96 Just ordinAry robots
increase patient autonomy and to provide care more eciently. rough
their TV or computer screen in their living room, patients could contact
doctors, assistants, and district nurses 24hours a day, 7days a week. It
also allowed them to forward data relating to medical test measurements,
such as blood glucose and blood pressure, through the system. e par-
ties involved, including the information and communication technology
(ICT) service provider, concluded that there is lot of potential in this
form of care. Yet, the results are not conclusive in terms of cost savings
and a reduction in personnel, because this remote care functioned not as
a substitute for but rather as a supplement to the care otherwise provided.
3.2.1 Paradigmatic Shift in Care
A combination of domotics and ambient intelligence (AmI) could
signicantly improve the functionality of domotics (Rodriguez,
Favula, Preciado, & Aurora, 2005). AmI consists of a vision in which
technology is integrated into and aware of environments and is able
to make reasoned decisions (Aarts & Marzano, 2003). People are
empowered through a digital environment that is aware of their pres-
ence and context and is sensitive, adaptive, and responsive to their
needs, habits, gestures, and emotions (Riva, 2003). AmI could con-
siderably enhance the eectiveness of standard domotics for care for
the elderly and enable new solutions. For example, simple alarm but-
tons worn by users could be enhanced to measure physical discomfort
and automatically alert emergency services (Meulendijk etal., 2011).
is intelligent technology brings about a paradigmatic shift in the
traditionally low technology social practice of care. e shift is going
to occur in the way we live with domotics: the handing over of con-
trol that increases the potential functionality of domotics—the house
itself can be empowered to perform a greater range of tasks relating
to the occupants’ comfort, convenience, security, and entertainment.
By using domotics, care practice can be enveloped in an ICT-friendly
infosphere in order to make telecare possible. is rationalization of
care oers remote care of elderly and physically less able people, pro-
viding the care and reassurance needed to allow them to remain living
in their own homes. Telecare implies a new kind of man-in-the-loop
for caregivers, since it reshapes the role of caregivers: caregivers will
become teleoperators for all kinds of care tasks.
97tAking CAre oF our PArents
According to Oudshoorn (2008), there are increasing possibili-
ties for telemonitoring and telediagnosing, or even treating patients,
using domotics and ambient intelligence. is also implies that vari-
ous technologies collect a lot of data about the people who receive
remote care; sensors at home capture when someone is lying in bed,
is opening the fridge, or goes for a walk outside; sensors in clothing
may capture the physical condition of people and transmit informa-
tion, and cameras can record what someone does around the house
or even watch the care recipient 24hours a day. ese data provide
a great deal of detailed information about the daily life of the care
recipients and thereby raise questions about the privacy of these care
recipients. e issue of proper treatment of these data is a sensitive
matter: who is responsible when data are lost; which data are stored
and for how long are they stored; and are the care recipients aware of
the fact that information is being collected about them? ese ques-
tions will play an important role in the near future with the growth
of remote care. e ever-increasing scale of providing remote care
requires reection on the degree of the invasion of privacy. According
to Borenstein and Pearson (2010), the degree of control by the care
recipient of the information collected is important. When someone
has actual control over the information collected, this enhances the
autonomy of that person.
3.2.2 Ethical Issues
With the implementation of domotics, ethical values such as privacy,
human contact, quality of care, and the competences of caregivers and
care recipients appear to be at stake. In this section, we will briey
reect on these ethical issues.
3.2.2.1 Privacy Monitoring and taking control of these senior citi-
zens may involve a breach of privacy. Care recipients will not like
being recorded when they are not properly dressed or when they are
taking a bath. e use of cameras for real-time observation could,
therefore, cause the most serious feelings of violations of privacy
(Mihailidis, Cockburn, Longley, & Boger, 2008), especially if the
users cannot turn these cameras o. A solution could be a two-way
communication system that uses a videophone on demand between
98 Just ordinAry robots
the caregiver and care. is system creates a feeling of social security.
It does not have the privacy restrictions of passive camera monitor-
ing, but at the same time it improves demand-driven care. People
can connect to the system whenever they feel like it (Kort, 2005).
A risk of such a system is that there is the potential for improper
use or overuse by the care recipients. Care recipients who feel lonely
could overwhelm the doctor’s surgery, for example, with unnecessary
inquiries to generate attention (Center for Practice Improvement and
Innovation, 2008).
e privacy issue becomes more complex in relation to dementia
in old age: to what extent can someone with dementia indicate that
they are aware of the presence of a technology that captures their
daily lives? Can we use track-and-trace systems to cope with the prob-
lems accompanying dementia, such as wandering, a potentially lethal
behavior? It is argued that a slight loss of liberty is acceptable in order
to increase safety (Van Hoof, Kort, Markopoulos, & Soede, 2007).
Another issue with respect to privacy concerns the collected data.
e questions are who exactly should own or control the data and how
can safe data storage be guaranteed (Bharucha etal., 2009). Currently,
no protocol is available for controlling and storing these data.
ese privacy questions should be taken into consideration by
developers and politicians when they are deploying home automation
as well as care robots. In this era of rapid developments in ambient
intelligence and robotics, where privacy issues are at stake, there is an
urgent need for total transparency and clear denitions, otherwise the
issue of privacy could block innovations in these areas. is requires
developers to consider the consequences right from the beginning of
the design process of their use of robotic technologies in terms of
privacy. It should become a balance between some kind of protection
of privacy on the one hand and the need to keep on living at home
independently on the other, since systems that are designed to pro-
mote independence require varying degrees of violations of privacy
(Bharucha etal., 2009).
Qualitative studies, however, have shown that most elderly people
do not feel as if their privacy is violated (Courtney, 2008). e need
for monitoring overrules any possible privacy concerns if there is an
appropriate balance between this need and privacy. For example, some
older adults prefer to be monitored in the bathroom while they are
99tAking CAre oF our PArents
naked, rather than running the risk of a fall or of their lying uncon-
scious on the oor being unnoticed (Van Hoof etal., 2007).
3.2.2.2 Human Contact and Quality of Care Domotics is focused on
giving elderly people more independence; however, this may involve
a threat of a reduction in social contact. Many authors worry that
the use of domotics devices might lead to loss of human contact and
humane care (see, e.g., Boissy, Corriveau, Michaud, Labonte, &
Royer, 2007; Mihailidis etal., 2008), which may lead to elderly people
becoming socially isolated, since for some people the visits of caregiv-
ers are the only social contact available to them. Furthermore, health
professionals feel that good care is linked to genuine relationships and
social interaction (Sävenstedt, Sandman, & Zingmark, 2006), includ-
ing aspects such as reciprocity, empathy, and warmth. Domotics will
create long-distance care relations instead of a personal and intimate
care relation (Boissy etal., 2007). However, a study by Pols (2010)
shows that the use of domotics could mean that care becomes even
closer to the care recipient, instead of being “care at a distance,” and
that domotics could turn out to be more, rather than less, intensive.
Care by telecommunication devices appears to be more intense and
frequent than face-to-face contact. For example, telecommunication
using a webcam makes a conversation seem even closer to each person
than real encounters, since one is more focused on the image of the
face of the other person (Pols, 2011). Although the domotics devices
allow for more frequent consultations, not “everything” can be seen,
as in the case of caregivers who provide care on the home, because
dierent variables cannot be taken into account for diagnoses, such as
physical examinations.
e use of domotics requires a vision of care practice, and the dis-
cussion should be about what exactly we mean by “care,” and what
the role of technology is in “care.” More research is needed to inves-
tigate the changes to clinical practices in care for the elderly made by
domotics in order to create a clear image of what these changes will
mean for the notion of “care” and how we can use domotics.
3.2.2.3 Competence of Caregivers and Care Recipients e introduc-
tion of domotics devices has an impact not only on care recipi-
ents but also on caregivers. As shown in the previously mentioned
100 Just ordinAry robots
domotics project KOALA, the use of remote care at a distance not
only requires acceptance by users, but caregivers have to adjust their
activities as well. According to Van Oost and Reed (2011), the
socio-technical network in which domotics is being implemented
must be closely observed, since the use of domotics creates a new
care practice. In this new practice, health care professionals get
new roles with a dierent division of responsibilities (Akrich, 1992;
Oudshoorn, 2008) that requires them to have new skills. rough
mediation of technology, caregivers receive dierent information,
and the possibilities for intervention are therefore changed. e use
of telecommunication, for example, requires a dierent method of
working by health care professionals or caregivers, such as being
able to diagnose, monitor, and reassure people via a computer or
TV screen.
New skills are also expected of the care recipient. e care recipi-
ent should be able to deal with teleconferencing and with forward-
ing messages containing data to a doctor. More serious is the use of
medical devices by the care recipients. If a care recipient with diabe-
tes, for example, has responsibility for monitoring their blood glucose
levels, there is no longer a professional involved in the process. Even
during training programs, patients make errors when calibrating and
using the device (Mykityshyn, Fisk, & Rogers, 2002). Well-designed
training and instructional programs for older adults, as well as care
professionals instructing patients about the technology and familiar-
izing them with its use, are needed for the successful use of medi-
cal devices (Czaja & Sharit, 2012). Dealing with robotic technology
therefore opens a new chapter in the training of caregivers as well as
care recipients so that both of these groups can easily cope with it and
can anticipate the possibilities and limitations of robotic technologies
(see also Shaw-Garlock, 2011).
To conclude this section, it seems true to say that there seems to be
little ethical objection against domotics by elderly people. Zwijsen,
Niemeijer, and Hertogh (2011) state that this might be because most
elderly people are eager to avoid the prospect of living in a nursing
home. Living at home is valued very highly, and is traded o for
any potential loss of human contact and privacy. at there is little
ethical objection does not automatically mean that domotics is an
ethically sound solution. As it is the prospect of living in a nursing
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