- The COVID-19 pandemic has revealed limitations in our capacity to support independence for those living at home with dementia.
- Investment in social care programs will undoubtedly be bolstered by technologies to meet current and future demands for care.
- Investigating how technologies become part of caring fosters space for care workers to tinker with technology to improve care.
We have learned through our studies that every person exhibits dementia differently, and those caring for that person do so differently. So, in considering a topic such as dementia care, we study in a field made up of many practices understood and treated by others as practices relating to someone living with dementia.
Studying Care Practices
We focus on the fields within which these practices taking place as worthy of critical investigation. We approach our research by maintaining an openness to the definitions used by people in their everyday situations. For instance, we try to learn about family members' improvisations to keep daily life going from day to day.
We pay attention to how formal care practices can be so different from family practices. Formal care practices often use general frameworks built from biomedical understandings of conditions like dementia to standardize programs. These programs are often referred to as social care. They are implemented in ways that make efforts to support families to continue to offer care to the person diagnosed with dementia for as long as possible.
What is Social Care?
From this perspective, we listen to news stories about governments coalescing around the topic of social care. Governments will fund formal care practices – and we anticipate the following programs may well conflict with families’ existing everyday practices.
In the United States, the Biden administration is trying to find support for infrastructure legislation that repairs roads and bridges and will invest in the care of older people.
In the United Kingdom, Boris Johnson and his Conservative government are weathering the storm of instituting tax increases – initially to shore up the health system – with a promise that, with a secure health system in place, the funding of social care will follow.
Here in Canada, we are nearing the end of a federal election campaign where regional disparities in how local governments have handled the coronavirus pandemic have revealed the need for targeted reinvestment in senior care.
This is a critical point as services networks are being envisaged, designed, and rolled out into communities. This blog will contribute some thinking to offer ways of examining the goods and the bad of such a widespread redesign of a renewed social contract between governments and their populations.
Use of Technology as Social Care
A recent presentation by Nete Schwennesen from the University of Copenhagen brought clarity. Schwennesen presented a paper at the most recent seminar hosted by the Socio-Gerontechnology Network entitled, “In between repair and bricolage. Digital entanglements in dementia care work.”
In her presentation, Schwennesen distinguished between repair work, described as “the work necessary to integrate ‘ready-made’ technologies” and bricolage care work where the creativity of the care worker comes into focus as they tinker with technology “with an open and experimenting attitude towards what care can be and how to provide it.”
Schwennesen drew on the example of care workers introducing a PARO Therapeutic Robot to a person living with dementia. Japanese engineers designed the PARO robot to simulate a small harp seal. The technology was introduced into dementia care settings in 2001. It exemplifies artificial intelligence with the ability to respond to petting by moving its tail and actively seeking eye contact. It is said to reduce stress for the person diagnosed with dementia.
However, before these positive outcomes could be achieved, effort was required by everyone involved as they worked out an understanding of what the robot was, how it worked, how to make sure it was plugged in after use so it would be available to do its work the next time and so on. All this was needed to integrate the PARO Robot into the care situation, and Schwennesen offered this as an instance of repair work.
By contrast, she described the situation of a care worker advised by her colleagues that the person she was newly assigned to care for was often agitated first thing in the morning. The person’s early morning agitation meant that care was challenging to complete. The care worker discovered that the person owned a small tablet. In conversation, the care worker learned about the sort of music the person enjoyed.
The care worker described how, with the music going, she was able to “create a kind of mood, and then one could get to work.” Schwennesen describes this as an instance of bricolage care work. The care worker found a way to accomplish her work through the creative use of tablet technology and, tinkering with it, find the sort of music that the person enjoyed.
Broadly Defining Technology
Schwennesen’s presentation focused on specific technologies used in the care of people living with dementia. We can think about technologies more broadly as any technique or skill used to produce something – in this case, good care for older people to support independence at home. This broad definition opens up opportunities to think about how technology is integrated into everyday care for an older adult. It is also possible to examine how such technologies may support or undermine aims for redesigning social care.
Schwennesen’s work examines the “fragile and temporary connections between technology and persons in dementia care work,” reminding us that technology is not just one thing. It is not all good nor all bad. Instead, examining how technologies become part of caring offers us a place to gain insights into their uses. It can help us encourage the use of “more fluid and flexible technologies” within a context where “more space for care workers to try out and tinker with technologies” can occur.
This isn't easy, challenging work. And we look forward to bringing many exciting examples to light in future blog posts.