smart homes for elderly care in india

Smart Homes for Elderly Care in India: A Need and OpportunityAUTHORS:

KALIKA SHARMA

DEEPA REDDY

@2015, ICE, ALL RIGHTS RESERVED

How do you imagine a smart home? Imagine stepping into a smart home that welcomes you, that draws the curtains for you each morning, dims down the lights in the evening, turns the gadgets off when you step out, and so on.

Image: https://www.flickr.com/photos/pestoverde/15207853585


It’s all connected in a smart home.

Electronic gadgets and sensors that can communicate with systems inside and outside the homeA network connecting these gadgets and sensors – wireless or wiredControls and an interface to manage the systemsComing together as the Internet of things, smart homes will operate in the larger connected networks of places, under the framework of smart cities. https://commons.wikimedia.org/wiki/File:Reliance_Smart_Client.jpg


Smart home tech is well-suited to the elderly.

While the smart home automation boom in India is still a luxury, it has a variety of uses for elderly care in general. Some examples are as follows:◦ Health care and assistance, e.g., a sensor in case of a

fall, medication reminders, etc.◦ Increased security for elderly people who might be

more vulnerable, e.g., an emergency button connected to hospital services

◦ Management of home devices through an interface helps if the elderly person is not mobile

◦ Reduced feeling of isolation or loneliness with home entertainment and internet, e.g., being constantly connected to other groups or family remotely

◦ Home maintenance is simpler with automated cleaners, refrigerators, kitchen systems, etc.

https://en.wikipedia.org/wiki/Home_automation#/media/File:Smart_Home_Control_Panel.png

A smart home control panel


The Situation with Smart Homes in India

While the home automation companies have come into India, the reality on the ground is that there are different dimensions to ageing in India that need to be taken into consideration. The Lavasa Smart Home Project and Ashiana are a few examples of pioneering work in this area, but these examples are only affordable for middle to upper classes.

https://commons.wikimedia.org/wiki/File:Lavasa_City.JPG Lavasa Smart City


Do smart homes map to the cultural dimensions of the elderly in India?

There is a gap that needs to be addressed by the industry as well as the government, which need to account for the needs of the elderly in India. We take a closer look at the cultural dimensions of the elderly in India.

Imagehttps://www.flickr.com/photos/vinothchandar/8523236119/


India’s Demographic Transition


[Source: Appendix I, UNFPA Report, 2012]

India’s demographic transition: summary

By all accounts, India is on the verge of a massive demographic transition. A 2012 report by the United Nations Population Fund (UNFPA) projects a rapid increase in India’s median age--from 20 years in the 1980s, to 31 years in 2026. It also projects a 325% increase in the number of people aged between 60 and 80 years by the year 2050 (measured from the year 2000), a 700% increase in the number of people over 80 in the same period. [Source]

The same report further projects that individuals over 60 years will represent 19% of India’s total population by 2050, approximately 300,000 people (see the table below). This data confirms the growth of a demographic at a faster rate than the rest of the Indian population.

http://www.livemint.com/Politics/jwab6RZ67J74aT9sPpTRhN/India-ageing-faster-than-expected.html

India’s demographic transition: facts

India is on the threshold of a massive demographic transition which will leave us with 19% of our population over the age of 60, by the year 2050.

Life expectancy has shot up: from 23 at the turn of the century to 65 years and death rates have fallen, from 25 per thousand to eight. The rapid greying is working on an “astonishingly low” per capita GDP. Over 70 per cent elders are fully dependent on family and other social supports.

Double-income families are common; lives are getting busier—leaving a vacuum when it comes to caring for family who cannot care for themselves.

Personal choice and privacy are increasingly buzzwords. Migration for jobs both within and outside India is the norm. The nature of social responsibility is changing alongside actual capacities to care for family.

Over 7% of elderly couples live on their own. 11% of India’s elderly have no young people staying with them. As many as 50% of elderly widows live alone in India.


Source: “Home Alone” India Today, July 16, 2007Graphic : http://www.heifer.org/join-the-conversation/magazine/2013/spring/aging-india.html

India’s demographic transition: Epidemiology

On the epidemiological front, the WHO reported in 2012 that disease patterns have shifted from communicable to non-communicable diseases and older adults face increasing health risks.

Sengupta and Agree (2003) analyze covariates of mobility difficulty among the older adults in India and find that there is a substantial association between mobility and chronic diseases in the elderly.

Kerketta et al. (2009) find that there is a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members and recommend for the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.

Only 1.6% of the elderly are covered by health insurance.


Image Source: http://silvertalkies.com/helping-hand-kolkata-seniors/http://timesofindia.indiatimes.com/india/Study-shows-a-dismal-1-6-elderly-are-covered-by-health-insurance-plans/articleshow/45391831.cms


India’s demographic transition: Social changes

Socio-economic changes such as increased urbanisation, modernisation, increasing participation of women in economic activities, mobility of the younger generation, the growth of individualism, and a rise in consumerism are leading to the breakdown of the joint family structure, which used to be the primary support for the elderly in India (Knodel et al.1992; Pandey2009).

As a result:

1. Residence patterns change (see table); and

2. There is a greater reliance on paid assistance, whether informal (maids) or professional (nurses, medical practitioners).


India’s demographic transition: The feminization of ageing

India’s senior population is slightly more female than male--a phenomenon described as the “feminization of ageing”--thanks largely to slightly higher female life-expectancy.

“[...] on one hand it is a victory of women in overcoming mortality from reproductive, communicable, and chronic conditions, yet on the other hand, for many women old age signals a period of social isolation, and frequently, economic adversity. Increased longevity is often not always matched by a health life expectancy, although there is some suggestion that the older you become, the healthier you have been.” (Davidson, Digiacomo, & McGrath, 2011, p.1033)

“The stigma of widowhood … leads to profound social ostracism that impinges not only on access to healthcare, but also a broader range of fundamental human rights, such as the right to shelter, food, property, and information (Chen, 1998;Dreze, 1990).”

Source: http://www.ncbi.nlm.nih.gov/books/NBK109208/#ch15.r18Image: http://blogs.reuters.com/india/files/2012/04/woman21.jpg

http://www.ncbi.nlm.nih.gov/books/NBK109208/#ch15.r11



Cultural Dimensions of the Elderly in India

1: The family model of careDemographic shifts and other social changes have not dislodged the family as the primary locus of care, support, and responsibility for the elderly. The stigma of abandonment is still very strong, with implications for both parents and children.

The 2007 Maintenance and Welfare of Parents and Senior Citizens Act legally reinstates the central position of the family, making it a legal obligation for children and heirs to provide maintenance to senior citizens and parents, by monthly allowance.

“In an analysis of NFHS-2,Agrawal (2012) found that elderly who are living alone are likely to suffer more from both chronic illnesses, such as asthma and tuberculosis, and acute illnesses, such as malaria and jaundice, than those elderly who are living with their family” (Gupta 2013)

Source: Gupta, Nidhi (2013). Older Women in India: Issues and Concerns. In S. Siva Raju,U. V. Somayajulu, & C. P. Prakasam (Eds.), Ageing, Health and Development. Delhi: B. R. Publishing Corporation. (pp.203-222)

@2015, ICE, ALL RIGHTS RESERVEDImage: http://www.livemint.com/Leisure/fWa1CaarbYDeVIQL1G9nDO/Grandmoms-helper.html


2: Elder abuseAnd yet, co-residence with family is also often the source of tension and what is increasingly classified as “elder abuse”:

Delhi saw a tripling of police reports of elderly seeking protection in an 18-month period, and Mumbai’s police helpline for seniors was receiving more than 80 calls daily (Datta, 2007). Reports of murder, rape, burglary, and violence inflicted upon the elderly remain and are more commonly reported in Indian metropolitan areas.

“While systematic studies are rare, there have been increasing reports of material exploitation, financial deprivation, property grabbing, abandonment, verbal humiliation, and emotional and psychological torment in India, all of which compromise the mental and physical health of the elderly.” (Dey et. al., 2012)

Datta D. Home alone. India Today. Jul 16, 2007. Available: http://www .indiatoday .com/itoday/20070716/cover.html Subhojit Dey, Devaki Nambiar, J. K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy. Health of the Elderly in India: Challenges of Access and Affordability: http://www.nap.edu/openbook.php?record_id=13361&page=376

Source: http://www.thehindu.com/news/cities/Madurai/elders-abuse-in-india-witnesses-drastic-rise/article6114195.ece. from 2014 HelpAge India Study: http://www.helpageindia.org/pdf/highlight-archives.pdf



http://www.nap.edu/openbook.php?record_id=13361&page=376



http://www.thehindu.com/news/cities/Madurai/elders-abuse-in-india-witnesses-drastic-rise/article6114195.ece

http://www.thehindu.com/news/cities/Madurai/elders-abuse-in-india-witnesses-drastic-rise/article6114195.ece

http://www.helpageindia.org/pdf/highlight-archives.pdf

http://www.helpageindia.org/pdf/highlight-archives.pdf

3: The ageing poorFor the poor, however, laws such as the 2007 Maintenance and Welfare of Parents and Senior Citizens Act have little value.

Lower middle class or poorer families particularly in urban areas may be simply unable to provide for ageing parents:

“Economic pressures on younger families have increased the pressure on older parents to provide greater and more regular assistance (housing, childcare, cash, loans) to their married children and to reduce their own consumption and expectations of support.” (Vera-Sanso et al, “Ageing, poverty and neoliberalism in urban South India,” 2010)Source: http://www.koodam.org/sites/default/files/subjects/NDAFindings_5Final11.11.10.pdf


Image credit: Penny Vera Sanso and CLPHRS Chennai, http://www.thehindu.com/features/magazine/zooming-in-on-the-elderly/article4862886.ece

http://www.koodam.org/sites/default/files/subjects/NDAFindings_5Final11.11.10.pdf

http://www.koodam.org/sites/default/files/subjects/NDAFindings_5Final11.11.10.pdf

http://www.thehindu.com/features/magazine/zooming-in-on-the-elderly/article4862886.ece



4: The consequences of “dependence”

Research in Chennai shows that thinking of the elderly as dependents and/or “wards” of either families or the state hardly takes into account both their contributions to household economies, or their unique needs and rights (Vera-Sanso, 2010)

By defining older people as ‘dependents’, in need of care and support and as not part of the work force, or as inferior workers, policies, planning and practices do not facilitate old age welfare. Instead, they exacerbate frailties and increase old age poverty.

Thinking of the elderly as dependents has two specific consequences:

A. Economic contributions of the elderly are hidden and unaccounted

B. Failure to recognize certain deficits as explicit health needs

C. Dependency Anxiety


4A: Unrecognized contributionsClassifying the elderly as “dependents” not only misrepresent “older people’s direct and continuing contribution to the economy, but also disempowers them in relation to younger family members and employers” (Vera-Sanso et al, 2010)

The study shows that ageing parents can and often do help out with housework, childcare, take on unpaid “helper” roles in a child’s petty business etc. -- and that they might be compelled to keep working well into their old age.


Vera-Sanso et. al., “Participation and Social Connectivity” in The New Science of Ageing, ed. Alan Walker. Chicago: Policy Press., 2014. p.192

Image: http://www.thehindu.com/news/national/most-indian-women-engaged-in-unpaid-housework/article6498326.ece


4B: Unrecognized health needsReliance on the family as normative, primary source of support actually prevents us from acknowledging certain mental health deficits as health needs.

“Conditions like dementia are viewed as normal aging and depression construed as the result of neglect by family. Such cases were therefore not considered the purview of health professionals and were more frequently acknowledged and addressed by community health workers. Access to mental health services in the medical sector are limited, and, thus, most care and support was provided ad hoc, informally, and in the family. “ (Patel and Prince, 2001)

Patel V, Prince M. Ageing and mental health in a developing country: Who cares? Qualitative studies from Goa, India. Psychological Medicine. 2001;31:29–38.

Image: http://www.thehindu.com/sci-tech/health/special-provisions-needed-for-healthcare-for-elderly-concludes-study/article2749900.ece


4C: Dependency anxietyThe centrality of the family as a normative support institution increases dependence on family, and precipitates “dependency anxiety”: an anxiety about complete dependence on family (and therefore trapped into abusive situations), and/or anxious about informing family about health issues. (Patel and Prince, 2001)

Such conditions are rarely recorded in databases cataloguing the issues facing the elderly. While depression is often cited as a major issue, the attendant isolation, loneliness, and dependency anxieties receive much less attention.


Image source: http://indiaspeaksnow.com/elderly-abuse-rise-metro-cities-india/


5: Independence in ageingSome wealthier classes of the elderly do articulate their need for independence, often suggesting it is compromised in living arrangements with adult children.

Their need for independence is cited as a reason not to relocate abroad or with children:

“I want to maintain my independence and individuality and I want to walk with my head held high. If we were to live with my children I would have to depend on them even for a cup of coffee. In such a situation, I don’t live; I merely exist.”

Some studies suggest internet use off-sets the effects of the isolation


Source: http://www.thehindu.com/features/magazine/retire-without-hurt/article4862888.eceImage: http://www.thehindubusinessline.com/features/investment-world/retirement-homescheck-out-before-you-check-in/article4323370.ece


The Potential for Smart Homes to Address Elderly Needs


We are looking at the rise of multi-generational housing options

More middle class and higher income group elderly people are opting to live in retirement homes. While they might be the pioneers of the movement today, this is the direction in which things are moving.

Source: http://www.hindustantimes.com/india-news/is-india-s-joint-family-system-breaking-down-with-seniors-willingly-moving-to-retirement-homes/article1-1333208.aspx

Retirement homes as an investment optionReal estate developers have picked up on a twin set of realities: that younger families are finding it increasingly difficult to care for their elderly parents, and that although the stigma of “old age homes” is still very strong, the need for assisted living, proximal medical services, and the demand for a better quality of life in senior years is increasing.

Housing “senior living” communities have been developed in several Indian cities—filling the gap left by insufficient state-services.

The senior living community model uses the idea of viable real-estate investment to legitimize a more independent living arrangement -- allowing kin to still feel connected to parents, but granting both the independence they need or wish to have.


Source: http://www.livemint.com/Money/dvN4ue8SccGtAB0vRXLthI/Whats-the-real-cost-of-retirement-homes.html


Retirement Homes and Home Automation Can Go Hand-in-Hand

With a retirement home boom following a smart home automation boom in India, there are few endeavors so far to make the two meet. Technology-enhanced senior care is well-established in many parts of the world.

Image: https://commons.wikimedia.org/wiki/File:Home_auto1.jpg


Pioneers in Tech for Elderly Care in India

Two examples of smart homes for the elderly in India are Lavasa Smart Homes and Ashiana Housing.

"Smart homes can notify a resident when it is time to take medicine and alert the hospital if the resident were to trip and fall. Also, the elderly folks just need to press a soft panic button in the house, in case of an emergency, to reach someone for help,"

Ankur Gupta, joint managing director of Ashiana Housing Ltd.

Source: http://articles.economictimes.indiatimes.com/2013-06-03/news/39715502_1_smart-homes-smart-living-household-chores Image: https://www.ashianahousing.com/senior-living-india/


Take a look at Norway’s example

http://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table Norway ranks #1 in elderly care (Helpage.org, 2014)

http://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table

http://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table


Smart homes are considered to improve the quality of life for the elderly in Norway• In Norway, smart homes have been considered a solution to improve the health and Quality of Life (QoL) for the elderly generations.

• There is support from the municipality, political entities and system developers/technology vendors in developing these smart homes.

• However, there is less research conducted on the effects of smart home technology for elderly care and the health benefits it brings.

Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May 2014Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf

Image: https://upload.wikimedia.org/wikipedia/commons/8/87/Nursing_home.JPG


Role of the Norwegian government in smart homes for the elderly

Norway has 10 years of experience using smart home technology as part of home care services. It all started with the BESTA-project in 1994, a project focusing on the use of smart home technology for elderly people. As part of the project, smart home technology was installed in residential flats, aiming at residents with dementia.

Smart homes are a now becoming a source of pride for Norwegians. For the elderly, a great responsibility lies with the government in planning for their old age, even with assisted care.

Laberg, Smart Home Technology; Technology supporting independent living - does it have an impact on health? http://www2.telemed.no/eHealth2005/PowerPoint_Presentations/Tuesday/Fokus4/1130-1300_F4_tue_TorilLaberg_Smarthouse.pdf


Quality of life and elderly care in Norway

Researchers in Norway are exploring whether smart home technology can contribute to enhance health and Quality of Life (QoL) in elderly citizens and allows them to live longer in their own homes, as opposed to an institution for the aged. In addition, they are exploring if such technology increases safety, independence and enhances social activity.

Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May 2014 Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf

https://en.wikipedia.org/wiki/Geriatrics#/media/File:Nurse_in_geriatry.jpg


Inspiration from Salutogenesis by Aaron Antonovsky• We can also draw inspiration from “Salutogenesis” Aaron Antonovsky, a professor of medical sociology.

• Salutogenesis is an approach focusing on factors that support human health and well-being, rather than on factors that cause disease.

• The “salutogenic model” is concerned with the relationship between health, stress, and coping.

• Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum".

http://en.wikipedia.org/wiki/Salutogenesis


Sense of Coherence Concept by Antonovsky

Comprehensibility : a belief that things happen in an orderly and predictable fashion and a sense that you can understand events in your life and reasonably predict what will happen in the future.

Manageability : a belief that you have the skills or ability, the support, the help, or the resources necessary to take care of things, and that things are manageable and within your control.

Meaningfulness : a belief that things in life are interesting and a source of satisfaction, that things are really worthwhile and that there is good reason or purpose to care about what happens. Source: http://en.wikipedia.org/wiki/Salutogenesis Image: http://www.dominicpote.co.uk/healthcare-hospital-design-projects/art-for-

hospitals/art-in-salutogenic-design/


Constructing smart homes with Salutogenesis

Is it possible to construct and develop smart homes based on these three elements and could they be central in further smart home development? If we take a closer look, investigating Antonovsky’s (2012) concept of the SOC it is possible to notice the transferability of the concept of SOC to almost anything.

In this case smart homes and the technology it consists of are under scrutiny. In relation to the smart home elderly people increase their chances for a beneficial interaction if the home is built in a way that makes them believe that

(1) they can understand the smart home;

(2) that they have the resources at their disposal to handle it; and

(3) that they wish to cope with the smart home (Hjelm, 2004).Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May 2014Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf


India needs low-cost solutions for the elderly

An example from a BBC news story shows a Norwegian couple with low cost sensors at home that help the woman with Alzheimer's in her day-to-day life.

“…The Albilia solution shows what you can do with a tablet, Skype and low-cost sensors. It is not rocket science and if you can keep an Alzheimer's patient living independently in their own home, it is good for the individual, good for the family, and you can save money by keeping them out of institutional care.”

Joe Dignan, analyst at Ovum

Source: http://www.bbc.com/news/technology-22984876


To summarize, we need to bridge the gap for elderly care through smart homes in India

1. Smart homes can improve the quality of life for the elderly in India.

2. India should have its own model for elderly care, drawing inspiration from Salutogenesis.

3. Government involvement in elder care flats is important, again looking at the Norwegian government initiatives for inspiration.

4. Retirement homes and smart home tech providers together form a great opportunity with multi-generational housing on the rise.

5. Low-cost sensors and wearable tech can be used to make smart home tech more inclusive for those who cannot afford the technology.

6. Smart home automation for elderly doesn’t mean offering features, rather it’s about care: enabling elderly people to live independently.

7. Ask elderly people what they want as users of smart homes and build that into designs.


Thank you!

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