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Smart Houses and Smart Technology: Overview and Implications for Independent Living and Supported Living Services

2010; Volume: 48; Issue: 6 Linguagem: Inglês

10.1352/1934-9556-48.6.464

1934-9556

Keith Storey,

Technology Use by Older Adults

How to best support individuals with intellectual and developmental disabilities in homes of their choosing has usually involved supports through either independent living or supported living services. Supports have generally involved teaching skills to individuals, providing staff to assist with activities that the person cannot perform independently, and making adaptations to the built environment. Although these supports have been effective, the development of smart houses and smart technology has not only changed how supports may be provided but offers great opportunities for additional development as technology continues to evolve. The purpose of this perspective is to provide an overview of how smart house and smart technology may be used in residential settings and discuss implications for support needs and for future research.Smart houses broadly refer to any technology that automates a home-based activity (Gentry, 2009). Smart houses may be thought of as networks between systems that are controlled by smart technological devices that are then controlled by an individual (or individuals). These networks can involve household items (e.g., drapes, door locks, microwave, furniture), electronics (e.g., televisions, stereos, videoconferencing devices), security (e.g., motion detectors, pressure sensors, surveillance, monitors), telephones (e.g., landlines, cell phones, personal digital assistants), and computers (e.g., desktop, laptops). This home network then becomes all of these devices interacting with and being controlled by a device such as a smart phone through home servers. The home network can be through electrical wiring or through other systems such as infrared or wireless technology (Briere & Hurley, 2007). Mann and Milton (2005) divided up smart house functions into eight levels based on complexity and availability:Smart technology may involve a variety of systems such as a computer, cell phone, personal digital assistant (PDA), voice activation system, touchpad controller, and/or other device such as a remote control that can interact with and manipulate the devices in the home network. Control can be through radio frequency, infrared extension units, or sound (i.e., clapping to turn lights on or off).One increasingly used smart technology is the use of smart phones because these phones have many capabilities beyond phone calling. Thus, it is important to consider the use of smart phones for both communication (i.e., keeping in touch with family and friends) as well as for supporting individuals in their homes. For example, an individual can receive communication (regarding time management or remembering schedules or routines) through calls, texts, or tweets as well as by programming the smart phone for prompts in these areas.Technological advances have also made it easier for individuals to operate home appliances and consumer electronics through the use of electronic control devices (environmental control units [ECUs]) or interface devices. ECUs may be controlled through voice activation systems, remote controls, sip-n-puffs, eye gaze commands, switches, and/or the use of smart phone applications (Gentry, 2009; Jeffrey & Myers, 2006; Robitaille, 2010). The ECUs then control the appliances through the use of infrared or other technology. For example, ECUs can be programmed to control lights, televisions, thermostats, electric beds, and so forth, which makes an individual more independent and less dependent on support providers. It is important to remember that one or multiple ECUs may be used for different functions (e.g., a computer to preset temperature controls and a remote control for controlling electronic devices such as stereo, television, lights, etc.).A frequent concern in supported living situations is the safety and health of the individual. Smart technology may be used to track health status as well as to provide supports. For example, global positioning systems (GPSs) can be used to track the movements of an individual in their home as well as in the community through their use in cell phones, worn devices, or clothing. Watches can be programmed to send a signal to caregivers when the wearer leaves their home. Internet cameras can be set up to monitor what the person is doing in their home.Telemedicine or telehealth technology uses electronic information and telecommunication technologies to transfer information to health care providers and others to diagnose, consult, monitor, treat, and/or educate individuals (Johnson & Bendixen, 2005). Medical needs, too, can be monitored through devices such as Medtronic's (Minneapolis, MN) product, which allows doctors to monitor their patients in their homes. The individual uses a monitor that allows the collection of information where the individual holds a small antenna over their implanted device. This information is then sent electronically to the network, and clinicians can monitor the information and make any necessary medical decisions. It is also possible for family members and other support providers to have access to this information as well.Emergency response systems can involve a variety of options. For example, devices for getting immediate help (e.g., "I've fallen and can't get up") use a wireless transceiver (worn around neck or wrist) to connect with a monitoring center that then can use speakers in the house to interact with the individual and summon help if necessary. Alarm systems can be used to notify remote monitoring staff, who can contact the individual or notify others regarding fires or medical emergencies.For individuals who must take medication, keeping track of the times, dosage, and needs for refills are important skills to learn and independently perform. Pill organizers have rows corresponding to daily doses and dispense one pill at a time so that individuals cannot accidentally over medicate themselves. Pill organizers also can have an alarm to remind individuals when to take the medication. In addition, pill organizers can also have an automated, electronic feature that monitors the dispenser and alerts independent living counselors or others by phone if medications are not dispensed (Pigot, Bauchet, & Giroux, 2008). Smart phones can also be used to cue individuals to call, e-mail, text, or go online to contact the pharmacy and request refills.For safety, wireless cameras can be lined to a television set, computer, or smart phone that lets the individual in their house see who is at the door and can be combined with a door-opener contact that can be used to let the person in if desired. Related to wireless cameras are video, auditory, or personal computer video camera surveillance systems (e.g., baby monitors) that allow monitoring of the inside of a person's home (e.g., www.smarthome.com or www.securityandmore.com).Domestic skills are those that are needed to maintain a home environment. These skills include but are not limited to cleaning, laundry, dishwashing, cooking, and home repair and maintenance, including exterior maintenance such as lawn care. Often, these activities are referred to as activities of daily living.Halpern, Close, and Nelson (1986) found that individuals receiving independent-living services indicated that the four hardest things about living independently were money management, social networking, home maintenance, and food management. Bosch (1994) pointed out that time management skills (e.g., prioritizing daily and weekly schedules) are often critical for success in residential settings. Personal computers, smart phones, and/or PDAs can be used to provide picture and/or audio prompts to help individuals perform daily tasks, such as with Pocket Coach, Schedule Assistant, Pocket Endeavor, or other AbleLink programs (www.ablelinktech.com).Many tasks involving activities of daily living can be controlled by handheld remote controls, manual controls on wall switch locations, and timer controls. For example, motorized window coverings can be programmed to go up or down at certain times of the day or can be controlled by remote control devices. Lights, thermostats, coffee makers, and so forth, can be controlled this way as well. It is possible to use home-automation systems that can be controlled from a smart phone, computer, or a standalone home controller from inside or outside of the home. These allow access to the home-controlled system to control appliances and to monitor what is happening in or outside of the home (to see who is at the door or just entered the home). The use of high-technology supports (e.g., the use of an automatic robot vacuum cleaner) or robots for feeding are becoming more common and accessible in home settings. Assistive robotic devices are commercially available and can assist individuals in a variety of activities such as eating and drinking (e.g., MySpoon or the Handy Robot; Abdulrazak & Mokhtari, 2008). In addition, a variety of robotic devices are available (e.g., Manus, Inventaid, Weston, Kares II, and WMRA) that can be placed on wheelchairs and, thus, accompany the person around their living and/or work environment and in the community. These devices can perform functions such as picking up, gripping, and moving items, opening doors, eating, or operating appliances.Software and hardware programs have been developed to provide cues and guidance for completing activities of daily living (Pigot et al., 2008; Yi-Lin, 2005). These include the Cognitive Orthosis for Assisting Activities in the Home (COACH; Mihailidis, Fernie, & Barbenel, 2001) software program, which provides prompts for carrying out activities; the Planning and Execution Assistant and Training system (PEAT; www.brainaid.com), which provides auditory or graphical prompts; the Mobile Extensible Memory Aid system (MEMOS; Schulze, 2004), which sends and receives information about scheduled activities; and the ISAAC program (Gorman, 2003) is a wearable, cognitive prosthesis that provides prompts and procedural information for individuals through a touchscreen. Digital watches such as the Timex Ironman Data Link can also be used for alarms and reminders, to-do-lists, schedule planners, and so forth (Yi-Lin, 2005) and can be linked to a personal computer for data analysis as well as providing real-time information for supported living staff. Although these programs were initially developed for individuals with dementia, their application for individuals with intellectual and developmental disabilities is logical.Issues of privacy and consent are relevant because with smart technology, personal information may be shared with family members, medical providers, and/or support providers. Thus, it is important that the individual receiving supports understands these issues and makes an informed choice about what information to share or keep private. Because much of this technology is abstract and difficult for many of us to understand, it may be even more difficult for an individual with intellectual and developmental disabilities. Therefore, it may be important to not only explain the technology and information to the individual but allow them to see what information that the technology provides. There should be built into the consent system the clear right of the individual (or guardian) to revoke consent. Agencies providing supported living services may also want to consider the use of an oversight committee (perhaps through the board of directors) to make consent and recommendations related to privacy and consent issues.It can be difficult to match current technology with individual support needs of the person in supported living. As with all support needs it is important to consider individual preferences, environmental factors, and the ability of the support individuals to understand and deliver the supports. The CUSTODIAN system (www.smartthinking.ukideas.com) provides a decision tree for matching smart home technology with the support needs of an individual.Many sources of information are available for developments in smart technology and independent living. One site that lists these developments, as well as technologies that are in development, is the Gator Tech smart house (http://www.icta.ufl.edu/gt.htm) at the University of Florida.Obviously, the individual must be taught how to use both the ECUs and the interface system, and they must be adapted to the needs and living environment of the individual. Ease of use is an important issue because complexity of systems can diminish their applicability for individuals with intellectual and developmental disabilities, especially if individuals providing supports are not technology savvy themselves, which increases the difficulty because support providers may not understand the technology or be able to teach the technology use to individuals with intellectual and developmental disabilities. Ideally, smart technology systems should be simple and intuitive to use, require little physical effort, and have tolerance for error.Although many of these programs are available for free, others need to be paid for. Costs vary greatly across devices. For example a pill organizer can be as cheap as a few dollars, whereas security devices can range from $30 to thousands of dollars. Unfortunately, there is no centralized place for assistive technology funding though Abledata (www.abledata.com), the Alliance for Technology Access (www.ataaccess.org), the Assistive Technology Industry Association (www.atia.org), and the Rehabilitation Engineering and Assistive Technology Society of North America (www.resna.org), but all provide information in this area. Federal (e.g., Medicare and Medicaid as well as the Medicaid Home and Community Based Waiver program, or TRICARE), state, and local programs may be available as well as private health insurance programs. In addition, service organizations such as the Lions, Rotary, Elks, and Kiwanis often help raise funds for individuals.Progress in smart technology is progressing rapidly and has endless possibilities for supporting individuals with intellectual and developmental disabilities (Fellbaum, 2008). Just as 40 years ago many people thought that "Star Trek" technology was only science fiction and would never become reality, how many of us can tell what impact smart materials or smart "dust" will have on services for people with intellectual and developmental disabilities? Although we do not need to predict the future, it is possible to offer some general guidelines for helping to guide development of smart technology supports for individuals with intellectual and developmental disabilities.Just because the technology exists does not mean that people will use it (e.g., Metlay, Cohen, & Polsky, 2005, found that only 2% of individuals who were elderly using pillboxes used one with a reminder alarm) or that it meets the specific support needs of an individual or group of individuals. Thus, it is important that technology developers involve individuals with a wide variety of support needs in the planning and development process. Thus, advocacy organizations should partner with technology developers and researchers to help guide technology advances so that they are useful and practical for individuals with intellectual and developmental disabilities.Because smart houses and smart technology involve home builders, individuals, groups, and agencies (e.g., local planning and housing authorities) that may not be directly involved with individuals with intellectual and developmental disabilities, the onus for coordination is likely to fall on organizations that provide residential supports for individuals with disabilities. For example, it is very important that developers, local government agencies (i.e., those providing oversight of housing development), and government housing agencies (i.e., those providing Section 8 housing) be involved together in new housing development involving smart houses and the inclusion of individuals with intellectual and developmental disabilities. The initiation of this coordination is likely to fall on agencies providing supported living services.As with most instruction, the earlier it is provided, the better that students can grasp it. If students learn how to use smart technology before exiting into the adult service system, the instructional burden for supported living staff is lessened. Skills may be taught in the criterion (e.g., supported living) environment or in a school setting for students. For students in school settings, in addition to school instruction, instruction with smart technology could also take place in student homes, in the teacher's home, or in an apartment that the school rents for instructional purposes. Older students might also spend some nights or weekends in a residential setting with smart technology for instructional purposes (Freagon et al., 1983). As always, with any simulated instruction, generalization becomes a concern (Horner, McDonnell, & Bellamy, 1986; Nietupski, Hamre-Nietupski, Clancy, & Veerhusen, 1986). For example, if a student is successful in using a smart phone to control appliances in a school setting, it would be important to assess if they can use the same smart phone in a residential environment, with a different smart phone, with different appliances to control.If students with intellectual and developmental disabilities are to learn how to use smart technology, their teachers must understand the technology and how to best teach it. This means that personnel preparation programs must instruct teachers in training in these skill areas.Individuals may initially use a smart technology system and then abandon its use for a variety of reasons. One study found that one third of all assistive technology devices were abandoned by users (Phillips & Zhao, 1993). Pigot et al. (2008) recommended that smart technology must not only meet skill levels and support needs but must meet physical, psychological, social, and economic criteria of individuals.I thank Carla Oden and Michal Post for their input on this article.