Two paragraphs about Caregivers Robots in family.

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Technology and Disability 24 (2012) 303–311 303 DOI 10.3233/TAD-120361 IOS Press

Service robots in elderly care at home: Users’ needs and perceptions as a basis for concept development

Lucia Piginia,∗, David Facalb, Lorenzo Blasic and Renzo Andricha aFondazione Don Carlo Gnocchi Onlus, Milano, Italy bFundación Instituto Gerontológico Matia – INGEMA, San Sebastian, Spain cHewlett-Packard Italiana S.r.l., Milano, Italy

Abstract. Background: Service robots may offer an innovative assistive solution to improve the quality of life of frail elderly people, by assisting them in specific situations identified as relevant to maintain independence. Objective: This paper describes the results of a qualitative and quantitative research based on a user-centered methodology carried out within the EU-funded project “Multi-Role Shadow Robotic System for Independent Living” (SRS), aiming to generate user requirements and realistic usage scenarios maximizing the alignment with users’ needs, perceptions, feelings and rights. Methods: A qualitative and quantitative research – based on focus groups (59 participants) and questionnaires (129 respondents) – was carried out in three countries: Italy, Spain and Germany. The survey involved prospective end-users (elderly people and family members who care for them), caregivers, and geriatric experts. Results: Results show that despite elderly people encounter difficulties in many activities of daily life, a semi-autonomous remotely-controlled and self-learning service robot has been judged an interesting solution only in some circumstances. Moni- toring and managing emergency situations, helping with reaching, fetching and carrying objects that are too heavy or positioned in unreachable places: these are tasks for which robotic support has been widely accepted, while tasks involving direct physical contact between the person and the robot are not appreciated instead. Relatives of the elderly could act as remote operators; however, family psychological burden and time restrictions should be considered too. Conclusions: A tele-operated robotic system may be of help for frail elderly people. In certain cases this solution may be effective only in conjunction with a 24-hour professional Service Centre able to manage tele-operation when relatives are not available. This survey adds further tokens of knowledge to previous literature studies on this subject; it compares the potential users’ and the professionals’ views; it helps identifying potentially successful applications of tele-operated robots in the care of elderly people living at home. The results obtained by the present study, generated specific requirements and the first versions of concrete usage scenarios, enabling designers and technologists to start with a first development phase of the SRS concept.

Keywords: Service robots, tele-operation, elderly people, caregivers, user requirements, user centered design

1. Introduction

Several robotic research projects are motivated by the challenges of ageing population with the aim of covering both care and social needs by designing ser- vice and / or companion robots [1–3]. Assistive service robots may be an interesting option to support elder- ly people’s independent living at home especially for

∗Corresponding author: Lucia Pigini, Fondazione Don Car- lo Gnocchi Onlus, Italia, Piazzale Morandi 6, 20121, Milano, Italy. Tel.: +39 0240308283; Fax: +39 024048919; E-mail: [email protected].

those frail elderly people who are chronically affected by several pathologies, with instable health conditions and declining capacity to cope with stressors [4–8].

Researches demonstrate that housing-related needs are at the core of the assistive technology adoption; so innovative assistive technologies – if perceived as straightforward, reliable and meeting a need – have an impact directly on the physical environment of the house, improving individual functioning, and have the potentials to indirectly improve beliefs, attitudes and social perceptions of independent living [9]. In this con- text, service robots are seen to have the potential of fa- voring independent living by supporting basic activities

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and mobility, providing help in household maintenance, monitoring of those who need continuous attention, maintaining safety and covering some social functions by facilitating interfacing with the family or caregivers. Solutions offered include mobility aids, manipulation aids, companion robots, and educational robots [10].

However, it is commonly accepted that one of the main reasons of failure in assistive technology advance- ment is the lack of key-users involvement in the devel- opment process and the small amount of efforts invest- ed in user involvement [11]; often technological chal- lenges are set above to the real needs. Moreover, in the field of artificial intelligence, technological challenges are very demanding; the heterogeneity of unmet needs and domestic environment specificities in the elderly population still poses substantial technological chal- lenges such as decision making, 3D environment per- ception, object recognition, classification, or safe ma- nipulation [12], hindering a rapid deployment of ser- vice robots in end user environment. And more, neg- ative attitudes towards robots are considered as one of the psychological factors preventing humans from in- teracting with robots in daily life [13]. Because of that, it is still important to gain an understanding about how people relate to personal service robots and how task assistance of a robot affects users’ acceptance towards the robot’s social role [14].

In order to address these issues, the research project “Multi-Role Shadow Robotic System for Independent Living” (SRS) [15], aims to supplement robotic intel- ligence with human intelligence. The proposed idea is that of a semi autonomous robot, assisted by a human operator when encountering an unknown situation that it can’t handle. Through progressive automated learn- ing from tele-operation and active teaching, human in- volvement will decrease over time, as the robot’s func- tional range is extended, and its behavior is adapted to the local context. In this sense, a semi-autonomous, tele-operated, and learning robotic system dedicated to the elderly would involve not only primary users such as frail elderly persons, but also secondary users (the remote operators) helping the frail elderly at distance through the use of the robot (so acting as a shadow of the robot). The project, based on a user-centered methodology [16], started investigating the most ur- gent needs of prospective users and the tasks for which users would accept help from a robot. Designers need a precise description of the profile of their future users, including information about experience with technol- ogy, performance in daily activities, capabilities and limitations.

An ethnographic research conducted in Italy and Spain towards the beginning of the project allowed to supplement literature information with field data about the social, economic, and environmental context of the target population. In summary, this survey [17] pro- vided an insight of the main beneficiaries of the SRS system, the so called “frail elderly people”. They are people who are still able to live at their home even in “a frail situation” linked to age-related problems, such as sense -related problems (vision and hearing problems), osteoarticular problems (e.g. arthritic and rheumatic problems or outcome of fractures), chron- ic health conditions (e.g. respiratory problems or car- diopathy). For these people, performing Activities of Daily Living (ADL) is limited by those health problems and some of them are already dealing with mobility as- sistive devices like sticks, walkers or even wheelchairs. Because of these problems they have some help of- fered by their children/grandchildren/partner or at least by house-keepers; some of them are already using a personal alarm or are in contact with a tele-assistance centre. Analyzing the attitudes of the target group, gender differences can be noticed [17]; women tend to minimize problems by finding out adaptive strategies to continue performing ADLs, sometimes even plac- ing themselves at risk (e.g. climbing self-made steps to reach objects on top shelves even if they are at risk of falling), while men encounter more difficulties with housekeeping tasks. Their houses show some common features; handgrips or seating devices can be easily found in most of the bathrooms and in some bedrooms. Not many technology devices can be found, and they are usually just common house hold appliances such for example television, dishwasher or vacuum clean- er. The houses are full of furniture, carpets, frail or- naments objects which are emotionally significant be- cause gathered during the course of their long life and so they are reluctant to remove them even if for example carpets could represent an obstacle for independence (stumbling, falling).

So, considering the achieved knowledge about the elderly’s problems at home, the study presented in this paper investigates the needs and perceptions of both pri- mary and secondary users (elderly people themselves and family members) as well as the opinion of profes- sionals (professional caregivers and health profession- als). The objective is to generate specific user require- ments and concrete scenarios for the development of a new technological assistive device fulfilling as much as possible the real needs of the potential users.

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Fig. 1. Robot application sketches presented to participants.

2. Method

User-centered design methodology is based on an iterative involvement of potential users, starting inves- tigating users and their requirements and then involv- ing users at each step of the system development; this paper reports on the two iterative steps which allowed to hypothesize the SRS concept; the steps in particular are the following:

– First: potential users were involved in focus groups, aimed at finding the general features of stakeholders, their predisposition to new technolo- gies, their most urgent needs (not only physical but also social and related to privacy) and the tasks for which users would accept help from a robot.

– Second: the qualitative results of the first phase, provided the researchers with enough informa- tion to design ad-hoc questionnaires, in order to achieve quantitative results about the users’ needs and expectations from a service robot.

2.1. Qualitative survey – focus groups

At the beginning of the study the focus group method was applied [18]. Participants were first interviewed on their difficulties in the care situation, regardless of tech- nology considerations. In the second phase, the con- cept of a semi-autonomous robot that could learn from continued usage and teaching and be tele-operated was introduced, with the help of robot application sketches and videos chosen from a wide range of situations like emergency, household, and emotional support. Exam- ples of illustrations are shown in Fig. 1.

2.2. Quantitative survey – questionnaires

After the focus groups, and considering the themes elicited through them, a 96 items ad hoc questionnaire, originating from those themes, was developed for quan- titative data collection. The questionnaire consisted of

Likert-type items assessing, through a rating scale from one to five, three main topics: a) the most difficult ac- tivities to carry out at home for elderly people, b) the participants’ feelings and perceptions about robot us- ability and remote control options and c) the perceived advantages/disadvantages and privacy issues related to the use of a remote control to operate the robot. In order to assess users’ attitudes towards technology, the Survey of Technology Use (SoTU) [19] was employed in the initial section of the questionnaire. A tailored version of the questionnaire was developed consider- ing the different needs and point of view of each in- terviewed group (potential primary users and potential secondary users, as detailed into the following “Partic- ipants” chapter).

2.3. Participants

Focus groups and individual interviews were carried out in three countries involved in the SRS project (Ger- many, Spain, and Italy). Informed consents forms were signed by participants (following national approval of an ethics review committee). Four types of intervie- wees were involved and could be divided into two main categories of potential users:

– Primary users; the so called “frail elderly people”. – Secondary users; relatives of the elderly people,

professional caregivers and health professionals. The term “professional caregivers” refers to peo- ple involved in direct care of elderly people (e.g. trained caregivers working permanently for a sin- gle elderly person at home or in assisted living fa- cilities or for mobile care services visiting different elderly people in their houses each day. . . ). The term “health professionals” refers to people with high experience in the geriatric field even if not in- volved in daily direct care (geriatric physicians and nurses, physiotherapists, social pedagogues. . . ).

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A total of twenty-two elderly persons (77% female), with a mean age of 80 years (65 to 90) participated in the focus groups in all the three countries. Sixty- four elderly persons (64% female) with a mean age of 77 years (65 to 92) participated to individual inter- views. They were recruited according to the criteria of being at least 65 years old, still able to live inde- pendently at home despite some difficulties in perform- ing activities of daily living (e.g., mobility, or sensorial difficulties). Most of them received some form of as- sistance because of that. Participants however did not present severe mental disabilities such as dementia. A short questionnaire by Barber et al. [20], was adopted as test for inclusion during the recruitment.

Seventeen relatives of elderly persons (88% female) with a mean age of 55 years (46 to 64) participated in 3 focus groups in Germany and Spain. Nineteen family members (88% female) with a mean age of 54 years (29 to 69) participated in individual interviews. They were recruited according to the criteria of being involved in care giving for their relatives. Most of them cared for their parent but some for grandparents, mothers-in-law, old aunts.

Twenty health professionals (80% female) with a mean age of 46 years (30 to 61) and eight profession- al caregivers (5 women, 3 men) with a mean age of 51 (27 to 60), participated in focus groups in all the three countries. Forty-six caregivers (considering both health professionals and professional caregivers) par- ticipated in individual interviews with a mean age of 45 years (27 to 62).

3. Results

3.1. Elderly people’s difficulties at home

Focus groups showed [21] that fall prevention and management are a critical issue for elderly people’s daily life. Caregivers and health professionals identi- fied mobility problems, vision problems and hearing problems as the most common and critical age-related changes. In addition to that, psychological and cogni- tive problems also emerged during focus groups. On the other hand, taking care of an old adult may be a heavy burden for a familiar as well as for a professional caregiver, depending on the level of disability of the old person taken care of. Professional caregivers’ main complaint in focus groups is the lack of sleep, problem mentioned several times.

Considering quantitative data, the mean results ob- tained from the section of the questionnaire about dif- ficulties in daily living are showed in Table 1. The main difficulties experienced by aging people at home as assessed through our survey are difficulties related to mobility; especially the risk of falling, the difficulty of carrying heavy objects (e.g. shopping bags but some- times just a full bottle of water) and reaching objects in hard to reach places (e.g. objects on a top shelf or too low on the ground). This is reflected in the problems while performing some housekeeping tasks; in accor- dance with the results obtained in other studies [22]. The highest rated items in this area for all the groups of participants are cleaning the floors and the windows, which are heavy tasks for people with mobility diffi- culties such as early fatigue, lack of force, difficulty or fear of falling while climbing a ladder and working on it.

Other annoying difficulties in elderly life assessed in our interviews derive from memory problems, such as remembering to take medicines. Body care activities on the other hand didn‘t receive a high score in the quantitative evaluation, likely because elderly people tend to disregard problems related to personal care, as mentioned by caregivers in the Focus groups. Howev- er, these outcomes contradict with the results of the fo- cus groups, where in the qualitative evaluation, elderly people clearly mentioned difficulties in personal care, mainly bathing.

3.2. The participants’ perception of a remote controlled robot

Looking at the qualitative results collected to high- light specific concerns regarding the intrusion at home caused by the adoption of a remote control option, some participants looked at it with suspicion but elderly peo- ple showed less concerns than the other interviewed groups, prioritizing the advantage received over priva- cy. Some family members and professional caregivers were also afraid that the remote control option might increase the burden of presence and availability, also psychologically. On the other hand, health profession- als mentioned the remote control function as a tool that could help strengthen the relationship between the el- derly user and the other members of his/her family; in this way in fact the number of occasions during which they could get in contact and physically interact could become possible also during period of absence (e.g. family living in another city. . . ). Finally, all the inter- viewed participants highlighted that people with cogni-

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Table 1 Mean results about elderly people’s difficulties at home. Comparison between four categories of people. 1 to 5 scale: where 1 means “No difficulty”; and 5 means “substantial difficulties” (standard deviation between brackets). Results are shown by elderly people ranking

Items Elderly Family Professional Health people caregivers caregivers professionals

Carrying objects 3.52 (1.469) 3.68 (1.635) 4.41 (0.908) 4.17 (0.963) Cleaning windows 3.25 (1.574) 4.37 (1.116) 4.27 (1.120) 4.54 (0.588) Reaching objects 3.22 (1.578) 3.47 (1.467) 4.09 (1.269) 4.08 (0.654) Reading 3.11 (1.358) 3.84 (1.463) 3.82 (1.296) 4.04 (0.550) Forgetfulness 2.88 (1.327) 3.68 (1.250) 3.82 (1.220) 3.67 (0.917) Falling management 2.81 (1.435) 3.47 (1.219) 4.41 (1.008) 4.13 (0.869) Opening bottles 2.77 (1.669) 4.21 (1.228) 3.59 (1.333) 3.71 (0.908) Cleaning floor 2.73 (1.546) 3.89 (1.449) 4.18 (1.097) 3.58 (0.929) Climbing bathtub 2.63 (1.609) 3.32 (1.416) 4.27 (0.985) 4.42 (0.584) Shopping 2.61 (1.476) 4.68 (0.749) 3.86 (1.167) 3.67 (1.007) Walking 2.55 (1.511) 3.11 (1.629) 3.32 (1.287) 3.42 (1.139) Bathing 2.34 (1.514) 3.37 (1.535) 3.86 (1.246) 4.00 (0.780) Getting up 2.20 (1.382) 2.89 (1.663) 3.27 (1.241) 3.63 (0.875) Loneliness 2.08 (1.349) 2.79 (1.357) 3.55 (1.438) 4.00 (0.978) Cooking 1.98 (1.327) 3.79 (1.584) 3.77 (1.270) 3.17 (1.007) Fetching objects 1.98 (1.279) 3.26 (1.240) 3.05 (1.253) 3.38 (1.056) Washing clothes 1.98 (1.253) 3.79 (1.512) 3.82 (1.053) 3.13 (0.900) Dressing 1.97 (1.284) 3.47 (1.504) 3.73 (1.120) 3.29 (0.908) Electronic devices 1.92 (1.264) 3.58 (1.305) 2.86 (1.521) 2.83 (1.129) Tyding up the room 1.92 (1.186) 3.68 (1.376) 3.64 (1.255) 2.71 (0.908) Washing crockery 1.72 (1.133) 3.16 (1.675) 3.77 (1.307) 2.96 (0.908) Taking medications 1.69 (1.082) 3.95 (1.393) 3.82 (1.097) 3.42 (1.060) Clearing the table 1.58 (1.066) 2.95 (1.580) 3.27 (1.352) 2.63 (0.875)

tive problems could not and should not use the system. In this case the interaction could not be considered any- more as cooperation, but rather as a control over the user.

Focus groups results provided also information about the appearance and control mode of the robot. Both the elderly and family caregivers showed a high preference for a human-like appearance and for the possibility of a voice-command way of controlling it rather than a more classical tele-control. Professional caregivers and health professionals instead, would prefer a machine- like robot. They also showed much more safety con- cerns than elderly people and family caregivers, while all the groups expressed their worries about the size of the robot due to spatial limitations in the elderly’s homes or potential presence of architectonic barriers. Elderly people worries were expressed also in rela- tion to the furniture and ornaments located inside their houses that could be damaged by robot movements.

The participants’ perception of the robot usefulness showed a higher variability among groups. Howev- er, one topic was mentioned in all groups as a crucial task that they wish the robot could help with: to man- age emergency after a fall. Consistently with these re- sults, quantitative data about the usefulness perception of remotely controlled robotic functions are similar to those collected on the usefulness of the robotic func-

tions them self, but somewhat lower. As shown in Ta- ble 2, mobility items like carrying heavy objects, shop- ping or reaching high objects scored highest together with a few items belonging to the housekeeping cluster, like cleaning windows or cleaning the floor. The items receiving the lowest score in this section were again those about body care.

Being remote control option perception the core re- sult of the study; quantitative responses were analyzed also comparing differences between countries concern- ing the elderly participants (since elderly group was the only recruited in the three countries). According to variables skewness, Kruskal-Wallis Test was adopted (SPSS 15.0 was used for calculation); group compar- isons showed significant differences for the following remotely controlled functions (see Table 3, showing al- so mean results): getting up (X2 9.178, df 2, p < 0.05), carrying heavy objects (X2 9.479, df 2, p < 0.01), climbing bath tub (X212.076, df 2, p < 0.01), fetching things (X2 7.786, df 2, p < 0.05), reaching objects (X2

13.086, df 2, p < 0.01), washing crockery (X2 9.337, df 2, p < 0.01), tidying up the room (X2 12.948, df 2, p < 0.01), getting dressed (X2 14.860, df 2, p < 0.01), bathing (X2 8.337, df 2, p < 0.05) and taking medications (X2 9.465, df 2, p < 0.01). With respect to usefulness related to all these robot functionalities, the attitude was significantly more positive in Spain, especially if compared to Germany.

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Table 2 Mean results about Robot remote control function usefulness. Comparison between four categories of people. 1 to 5 scale: where 1 means “idea of a remote controlled robot for this task execution considered very useful”; and 5 means “idea of a remote controlled robot for this task execution considered useless” (standard deviation between brackets). Results are shown by elderly people ranking

Items Elderly Family Professional Health people caregivers caregivers professionals

Falling management 1.77 (1.137) 1.26 (0.653) 1.77 (1.412) 1.50 (0.722) Reaching objects 2.34 (1.428) 1.68 (0.820) 1.68 (1.249) 2.22 (0.850) Fetching objects 2.55 (1.413) 2.32 (1.293) 1.77 (1.270) 2.39 (1.158) Shopping 2.67 (1.604) 1.95 (1.393) 2.23 (1.541) 2.14 (0.889) Carrying objects 2.70 (1.550) 2.68 (1.600) 1.77 (1.270) 2.65 (1.071) Cleaning windows 2.80 (1.625) 1.84 (1.167) 2.00 (1.309) 2.52 (1.275) Taking medications 2.84 (1.586) 2.05 (1.471) 1.77 (1.343) 1.70 (0.974) Electronic devices 2.86 (1.542) 1.74 (1.195) 1.59 (0.908) 2.57 (1.121) Reading 2.86 (1.562) 2.16 (1.537) 2.14 (1.552) 2.70 (1.222) Cleaning floor 2.89 (1.565) 1.74 (1.284) 1.82 (1.332) 2.17 (1.154) Washing clothes 2.94 (1.582) 2.05 (1.311) 2.00 (1.345) 2.39 (0.941) Getting up 3.00 (1.563) 2.74 (1.368) 2.55 (1.503) 2.58 (1.100) Opening bottles 3.02 (1.496) 2.32 (1.529) 1.95 (1.463) 2.65 (1.301) Walking 3.06 (1.562) 3.37 (1.461) 2.55 (1.535) 2.87 (1.180) Climbing bathtub 3.09 (1.669) 3.11 (1.595) 3.09 (1.716) 2.54 (1.285) Washing crockery 3.17 (1.569) 2.47 (1.467) 2.32 (1.524) 2.83 (1.267) Cooking 3.22 (1.474) 2.47 (1.679) 2.50 (1.596) 2.35 (1.112) Tidying up the room 3.31 (1.521) 2.21 (1.316) 2.09 (1.411) 2.74 (0.915) Clearing the table 3.33 (1.481) 2.47 (1.467) 2.45 (1.535) 3.00 (1.087) Dressing 3.38 (1.475) 2.79 (1.475) 2.82 (1.918) 2.92 (1.139) Bathing 3.64 (1.384) 2.74 (1.485) 3.05 (1.864) 2.79 (1.382)

Table 3 Mean results about the elderly people perception of Remote Control usefulness, comparison between three countries. 1 to 5 scale: where 1 means “idea of a remote controlled robot for this task execution considered very useful”; and 5 means “idea of a remote controlled robot for this task execution considered useless” (standard deviation between brackets). Results are still shown by elderly people ranking. Significant differences between countries are shown by asterisks for each item (∗if p < 0.05, ∗∗ if p < 0.01)

Items Germany Italy Spain

Falling management 1.82 (1.156) 1.89 (1.41) 1.53 (0.717) Reaching objects∗∗ 3.04 (1.478) 2.11 (1.41) 1.47 (0.624) Fetching objects∗ 3.11 (1.449) 2.05 (1.471) 2.18 (0.951) Shopping 2.96 (1.71) 2.84 (1.772) 2 (1) Carrying objects∗∗ 3.18 (1.492) 2.89 (1.792) 1.71 (0.772) Cleaning windows 3.11 (1.729) 2.84 (1.675) 2.24 (1.3) Taking medications∗∗ 3.39 (1.499) 2.89 (1.823) 1.88 (0.928) Electronic devices 2.82 (1.611) 3.21 (1.686) 2.53 (1.231) Reading 3.04 (1.621) 2.95 (1.715) 2.47 (1.281) Cleaning floor 3 (1.7) 2.95 (1.715) 2.65 (1.169) Washing clothes 3.14 (1.604) 3.32 (1.701) 2.18 (1.185) Getting up∗ 3.57 (1.399) 2.95 (1.84) 2.12 (1.054) Opening bottles 3.11 (1.571) 3.37 (1.64) 2.47 (1.068) Walking 3.43 (1.451) 3.11 (1.853) 2.41 (1.228) Climbing bathtub∗∗ 3.68 (1.517 3.26 (1.821) 1.94 (1.144) Washing crockery∗∗ 3.75 (1.506) 3.11 (1.663) 2.29 (1.16) Cooking 3.5 (1.528) 3.37 (1.499) 2.59 (1.228) Tidying up the room∗∗ 3.79 (1.475) 3.63 (1.342) 2.18 (1.237) Clearing the table 3.54 (1.478) 3.47 (1.504) 2.82 (1.425) Dressing∗∗ 3.75 (1.323) 3.89 (1.329) 2.18 (1.237) Bathing∗ 3.93 (1.215) 4 (1.202) 2.76 (1.522)

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4. Discussion

This work reports the results of a qualitative and quantitative research aiming to generate user require- ments and realistic usage scenarios maximizing the alignment with users’ needs, perceptions, feelings and rights toward the development of a service robot dedi- cated to elderly people’s assistance.

There have not been many studies on caregivers’ re- quirements for service robots [23]. This survey adds further tokens of knowledge to previous literature stud- ies on this subject [24,25], by comparing different po- tential users’ views: elderly people, their relatives, pro- fessional caregivers and health professionals. More- over, the distinctive characteristic of the present study is its focus on tele-operation. Results show that, despite elderly people encounter difficulties in many activities of daily life, a semi-autonomous remotely-controlled and self-learning service robot has been judged an in- teresting solution only in some circumstances.

Across all user groups and countries, mobility dif- ficulties were highlighted and, on the whole, partic- ipants were mostly interested in functions related to health monitoring, emergency managing and house- work through a remotely operated robot. About the re- mote control option another issue emerged: the group of the elderly people showed fewer concerns about pri- vacy than the other interviewed groups, giving again priority to safety. This highlights that feeling safe at home is key issue for elderly people, so not in con- flict with their caregivers’ need to monitor the situation, even if health professionals showed skepticism toward the safety of a robotic assistive system.

On the contrary, social and body care functions were most often rejected, thus highlighting that the robot they can imagine could or should help in several tasks, but elderly users still don‘t trust robots for help with personal care.

Regarding potential remote operators of the sys- tem; perhaps the most unexpected finding is that there was substantial opposition by professional caregivers, health professionals and to some extent also by family caregivers to the prospect of teaching and tele-operating a domestic service robot by themselves [21]. Profes- sional caregivers and health professionals seem to be an unsuitable target group for tele-operation due to their refusal to engage in care via technology and their per- ception of the robot as a “competitor” for their job [26]. Family caregivers opposition instead, is mainly related to the psychological burden and time restrictions due to work, children to care for . . . ; however, surveillance

of their old parent’s health and security are things very valuable for them; so, an option to address this could be to employ a 24-hour professional service center for tele-operation, better if it is the last resource in a call priority chain, first contacting family caregivers.

Regarding human robot interfaces; the design pro- cess of the user interface for tele-operating the robot, should take with high priority into account the develop- ment of a portable and possibly intuitive user interface for a rapid intervention. Both the elderly and family caregivers showed a high preference for the possibility of a voice-command way of controlling the robot rather than a more classical remote-control. However, simpli- fying too much the interaction devices would impose some limitations on the control of the more complex robot functions; this problem has been solved planning to provide the different group of users with different robot interfaces; one dedicated to the elderly people with limited functionalities and very simple, one ded- icated to the family remote operator allowing most of the robot functionalities but still user friendly and fi- nally a professional interface dedicated to the 24 hour remote assistance service, enabling intervention in the event of failure of the family interface and the control of the most complex robot functionalities.

Regarding the robotic platform, professional care- givers and health professionals preference for a machine-like robot, was related to their opinion that an appearance similar to a household appliance could be more acceptable from elderly, however the elder- ly and family preference for a human-like appearance probably reflects the difficulty in imagining a machine taking care of people in place of a human caregiver or also shows the high relevance of social factors in elder care. Other important aspects are related to it’s entering the home environments, which often present narrow passages and other architectonical barriers [17]; these constraints, together with elderly’s psychological attachment to house furniture and ornaments (a com- mon statement between the elderly interviewed was sounding like “the robot must not break anything while moving around in the home”) and avversion to changes of habits, inevitably turn into requirements connected to the mobility and size of the robotic platform. The robot should be able to move inside the house without making too many changes in the environment and with- out representing itself another barrier inside the house. The option considered was to set a storage place where the robot can autonomously go to recharge itself and stay out of the way when it‘s not needed, thus avoiding being an obstacle for the elderly’s movements.

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Table 4 Example of concept requirements and usage scenario derived from user requirements survey

User requirements SRS concept requirement Scenario

– Request for help – Bringing objects difficult to

reach – Low interaction with technol-

ogy – Concern for the home environ-

ment

– Simple and wearable personal device (few large buttons for place an SRS request to a remote operator or for starting autonomous robot func- tions).

– Robot’s Accurate and safe manipulation of ob- jects

– Robot on a mobile platform – Robot’s Autonomous recognizing of obstacles – Robot’s Autonomous functions execution

Elisabeth Baker, 84 years old, widow, suffers of high blood pressure; this morning she wakes up and she feel so dizzy that she can’t get up to reach the medicine she has to take. She decides to call for the help of the SRS robot using her personal device that she always carries with her. She is not confident with technology so she just send the robot to the kitchen and a call for a remote operator. The robot activates from its recharging station and au- tonomously starts going to the kitchen. . .

– Monitoring health of the elder- ly relative/assisted

– Be able to give help at distance – Time retrictions: avoiding ex-

tra burden

– Portable and ready for use device to tele- operate the robot: navigation through the map of the house, easy teaching to the robot of new objects and new procedures. . .

– Robot automatic recognition of already learned objects and procedures from a database

Case A) The woman’s request is sent to her son: The son is at work but seeing a request from the mother on his SRS-portable device starts a remote session from his workplace. So communication is established and he can immediately find the robot already into the kitchen, so he has just to make it bringing the medicine and a glass of water to take it to her mother. . .

– Lowering family charge, – Assuring intervention in every

case, – Considering privacy and ethics

– Call priority chain: first contacting family, then assistance centre.

– Authorization procedure for privacy protection – Professional SRS-workstation to control the

robot executing particularly complex maneu- vers (manual control of the robotic arm. . . )

Case B) The request is sent to her son: He is in a meeting so he doesn’t see the call; thus the call is immediately forwarded to the 24-hour teleassistance centre; the first free authorized operator starts a remote session from a SRS dedicated work station to help the old woman through SRS. The operator sends the robot to the kitchen but the glass is placed in a difficult place to be fetched through the basic procedure. However through the professional SRS-workstation she can teleoperate it in very accurate way, so that, she manage to make the robot fecthing it and complete the operations. . . .

Fig. 2. The developed concept of SRS. The figure shows the stake- holders of the systems, the idea of three different devices with in- creasing complexity that they should use to interact with the robot or with the other stakeholders.

Finally, some indications for cultural differences be- tween countries were also found: for example, results show that Italian and German participants object more towards several aspects of a robot at home, in particular about the body care and the cooking functions. Span- ish sample instead showed a more positive attitude; in- terestingly, questionnaires results regarding items from the body care cluster were positively evaluated as well,

showing minor concerns about privacy during activities like bathing or getting dressed. Cortellessa et al. [27] mention differences between different nations in elder- ly care culture and in technology uptake as possible reasons.

The results obtained by the present study together with literature results, generated specific requirements and the first versions of concrete usage scenarios (see example in Table 4), enabling designers and technol- ogists to start with the first development phase of the SRS concept (Fig. 2).

Acknowledgment

This research was carried out as part of the re- search project “Multi-Role Shadow Robotic System for Independent Living” (SRS), funded by the European Commission under the 7th Framework Program, grant agreement no. 247772. We would like to thank Mar- cus Mast, Michael Burmester, and Eva Berner from Stuttgart Media University for the data collection in Germany.

L. Pigini et al. / Service robots in elderly care at home 311

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