer supported cooperative work (CSCW)

• Human Computer Interaction (HCI)

• Participatory design (PD)

CSCW, HCI and PD

• CSCW • Work practice studies

– Health care workers

– Elderly care receivers

• HCI – Collaborative change

experiment (telecare study) • Usability study

• Diagnostic evaluation

• PD • Need driven innovation requires

active user participation

• "Welfare technology is not about technology but about people ..." quote Nis Peter Nissen (Directorate of Health 2012)

• “A successful implementation of welfare technology depends 20% of the technological solution and 80% of the organization around the technology ... As the technology needs to be incorporated as part of the service assignments” (Directorate of Health 2012)

Research analysis - AT

• Modern and active technology is not for all elders, but for those who mastery

these are enabled to continue active aging and maintain a continuty in daily

life activities.

• Building on excisting and familar technology in the home can be benificial.

• Technology for welfare services should be introduced for younger elderly to

better succeed in supporting their independence and in order for them to use

technology later in life when more complex health challenges are present.

• Fragemented elderly care services need to be «sewed together» to better

support the elderly users over time.

• When active technology is not appropriate or useful, passive technology is still

a support for the safety of elderly residents.

• Passive technology is less intruding in the care receivers envirorment.

Preliminary findings

Lessons learned from the fieldwork

• It is much more time consuming than you may expect

• If you are dependent on other professionals to get access to the field, it even takes longer time..

• Elderly participants are espesially challenging to recruit

• Start early to work on your study design – so you know what you are looking for.

• Things may not turn out as planned so then you should readjust your path and go for a plan B.

• Field work in private homes requires carefully considerations.

• Research results can be sensitive and be perceived as negative for some stakeholders

• But it is also very fun to met new people, and to explore what is going on in the field - GOOD LUCK!!

Thank you!

• Anita Woll {anitwo@ifi.uio.no}