Smart Homes for Elderly Care in India

Smart Homes for
Elderly Care in India:
A Need and
Opportunity
AUTHORS:
KALIKA SHARMA
DEEPA REDDY

How do you imagine a smart home?
Imagine stepping into a
smart home that welcomes
you, that draws the curtains
for you each morning, dims
down the lights in the
evening, turns the gadgets
off when you step out, and
so on.
@2015, ICE, ALL RIGHTS RESERVED
Image: https://www.flickr.com/photos/pestoverde/15207853585

It’s all connected in a smart home.
Electronic gadgets and sensors that
can communicate with systems inside
and outside the home
A network connecting these gadgets
and sensors – wireless or wired
Controls and an interface to manage
the systems
Coming together as the Internet of
things, smart homes will operate in
the larger connected networks of
places, under the framework of
smart cities.
https://commons.wikimedia.org/wiki/File:Reliance_Smart_Client.jpg

Smart home tech is well-suited to the elderly.
While the smart home automation boom in India is still a
luxury, it has a variety of uses for elderly care in general.
Some examples are as follows:
◦ Health care and assistance, e.g., a sensor in case of a
fall, medication reminders, etc.
◦ Increased security for elderly people who might be
more vulnerable, e.g., an emergency button connected
to hospital services
◦ Management of home devices through an interface
helps if the elderly person is not mobile
◦ Reduced feeling of isolation or loneliness with home
entertainment and internet, e.g., being constantly
connected to other groups or family remotely
◦ Home maintenance is simpler with automated cleaners,
refrigerators, kitchen systems, etc.
https://en.wikipedia.org/wiki/Home_automation#/media/File:S
mart_Home_Control_Panel.png
A smart home control panel

The Situation with Smart Homes in India
While the home automation companies
have come into India, the reality on the
ground is that there are different
dimensions to ageing in India that need
to be taken into consideration. The
Lavasa Smart Home Project and Ashiana
are a few examples of pioneering work in
this area, but these examples are only
affordable for middle to upper classes.
https://commons.wikimedia.org/wiki/File:Lavasa_City.JPG
Lavasa Smart City

Do smart homes map to the cultural
dimensions of the elderly in India?
There is a gap that needs to be
addressed by the industry as well
as the government, which need
to account for the needs of the
elderly in India. We take a closer
look at the cultural dimensions of
the elderly in India.
Imagehttps://www.flickr.com/photos/vinothchandar/8523236119/

India’s Demographic Transition

[Source: Appendix I, UNFPA Report, 2012]
India’s demographic transition:
summary
By all accounts, India is on the verge of a massive demographic transition. A 2012 report by the
United Nations Population Fund (UNFPA) projects a rapid increase in India’s median age--from 20
years in the 1980s, to 31 years in 2026. It also projects a 325% increase in the number of people
aged between 60 and 80 years by the year 2050 (measured from the year 2000), a 700% increase in
the number of people over 80 in the same period. [Source]
The same report further projects that individuals over 60 years will represent 19% of India’s total
population by 2050, approximately 300,000 people (see the table below). This data confirms the
growth of a demographic at a faster rate than the rest of the Indian population.

facts
India is on the threshold of a massive demographic transition which will leave us
with 19% of our population over the age of 60, by the year 2050.
Life expectancy has shot up: from 23 at the turn of the century to 65 years and
death rates have fallen, from 25 per thousand to eight. The rapid greying is working
on an “astonishingly low” per capita GDP. Over 70 per cent elders are fully
dependent on family and other social supports.
Double-income families are common; lives are getting busier—leaving a vacuum
when it comes to caring for family who cannot care for themselves.
Personal choice and privacy are increasingly buzzwords. Migration for jobs both
within and outside India is the norm. The nature of social responsibility is changing
alongside actual capacities to care for family.
Over 7% of elderly couples live on their own. 11% of India’s elderly have no young
people staying with them. As many as 50% of elderly widows live alone in India.
Source: “Home Alone” India Today, July 16, 2007
Graphic : http://www.heifer.org/join-the-conversation/magazine/2013/spring/aging-india.html

Epidemiology
On the epidemiological front, the WHO reported in 2012
that disease patterns have shifted from communicable to
non-communicable diseases and older adults face
increasing health risks.
Sengupta and Agree (2003) analyze covariates of mobility
difficulty among the older adults in India and find that
there is a substantial association between mobility and
chronic diseases in the elderly.
Kerketta et al. (2009) find that there is a high prevalence
of physical disabilities with both non-communicable as
well as communicable diseases among the elderly
primitive tribal members and recommend for the
implementation of a special health care strategy to
reduce suffering at this crucial age and improve quality of
life.
Only 1.6% of the elderly are covered by health insurance.
Image Source: http://silvertalkies.com/helping-hand-kolkata-seniors/
http://timesofindia.indiatimes.com/india/Study-shows-a-dismal-1-6-elderly-are-
covered-by-health-insurance-plans/articleshow/45391831.cms

Social changes
Socio-economic changes such as increased urbanisation,
modernisation, increasing participation of women in
economic activities, mobility of the younger generation,
the growth of individualism, and a rise in consumerism
are leading to the breakdown of the joint family structure,
which used to be the primary support for the elderly in
India (Knodel et al.1992; Pandey2009).
As a result:
1. Residence patterns change (see table); and
2. There is a greater reliance on paid assistance,
whether informal (maids) or professional (nurses,
medical practitioners).

The feminization of ageing
India’s senior population is slightly more female than male--a
phenomenon described as the “feminization of ageing”--thanks
largely to slightly higher female life-expectancy.
“[...] on one hand it is a victory of women in overcoming mortality
from reproductive, communicable, and chronic conditions, yet on
the other hand, for many women old age signals a period of social
isolation, and frequently, economic adversity. Increased longevity
is often not always matched by a health life expectancy, although
there is some suggestion that the older you become, the healthier
you have been.” (Davidson, Digiacomo, & McGrath, 2011, p.1033)
“The stigma of widowhood … leads to profound social ostracism
that impinges not only on access to healthcare, but also a broader
range of fundamental human rights, such as the right to shelter,
food, property, and information (Chen, 1998;Dreze, 1990).”
Source: http://www.ncbi.nlm.nih.gov/books/NBK109208/#ch15.r18
Image: http://blogs.reuters.com/india/files/2012/04/woman21.jpg

Cultural Dimensions of the Elderly in India

1: The family model of care
Demographic shifts and other social changes have not dislodged the
family as the primary locus of care, support, and responsibility for the
elderly. The stigma of abandonment is still very strong, with
implications for both parents and children.
The 2007 Maintenance and Welfare of Parents and Senior Citizens Act
legally reinstates the central position of the family, making it a legal
obligation for children and heirs to provide maintenance to senior
citizens and parents, by monthly allowance.
“In an analysis of NFHS-2,Agrawal (2012) found that elderly who are
living alone are likely to suffer more from both chronic illnesses, such
as asthma and tuberculosis, and acute illnesses, such as malaria and
jaundice, than those elderly who are living with their family” (Gupta
2013)
Source: Gupta, Nidhi (2013). Older Women in India: Issues and Concerns. In S. Siva Raju,U. V. Somayajulu, & C.
P. Prakasam (Eds.), Ageing, Health and Development. Delhi: B. R. Publishing Corporation. (pp.203-222)
Image: http://www.livemint.com/Leisure/fWa1CaarbYDeVIQL1G9nDO/Grandmoms-
helper.html

2: Elder abuse
And yet, co-residence with family is also often the source of
tension and what is increasingly classified as “elder abuse”:
Delhi saw a tripling of police reports of elderly seeking
protection in an 18-month period, and Mumbai’s police
helpline for seniors was receiving more than 80 calls daily
(Datta, 2007). Reports of murder, rape, burglary, and violence
inflicted upon the elderly remain and are more commonly
reported in Indian metropolitan areas.
“While systematic studies are rare, there have been
increasing reports of material exploitation, financial
deprivation, property grabbing, abandonment, verbal
humiliation, and emotional and psychological torment in
India, all of which compromise the mental and physical health
of the elderly.” (Dey et. al., 2012)
Datta D. Home alone. India Today. Jul 16, 2007. Available:
http://www.indiatoday.com/itoday/20070716/cover.html
Subhojit Dey, Devaki Nambiar, J. K. Lakshmi, Kabir Sheikh, and K. Srinath Reddy. Health
of the Elderly in India: Challenges of Access and Affordability:
http://www.nap.edu/openbook.php?record_id=13361&page=376
Source: http://www.thehindu.com/news/cities/Madurai/elders-abuse-in-india-
witnesses-drastic-rise/article6114195.ece. from 2014 HelpAge India Study:
http://www.helpageindia.org/pdf/highlight-archives.pdf

3: The ageing poor
For the poor, however, laws such as the 2007
Maintenance and Welfare of Parents and Senior
Citizens Act have little value.
Lower middle class or poorer families particularly in
urban areas may be simply unable to provide for
ageing parents:
“Economic pressures on younger families have
increased the pressure on older parents to provide
greater and more regular assistance (housing,
childcare, cash, loans) to their married children and
to reduce their own consumption and expectations
of support.” (Vera-Sanso et al, “Ageing, poverty and
neoliberalism in urban South India,” 2010)
Source:
http://www.koodam.org/sites/default/files/subjects/NDAFindings_5Final11.
11.10.pdf
Image credit: Penny Vera Sanso and CLPHRS Chennai,
http://www.thehindu.com/features/magazine/zooming-in-on-the-
elderly/article4862886.ece

4: The consequences of “dependence”
Research in Chennai shows that thinking of the elderly as dependents
and/or “wards” of either families or the state hardly takes into account
both their contributions to household economies, or their unique needs
and rights (Vera-Sanso, 2010)
By defining older people as ‘dependents’, in need of care and support
and as not part of the work force, or as inferior workers, policies,
planning and practices do not facilitate old age welfare. Instead, they
exacerbate frailties and increase old age poverty.
Thinking of the elderly as dependents has two specific consequences:
A. Economic contributions of the elderly are hidden and unaccounted
B. Failure to recognize certain deficits as explicit health needs
C. Dependency Anxiety

4A: Unrecognized contributions
Classifying the elderly as “dependents” not
only misrepresent “older people’s direct
and continuing contribution to the
economy, but also disempowers them in
relation to younger family members and
employers” (Vera-Sanso et al, 2010)
The study shows that ageing parents can
and often do help out with housework,
childcare, take on unpaid “helper” roles in
a child’s petty business etc. -- and that they
might be compelled to keep working well
into their old age.
Vera-Sanso et. al., “Participation and Social Connectivity” in The New Science of Ageing, ed.
Alan Walker. Chicago: Policy Press., 2014. p.192
Image: http://www.thehindu.com/news/national/most-indian-women-engaged-in-unpaid-
housework/article6498326.ece

4B: Unrecognized health needs
Reliance on the family as normative, primary source of
support actually prevents us from acknowledging certain
mental health deficits as health needs.
“Conditions like dementia are viewed as normal aging and
depression construed as the result of neglect by family.
Such cases were therefore not considered the purview of
health professionals and were more frequently
acknowledged and addressed by community health
workers. Access to mental health services in the medical
sector are limited, and, thus, most care and support was
provided ad hoc, informally, and in the family. “ (Patel and
Prince, 2001)
Patel V, Prince M. Ageing and mental health in a developing country: Who cares? Qualitative
studies from Goa, India. Psychological Medicine. 2001;31:29–38.
Image: http://www.thehindu.com/sci-tech/health/special-
provisions-needed-for-healthcare-for-elderly-concludes-
study/article2749900.ece

4C: Dependency anxiety
The centrality of the family as a normative
support institution increases dependence on
family, and precipitates “dependency anxiety”: an
anxiety about complete dependence on family
(and therefore trapped into abusive situations),
and/or anxious about informing family about
health issues. (Patel and Prince, 2001)
Such conditions are rarely recorded in databases
cataloguing the issues facing the elderly. While
depression is often cited as a major issue, the
attendant isolation, loneliness, and dependency
anxieties receive much less attention.
Image source: http://indiaspeaksnow.com/elderly-abuse-rise-metro-cities-india/

5: Independence in ageing
Some wealthier classes of the elderly do articulate their
need for independence, often suggesting it is
compromised in living arrangements with adult children.
Their need for independence is cited as a reason not to
relocate abroad or with children:
“I want to maintain my independence and individuality
and I want to walk with my head held high. If we were to
live with my children I would have to depend on them
even for a cup of coffee. In such a situation, I don’t live; I
merely exist.”
Some studies suggest internet use off-sets the effects of
the isolation
Source: http://www.thehindu.com/features/magazine/retire-without-hurt/article4862888.ece
Image: http://www.thehindubusinessline.com/features/investment-world/retirement-
homescheck-out-before-you-check-in/article4323370.ece

The Potential for Smart Homes to
Address Elderly Needs

We are looking at the rise of multi-
generational housing options
More middle class and higher
income group elderly people are
opting to live in retirement
homes. While they might be the
pioneers of the movement today,
this is the direction in which
things are moving.
Source: http://www.hindustantimes.com/india-news/is-india-s-joint-family-
system-breaking-down-with-seniors-willingly-moving-to-retirement-
homes/article1-1333208.aspx

Retirement homes as an investment option
Real estate developers have picked up on a twin set of realities:
that younger families are finding it increasingly difficult to care
for their elderly parents, and that although the stigma of “old
age homes” is still very strong, the need for assisted living,
proximal medical services, and the demand for a better quality
of life in senior years is increasing.
Housing “senior living” communities have been developed in
several Indian cities—filling the gap left by insufficient state-
services.
The senior living community model uses the idea of viable real-
estate investment to legitimize a more independent living
arrangement -- allowing kin to still feel connected to parents,
but granting both the independence they need or wish to have.
Source: http://www.livemint.com/Money/dvN4ue8SccGtAB0vRXLthI/Whats-the-real-cost-of-
retirement-homes.html

Retirement Homes and Home
Automation Can Go Hand-in-Hand
With a retirement home boom following a smart home automation
boom in India, there are few endeavors so far to make the two meet.
Technology-enhanced senior care is well-established in many parts
of the world.
Image: https://commons.wikimedia.org/wiki/File:Home_auto1.jpg

Pioneers in Tech for Elderly Care in India
Two examples of smart homes for the elderly
in India are Lavasa Smart Homes and Ashiana
Housing.
"Smart homes can notify a resident when it is
time to take medicine and alert the hospital if
the resident were to trip and fall. Also, the
elderly folks just need to press a soft panic
button in the house, in case of an emergency,
to reach someone for help,"
Ankur Gupta, joint managing director of
Ashiana Housing Ltd.
Source: http://articles.economictimes.indiatimes.com/2013-06-
03/news/39715502_1_smart-homes-smart-living-household-chores
Image: https://www.ashianahousing.com/senior-living-india/

Take a look at Norway’s example
http://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table
Norway ranks #1 in elderly care (Helpage.org, 2014)

Smart homes are considered to improve the
quality of life for the elderly in Norway
• In Norway, smart homes have been
considered a solution to improve the health
and Quality of Life (QoL) for the elderly
generations.
• There is support from the municipality,
political entities and system
developers/technology vendors in developing
these smart homes.
• However, there is less research conducted on
the effects of smart home technology for
elderly care and the health benefits it brings.
Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May 2014
Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf
Image: https://upload.wikimedia.org/wikipedia/commons/8/87/Nursing_home.JPG

Role of the Norwegian government in
smart homes for the elderly
Norway has 10 years of experience using smart home technology as part of
home care services. It all started with the BESTA-project in 1994, a project
focusing on the use of smart home technology for elderly people. As part of the
project, smart home technology was installed in residential flats, aiming at
residents with dementia.
Smart homes are a now becoming a source of pride for Norwegians. For the
elderly, a great responsibility lies with the government in planning for their old
age, even with assisted care.
Laberg, Smart Home Technology; Technology supporting independent living - does it have an impact on health?
http://www2.telemed.no/eHealth2005/PowerPoint_Presentations/Tuesday/Fokus4/1130-1300_F4_tue_TorilLaberg_Smarthouse.pdf

Quality of life and elderly care in Norway
Researchers in Norway are exploring
whether smart home technology can
contribute to enhance health and Quality
of Life (QoL) in elderly citizens and allows
them to live longer in their own homes,
as opposed to an institution for the aged.
In addition, they are exploring if such
technology increases safety,
independence and enhances social
activity.
Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May
2014 Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf
https://en.wikipedia.org/wiki/Geriatrics#/media/File:Nurse_in_geriatry.jpg

Inspiration from Salutogenesis by Aaron Antonovsky
• We can also draw inspiration from
“Salutogenesis” Aaron Antonovsky, a professor
of medical sociology.
• Salutogenesis is an approach focusing on factors
that support human health and well-being,
rather than on factors that cause disease.
• The “salutogenic model” is concerned with the
relationship between health, stress, and coping.
• Antonovsky's theories reject the "traditional
medical-model dichotomy separating health and
illness". He described the relationship as a
continuous variable, what he called the "health-
ease versus dis-ease continuum".
http://en.wikipedia.org/wiki/Salutogenesis

Sense of Coherence Concept by Antonovsky
Comprehensibility : a belief that things happen in
an orderly and predictable fashion and a sense
that you can understand events in your life and
reasonably predict what will happen in the
future.
Manageability : a belief that you have the skills
or ability, the support, the help, or the resources
necessary to take care of things, and that things
are manageable and within your control.
Meaningfulness : a belief that things in life are
interesting and a source of satisfaction, that
things are really worthwhile and that there is
good reason or purpose to care about what
happens.
Source: http://en.wikipedia.org/wiki/Salutogenesis Image: http://www.dominicpote.co.uk/healthcare-hospital-design-projects/art-for-
hospitals/art-in-salutogenic-design/

Constructing smart homes with Salutogenesis
Is it possible to construct and develop smart homes based on these three
elements and could they be central in further smart home development? If we
take a closer look, investigating Antonovsky’s (2012) concept of the SOC it is
possible to notice the transferability of the concept of SOC to almost anything.
In this case smart homes and the technology it consists of are under scrutiny. In
relation to the smart home elderly people increase their chances for a beneficial
interaction if the home is built in a way that makes them believe that
(1) they can understand the smart home;
(2) that they have the resources at their disposal to handle it; and
(3) that they wish to cope with the smart home (Hjelm, 2004).
Erlend Kydland Faanes, Smart Cities – Smart Homes and Smart Technologies, Norwegian University of Science and Technology, May 2014
Source: http://biblioteket.husbanken.no/arkiv/dok/Komp/Smart%20homes%20and%20smart%20home%20technology.pdf

India needs low-cost solutions for the elderly
An example from a BBC news story shows a
Norwegian couple with low cost sensors at
home that help the woman with Alzheimer's in
her day-to-day life.
“…The Albilia solution shows what you can do
with a tablet, Skype and low-cost sensors. It is
not rocket science and if you can keep an
Alzheimer's patient living independently in
their own home, it is good for the individual,
good for the family, and you can save money
by keeping them out of institutional care.”
Joe Dignan, analyst at Ovum
Source: http://www.bbc.com/news/technology-22984876

To summarize, we need to bridge the gap for
elderly care through smart homes in India
1. Smart homes can improve the quality of life for the elderly in India.
2. India should have its own model for elderly care, drawing inspiration from Salutogenesis.
3. Government involvement in elder care flats is important, again looking at the Norwegian
government initiatives for inspiration.
4. Retirement homes and smart home tech providers together form a great opportunity with
multi-generational housing on the rise.
5. Low-cost sensors and wearable tech can be used to make smart home tech more inclusive
for those who cannot afford the technology.
6. Smart home automation for elderly doesn’t mean offering features, rather it’s about care:
enabling elderly people to live independently.
7. Ask elderly people what they want as users of smart homes and build that into designs.

Thank you!
Interested in future trends and reports?
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Smart Homes for Elderly Care in India

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