The term ‘smart home’ has been confused by some by using it to describe technology that relies on sensors in the home that can send messages to call centres. Such technology is really telecare and will be referred to as such in this chapter. The primary property that endows a house with the smart home label is its ability to support the user in an autonomous fashion. In other words, it can monitor the user’s activities and the way they interact with appliances in the home, but it is also able to supply a response itself to support the user. For example, if a smart home detects a running bath being nearly full it will respond by turning off the taps rather than calling for someone to come and intervene.

Given the ready availability of smart home components, a number of groups have explored the possibility of using them in a domestic setting to provide support that augments the help received from carers. A lot of work has been carried out to see if people with physical disabilities can be supported. The Edinvar Housing Association in Edinburgh undertook pioneering work to explore the potential of this technology. The Joseph Rowntree Foundation (JRF) has provided a number of installations in York with a fair amount of success. The JRF has published a number of guides about the technology.1, 2 Some pioneering work in Norway has also explored the potential of this technology to support people with dementia.3 The installations have primarily used commercial smart home components developed for public buildings and configured them in a form that allows their use in a domestic environment. More recently, purpose-designed technology has been developed, such as work at Brunel University on the Millennium Homes project,4 which enabled the home to give voice prompts to the user to check if they needed outside support.

The majority of these installations have used the ready availability of smart home components to provide the technology that is used. For lighting and ventilation, these components are very appropriate. However, there are a number of situations where such technology is not so appropriate and where support devices need to be better tailored to the needs of the end user. A typical example is the use of commercially available technology to provide tap control. Several installations have used taps controlled by an infrared sensor that could be very useful for someone with poor hand function. All the user has to do is wave their hands in front of the sensor, usually mounted just underneath the tap, and water will be provided while the hands are in position. However, this operation is somewhat unnatural and for someone with a cognitive problem such taps would be totally confusing. These kinds of installations take a somewhat technology-led approach to their design. In other words, the installations start from looking at what technology is available and then configuring it in a form that seems to be close to providing the support needed.

The work carried out at the Bath Institute of Medical Engineering on the Gloucester smart house project explores these issues from a somewhat different perspective.5 This project is aimed specifically at supporting people with dementia and uses a design technique that is very user-led. In other words, user needs are explored initially to provide a definition of the kind of problems that have to be supported by the technology. Having made these definitions, the design work then moves on to create purpose-designed devices that provide the care needed.

There is, of course, a spectrum of reaction to technology on the part of elderly people in the same way as there is for any other age group, and some elderly people are very excited and very proficient in using equipment such as computers. However, there is no doubt that interaction with sophisticated technology can cause a lot of anxiety, which may deter many people from using it. Consequently, when it comes to providing supportive technology for the majority of users, it is preferable that the cognitive load on the user is kept as low as possible. The technology should really provide support with as little intervention as possible from the user.

The problems of designing user-friendly installations are exacerbated when it comes to providing support for people with dementia. For such a user group, having to learn new skills or make sense of a new piece of technology is out of the question. The technology really does have to be invisible and just intervene and provide support when the house deems it to be necessary. The technology has to be totally in the background, where the home appears to be just the same as any other home, where the user does not have to learn any new skills or interact with the new technology. But such installations are also going to be very user friendly for more cognitively able users and will be suitable for those who are less able to cope with new technology. Design approaches that embody this approach have been published.6, 7

The individual nature of the problems faced by older people has a big impact on the installation of smart home systems. As with all assistive technology, any means of tailoring it to the needs of the individual will make it more effective. Smart home technology is inherently flexible in that the way in which a system responds depends on the control software and this in turn can be easily configured for the individual. Ideally, installations need to be set up for an individual client by a non-technical professional such as an occupational therapist (OT), and this in turn means that such configuring interfaces also need to be user friendly.

Simple application of smart home technology can, in the ways illustrated, provide a lot of support for the user. However, if it is to be effective it has to be designed from a close understanding of the issues that are likely to arise and the way in which users are likely to interact with the technology. A very useful rule of thumb that was used in the development of technology within the Gloucester smart house project was to try to design new support equipment that reacted in a way that emulated the behaviour of personal carers. The reasoning behind this approach was that in many circumstances a personal carer is likely to be the person who best understands what works in caring for the person they are looking after. If they have developed a strategy that works for them, it is likely that any new technology that reacts in a similar way is going to be helpful. Surveys of personal carers showed that there was often a good consensus about strategies found to work. This understanding was a starting point for the new technology developed by the team for use in a smart home. During the design and development work, whenever a situation arose where it was not clear how the technology should react, it was found to be very useful to ask, ‘What would the carer do in this situation?’. In this way, the technology is being designed to act as a kind of invisible carer that is ever present, just looking over the user’s shoulder, checking that things are alright and just providing help when needed.

A good example of the use of the ‘carer emulation’ approach is provided by the designs used to control a bath. It would be easy to install a bath water-level sensor that shuts off the water supply when the bath is nearly full. Such a facility would ensure that a forgetful user did not flood the bathroom. However, if they came back to add some more hot water or they let out the water and wanted to run a bath the next day, they would find that the taps did not work because the water had been shut off. A key element in maintaining quality of life for someone with a cognitive problem is to enable them to feel they are still in control of their lives, and finding that their house is taking that control away from them would be counterproductive. How would a carer react to the problem of someone forgetting they were running a bath? It was found that, in these kinds of situations, the carer would follow a simple three-stage response. They would first provide a reminder, ‘Don’t forget you’ve got the bath running’. If that did not do the trick, they would then intervene to turn off the bath (or the cooker or other appliance). However, they would turn off the tap in the usual way, which would mean that it could still be used subsequently. Third, they would provide some reassurance to the user, such as, ‘I’ve turned off your bath. It’s ready now’, so that the user knew why something had happened.