1. Almas Hus Manager Sigrid Aketun
My name is Sigrid Aketun and I am an Occupational therapist since I have Worked in hospitals with stroke patient rehabilitation and the last 10 years with people with dementia. My speciality are Diagnostics and treatment of Dementia and Dementia Friendly Design. I have Participated in research projects on Dementia treatment and assistive technology needs. I have been the leader of the planning of Almas house since the beginning of 2010 and are now the leader of Almas house services.

2. Almas hus Oslo, A Competence Centre for Welfare Technology and Dementia Friendly Environment
Background,
Consept
Aim
Function
Service and
co-operation in municipal elderly care
Almas hus in Oslo, is A Competence Centre for Welfare Technology and Dementia Friendly Environment
I will talk about the Background, Consept, Aim, Function, Service and co-operation in municipal elderly care

3. Background In Norway, 70.000 people have dementia
The number is expected to double by 2040
(St.meld 25, )
City of Oslo: people with dementia
Lack of information and access to technology to people with dementia
(Aketun, Grut, Holthe & Bjørneby 2010; Holthe, 2011)
Around people in Norway suffer from dementia, and given that they have one or two family carers, quite many are affected by the dementia condition. The number is expected to raise in the future.
It is estimated that around 7000 people in the area of Oslo suffer from dementia and of these, 3200 people are living in their own home. Research tell us that 43 % of the elderly person above 70 years who are getting home care in Norway, have cognitive decline.
During the Alma’s house planning process, a pre-project about provision of Assistive technology in Oslo took place in 2010:
The results showed that few health workers, occupational therapists included, had sufficient knowledge and competence in assessing needs for Assistive technology to support cognition. A consequence was that Assistive technology seldom were provided to people with dementia and their family carers. Family carers tended to know most about needs and how to solve everyday challenges. However, they often felt quite distressed, and they felt alone with the responsibility. (Aketun et al: Where the shoe pinches, 2010).

4. Background
Norway was the first country in the world to introduce a national plan for dementia care.
As a consequence of lower birth rates, the number of staff is expected to decrease, and new technological solutions are likely to be important strategies in caring for older people at home (ref NOU 11:2011) .
The Norwegian Health Directorate encourage the municipalities to include assistive technologies (AT) into the community health services, along with service development and innovation of existing services (ref Velferdsteknologirapporten).
There is a hope that modern technology may support people with cognitive decline and dementia to stay at home longer and safer, and that access to such technology may reduce burden of family carers.
This initiative must go hand in hand with general innovation in service provision, integrated with mainstream care.

5. Consept The idea behind Alma :
”see and touch” devices, products and technology in a natural, home-like environment
A show room/flat run by trained personnel – Alma-team from the Geriatric ressoursecenter
Several suppliers of technology
Our idea was that
Alma’s house should be a demonstration and visualization facility (flat) designed particularly for persons with cognitive impairments and dementia, and to show how new technological products and innovative solutions can be integrated to meet personal needs and preferences.
We vanted
Alma’s house to be a knowledge service, and health professionals should be employed to guide visitors, collect experiences from different stakeholders, and disseminate updated knowledge.
There should be different types of Assitive technology devices to see and touch in the flat. And the flat should have a home-like environment, recalling everyday tasks.
The health team should have different professionals like occupational therapists, special trained nurse and information officer as well as fysiotherapist. This team must keep updated regarding new assistive technology comming on the marked.
Several suppliers:
All the devices and the technology in the apartment should be donated to Almas house. We planned to have an advertisement in the newspapers targeting suppliers of products and askining for donations. We needed to develop a contract to secure that the technology in Almas house is updated and can be substituted with other things

6. Implementation methods
Service design process
Discussing and planning the process of obtaining the assistive technology
Designed in cooperation with an architect and lighting designer
During the planning process we were invited into a joint project, which included collaboration with a service design company. They helped us to focus on building the service; what happens in Alma’s house? And what efforts should Alma’s house priorities?
We had a series of work meetings in order to specify what target groups to focus on, what to offer them and how to facilitate for a good experience before, during and after the visit.
As a result the process of establishing Alma’s house was stepwise.
Step one was to plan the flat and decide situation of rooms, and how to take both universal design and dementia friendly design into account. An architect and a lighting designer contributed with their expertise to ensure the design both dementia friendly and comfortable for all people, whether able or disable.
Second step was to identify assistive technology that might be relevant to present as help for persons with cognitive impairments and dementia. Both smart-house installation and different wireless technologies were included in the infrastructure of the flat.
In order to show a variety of solutions, companies were invited to provide relevant products and equipment through an advertisement in the paper. More than twenty companies have contributed with gifts to Alma’s house. Implementation of products and solutions required that the companies had to collaborate, and to agree about different functions and configurations. They also had to sign an agreement about how they could expect to co-operate with the staff at the centre.

7. Service design prosess and pilot
Combine physical solutions with human expertise
Show good examples
Prepare for different scenarios
Testing tools
Piloting visits
A space for continual learning
(Combine physical solutions with human expertise)
Almas Hus looks like a normal flat. It demonstrates how people with dementia and cognitive failure can adapt their homes so that they can continue to live there safely, without feeling defined by their illness. Geriatric ressoursecenter collaborated with an architect, interior designer and light designer to work out the challenge of creating a desirable physical space that accommodates the users’ needs.
The challenge for the pilots was to create services that both showcased the physical solutions – and made the most out of expertise of Geriatric ressoursecenter staff in meetings with visitors.
(Show good examples)
The service design research showed a large need for knowledge and practical advice for people with dementia and their relatives. In addition, there was a need to demonstrate good service examples for the care staff as well as for Local Authority Officials.
A workshop with occupational therapists, care staff, administrative staff, a unit for assistive technology and relatives gave a clear picture of how Almas Hus could fit in with the existing ecology of service providers. In addition, the service design company Livework wanted to uncover complications in dementia patients’ lifecycle to see how Almas Hus could support unmet needs.
(Prepare for different scenarios)
The project also explored new services for different user groups. One of these services was a ‘solution database’. The database is an internet-based service that the public, care staff and administrators can use to navigate tools, technologies, services and advice.
The database was based on resources already available within Geriatric ressoursecenter. In addition, the database serves as a resource for employees at Almas Hus. It helps prepare and conduct visits with patients, relatives, care staff and other decision-makers.
(Testing tools)
The project with Almas Hus explored the different types of visit experiences the simulation flat could offer. For example, visitors could experience an entire day in the flat and go through a range of typical activities from morning to evening. Another scenario could demonstrate activities in certain rooms of the flat, from bedroom to kitchen.
Whichever service Almas Hus would offer, staff would always need to clarify what specific knowledge visitors needed prior to a visit. Therefore, a range of ‘pre-visit’ tools were tested to map visitor’s needs, and tailor relevant experiences. We decided not to use this tool because it was to demanding and not useful for our practice today.
(Piloting visits)
Vital to our tests were the visits by people with dementia, their relatives and the general public. In addition, working with employees of Almas Hus allowed the pilot to go through a valuable process of trial and error in learning how to design up visits that were meaningful to users.
Pilot visits by the care staff and administrators revealed that these two groups came to Almas Hus to get recommendations and see good practical examples – enabling them to make decisions on behalf of their local authority.
Occupational therapists were another group invited to visit Almas Hus, to conduct sessions with dementia patients and their relatives. In these cases we found it most natural to let the occupational therapists be in charge of the visit.  They have close relationships with the patient, and could handle them more delicately than Almas Hus staff could accomplish. We now train occupational therapists to be Alma supervisors.
(A space for continual learning)
Since Almas Hus was officially opened, the flat has served hundreds of visitors. As result of the pilotproject, staff managed to make the most out of combining a unique space with personal expertise. Based on the learning process of projects, the services offered at Almas Hus are in continuous development.
The solution database captured
visitor information at booking that
helped tailor individual experiences

8. Mission completed!
We establish a centre for assistive technology with a demonstration flat that contains dementia friendly design, products and technology.
We establish a centre for assistive technology with a demonstration flat that contains dementia friendly design, products and technology.

9. 09.10.2012 Almas house became a reality and opened for the public
A happy day!
Almas house became a reality and opened for the public
Alma’s house opened officially Oct 9, 2012, by the Aud Kvalbein the chief commissioner of Health in Oslo City.
And since then there have been approximately 125 visitors every month.
A lot of people ask: who is Alma? Alma is an acronym for Alzheimer Material, and we have used the name since the first paper guide was released in 2003, showing different AT devices for cognitive support.

10. Almas House Aims A demonstration site A knowledge service
A visitors’ centre
Alma’s house has three aims–
First, it is a demonstration site – a place where users and family carers, health staff and planners, architechts and managers can see and touch different technolgies and learn how AT possibly could support people with dementia/cognitive impairments and their family carers.
Almost all of us need inspiration, and visiting Alma’s house is one way to have updated information and get an overview over what AT that exist and have potentials to support people with dementia/cognitive impairments.
Second: It is a knowledge service: The Alma team currently has 3 OT’s , one physiotherapist and one nurse in the Alma-team, and we develop, generate and disseminate knowledge to others, on visits, training courses or lectures.
Third: A visitors’ centre – at the web-site the target-groups can book time for a visit. We have three main target groups: the public (users and family carers included), health professionals and planners, architechts, managers etc.

11. Plan drawing
Alma’s house is a flat of 60 square meter, particularly refurbished following principals for dementia friendly design. Within this frame, a range of technological products and innovative solutions are displayed in a homelike environmemt.
There is a - bedroom
- bathroom
- kitchen
- living room
- entrance area inside and we tried to make an outside entrance area as well
We also wanted to focus on establishing so- called ”sightlines” where Alma can have an overview of her apartment

12. Three target groups The public Health personnel Decision makers
people with dementia and cognitive decline, their family carers and friends
Health personnel
Alma’s house has defined three target groups; people with dementia and their family career, health professionals and service providers, administrators, planners and politicians.
A visit to Almas House can help desicion makers and planners to see possibilities and solutions, and discuss experience and solutions regarding housings for people with dementia.
Health personnell work closely with people with dementia and relatives, and they know what challenges they experience and they might seek for solutions that can provide support or compensate for lost abilities.
Finally, users with dementia and their family carer are welcome to visit Alma’s house together with their district Occupational therapist trained as Alma supervisor, to see and touch Assistive technology, and to discuss what might be a solution for them.
In 2015 the number of visitors were 1700 persons from all three target groups. There were 50 uservisits by Alma supervisors.
occupational therapists, employees in home health care, general practitioners and other professionals
Decision makers
politicians, general practitioners, architects, hospital planners

13. Todays Service Open viewing The public Health personnel
Decision makers
User visits
People with dementia, elderly people with cognitive impairments and their relatives are coming together with health personnel, Alma supervisors.
Alma’s house is situated in Oslo. However, visitors from other parts of Norway are welcome. And from other countries as well. Polen for example.
A booking system on internet is used, in order to keep an overview of the appointments done. When an appointment has been done, the visitor gets a written confirmation with a map to Alma’s house and name of the guide.
If the visitor has a special request or issue that he/she wants to discuss, it should be reported in advance.
The technology in the flat can thus be configured to a particular situation.
During the visit, different functions and possibilities of low-tech and high-tech solutions can be presented.
If there are particular products or solutions that are of interest, the visitor can have one written page with information about this product from a data base to bring home. Also, many may need advices on where to buy or apply for products and what to do next.

14. Todays Tasks Demonstration and training arena for the target groups
User participation and involvement to develop knowledge & skills
Arena for dialogue and development of technology
Network agent for OT’s in Oslo
Part of national network for demonstration sites
Participation in research projects
Alma’s house is a demonstration and training arena for the target groups and a knowledge base on AT for people with dementia.
User participation is vital to understand the depth of individual everyday challenges. By involving users and Occupational therapists, Alma supervisors, family carers and nurses, we build a solid knowledge base, and we disseminate this knowledge in the dialogue with visitors and with Assistive technology companies, as part of improving/developing the technology.
Alma’ s house also serves as a network base for occupational therapists and other dementia specialists in Oslo.
And, it is a part of the National network for demonstration sites in Norway, meeting with other demonstration sites once a year to learn from each other.
And finally, we participate in different research projects – the last one is about GPS and how this Assistive technology can support people with dementia.

15. Implications for OT practice
Method to develop empirical knowledge
Collect real life scenarios
Analyze problem, need, resources,
Estimate possible interventions
Elaborate solutions, provide advices, test solutions
Learn from experiences, and share with others
«pre-understanding & post-understanding»
Knowledgebased practice (evidencebased practice) is understood as enabling participation and activity based upon the user’s preferences, wishes, expert- and empirical knowledge and research. This includes reasoning based on integration of knowledge from users and experts as well as research, in order to develop best OT-practice. User cooperation, user participation and methods to collect evidences are important to develop OT-practice.
For example: when a person with Alzheimer’s is visiting Alma’s house, together with her OT, and with a particular issue or problem in focus, the Alma-team person can be present. Taking part in a visitors situation, and testing/simulating use of AT in order to identify the optimal solution for the visitor, have two advantages: 1) access to in-depth knowledge about specific needs for tailoring AT and solutions to a particular problem, and 2)testing the products by simulating real life situations, and become aware of the pre’s and con’s, and can report back to the company about any flaws. Our pre-understanding will through a post-understanding, grow. And a new and more extensive pre-understanding will help us further in developing knowledge and skills.

16. https://vimeo.com/63307567 www.almashus.no
A short film illustrating Almas house

17. Thank you for your attention
Thank you for your attention and hopefully you will have a Almas house in Wroclaw someday in the future.