1. Can technology provide safety and security for people with dementia? Technology and Dementia seminar, Dublin 28.10.10 Sidsel Bjørneby Norway sidsel.b@bluezone.no +47/ 92 89 58 62

2. Norway

3. Impressions from the situation in Norway There are fragmented initiatives so far, but growing awareness among researchers and local authorities But there is still too little overall awareness about potentials of new technology as an aspect of dementia care There is little awareness of the potentials of new technology to support carers and family carers

4. Today’s presentation Some examples of common problem situations where safety and security are infringed Some ethical considerations

5. Important baseline A persons feeling of safety and security also depends on how he/she experiences a feeling of quality of life Overall wellbeing Personal contact and help Self help/independence Pleasure and stimulation Dementia friendly surroundings

6. Individual needs Each person is different and has different needs and problems ”Finding the person within the patient” is a challenge Procedures for ethical considerations Choosing what is best for this person

7. Technology seen in a total social context Personal care and contact Dementia friendly surroundings Technology

8. Examples of typical problems The three examples represent situations where it is relevant to discuss possible use of monitoring and automation

9. Example 1. Mrs Hansen lives in a nursing home. She gets up at night to go to the toilet. She does not use a diaper. 3-4 times a week she cannot find the toilet, and subsequently pees on the floor The staff tries to wake her at night to follow her to the toilet, but she gets very upset Alternative solutions?

10. Possible technology ?

11. How does it work? A pressure pad under her mattress or under a mat by the bed has sensors When she gets out of bed, the light by her bed switches on and a message goes from the sensor to the mobile phone of a night nurse, and she goes to help mrs Hansen to the toilet

12. Mr Olsen (77) has moderate dementia, lives at home, and is an active gentleman who likes to take daily walks in his neighbourhood He is safe an the traffic, but gets lost several times a week His wife is very concerned, this makes her life difficult, but she wants him to stay at home as long as possible His doctor suggests that they apply for as place in a nursing home Alternative solutions? Example 2.

13. Possible technology GPS+GSM

14. How does it work? Device is worn in belt, pocket, bag? Who remembers that he should wear it? Who loads the battery at night? A panic button can send a ”help message” This is rarely used Can be tracked by sending a text message to it from 1-3 mobile phones Respons as text message and map on mobile phone and/or the Internet

15. Example 3. Mrs Nilsen has early dementia and lives alone in a care flat. She likes entertaining friends One evening a candle falls over and the table cloth catches fire after her friend has left. The fire alarm is making a noise in the corridor She does not know how to put out the fire or call the fire department, so goes to her neighbour and asks for help Fire men are there within 15 minutes, but then the entire flat is on fire Alternative solutions?

16. Possible technology A smoke detector in her flat sends a direct message to the resident care taker and/or to local fire department A ”fog machine” is activated and puts out the fire

17. Safety and security technology Active reporting of dangers and accidents by user Telehone, alarm cord, pendant alarm Automatic message through sensors and telecom to care staff, alert centre or to family cares Smart home technology, other telecare options Tracking when somebody is prone to getting lost Sensor on doors, GPS/GSM Monitoring with camera or microphone is illegal in Norway

18. Controversial aspects The laws in Norway make it possible to get public finance for technology solutions, but If a person lives in own home, the State can pay for a sensor that sends message within the house But message out of the house to a care centre or ambulant staff has to be paid by the person himself or the local authority Therefore applications and procedures are complicated and often prevents the use

19. Objections we often meet from care staff ”Technology is not good for him” ”Technology means removing personal contact” Negative attitude to technology amongst nurses technofobia They need to learn new ways of giving care

20. Passive and negative attitude to technology Is used to put up limits, derails discussions The more negative, the more moral???? There is little reporting of positive applications Little disussion of how ethical alternative solutions are Often possibilities for positive use are not even considered! Care workers have power to make desicions

22. Some ethical considerations Autonomy, beneficience and justice are usually listed as basis for ethical questions, but ethics have a wider context: People with dementia have diminished ability to protect their own interest Family members may be collaterally affected – (consequence ethics, feminist ethics)

24. Continued ethical considerations Who responds when a person with dementia needs help? (organisation) Shifting to the house as a place for delivering care and support asks for a variety of ethical considerations! Professional codes of practice seldom include ethical codes conserning telecare and telehealth

25. Continued ethical considerations Staff often feel insecure about what is right and wrong Justice is a question of how society decides and provides support to older people and who can afford new technology – Distributive ethics ICT & Ageing: Users, Markets and Technologies, D11: Ethical issues compilation report

26. Some initiatives in Norway 1.The Technology Council made concrete recommendations on how to include tecnology into care work. Sent to Parliament 2009 2.The Hagen Committee will deliver recommendations in 2011 3.The Directorate for Health is working on a guide book for practitioners on how to use different types of tracking and monitoring devices. Planned to be ready in 2011 4.Several research insitutions and designers have discovered the needs and potential markets for new technology for people with dementia, and get financial support Norway has the possibilities and the financial strength, but there are still too many organisational obstacles