By Louise Reid, University of St Andrews, and Rachel Creaney, University of St Andrews/ James Hutton Institute, UK
Lockdown restrictions have confined us to our homes, heightening awareness of what home means and (re)configuring relationships with this ‘irreplaceable centre of significance’. For most, digital technologies have played a central role in coping strategies, helping to ‘stay connected’ at home via devices and infrastructure that enable virtual social contact. Amazon even has a page on the ‘helpful things Alexa can do at home during Covid-19’. But the use of devices such as Alexa, Google Home, Hive, Zoom, Ring Doorbells, and indoor CCTV that are readily available, affordable, and intuitive have potentially significant implications when used at home, not least for work-life-balance, gender issues, new regimes of observability, domestic routines and practices.
Digital tools and devices have become increasingly popular during Covid-19, and their use to enable care from afar to, for instance, do the online shop, manage heating systems, monitor movements within the home, or check who is at the door is no exception. Organisations such as NHS Digital have been providing advice on digital solutions for use to support informal caring just as the RNIBand Alzheimer Scotland have. The extent to which these phenomena supplement or provide a substitute for in-person visits, how they interact with existing domestic or caring routines, and importantly, shape experiences of home, for a vast range of different people, are key questions for Geographers. Moreover, the spatial and temporal dynamics of these relations – how they evolve over time as the pandemic unfolds, are interesting to consider and explore.
Homes, and our attachment to them, is a well-established area of geographical scholarship revealing home as a theoretical concept and an experience, loaded with desirable, problematic, complex and multiple dimensions. It is central to our everyday experiences, imagined and real, is where we spend vast amounts of time (even before Covid-19), and where we think about spending time in the future, our ‘home-to-be’. Geographers have challenged nostalgic notions of home, questioning ideas of stability and autonomy to reveal the contingency, tensions, and paradoxes of home. This work has helped shed light on how ideas of home are produced, by whom, for what purpose, and the variations in these experiences around the world and over time. Indeed, accounts of the diverse ways in which Covid-19 will shape experiences of home have been appearing, with some attempting to challenge, for instance, the heteronormative, nation-based, race, class and gender privileged logics of ‘the household’. Moreover, and during COVID-19 we should remember that many people do not have a home while others, such as key workers, are staying away from theirs.
The focus on healthcare at home and how it intersects with caring and domestic routines and practices is not a new concern for Geography. The desire for solutions that encourage greater patient independence and cost-savings for public health, has resulted in ‘shifting landscapes of care provision’, and materialised in several generations of healthcare technology for use in homes.Homes are not just places we care for, but, increasingly, are able to care for us. For example, this morning when you stood in front of the bathroom mirror to brush your teeth, you could have been measuring your cardiovascular health using an optical sensor embedded in the mirror (monitoring your skin colour and blood flow). In January 2018, Google submitted a patent to develop such technology. With new ‘smart’ technology, homes are increasingly being viewed and used as sites of healthcare, or mini-hospitals, and may contribute to Covid-19 ‘track and trace’ efforts. But what does this mean for our homes, how we live in them, and how this may change in the future, particularly post-Covid? Specifically, how are these futures anticipated, and by whom?
In interviews Louise undertook with healthcare professionals about technology-enabled-care (TEC) at home, just weeks before the first case of Covid-19 was detected in China, ideas of risk featured heavily and were fundamental in imagining future TEC at home. Foremost concerns surrounded the risk of someone falling; the risk of someone lying undetected after a fall or a worsening of their health; data risk (who has access to data, how it is stored, who owns it (e.g. software developer, device creator)); risk of abuse if new forms of access and control are acquired; risk of inaccurate readings given lack of clinical calibration of devices; and, the obduracy of devices/systems. These perceived risks were central in shaping caring services and interventions in addition to the structure, fabric, and design of homes.
Arguably, Covid-19 will magnify and present new types of risk: installers may need to enter homes to install new devices or give technical installation advice from afar; a heightened risk of scams(possibly also by fake/unregulated installers); a false sense of security which new devices may give; and, in the context of Covid-19 where the shielding of vulnerable people for prolonged periods is likely, a resistance to isolation may also materialise in the undertaking of risky activities. Whilst the use of mainstream devices for informal care may help reduce immediate risks during Covid-19, by replacing in-person visits or providing connection and reassurance, they may create legacy-effects in terms of a new reliance on technology, on new routines of observation, and changed relationships with home.
These new risks, generating new patterns of care and caring practices are entwined with ideas of home given the need for lockdown. Staying at home may present extra risks for some, and different household configurations may be more risky than others. Patterns of excess deaths may, in part, be a reflection of concerns about seeking help for non-Covid-19 issues, and likely will generate an increased appetite for technology-enabled-care. Indeed, a discussion amongst practitioners, just last week, about ‘High Street Tech; Should it be our business?’ reflects the ways in which mainstream devices for care are being used, and how that may develop in the future.
Ongoing PhD research, by Rachel, exploring the experience of mainstream devices and technology-enabled-care services, by older people and their wider caring networks in rural Scotland provides further insights now useful in Covid-19. Her emerging findings show how participants were motivated to use such devices to satisfy a range of anticipated futures and feelings of homeliness, acting to reinforce various roles within the home and society (e.g. good parent, good child). The Covid-19 related acceleration of mainstream smart and care technology, combined with well-publicised risks from PPE shortages in care homes and the sheer numbers of Covid-19 deathswithin care settings, will have wider implications on the desirability to age-in-place. There may also be a greater preference of continued home living for many older people and their families, and potential for existing hierarchies of use and access to health and social care to be reinforced or perpetuated.
It is therefore critical that we interrogate how relations within technology-enabled-care have changed, in which ways, why, and how this varies in different places for different people. We particularly need to understand the lived experiences of Covid-19. How have policies such as ‘stay at home’ or shielding impacted on people’s feelings of home, and how has this been shaped by technologies-for-care? Indeed, have these experiences differed depending on what type of device was used, or who instigated its use (e.g. householder, family member, or social care services). Moreover, how will these relationships change post-Covid? Will householders extend the frequency with which they use these technologies, get more of them, or will they ‘step back’ and reduce reliance on these? Furthermore, to what degree will choice around TEC use remain in post-Covid healthcare decisions? These are important issues that policy and practice communities are already engaging with, but we need to be careful not to overlook where these devices are used; home, and why that matters.
About the authors: Louise Reid is a Senior Lecturer in the School of Geography and Sustainable Development at the University of St Andrews. Louise currently holds a Royal Society of EdinburghSabbatical Research Grant, and a Carnegie Trust Research Incentive Grant on ‘Homes that Care’; exploring how ‘healthcare smart homes’ are imagined and experienced in Scotland.
Rachel Creaney is a final year PhD researcher looking at the lived experiences of older residents of rural healthcare smart homes. She is jointly supervised within the School of Geography and Sustainable Development at the University of St Andrews, and the Social, Economic and Geographical Sciences Group at the James Hutton Institute, Aberdeen. Rachel is also the Communications Assistant for the Housing Studies Association.
Suggested further reading
Gibas, P (2019) Between roots and rhizomes: Towards a post-phenomenology of home, Transactions of the Institute of British Geographers, https://rgs-ibg.onlinelibrary.wiley.com/doi/10.1111/tran.12304
Power, E (2019) Assembling the capacity to care: Caring-with precarious housing, Transactions of the Institute of British Geographers, https://doi.org/10.1111/tran.12306Special Section: Interstices of care: re-imagining the geographies of care, Areahttps://rgs-ibg.onlinelibrary.wiley.com/toc/14754762/2020/52/2
Special Section: Interstices of care: re-imagining the geographies of care, Area https://rgs-ibg.onlinelibrary.wiley.com/toc/14754762/2020/52/2