Popular debates about technology for professional elder care are based on the idea of women doing care work out of love and the negative perception of elder care institutions, aging bodies, and cold technology. Marlene Hobbs challenges these ideas, opposing technologically deterministic visions of dehumanized care work in the future. She calls for a reevaluation of nursing homes and explores how technology is integrated into care space design.
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In Germany, there are current efforts to digitize care facilities, but many institutions lack the necessary digital infrastructure. New technologies for ‘good care’ in old age are more likely to be conceived in the so-called smart home. The German government’s 2020 Eighth Ageing Report emphasizes the goal of aging in place, meaning older people should age in their homes and neighborhoods for as long as possible. This shifts responsibility for independence and health to the private sphere. However, it remains unclear who can afford to age in place and where, as there are not enough affordable, barrier-free apartments to enable ‘good aging’ at home.
Political support for aging in place is reinforced by the poor reputation of nursing homes. Staff shortages and the perception of nursing homes as cold, impersonal institutions contribute to this poor reputation. Although modern care facilities aim to feel like home, the image of a total institution persists. Today, older adults are moving into nursing homes at a later stage, when they can no longer be cared for by friends or relatives. Consequently, nursing homes are increasingly populated by older and sicker individuals.
Towards ‘Care 4.0’?
New technologies in elderly care facilities are currently intended primarily to reduce bureaucratic burdens. Care workers are expected to perform tasks specific to their qualifications with the help of modern, partially AI-supported administration systems. This gives them more time to build emotional and intimate bonds with residents, which are often equated with a technology-free environment.
Unlike the industrial revolution in households, ‘Care 4.0’ does not promote tech-empowered superhero caregivers, but rather self-determined and self-reliant individuals who need care. Professional nursing and support staff are seen as passive users of new technologies or as victims of technological control and devaluation. This is partly due to the social devaluation of the nursing profession. Care and reproductive work are considered female and natural abilities. The associated lack of professionalization is reflected in the nursing profession’s low level of academic qualification, continuing feminization, and increasing migrantization. This devaluation is supposed to be compensated for by symbolic revaluation, such as applause. However, this is more reminiscent of canonization than an appeal for actual recognition.
Care technologies operate in a highly symbolic area of work and life. However, the question of how caregivers use these technologies in their daily lives and how this relationship shapes elder care spaces is rarely asked. Feminist technology research has long examined the technologization of supposedly tedious, routine activities in everyday and marginalized spaces. Building on this, I will discuss two examples of technologized micropolitics in care facilities.
Negotation of digitally assisted everyday care
Research on shared apartments for people with dementia with digital assistance systems has shown that the essentialist view of ‘warm care’ and ‘cold technology’ is not feasible in everyday life. As part of a research project, we demonstrated that technologized elderly care requires effort and negotiation, and can be caring for both those receiving and providing care. Two examples illustrate this: ‘caring surveillance’ and administration as a space for caregivers’ emotions.
Sensor technology is increasingly being used in dementia care. In the facilities we studied, no personal data is stored, and no camera recordings are made. Only when a door opens or someone gets out of bed is a signal triggered and reported to the staff telephone. Since the nursing staff knows the residents well, they know who is moving where and decide with each report whether someone needs assistance or can move around independently. This practice is complex to assess because, although it involves surveillance, it actually gives residents more freedom of movement. Otherwise, they would only be able to leave the premises when accompanied by scarce nursing staff.
In all facilities, the night watch depended on technology because one night watch is responsible for approximately 25 residents on different floors. For technology to have a positive effect, there must be interaction and negotiation between technology, nursing staff, residents, and premises. Sensor technology is not inherently supportive; it must be actively embedded in everyday life to be useful and caring. Therefore, caring for the elderly is a matter of negotiation that requires technology and labor.
Another example is how time and space are allocated for care documentation. In some facilities, documentation takes place on mobile screens next to residents’ rooms. In the future, it may take place simultaneously with care via voice assistants. However, these attempts have rarely been successful. Instead, care staff use this time for documentation and other administrative tasks to socialize, share ideas, and manage their emotions, which is necessary due to the demanding, sometimes shameful, and occasionally violent nature of elderly care. For this reason, they meet at lunchtime or in the early evening while the residents are resting. Administrative work provides an opportunity for emotional regulation and interaction that would otherwise be unavailable. Therefore, it is difficult to assess the consequences of rationalizing joint administration without creating alternative spaces for it.
The decision about what kinds of activities new technologies are developed for reflects different valuations of physical, emotional, and administrative work. In an effort to make care work more efficient, administrative tasks are mostly automated to save labor costs and create more time for ‘real’ intimate physical care and emotional closeness. Consequently, heavy physical work is usually untouched by automation because the few existing technologies, such as exoskeletons, are expensive.
As the examples show, automation cannot be viewed as a purely technical process. New technologies only take on meaning when they are embedded in everyday practices and spaces. Therefore, technologies can help shape ‘good care.’ However, this requires negotiation. This, in turn, creates or reveals spaces linked to central social issues of participation.
The digitized nursing home as a political space
The future of ‘good care’ and the role of digitization are political issues. The spaces in which these issues are negotiated not only serve as playing fields, but also help shape the use of technology. A closer look at everyday technological care reveals that there is already a great deal of knowledge about ‘good technological care’ and the necessary framework conditions. However, this knowledge is rarely incorporated into profit-oriented technology development. An important approach is building on existing knowledge and work processes and involving nursing staff in technology development. It is also a matter of debate across society as a whole.
To ensure that ‘good aging’ and ‘good elderly care’ do not remain class issues, we must examine care facilities and determine how they can be designed as collective spaces that provide good care and support for all with the help of new technologies. This raises the question of what spaces of aging and care we can envision beyond the idealized private living space where female members of the nuclear family must care for their relatives. How can technologies help in this regard? Who can demand a digital revolution in nursing homes while recognizing that automation is not just a technological issue?
A provider of digital technologies for care facilities pointed to an initial step regarding the role of new technologies for residents. If residents increasingly use smartphones, they will likely publicize the conditions in care facilities on social media and demand improvements.