Health and social care management is constantly bombarded by conflicting philosophies of care, whereby the needs of the patient are increasingly important whilst balancing the books. Higher standards and quality of care are expected as the resource allocations in many cases are decreased. The spiral continues, placing the health manager in the invidious position of the giver and denier. The same is true in the social care field.

An ever-increasing group, which will for the foreseeable future be incrementally rising, are older people. Other groups, which place a high demand on resources, are the disabled and cognitively impaired. Each of these groups requires quality care within constrained resources. Is there a technological solution to this crisis?The answer is ‘Yes’, possibly . The solution is the intervention of smart home technology into this area. Smart home technology uses common devices, such as movement sensors for burglar alarms, to enable and empower individuals with physical and/or cognitive disabilities. Devices such as door or window openers are commonplace in offices and supermarkets, but now have the ability to be used within the domestic residence. The devices themselves are not the main features, although they are intrinsic, as the way that these devices are networked together is the central feature of a 'smart' home.

The networking of devices allows more functionality to be given to the device, so that a door opener can be connected with the lighting circuit, such that when the door opens the will be turned lights on automatically. All this is fairly simple, and no longer seems futuristic. What is new is the use of these devices in developing specified homes for individuals with physical or mental impairments or the elderly who might have degenerative conditions. Systems that are specifically meeting the needs of the individual provide empowerment and can add to the quality of life of an individual allowing them to retain some measure of control over their environment. Moreover, through smart home technology, individuals have the possibility of living non-institutional based lives. The possibilities are phenomenal, considering this technology can be applied to people of age, the disabled and the cognitively impaired. It could be used for degenerative conditions as well as rehabilitation.

Although this sounds hypothetical, smart technology is being currently used in these areas. Within Scotland, a number of Health Trusts and social work departments are using advanced environmental control systems to facilitate individuals with disabilities. There is a 'smart house' for a person who acquired a brain injury, a smart home rehabilitation flat for people with acquired brain injuries, and numerous other smaller localised projects, which use some form of networking of devices. The reality is smart home technology does have a critical part to play in future health care initiatives if it is used correctly. Health and social care managers should investigate this technology, as there are potential savings by its use. Although the initial expenditure can be perceived as fairly high, this should be seen as a one-off payment as opposed to the cost of institutional or community care packages. This does not mean that community care packages will cease for patients who have their homes adapted to smart home, care packages will still be required, but the expenditure on each package will be able to be decreased over time in many cases. Early intervention by proactive health managers can also save money in the long term. An example of this could be installing the minimal smart home technology for a patient in the early stages of dementia, to allow the informal carers and the patient to remain at home for a considerably longer time. As the condition increases in severity, more devices can be configured to enable the patient to be cared for within the community with minimal external intervention.

A development in this field is a software package that enables trained health workers to design complex smart homes that could meet the needs of the stakeholders and end users. The software is design to be run on a laptop computer and allows the user of the tool (known as the Process Facilitator) to design and configure highly complex networks as a result of an assessment of the end user, discussions with the main stakeholders (Health, Social and Housing related). After these discussions the Process Facilitator (PF) is able to draw up a provisional network design which is graphically displayed in order to consult with the stakeholders and end users to ensure that all needs are catered for. The software also allows the PF to add the networking configurations and settings to the proposed devices and provides a rough cost estimate for the installation.The usefulness of this tool is manifold. By its use the PF is saving the stakeholders money as installers and engineers will not be required until the installation has received approval. Health managers are able to consider the option of smart home technology and assess the cost compared to other more conventional solutions. The PF acts as a mediator between the differing interest groups to provide the best solution for the patient considering the constraints that might apply.

The developers of this software are currently seeking health care professionals who wish to train as Process Facilitators. Training is crucial, as once the specification is agreed the PF is solely responsible for the implementation and appropriateness of the design. Furthermore, it is envisaged that a network of PFs will exist throughout Europe who will be facilitating the design of appropriate smart homes for differing client groups with this software. Smart home technology can be a cost effective and resource driven answer to better quality care at no additional cost.

Guy Dewsbury
Copyright 2000,
G.Dewsbury,
RGU;
CUSTODIAN,
TIDE DE4004