Sensor-activated social work: how assistive technology helps maintain contact and control living space

“Alexa, stop,” commands Jane Stevens, Wigan council’s assistive technology manager in a stern voice.

We’re sitting in the living room of an untenanted bungalow that the Greater Manchester council has packed with consumer and specialist technology, all of which is being trialled for health and social care use.

Stevens is in the process of explaining how Amazon’s voice-activated Alexa assistant can help people maintain contact with others and control their living environment. But when she mentions Alexa by name, the Echo device within which ‘she’ resides keeps piping up to try to offer some help – driving Stevens to request a little peace.

Wigan council set up its bungalow in 2017 as a test-bed and demonstration site. It enables social workers, other professionals, and service users and their families to see in a home environment how new products – especially consumer-oriented ‘internet of things’ devices – are revolutionising assistive technology, which helps people stay independent longer.

Helen Sunderland, the national social care lead at EY (formerly known as Ernst & Young), drew attention to the rapid progress being made during a panel debate on assistive technology at Community Care Live last year. She says the fact that local authorities need no longer rely on clunky, purpose-built “disability technology” has been crucial.

“[Now it’s about] how do you make a smartphone do the stuff you need it to? How do you take personal gadgets and make them a part of helping people live their lives more easily?”

In Wigan, Stevens says the council “likes to scope out what’s going on” to meet peoples’ needs and has always avoided being tied into individual suppliers of equipment.

“We had our normal telecare service,” she continues. “But then in 2016 Jo Willmott, one of our assistant directors, recognised that we needed to start expanding our assistive tech offer, looking at consumer products and whether we could utilise them. That’s the journey we are on at the moment.”

Voice-controlled empowerment

Amazon Echo, which some other councils such as Hampshire are also now trialling, has proved to be one of the most valuable companions on that journey. Wigan council began by distributing 29 Amazon Echos to residents in supported housing schemes in partnership with Alcove, an assistive tech provider that combines its own sensor technology with bespoke software that augments third-party devices.

The project, called Voice Controlled Empowerment, aimed to explore how Alexa could support people to live independently and bridge the ‘digital literacy’ gap that can prevent older people – especially those with cognitive impairments – benefiting from technology. Beyond this, it also set out to discover how the assistant could be improved via bespoke ‘skills’ (in other words, applets) designed by Alcove.

“One we chose to develop [based on feedback from the Wigan group] was to enable family, friends and carers to check in and out of someone’s home,” says Alcove co-founder and chief executive Hellen Bowey.

“In the hallway where a warden callbox would go, our video-calling screen [the Alcove Connect, a customised Android tablet] and an Amazon Echo can be plumbed into the walls,” she adds. “When carers come in they go, ‘Alexa, open check-in,’ it goes, ‘What’s your name?’ You say it and that’s check-in done.”

Bowey says this setup, which Alcove has been rolling out in supported housing schemes around London and the South East (attracting praise from Care Quality Commission inspectors in a soon-to-be-published report) has a number of advantages. The check-in process disturbs the resident as little as possible, while tabs are kept on who has actually entered someone’s property and video calls can also be made via the tablet. Meanwhile the person whose flat the devices are installed in also gets the other benefits of the Echo, which now retails for about £90.

Some of these relate to simple interaction. Participants in the Voice Controlled Empowerment pilot described having a digital assistant about the place as “thoroughly enjoyable” and even “good company”. Ninety-five per cent said they used it daily for things such as reminders (though a third also said Alexa struggled with a Wigan accent).

Other advantages become obvious from a few minutes in the bungalow at Wigan.

“Walking round it, you see how technology could be used in your own life and, from that, how it can work to help others keep independent,” says Sue Neilson, an adults’ social worker at Wigan council. “It’s things like older people, who might struggle to close their curtains or turn a light on, being able to do so at the command of an Alexa.”

By linking an Echo with a standard telecare system, Wigan has also enabled one of its service users, who has MS and can now only move her head, to call for outside assistance via voice activation alone.

“She used to have a standard pendant; there was never an alternative before,” says Stevens. “Now we’ve been able to give her the ability to summon help when she hasn’t got support around her.”

Life tracking

Beyond voice-activated assistants – Google’s Home system is also being explored – some of the subtler pieces of assistive kit installed in Wigan council’s bungalow are also intriguing.

Before even entering the property, our images have been captured by the Ring video doorbell outside. When pressed, it can link to one or more mobile phones to enable a door to be answered remotely.

“We were given a case where John, who has an acquired brain injury but manages well at home with minimal support, had been targeted numerous times by bogus callers,” says Stevens. “We wondered whether there was any mileage in the Ring doorbell, attached it to his sister’s phone so she can see who is at door and that’s what we’ve ended up doing for him.”

While the device does not stop people coming to the door, it retains footage that can be passed on to the police. “John’s sister has her own physical health issues, and feels much more secure knowing that she can vet people so John isn’t put in those situations,” Stevens says.

As we move through the bungalow’s interior, soft pings sound from Stevens’ phone. While it’s easy to miss them, sensors – both from Alcove and other operators such as Canary Care – are mounted in doorways and cupboards, to the side of the fridge, under the living room table and within furniture. As well as our motion, which is triggering those notifications, they monitor light levels, temperature, pressure and other metrics.

Such sensors are becoming increasingly sophisticated, but are not in themselves new. Pioneered by the firm Just Checking, since the early 2000s they have enabled people’s activities to be monitored; far less disruptive than if human carers were popping in and out of homes.

“When we started, there was immense concern that this was Big Brother-like; intrusive on people,” says Just Checking founder Celia Price.

“Actually, we found over time that the type of information we were getting out gave practitioners and families a clearer, better picture of what people’s capability was when there was nobody else there,” she adds. “Before, many decisions about people’s care were pretty much made in the dark, and often assumed they were less able than they turned out to be.”

Neilson explains that sensors like those deployed in the bungalow are routinely used in a project she’s involved in, Right Support, which is exploring how technology can be put to work in supported living.

She cites an example of a young man with mental health issues and suspected autism, who had carers in during the night, during which time he was restless and often up and about. In the day, when he had no support, he was tired, disengaged and would often nap.

“His provider was pulling out, so we put Canary in to monitor his movements at night,” says Neilson. “Although he did get up at night, we were able to establish that he didn’t need staff to attend to him – he was perfectly safe with some sensors on his door to alert us.”

Instead, support workers were reassigned to daytimes, in a much more effective use of resources, helping the young man to get up, structure his day and explore education and job possibilities. A knock-on effect of the more active day, Neilson says, is that he also sleeps better at night.

Machine learning

While Neilson’s example is a simple one, the increasingly rich detail provided by sensors, and the ‘patterns of life’ they can map onto dashboards, are driving forward the complexity of what can be achieved.

Their value, says Stevens, is in enabling people to live with the minimum infringement on their independence, only notifying others when the patterns change, or when specific circumstances are detected.

“We recently used Canary for a lady with dementia, whose daughter lives over the road from her,” she says. “She goes to day centres five days a week and always has a shower – she’s still in that routine – but then forgets to turn it off, so the bathroom would steam up.

“We mapped out sensors with door contacts, put a temperature sensor in the bathroom, and wrote a rule [for the system] that if the temperature rises over a certain level it pushes a notification to the daughter’s phone and she can go over and turn the shower off,” Stevens goes on.

In the near future, even that direct human intervention may not be required, according to Alcove’s Hellen Bowey, who claims her product can now collect data from up to 255 sensors within the home.

“We met one old lady with dementia whose daughter picked up [via sensors] that the back door was opening 60 times a day,” Bowey says. “She knows that’s where she has a fag, going in, coming out.”

Machine learning, Bowey adds, and further integration with an Echo, could enable the system to give its own nudges. “Down the line, Alexa will go, ‘Mary, you’ve had 12 cigarettes already, please do not go outside again’.”

A similar setup, she goes on, could be used for medication reminders if a cupboard is not opened, or to prompt people prone to wandering at night not to leave their homes.

Asked about the potential for such systems to seem sinister or disorienting, Bowey’s response is that vulnerable elderly people have experienced visitors they may not recognise, and “disembodied voices through their telecare boxes” for decades already.

“You might display an avatar in the hallway of the daughter’s face saying, ‘Mum, please don’t go wandering’,” she adds.

Eyes to the future

While there’s nothing as sci-fi as that on display in the Wigan bungalow, we have time to inspect a few of Stevens’ more weird and wonderful kit choices before we leave.

In the living room is a large and apparently bombproof table, incorporating a computer and with a full-touchscreen top that can turn into a piano, display photos or play music or games. It is destined for the communal area of a residential scheme for people with autism.

Nestling in the bedrooms meanwhile are a pillow that monitors sleep quality – again sending data to an app – and a mask that beams red light through the eyelids, dispelling anxiety and promoting slumber. Sadly a self-making bed, on order from the US, had still to arrive on the day of our visit.

While some of these products might seem like “a bit of a laugh”, Stevens says most end up with genuine purposes. The pillow, for instance, may be used in accommodation for people with learning disabilities – again with the intention of mapping when sleepers are unsettled, without sending humans in to disturb them.

Being able to experiment with new things as they become available, adds Neilson, means social workers can be “a bit more” person-centred. “Historically, you’ve had in the back of mind an awareness of [the limits of] what you could support people with,” she says. “These pieces of technology are being explored because someone said, ‘This is my difficulty’. Let’s try to find a solution, not just say, ‘We’ve got this [standard piece of equipment], does it fit your difficulty?'”

More broadly, as adult social care finances continue to be stretched, there is obvious potential for advances in assistive technology to foster more efficient, as well as less intrusive, use of staffing resources. This should certainly be a consideration, says Stevens, so long as it does not become a rationale in itself when designing or reviewing support packages.

“We have to accept that a lot of time people might think this is about cost-cutting,” she says. “But it’s about ensuring a person gets the right support at the right time, and redirecting support that they don’t need to someone else. That’s what we are hoping to do.”