'Aging in Place' in Italy and Sweden: Outcomes from Two Housing Experiences
Luigi Biocca, Construction Technologies Institute Unit of Rome, National Research Council (CNR ITC), Rome, Italy
Greger Sandström, The Architectural School, Royal Institute of Technology, Stockholm, Sweden
Abstract
Aging in place with the concept of inclusive design, enhancement of a better life quality and provision of suitable technologies is illustrated in two recent outcomes from Italy and Sweden with the attempt to underline the most interesting issues as well as similarities.
In the Italian situation, a number of recent initiatives, funded by the national program for housing 'Neighbourhood Agreements' is involving some City Councils in promoting urban regeneration/housing renovation plans of areas, with in mind a higher supply of life quality and relationship with the community, also thanks to the support of basic technology packages and tools.
In particular, one of those project (Home Technologies improving Usability for older users or people with specific needs) developed as a partnership between the City Council of Pinerolo (located next to Torino, North Italy) and the ITC CNR. It consisted of remodelling 5 existing apartment blocks and building 34 dwellings, basing on a check-list of guidelines for suitable fittings and supports to 'aging in place': from the design to the technology perspective as a support to daily activities at home and interface with outdoor services/facilities, and also, how to determine which design measures and instalments can increase the social inclusion and participation of older citizens in the community.
The outcomes, recorded in design guidelines files covering various aspects for improving domestic quality of life, will be further refined for building a wider evaluation tool in future scenarios of urban renovation plans.
In the end of the 1990s, IT functions in homes became a popular subject. In Sweden a residential housing unit comprising 126 flats, called Vallgossen, was developed. The technology comprises a home network with different alarms, energy measurement, bookings of common facilities etc. To control the home network the residents have a laptop computer. Beyond this the flats are equipped with a broadband connection, an integrated system for computer and telephone and electronic keys. In addition to these functions, 21 flats are equipped with a security camera at the front door, reception boxes and a built-in grid system for loud speakers. Two flats were also designed for trying out the possibilities for assisted living. The project has been evaluated. The objective of the study was to clarify whether there is a user value in built-in IT technology in dwellings.
This paper points out the relationship between the design guidelines and their applicability in different housing scenarios in terms of satisfactory responsiveness to user needs and competitiveness of technology/tools installation costs.
The Italian Experience
The 'Home Technologies improving Usability for older users or people with specific needs' guideline project in Pinerolo for housing and care/assistance facilities integration.
ITC has been recently involved in a city office consulting group for defining technology guidelines and supportive care/assistance facilities/tools for the benefit of older tenants accommodated in a newly built housing complex in Piemonte, Northern Italy (Biocca, Morini, Pomposini, 2003).
The pre-requisite of the project was a housing scheme able to integrate the requirements of suitably planned dwellings equipped with accessible and easy-usable furniture/fittings to the need for life independence, which may be hindered in older users as to outdoor mobility and home activities also because of health problems.
The goal was then to enhance users' lifestyle at home, with both home and health supportive systems/tools, also through communication systems with outdoor facilities centres (Biocca, Morini, 2001).
The work plan consists of the following two addresses:
- Survey of the state-of-the-art of the newest technologies and products available in the marketplace and suitable to older tenants' needs;
- Definition of guidelines of suitable house design in harmony with the suggested technologies/tools/facilities to install for the real and useful benefits of the future residents.
Such addresses have been conducted with the concept of aging in place and home modifiability, i.e. to give solutions also to be adopted or implemented in the next future, according to changing needs of residents, so they can choose to enjoy a good life quality at home with any kind of aid they can need.
State-of-the-art
Assessing the most proper home technologies and supportive aids to the persons is being conducted by ITC at different levels of technology complexity as a research hypothesis for home technology classification.
The follow-up will be to mainstream future housing surveys/renovations/installation/guidelines into a grid of the defined relations user needs/requirements/solutions/technologies.
Classification is then in accordance with the following system subcategories:
- First Level System (or Basic System): this category includes products, tools and/or technologies resulting in a 'basic' system equipment of housing, suitable for elderly with fairly good abilities or, in any case, with no need of specific supports.
- Second Level System: this category includes products, tools and/or technologies resulting as additions to the basic system, in order to comply with specific needs we can find in some cases of non self-reliant older citizens (aids for orienting, dementia, Alzheimer, support to cognitive problems).
First Level System
The first level system or basic system includes four automation types, two of them related to safety and two for supporting home daily routines:
Home safety: Components for preventing home dangers and damages (intrusion, water flow, smoke and gas alarms) belong to this category. Safety systems can be set up independent or connected altogether in an integrated system (technologies) and in any case they use sensors.
Safety of people: Additional components for home safety, and more specifically addressed to persons. They can be products, tools or supports for preventing or intervening after chronic or impairing health problems of people living at home and, in most cases, alone (active alarm for illness/fall emergencies).
Easy house management: This system can integrate technologies of different kinds (sensors, actuators, alarms, etc.) to a network connected to a station (PC or control panel), enlarged through peripheral control terminals (e.g. home or mobile phone, remote control). The system is especially aimed to optimizing the basic home routines, as follows:
- Air conditioning/energy control
- Routine planning and online maintenance of appliances
- Garden watering automation
Easy management of some routines:
- Provides for controlling and managing additional home routines, specifically aimed to an easier use and comfort for the user.
- Entrance door automation (smart card)
- Doors, windows, shutters and curtains automation system
- Lighting system control
- Motorized components for furniture and fixtures.
Second Level Systems
In addition to characteristics of first level systems, the second level supplies technologies and supports for specific needs, which mostly take advantage of informatics (PC) or communication tools (screens, messages, LAN networks). They can be mainly divided into four categories:
- Supporting tools (for memory, to perform some activities) in order to allow users with cognitive problems perform easily the basic daily life activities (e.g. personal care or eating) (Keijer 1999).
- Health data monitoring (pressure, glicemy, ECG, etc.);
- Wandering monitoring in order to assess the wandering event so to prevent from environmental dangers (e.g., if a person goes out and does not know how to come back),
- Lifestyle monitoring (to prevent, instead of reacting; passive systems) (Fisk 2001).
Outcomes from the Checklist of Supportive Tools/Technologies at Home
The definition of guidelines for supportive tools/technologies at home, resulted in the checklist illustrated above, is a first milestone to include a larger range of newly built or renovated housing stocks for the benefit of older citizens' life independence in home-related activities. These guidelines are collected in records of products/tools/technologies/facilities with description, information, user target and installation/use characteristics, criteria and recommendations (see Figure 1).
Figure 1. Sample of a technology classification record
(Source: Biocca, Morini, Pomposini, see References)
Files and guidelines are being periodically updated and/or implemented by introducing new products/tools developments or evolutions. In addition, a collection of some representative samples of good practices of home equipment and installation covering a large range of needs is filed with the aim of promoting them as a current ordinary practice for next housing renovations (Biocca, Dewsbury, 2004).
The renovation and construction plan.
The urban renovation project of Pinerolo aimed to redeveloping a degraded built area that had long been remained torn out of facilities and social life of town community.
The existing situation prior to renovation reported obsolete houses with poor materials and equipment, no heating nor insulation system, then some dismissed factories and poor maintenance of common spaces. Inhabitants were not feeling any longer their identity as an integrated town district (D'Innocenzo, 2003).
The new master plan gave the opportunity of a new urban image by retrofitting/adjusting older dwelling blocks and building a new housing complex with in mind adaptability to evolving household needs, materials sustainability and energy saving (see Fig. 2).
Figure 2. General view of the master plan
(Source: Pavoni, see References)
The retrofit design
Five old blocks of dwelling have been equipped with new systems, fittings, and double ventilated facades. Accessibility was improved by installing elevators. When in lack of room, lifts with connecting passages have been built out of the block (see Fig. 3)
Figure 3. View of the outside lifts and double ventilated facade
(Photographer Luigi Biocca)
The new construction
A dismissed area is now being replaced by a housing complex of 34 one and two room dwellings, with some common halls and facilities, connection to teleaid service and a basic package of technologies for supporting tenants' everyday life at home (see Fig. 4-5-6). Houses were not designed specifically for older people only, but also suitably to younger couples in order to encourage community exchange and participation as well as a new awareness as a core town district (Pavoni, 2003).
Figure 4 - View from the south
(Photographer Luigi Biocca)
Figure 5 - View of the corridor
(Photographer Luigi Biocca)
Figure 6 - View of a dwelling unit
(Photographer Luigi Biocca)
The common areas of the complex are usable and accessible (see Fig. 7); all dwelling units are visitable (see Figure 8), while three of them are entirely accessible and can accommodate people with serious mobility difficulties.
Figure 7 - View of the community hall
(Photographer Luigi Biocca)
Figure 8 - Plan of standard houses
(Source: D'Innocenzo, see References)
User participation also allowed future tenants to customize layout of key rooms according to their needs and lifestyle, so that houses feature a good flexibility level.
Features related to accessibility, usability and safety include:
For corridors and common rooms:
- slipping proof floor;
- colour and contrast orienting pathways;
- emergency lighting system automatically switching on/off;
- teleaid system for health emergency remotely alerted;
- smoke and water flood detecting systems remotely alerted.
For dwelling units:
- electrically adjustable kitchen counter (only units for people with disabilities);
- adjustable washbasin in the bathroom (only units for people with disabilities);
- electric door opening control (only units for people with disabilities);
- lifting system in the bedroom (only units for people with disabilities);
- Solar balconies at the first floor (see Fig. 9);
- floor shower areas;
- electric cooking counter;
- outlets and devices easily visible.
Figure 9. View of indoor solar balcony
(Photographer Luigi Biocca)
Additional technology tools for dwelling units include:
- alarm control button in the living room;
- two alarm control wires in the bathroom;
- wearable alarm remote control;
- smoke detecting system;
- water flood sensor system.
Alert situations are transmitted to an emergency station and forwarded to outside aid centres.
The Swedish Expeience
The Project Vallgossen
Between 1999-2002 a project called Vallgossen was developed in the inner city of Stockholm, Sweden. The project is characterized by its IT technology, its modern architecture and design. The building comprises 126 flats. The flat sizes vary from 44 to 144 square meters. On the ground floor there are small area-efficient flats while the upper floors have spacious, large terrace flats. The top floor includes a few exclusive penthouses with a very open floor layout and increased ceiling height. Material and equipment were chosen so as to correspond to a higher standard than usual in this type of building development in Sweden. The architecture is characterised by open floor layout, large windows, high room height and that the daylight is illuminating the whole flat. The first occupancy in Vallgossen took place in September 2001.
Figure 10. Facade of Vallgossen.
Photographer: Greger Sandström
The architect's aim was to design flats with a flavour of the future. Examples of this design are the frequent use of white colour and clean surfaces. No lintels or architrave's frame the windows. In addition, all rooms are designed so as to allow easy cleaning. For instant, toilets are wall mounted, no front on the bathtub and folding radiators.
Figure 11. Floor layout of a two bedroom flat.
(Source BAU Architects)
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The purpose was to offer all residents, regardless of their age, desire and need, a secure and comfortable living environment and a high quality of life. A specific goal was to offer people an opportunity to stay longer in their homes as they grow older, or acquire a disease or become disabled. Large effort was put on the design of accessibility, e.g. no thresholds and large spaces in entrances, stairwells, elevators and flats.
IT Functions
Regarding the IT functions in Vallgossen, all 126 flats have a set of basic functions called type 1, while 21 flats have some additional, more advanced functions, type 2. Two flats had functions of type 3, which have been test units for trying out the possibilities for assisted living (Sandström & Keijer, 2003).
The availability of technology defined to a large extent the content of IT functions. At that point of time there was limited knowledge of consumers' opinions and perceived user value of smart functions in dwellings in general. One important objective, when designing the IT functions, was to make their physical appearance as invisible as possible. Another objective was to make these functions user-friendly. The demand on the users is moderate to control the different IT functions in their flats. The users are not forced to manipulate these IT functions. They decide on their own how quickly they want to apply the home network and to apprehend the offered IT functions.
The functions in type 1 are a home network, a laptop computer to control the home network and a broadband connection. To open the doors to the lobby and general spaces, e.g. garage and laundry room the residents use an electronic key. The flats are also equipped with an integrated system for computer and telephone. In every room there are at least one socket with two jacks. With this system the residents can make their computer socket function as a telephone socket in every room. This makes the layout of the flat flexible and the residents can arrange the furniture and use every room as they desire.
Figure 14. Example of screen shot of the home network.
(Source E2-home)
At the beginning, the basic idea was that the home network should be central in the residents' everyday life. The residents would now be able to gather all their families' information in one place, e.g. to communicate with each other (e-notes), to communicate with their friends (e-mail and address book) and to co-ordinate their activities (calendar). Further, it would help them to feel safer at home (alarms) and to have control over their energy use.
In addition, the flats in type 2 have another three specific functions. These functions are a built in grid system for loud speakers in the living room, kitchen and bathroom, a security camera at the front door and reception boxes. The reception boxes are next to the door outside the flat and offer space for reception of goods, e.g. groceries and laundry. The deliverer gets a disposable key code in order to deliver the goods directly to the building. Only the resident who placed the order can open the reception box by his own electronic key. Further description of the IT functions is shown in table 1.
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| System/Equipment | Function | Vallgossen | |
|---|---|---|---|
| Type 1 | Type 2 | ||
| Home network | Includes energy use, weather forecast, home-security, a family calendar, e-notes, e-mail, "away lock" and bookings of common facilities. | x | x |
| Energy use | Presents the measured use of electricity, gas and water on a daily basis as well as over a requested period for each energy type. The resident can also compare this usage with the average use in the building. | x | x |
| Alarms | Includes fire, leakage and burglar alarms. If anything is wrong the alarm is set to send a message to the resident by SMS or e-mail or to an operator of security. | x | x |
| Weather forecast | Shows the weather of today and the following day. | x | x |
| Calendar | A calendar that co-ordinates the family's activities. | x | x |
| E-notes | The residents can leave e-notes to the rest of the family and create common reminder lists. Then, SMS or e-mail can send the list to a recipient. | x | x |
| Ordinary e-mail. | x | x | |
| "Away Lock" | Controls the main water supply, electricity and/or gas to the stove, lamp in the hall, the burglar motion detector, power sockets, ventilation, lighting and heating.* | x | x |
| Bookings of common facilities | To operate the laundry room or the sauna, the use of a party room or a guestroom. A signal to the residents' mobile phone or laptop computer reminds the residents that they have a service booked. The residents can also supervise the washing machines in the laundry room and receive a signal via the laptop computer when the washing machines are done. | x | x |
| Laptop computer | To control the home network. | x | x |
| Broadband connection | To surf on the Internet. | x | x |
| Integrated system for computer and telephone | Same socket in a room can be used for both units. | x | x |
| Electronic key | To open the door to the lobby and general spaces, e.g. the garage and the laundry room. | x | x |
| Security camera at the front door | The residents can both see and talk to the visitors via the camera before letting them into the building.** | x | |
| Reception boxes | A space for reception of ordered goods. | x | |
| Built-in grid system for loud speakers | Connects the stereo in the living room with loud speakers in the kitchen and in the bathroom. | x | |
* When the entrance door is locked, the water is automatically shut off two hours after locking, as well as gas or electricity to stove, sockets above the worktop, lighting and heating. Further, the ventilation in the bathroom is reduced (if the moisture detector does not indicate a need for ventilation) and the burglar alarm is set on. When the resident comes home the lamp in the hall lights up and the main water supply, the gas, sockets, ventilation are switched on automatically. The light in the hall is on until the resident manually turns it off.
** The security camera at the front door is separated from the home network. The residents can look at the person who stands at the front door without bringing it to that person's knowledge. This gives the residents an opportunity to choose if they want to "be at home or not."
In addition to the functions described in type 1 and type 2, flats with type 3 are provided with several IT functions to make assisted living possible. The objective partly has been to facilitate the daily work in the flat and partly to make it possible for a longer and safer assisted living in the home environment.
This part of the Vallgossen project aimed at demonstrating that flats designed with these facilities offer possibilities for assisted living. The type 3 functions are meaningful regardless of the tenants' impairment, whether caused by accident, by an emerging disease or just due to old age.
Some specific functions in the two flats designed for assisted-living, are listed below:
- remote control of all ceiling lights, all Venetian blinds and some electric sockets,
- the light in the bathroom is turned on when someone is in the bathroom,
- the entrance door is locked/unlocked via a remote control, e.g. from the bed,
- "Good Night"-function: by pressing the remote control, e.g. from the bed, all lighting, power to the stove or to the coffee machine is switched off. If an entrance door is open the tenant will get a voice message,
- a necessary guide light is switched on if the tenant leaves the bed at night. The guide light also activates if the fire alarm triggers. The guide lights are switched off by the "Good Night-function" remote control close to the bed,
- photoelectric controlled water taps in both kitchen and bathroom. The water is turned on by simply putting your hands under the tap,
- safety alarm - in an emergency situation the tenant can trigger the alarm. The alarm is a function of the ordinary telephone and directly routed to either a relative or to a security operator. The tenant can speak into a telephone without lifting the earpiece and without being close to the telephone,
- a "vibrating alarm" in the bed vibrates if any alarm triggers, e.g. the fire alarm,
- overheating the stove alarm. The power automatically shuts off at too high a temperature,
- burglar and fire alarms are directly routed to a security operator.
Type of Residents
The type of residents in type 1 and 2 are all ages. They have chosen on their own to buy a flat in Vallgossen. The Danderyd Hospital selected the residents in type 3. During the project persons who suffer from cognitive disorders, and their families, were offered the opportunity to live in these flats for a period of three to six months. One criterion was that the patient, as an adult, has been in an accident or any other event, and suddenly and unexpectedly has passed from a healthy normal way of life to being a disabled person requiring assistance. Another criterion was that the test person has lived in his or her own home before the accident. In this way a comparison could be made between their ordinary living and their living in Vallgossen.
Evaluation
As this was a new field of evaluation it was considered important to understand the respondents' expectations and experiences in connection with the new technology. The study was conducted by interviewing 11 households, in all 22 interviews. Ages raging from 22-77 years old. The study was a combined pre- and post occupancy evaluation. The evaluation focused on the IT functions usability. The first evaluation was conducted in year 2002 and a second evaluation will be conducted during 2004. It is only the conclusions from the first evaluation that will be described in this paper. For more detailed description of the results from the evaluation of type 1 and 2, see Sandström (2003) and Sandström et al. (2003).
The evaluation of the type 3 flats was carried out by the Department of Rehabilitation Medicine at the Danderyd Hospital. This evaluation focused on the parameters of medicine, security and care of the IT-based services in these flats. The study was conducted by interviewing 8 households in the age of 20-63 years old.
Central concepts in the surveys have been usability, usefulness and accessibility. Usability can be seen as something that arises when a product is used (Löwgren, 1993). The concept usefulness determines if a product or a service supports the user in fulfilling a task, satisfying a need or solving a problem. However, there is always a problem to confuse usefulness and usability. A product or a service can be demanded by a user and appear useful to her. Still it remains useless in practice. It may depend on the fact that the user does not understand how she is supposed to use the function. It can also be out of order or not available when asked for. One could say that the function is not accessible. Accessibility is a complement to usefulness in order to reach usability.
Conclusions from the Evaluations
The most important conclusions drawn from the evaluations are:
- An IT function has to come from users genuine needs and must be designed with focus on usability and physical and cognitive accessibility. It has to be easy to learn and easy to remember, i.e. it should be designed for intuitive use. The concept "Design for all" has to be put forward if the technology will be common in our homes.
- An IT function has to have high and stable technical accessibility from the beginning when a new users starts to use the function.
- A user should get information that shows the IT functions usefulness so that a person that has not tried the function knows what he or she can expect from it. The question about the technologies invisibility is an important question that can lead to complex adjustments when it comes to the design of IT functions.
- An IT function has to be designed with respect to the whole service. A good example is the reception box. The reception box showed obvious absence in the distribution chain that is supposed to deliver goods into the box.
It is still too early to draw absolute conclusions about the real value of the technology. It is important to conduct a deeper study about the real use and the permanent attitudes towards the technology.
The above mentioned paragraphs can be obvious but it probably demands huge effort to fulfil them in this stage of technology development. It should be mentioned that even if these paragraphs are met it is no guarantee that there will be a demand for these IT systems. This question is tied together with another issue, i.e. the consumers' willingness to pay. The residents must in the end pay for the technology and services.
Different users have different needs and capability to use IT supported services in their housing. Compatibility with other types of IT systems, such as cable TV, mobile phones and computers, are also important for IT services development and the consumers valuing, i.e. the residents valuing. The technology must also be secured over time. Maintenance and upgrading of the technology will be important questions for the future. IT in homes will remain a hot issue for the future, providing functional quality is pursued and users' benefit and comfort are kept in focus.
Conclusion
The Italian and Swedish experiences show case-studies from two different European situations for culture, design practising, supply and delivery of care services. However, some common findings can be seen in that they place people's lifestyle as a core of the design process.
The user-focused approach becomes then a space where technology does not play a 'first-rate' role.
These experiences seem to 'camouflage' technology inside home daily activities unobtrusively but very effectively at the same time, so that even users not very familiar with technology can benefit of what they really need. This mode allows a technology system to act autonomously inside home as well as to be customized case by case with no need of user's intervention and, moreover, simplifying/limiting the user's involvement to the easiest tasks.
What users really need has been partly investigated till now and will extend to further users' groups to define more precisely the impact of technology features on home lifetime benefits as well as to take out larger basis similarities/differences from different contexts.
References
Biocca, L. & Dewsbury, G. (2004). Housing and Technologies in the EU for promoting quality of life: current trends in the UK and Italy, CIB World Congress, Toronto, May.
Biocca, L. (2004). Svezia, stili di vita e orientamenti abitativi, Assistenza Anziani, May, pp. 28-30 (in Italian)
Biocca, L. & Morini, A. (2001). Technologies to maintain people at home: Italian experiences, International Conference on Technology and Aging, Proceedings, September, ICTA, Toronto, Canada.
Biocca, L., Morini, A. & Pomposini, R. (2003). Tecnologie domotiche per migliorare la fruizione residenziale di utenti anziani o con specifiche esigenze (Guidelines Report Contract on Home Technologies Assessment) for Comune di Pinerolo (in Italian).
D'Innocenzo, A. (2003). Recuperare e rivitalizzare un quartiere di anziani: la sfida e le attese di un programma sperimentale, AeA Informa, no. 5/6, pp. 24-33.
Fisk, M. (2001) Smart homes and lifestyle monitoring, Inview: Focus on Technical issues in housing, Northern Ireland Housing Executive May.
Löwgren, J. (1993). Human-Computer Interaction. What every system developer should know. Studentlitteratur AB, Lund, Sweden.
Pavoni, G. (2003). Foro Boario: gli interventi edilizi sperimentali, AeA Informa, no. 5/6, pp. 34-41.
Sandström, G. (2003). Evaluation of ICT functions in flats. Presented at SASBE2003 Conference, November 19-21st, Brisbane, Australia.
Sandström, G. & Keijer, U. (2003). Alloggi domotici integrati e di addestramento per persone con problemi mentali (Integrated smart living - Training flats for persons with acquired brain dysfunction). AeA Informa, no. 1/2, pp. 85-90. (in Italian)
Sandström, G., Werner, I.B. & Keijer, U. (2003). Smart Homes Evaluated. Open House International, Vol. 28, No. 4, pp. 14-23.