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Towa ds E hical Guidelines o Using Telep esence Robo s in Residen ial Ca e
© The Au ho (s) 2019
Accep ed e sion (Final d a )
Niemelä, Ma ke a; Van Ae scho , Lina; Tammela, An i; Aal onen, Iina; Lammi,
Hanna
Niemelä, M., Van Ae scho , L., Tammela, A., Aal onen, I., & Lammi, H. (2021). Towa ds E hical
Guidelines o Using Telep esence Robo s in Residen ial Ca e. In e na ional Jou nal o Social
Robo ics, 13(3), 431-439. h ps://doi.o g/10.1007/s12369-019-00529-8
2021
Vol.:(0123456789)
1 3
In e na ional Jou nal o Social Robo ics
h ps://doi.o g/10.1007/s12369-019-00529-8
Towa ds E hical Guidelines o Using Telep esence Robo s inResiden ial
Ca e
Ma ke aNiemelä1 · Lina anAe scho 2· An iTammela1· IinaAal onen1· HannaLammi1
Accep ed: 5 Feb ua y 2019
© The Au ho (s) 2019
Abs ac
Robo ic elep esence is a po en ial echnology o help alle ia ing he loneliness o elde ly people. The impac s o long- e m
use o elep esence obo s in esiden ial ca e a e no well known. We we e in e es ed in how using a elep esence obo
in luences he esiden , amily membe s and ca e wo ke s a a acili y, and wha challenges and solu ions he e a e o wide
adop ion o such obo s in esiden ial ca e. Wi h a elep esence obo Double, we a anged a se ies o h ee ials in wo
sepa a e esiden ial ca e acili ies: one 12-week ial in a p i a e acili y and wo successi e 6-week ials in a public acili y.
In each ial, we ins alled he elep esence obo in a oom o a long- e m ca e home esiden o communica ing wi h he /
his amily membe s. Based on he esul s, elep esence obo s do inc ease p esence and possibly engagemen o amily mem-
be s in esiden ial ca e, bu p i acy is a cen al conce n. The mobili y o a elep esence obo is ha d o u ilize in esiden ial
ca e, and o be able o do so, e hical conside a ion and guidelines a e needed. We p o ide a d a o such e hical guidelines.
Keywo ds Elde ly· Residen ial ca e· Telep esence obo · Social ela ionships· P i acy· E hical guidelines
1 In oduc ion
Loneliness and dep ession a e se ious conce ns o elde ly
people li ing in ca e acili ies [1, 2]. Communica ion
and con ac s wi h amily and iends a e among he mos
impo an aspec s in suppo ing he well-being o people.
The e o e, o inc ease hei quali y o li e, elde ly people
in esiden ial ca e should be o e ed mo e possibili ies o
pa icipa ion, social ac i i ies and main aining social ela-
ions— his app oach can be called pe son-cen e ed ca e [3].
Telep esence is a po en ial echnology o alle ia e loneli-
ness by allowing iends and amily membe s o be i ually
p esen o he elde ly pe son (e.g. [4]). Telep esence obo s
(e.g., Beam, VGo, Gi a and Double), also known as i ual
p esence o emo e p esence obo s, a e emo e-con olled
obo ic de ices which enable a pe son no jus o be i u-
ally p esen , in e ac and socially pa icipa e om a emo e
loca ion, bu also physically mo e in he obo ’s local en i-
onmen , so allowing he emo e use o ake mo e con ol
o e he /his p esence.1
Fo elde ly pe sons, obo ic elep esence p o ides bene i s
compa ed o non-mobile ideo connec ion [7]: because o
he emo e con ol o he obo , he elde ly use can in e ac
wi h i in a na u al manne , wi h li le addi ional lea ning.
The emo e use ha ing he con ol o he obo can mo e
lexibly adap o he physical equi emen s o he elde ly
pe son, o ins ance, by mo ing close o he /him. A elep-
esence obo is adjus able o many kind o uses, o bo h
mobile and less mobile elde ly use s, who may also wan o
* Ma ke a Niemelä
ma ke [email p o ec ed]
Lina an Ae scho
Ae sc[email p o ec ed]; lina. [email p o ec ed]
An i Tammela
[email p o ec ed]
Iina Aal onen
[email p o ec ed]
Hanna Lammi
[email p o ec ed]
1 VTT Technical Resea ch Cen e o Finland L d, Tampe e,
Finland
2 Uni e si y o Jy äskylä, Jy äskylä, Finland
1 Some ad anced obo ic sys ems such as Telenoid o Geminoid also
p o ide obo -media ed social p esence o a emo e pe son o a local
use in e ac ing wi h he obo . These sys ems a e a he desc ibed as
eleope a ed and oid obo s han elep esence obo s [5, 6]. Telenoid
and Geminoid allow ”anonymous in e ac ion” as he local use may
no know who is ope a ing he obo ; his ou o he scope o ou
s udy.
In e na ional Jou nal o Social Robo ics
1 3
d i e he obo hemsel es. The obo can inc ease he eel-
ings o sa e y and connec ion as he elde ly use knows ha
o he s can easily “s op by” i ually.
In addi ion o he bene i s, many empi ical s udies ha e
poin ed ou also po en ial d awbacks (see nex chap e ).
Howe e , ewe s udies ha e been conduc ed in he con ex
o esiden ial ca e, and especially he pe spec i e o ca e
wo ke s is no well unde s ood. In his pape , we u he
elabo a e wha kind o social bene i s, conce ns and impac s
a e ela ed o he use o a elep esence obo in esiden ial
ca e, om he pe spec i es o (1) a esiden in a acili y and
he amily and (2) he ca e wo ke s in ol ed in aking ca e o
he esiden . The da a has been collec ed in h ee ield ials
o a elep esence obo in wo esiden ial ca e acili ies ( he
esul s o he i s ial ha e been ea lie epo ed in [8]. In
pa icula , we analyze he e hical (p i acy) challenges ha
ela e o mobile elep esence a a wa d, and as a esul , we
p esen a d a o e hical guidelines o using elep esence
obo s in esiden ial ca e.
2 Backg ound
2.1 Assis ed Li ing: In Be ween Home
andIns i u ional Ca e
Assis ed li ing is a combina ion o housing and basic nu s-
ing ca e. I holds a p omise o ageing in place as he acili y
se ices adap acco ding o he esiden s’ changing needs.
This ype o ca e is also called esiden ial ca e [9]. The esi-
dences a e o en a anged o di e en uni s (e.g. sepa a e
wa ds o in ensi e ca e wi h de e mined daily ou ines) bu
inside people li e in hei own small apa men s o ooms
wi h a ki chene e and a ba h oom. Unlike long- e m ca e
ins i u ions, assis ed li ing p o ides he esiden a home-
like en i onmen o os e au onomy, p i acy and eedom
o choice [10, p. 216]. People in esiden ial ca e can mo e
easily make indi idual choices ega ding he se ices hey
use, he daily ou ines and he ways o li ing [11]. This sup-
po s he indi idual well-being o he esiden s.
Ye , dep ession is common among olde people. Pe sons
in esiden ial ca e a e also a isk [12]. Despi e he aim o
p o iding a home-like en i onmen and con inua ion o he
li es yle o hei choice, many eel dec eased p i acy, and
he common a eas like dining ooms o li ing ooms a e
no el as home-like [13]. Quali y o li e may su e also
because mo ing in o a ca e acili y is a signi ican change
in he li es o olde people. The ea lie social su ounding
changes comple ely and he old ou ines and habi s a e b o-
ken [14]. People may lose hei e e yday social con ac s,
and eel socially isola ed [3, p. 64]. Fu he mo e, in Finland
he municipal au ho i ies decide on a pe son’s en i lemen
o a place in esiden ial ca e and o en e e people o he
ca e uni s acco ding o he speci ic ca e needs and a ailable
places [15], no acco ding o hei wishes o p e e ences.
Thus, i is essen ial o suppo he social con ac s and
con inui y o he social ela ionships be ween he esiden s in
assis ed li ing and hei amilies and iends. Social engage-
men in he sense o making social and emo ional connec-
ions wi h people and he communi y [16] has a posi i e
e ec on bo h physical heal h and social well-being o olde
people [17].
2.2 Telep esence Robo s o Elde ly inHome
andinResiden ial Ca e
Telep esence obo s ha e been es ed in di e en se ings
o hei po en ial o suppo social ela ionships o elde ly
people. Bo h lab and in-home sho ials ha e epo ed
mos ly posi i e pe cep ions o mobile elep esence sys ems
e.g., [18, 19]. In addi ion, long- e m s udies o a elep es-
ence obo suppo ing independen li ing ha e shown posi-
i e in luences [4, 20]. In pa icula , olde people and hei
amilies ha e liked he possibili y o seeing he emo e pe -
son. The e a e many o he bene i s, such as educed a el
ime o emo e use s and he appeal o he obo i sel . The
conce ns aised in he home con ex ha e included he call
e ique e (how o end/ e use call), he elde ly pe son’s (lack-
ing) con ol o e accep ing/ e using calls, he lack o ace-
o- ace con ac , and mis/o e use o he sys em.
In esiden ial ca e se ing, simila esul s ha e been
achie ed. The es ed obo s ha e gained posi i e esponses
om elde ly esiden s, hei amilies, and heal hca e p o es-
sionals. In one s udy, a mul i unc ional assis i e elep es-
ence obo was placed in he nu sing home o 1mon h, and
bo h he elde ly use s and p o essional ca egi e s ound he
obo use ul o educing loneliness and inc easing con ac
wi h amily and iends [21]. Telep esence p o ided posi-
i e emo ional e ec bo h sides: seeing he aces o amily
membe s main ains he esiden ’s connec ion wi h hem, and
he amily eels enjoymen and eassu ance o seeing he
esiden is doing well.
Ca e acili y as a use en i onmen o a elep esence
obo b ings also new issues a s ake [22]. Repo a s udy
in which a Gi a obo was used 6–8weeks in a nu sing
home by i e elde ly pa icipan s, who su e ed om mild
o mode a e demen ia, and hei amily membe s. In addi-
ion o he gene al posi i e esponse and social e ec s, he
amily could ge mo e in ol ed in he li e o he acili y by
being able o alk o s a . The abili y o mo e a ound wi h
he obo was epo ed bene icial o he amily membe s,
as hey could obse e places and ollow he esiden in
he acili y, al hough he p i acy issue was in conce n.
The elep esence obo was p e e ed o exis ing ideo call
applica ions because o he g ea e le el o con ol he
amily has in e ms o connec ing, mo ing, and posi ioning
In e na ional Jou nal o Social Robo ics
1 3
he came a. The s a liked seeing he esiden s enjoying
he communica ion wi h he amily.
The pa icipan s exp essed also conce ns abou whe he
he esiden s would eac by con usion o ea o he obo ,
o would he amily membe s wi ness esiden s’ dis up-
i e beha io . The s a el unskilled and ha hey had
no ime o lea n o use he obo . I has been poin ed also
elsewhe e ha he easiness o use o he obo , so ha
i equi es minimum assis ance om he acili y s a , is
essen ial [23].
The main bene i s and conce ns ela ed o elep esence
obo s in esiden ial ca e a e collec ed in he Table1 (pa -
ially published ea lie in [8]). Telep esence obo s appea
o be a bene icial echnology o olde people in esiden ial
ca e and hei amilies. The conce ns ela ed especially o
p i acy and con ol mus be aken in o accoun . The bene i s
and conce ns o ca e wo ke s and a elep esence obo ’s
possible in luences o hei wo k a e less clea , and ca e
wo ke s may ind he obo as an ex a wo kload. Howe e ,
o elep esence obo s o become common, hei pe spec i e
and accep ance a e c i ical.
3 S udy Se ing
The empi ical s udy was ca ied ou as h ee sepa a e ield
ials, in which a elep esence obo Double (h ps ://www.
doubl e obo ics.com) was placed in he ooms o h ee long-
e m esiden s in wo esiden ial ca e homes (Table2). The
esiden s li ed a wa ds o in ensi e ca e, wi h 15–16 beds
o long- e m esiden s. In each ial, he pa icipan s we e
a esiden as a p ima y (local) use , one o mo e o he /his
amily membe s as seconda y ( emo e) use s, he pe sonal
nu se o he esiden , and o he ca e wo ke s a he wa d. The
esiden pa icipan s we e selec ed and in i ed o pa icipa e
by he ca e pe sonnel who had he knowledge abou he pa -
icipan s’ heal h condi ions and capabili y o pa icipa e. The
ials las ed be ween 6–12weeks.
The elep esence obo sys em ins alled in he p ima y
use s’ ooms included he elep esence obo and i s cha ging
s a ion, and a “call eques bu on”: by p essing a sepa a e
big bu on he esiden could send an SMS eques o he
mobile phone o he amily membe o ask he /him o open
Table 1 Bene i s and conce ns when using a elep esence obo in esiden ial ca e
Bene i s Conce ns
Residen (s) Reduced social isola ion, inc eased connec ion be ween he
esiden and amily membe s [4, 19–22]
Especially being able o see he amily membe ’s ace is impo -
an o he esiden [4, 18, 21, 22]
Robo mo e in e ac i e and appealing o communica ion han
phone [20]
The esiden may eac nega i ely (be con used, igh ened) [22]
Lack o physical ace- o- ace con ac s due o educed isi s o he
amily [20, 22]
Mis/o e use o he obo [18]
The esiden does no ha e enough con ol ( o end/ e use a call
and o manage who has access) [18]
In asions o p i acy [22]
Family Enjoymen when connec ing o he esiden ; eassu ance when
seeing ha he esiden is doing well [22]
Less guil o no pu ing enough a en ion o he elde pe son
[20]
Reduced a el ime and ela ed con enience [18, 22]
Family and s a discuss abou ca e; he amily eels mo e
in ol ed and connec ed wi h he acili y [22]
Family membe s may wi ness esiden s’ dis up i e beha io [22]
Guil because using he obo pa ially subs i u es eal isi s [20]
S a Feeling good when seeing he esiden expe iencing enjoymen
[22]
Requi es li le e o om he s a , i he obo is easy o use
[23]
S a may eel unskilled and oo busy o lea n [22]
Table 2 The p ima y use s in he h ee ield ials
T ial Ca e acili y P ima y and seconda y
use s o he obo
Backg ound o he p ima y use
1 A Residen 1, F, 83yea .
Two daugh e s
No diagnosed memo y illness; mos ly mo ed in a wheelchai . No expe ience o echnology.
One daugh e isi s 2–3 imes a week; he o he calls 2–3 imes a week.
2 B Residen 2, M, 85yea .
Daugh e
Mino symp oms o memo y illness. The daugh e isi s 1–2 imes a mon h and calls 1–2
imes a week.
3 B Residen 3, F, 93yea .
Daugh e ; Son and his wi e
Some symp oms o memo y illness. Ha d o hea ing. No expe ience o echnology. The
daugh e has jus mo ed u he away, calls e e y day. The son isi s a ew imes a yea
and calls 3–6 imes a week.
In e na ional Jou nal o Social Robo ics
1 3
he elep esence connec ion. The seconda y use s used lap-
ops o open he ideo connec ion o he obo . The sys em
is shown in Fig.1.
The obo use in i s d i ing mode was limi ed o he p i-
ma y use ’s oom o a oid unin ended and unmoni o ed
in e ac ions wi h o he esiden s a he wa d. Howe e , se -
e al d i ing sessions in he common spaces we e sepa a ely
a anged du ing he aining and ials in o de o ge expe i-
ence o hem. In hese sessions, esea che s (also wi h he
emo e use ) and ca e pe sonnel collabo a ed o ensu e ha
o he esiden s we e no eco ded and no ha m would be
caused o hem.
In each ial, he da a was collec ed in p e- and pos -in e -
iews (o he esiden , he amily membe s, and he pe sonal
nu se), use obse a ions, and keeping logs o he use o
he obo and he call eques bu ons. In T ial 1, we also
ideo aped h ee call sessions (1–10min) o one daugh e
h ough he obo .
Ca e wo ke s pa icipa ed in ocus g oup in e iews a e
he ials: h ee ca e wo ke s a he i s acili y (T ial 1)
and i e ca e wo ke s and he manage a he second acili y
(T ials 2 and 3).
The esul s o he e y i s ial al eady indica ed ha
ca e wo ke s a e wo ied abou many e hical issues ela ed
o mobile elep esence a he wa d [8]. In o de o in es i-
ga e his aspec mo e, we a anged an online ques ionnai e
su ey o he ca e wo ke s a he second acili y (T ials 2
and 3) abou hei pe spec i e and e hical conside a ions o
he elep esence obo in he ca e acili y con ex . The ques-
ionnai e consis ed o s a emen s in i e sec ions, o which
we epo h ee o he pu pose o his a icle: (1) open-
ing and closing he elep esence connec ion, (2) accep able
spaces o he emo e isi o o go by using he obo and (3)
accep able ac i i ies o he emo e isi o o pa icipa e in
by using he obo . Each sec ion con ained 4–5 s a emen s.
The esponses we e gi en by using a 6-poin Like scale
om “To ally disag ee” o “To ally ag ee”.
The da a collec ion me hods a e summa ized in Fig.2.
The s udy se ing was accep ed by he acili y managemen
and he E hical Commi ee o he i s au ho ’s a ilia ion
(T ial 1), and by he acili y managemen and he municipal-
i y esponsible o p o iding he local elde ly ca e se ices
(T ials 2 and 3). All pa icipan s signed an in o med consen
o m o aking pa in he s udy.
4 Resul s
The use o he elep esence obo du ing he h ee ials is
summa ized in Table3.
The ials aced some echnical di icul ies and p ac-
ical challenges ha ha e been acknowledged ea lie as
well (e.g. [22]), such as connec i i y ailu es due o he
poo o slow in e ne connec ion. Some imes he connec-
ion b oke many imes and had o be e-es ablished, which
o en explains he se e al successi e sho ish calls pe one
day. Audibili y and se ing he audio le el was a challenge
o p ima y use s in T ials 1 and 3. Fo he la e esiden ,
we se up an ex e nal loudspeake in he oom, o ensu e
he hea ing.
4.1 Residen s’ Pe spec i e
The esiden s did no ha e s ong expec a ions o he obo :
“No eally any expec a ions” (T ial 3) and ”O cou se I wish
ha i would be o some use a leas ” (T ial 2). Use ulness
was ela ed o communica ion and i s cla i y h ough he
obo . The esiden o he i s ial looked o wa d o be in
con ac wi h he amily membe s and, in pa icula , see he
g andchild en h ough he obo .
A e he ials, he expe ience o using he obo was
posi i ely gea ed o all h ee p ima y use s. In pa icula ,
he ideo connec ion was app ecia ed, like in p e ious s ud-
ies [4, 18, 21, 22], and seen o inc ease he eeling o amily
Fig. 1 The elep esence obo was placed in he oom o he p ima y use in he ca e home (on he le ). The esiden could p ess a sepa a e bu -
on o send an SMS eques o he daugh e o connec (in he middle). He daugh e used a lap op o connec wi h he esiden (on he igh )

In e na ional Jou nal o Social Robo ics
1 3
membe s’ p esence: “Yes i el close.” (T ial 3) and “Com-
munica ion was kind o mo e na u al […] in pa icula wi h
he child en, i was e ibly nice o see hei exp essions”
(T ial 2). The elep esence connec ion allowed he p ima y
use in T ial 1 o see he g andchild play piano. In T ial 2,
he amily opened a connec ion om hei holiday ip.
The obo was el easy o use in spi e o he audibili y
p oblems. Two o h ee p ima y use s ound ha he sys em
is especially good o connec wi h amily membe s bu pos-
sibly no o he s: “I don’ know i i sui s any o he bu his
kind o amily use” (T ial 3).
The con en s o he communica ion h ough he obo was
mainly “e e yday issues” and simila o when using a phone.
P ima y use s p e e ed hei mobile phones o quick checks
and also o longe discussions because o be e audibili y.
P i acy was no a conce n and he p ima y use s did no
seem o mind ha he connec ion could be opened any ime
by hei amily membe : “We don’ ha e any sec e s om
each o he ” (T ial 2). They we e no in e es ed in he obo
ollowing hem o common spaces o he acili y: “I is be e
ha i is he e in my own ga ” (T ial 2).
4.2 Family Membe s’ Pe spec i e
The elep esence connec ion c ea ed a eeling o p esence
o he esiden o he amily membe s and he p esence was
s onge han on he phone: “I was like a sho isi [ o he
esiden ]” (T ial 3). One o he pa icipan s belie ed ha
he mo he el he same abou hei p esence: “She seemed,
somehow, so happy e e y ime she ealized ha aha, he e’s
somebody he e now” (T ial 1). Seeing he physical condi-
ion and i edness o he esiden was impo an . One p i-
ma y use (T ial 2) some imes seemed o be li le con used,
and he amily membe explained his wi h he no el y o
he sys em. In T ial 1, a amily membe old ha some imes
hei mo he was less able o concen a e on he ideo image
compa ed o he oice on he phone.
The amily membe s did no ind ha he con en s o
communica ion would ha e changed due o he obo . This
is in line wi h he p ima y use s’ iew. The numbe o phone
calls dec eased du ing he ials; using he obo eplaced
phone calls o some ex en .
The main conce ns o amily membe s we e ela ed o
p i acy. In all ials, hey aised up he bo he some issue o
Fig. 2 The imeline o da a collec ion du ing he ials. The ials
we e successi e o each o he . When he e we e o e lapping e en s
in T ial 2 and 3, he week coun is shown o bo h (T ial2/T ial3). In
T ial 3, he i s aining and p e-in e iews we e ca ied six weeks
be o e he ac ual ial (i.e. use o he obo ) s a ed
Table 3 Analysis o calls wi h he elep esence obo du ing he ials
T ial Leng h o ial To al N o
calls
Du a ion o calls N o calls pe week
1 12weeks 29 Typically 5–10min; 21% o calls a leas 10min
Va iance 2–34min
2–5 (excluding weeks 7–9)
2 6, 5weeks 18 Typically 2–6min; 28% o calls a leas 10min
Va iance 2–22min
1–5 (o en se e al calls pe day)
3 6weeks 22 Call du a ion a ied a lo be ween 2–16min; 36% o
calls a leas 10min
0–5 (o en se e al calls pe day)
In e na ional Jou nal o Social Robo ics
1 3
some imes eeling like spying and “going o he esiden ’s
u ” (T ial 2), especially when he esiden was no awa e
o he connec ion being opened (e.g. when sleeping). Family
membe s showed ac i e s a egies, e.g. scheduling hei calls
acco ding o he daily hy hm o he esiden , o a oid hese
si ua ions. The emba assmen was balanced by eelings o
elie , eassu ance and sa e y, when hey saw he esiden
was well e en s/he did no esponse o he call.
The seconda y use s wished ha he esiden would ha e
mo e con ol o e he call. The communica ion was el one-
sided and “I was always a su p ise wha is happening on
he o he side” (T ial 3). Using he obo in a “su eillance
mode” could be accep able i he esiden was su e ing om
demen ia o simila illness, he esiden had allen o been in
an acciden , o he obo was genuinely only in pe sonal am-
ily use. Also in hese condi ions, he esiden would need o
ag ee wi h he possibili y o su eillance. Fu he mo e, he
pa icipan s commen ed ha he p ima y use should be able
o choose whom she wan s o alk wi h and who is allowed
o connec wi hou a speci ic pe mission. The de ice should
signal in a salien way ha he connec ion is open.
The emo e d i ing was no u ilized much. I was expe-
ienced challenging due o he limi ed ield o iew o he
su ounding space h ough he obo ’s came a. The main
a ge o he seconda y use s was o see he esiden in he
oom, and being able o u n he came a/display o he obo
was enough. They did no ind d i ing in he common spaces
use ul. Ins ead, ha migh e en cause he eeling ha he
emo e use is “mo e like lu king he nu ses” (T ial 3).
4.3 Ca e Wo ke s’ Pe spec i e
The ca e wo ke s’ expe ience o he ial was mainly posi-
i e: he obo inc eased he amily membe s’ p esence o
he esiden s, and he esiden s appea ed o be b igh ened up
a e sessions o communica ion. Again, especially seeing
he ace and exp essions o he ela i es was c ucial.
The obo ’s cen al unc ion, pe cei ed by he ca e wo k-
e s, was ha he obo enables amily membe s o pa icipa e
mo e in he daily li e and ac i i ies o he acili y. In pa icu-
la , amily membe s can mo e lexibly join he planning o
ca e o he esiden . In addi ion, hey unde s and be e he
heal h condi ion o he esiden as well as ca e wo k i sel :
“issues ha we all day long deal wi h” (FG2). The obo was
seen as an enable o inc ease collabo a ion wi h amilies in
acili y ca e and imp o e amily ca e, bo h which a e gene al
a ge s in he Finnish elde ly ca e sys em nowadays.
The e we e some small occu ences in which he p esence
o a amily membe h ough he obo di ec ly in luenced he
daily ca e wo k. Fo ins ance, a esiden was in he oom dis-
cussing wi h he daugh e h ough he obo . A ca e wo ke
popped a he doo , when he daugh e called he ha he
mo he should ake some es . The ca e wo ke ollowed he
daugh e ’s sugges ion. O e all, he ca e wo ke s el com-
munica ion wi h esiden s o be di e en due o he p esence
o amily membe s; hey ge “ano he ouch” in hei wo k.
They explain issues be e and “ he e’s a ce ain di e ence
in he cus ome se ice oo” (FG2).
The limi s o amily membe s’ pa icipa ion in he ca e
wo k we e no clea . Fo ins ance, some ca e wo ke s can
accep amily o pa icipan in in ima e ac i i ies such as
washing a bed- idden esiden , i he esiden has gi en pe -
mission. O he ca e wo ke s would deny such pa icipa ion.
The ca e wo ke s we e also unsu e, would hey ha e he
igh o end he call o he esiden , as opposing o he will
o a (dis u bing o con ollable) amily membe . Wha i he
esiden was no able o say aloud he /his wish abou ending
he call? Mo eo e , i he calls we e ejec ed o ended by a
wo ke , would amily membe s doub ha he e is some hing
suspicious going on?
In any case, he decision o e accep ing o ejec ing he
call should be local, by he esiden . The ca e wo ke s el
some anxie y because in he ials, he amily membe ully
con olled opening he connec ion. An “O -bu on” would
be handy o ( empo a ily) le no calls come h ough, o
ins ance, in sensi i e ca e si ua ions.
Remo e d i ing o he obo in common a eas was posi-
i ely pe cei ed o enable amily membe s o pa icipa e
e en mo e o he daily li e a he acili y and o see he ac i -
i y and condi ion o he esiden . Remo e d i ing howe e
includes many challenges. Fi s , he ca e wo ke s ound ou
ha some esiden s (in common spaces in he acili y) we e
con used abou he obo and did no ealize ha he human
oice was coming om he obo . A leas one esiden
ang ily old he obo o go away. Second, he e is a isk ha
amily membe s would e idence emba assing si ua ions
wi h o he esiden s (c . [22]), and hey could e en eco d
such si ua ions in pu pose. (This kind o si ua ions o in en-
ions we e no obse ed du ing ou ials.) As ph ased by
one ca e wo ke , he obo should only “shoo my ela i e
o me” (FG1).
Thi d, amily membe s could hea ca e wo ke s’ nego ia-
ions abou o he esiden s “Names would become public and
possible ailmen s and oubles” (FG2). They did no like he
idea “ ha you ne e know i he e is a obo lis ening behind
a co ne ” (FG2).
4.4 E hical Ques ionnai e o Ca e Wo ke s
We ecei ed 16 esponses o ou online su ey ques ion-
nai e. The numbe is oo small o allow s a is ical analysis,
so he esul s a e p esen ed he e in a desc ip i e manne
and o complemen he quali a i e in e iew da a. The 16
esponden s included 13 ca e wo ke s, wo o he membe s
o he pe sonnel, and a social wo ke ; 15 o hem wo ked
a he wa d and one in day ca e se ices p o ided a he
In e na ional Jou nal o Social Robo ics
1 3
ca e acili y. Mos (69%) o hem we e 30–49yea s old and
all we e emale. Fi e esponden s had used he obo hem-
sel es, i e had moni o ed o he s using i and six had only
seen i as u ned o .
The ca e wo ke s we e mos app o ing o he idea ha in
case o an eme gency, amily membe s could isi he esi-
den ’s oom and also ba h oom (Fig.3). Fo non-eme gen
isi s, he app o al was mode a e o isi ing he oom o
he esiden as well as he same spaces han physical isi o s
(dining oom excluded). Visi ing o he esiden s’ ooms was
no seen accep able. Rega ding ac i i ies in he acili y, he
esponden s pe cei ed mos accep able ha amily membe s
would pa icipa e in ca e nego ia ions and social ga he ings
ou side he esiden ’s oom (Fig.4). Common meals and
heal h checks o he esiden seem o be less accep able
ac i i ies.
The esponden s we e mode a ely in a o o ha he esi-
den should ha e ac i e con ol o e accep ing calls h ough
he obo (Fig.5). In con adic ion, hey ag eed ha accep -
ing calls would be easy enough only i i does no equi e any
ac ion om he esiden . The esiden should ne e heless
be able o shu he connec ion possibili y down o p e e ed
imes, and also ca e pe sonnel migh be allowed o do ha .
Closing he connec ion should no howe e be he esponsi-
bili y o he elde ly pe son alone.
5 Discussion
In he h ee ield ials las ing om 6 o 12weeks, we we e
able o con i m ha elep esence obo s do inc ease amily
membe s’ p esence o hei elde ly pa en s in esiden ial ca e
and hus posi i ely a ec he esiden s’ wellbeing. Fu he -
mo e, elep esence obo s ha e s ong po en ial o inc ease
amily membe s’ pa icipa ion in he daily li e in ca e acili-
ies and in planning o ca e.
Apa om ma u i y o echnology (connec i i y and
audibili y issues; easy and sa e emo e d i ing), he main
challenge seems o be he p o ec ion o p i acy - o he esi-
den as he p ima y use , o o he esiden s in he acili y,
and o ca e wo ke s. Mos impo an ly, he amily membe s
and he ca e wo ke s el ha he p ima y use should ha e
con ol o e accep ing o ejec ing he call, al hough his is
ecognized o be in con lic wi h he usabili y o he obo
o elde ly pe sons, as shown in he su ey esul s. Be o e
he ials, all pa icipan s accep ed ha he calling du ing he
ials was ully con olled by he emo e use . This se ing
led o si ua ions o possibili ies ha we e el uneasy and
une hical by he amily membe s and ca e wo ke s. I seems
ha he p i acy and he usabili y o he sys em o he p i-
ma y use need o be handled case by case, nego ia ed by he
use s hemsel es and also du ing he ac ual use. The p i acy
p o ec ion should howe e be he de aul .
Al hough in his s udy he esiden s and amily mem-
be s we e no much in e es ed in emo e d i ing in common
spaces (pa ially due o he p ac ical di icul y o d i ing),
he ca e wo ke s sugges ed ha i would inc ease he engage-
men o he amily membe s. Howe e , a he same ime, he
isk o in ade o he esiden s’ p i acy would inc ease also.
I seems ha o ully in eg a e elep esence obo s in o esi-
den ial ca e and, in pa icula , use hei mobili y po en ial
o inc ease he amily engagemen and esiden s’ quali y o
li e, clea guidelines a e needed o how and whe e he obo
can be used.
Based on he da a collec ed in he s udy, we he e p esen
a d a o e hical guidelines o using mobile elep esence
5.4
4.1 3.9
3.3
1.7
1
2
3
4
5
6
In case o
eme gency,
ba h oom in
addi ion o
esiden 's oom
The oom o he
esiden bu no
he ba h oom
Same spaces han
o he (physical)
isi o s
Common spaces o
he ca e acili y
(e.g. ea ing space)
O he esiden s'
ooms
Fig. 3 Accep ance o di e en spaces ha amily membe s could isi
h ough he obo (1 = low accep ance, 6 = high accep ance)
5.7
4.9
3.8 3.7
1
2
3
4
5
6
Ca e nego ia ions Mo ning assemblies and
o he ga he ings
Common ea ingsWhen heal h condi ion
o he esiden is
examined
Fig. 4 Accep ance o di e en ac i i ies ha amily membe s could
pa icipa e in h ough he obo (1 = low accep ance. 6 = high accep -
ance)
5.4
4.7
4.2
4.2
1.9
123456
Residen mus be able o shu he connec ion
possibili y down o p e e ed ime
Accep ing a call is easy enough only i i equi es
no ac ion om he esiden
Accep ing a call always equi es ac ion om he
esiden be o e opening he connec ion
Ca e pe sonnel is allowed o shu he connec ion
possibili y down o p e e ed ime
Closing he connec ion is always he esponsibili y
o he esiden
Fig. 5 S a emen s conce ning he con ol o e accep ing and e using
calls h ough he obo (1 = o ally disag ee, 6 = o ally ag ee)
In e na ional Jou nal o Social Robo ics
1 3
obo s o esiden - amily communica ion in esiden ial ca e
(Table4).
In o de o allow emo e use s o d i e he obo in com-
mon spaces, equi ed u he ac i i ies should be asking a
signed pe mission om all esiden s o le ing he obo
in o common spaces and asking a signed commi men
om emo e use s ha hey do no misuse he in o ma ion
acqui ed h ough he obo .
The e would s ill be challenges i some esiden s would
e use using he obo in common spaces. Fi s o all, hei
choice should be espec ed, as he ca e acili y is hei home
and hey should be able o easily make indi idual choices
ega ding he se ices hey use, hei daily ou ines and
hei pe sonal ways o li ing [11]. In o de o allow using
he obo in common spaces in spi e o he e usal o some
esiden s, echnical solu ions could be possible, o ins ance:
“blind” au onomous d i ing o he obo be ween p i acy-
secu ed a eas, o AI-based p e- ecogni ion o people who
ha e signed he pe mission and au oma ed blu ing o o he s
in he ideo image. In he la e , ans e o p i a e audio
would s ill be a p oblem o be sol ed.
As a bounda y condi ion o using a elep esence obo
o inc ease amily p esence and engagemen , we s ill mus
aise he quali y o he exis ing ela ionship be ween he esi-
den and he elde ly. In ou ials, he amily membe s we e
al eady ac i ely communica ing wi h hei elde ly pa en s,
bu li ed a away and hus we e in e es ed in seeking addi-
ional ways o communica e. The obo would no c ea e
ela ionships om sc a ch, o imp o e p oblema ic ones.
Howe e , he obo would s ill ha e po en ial in imp o ing
social connec ions o bed- idden esiden s by le ing hem
enjoy social e en s in he acili y (e.g. emo e-d i en by a
ca e wo ke ), o a anging olun ee o e en he apy wo ke s
o con ac he esiden s h ough he obo .
Acknowledgemen s Open access unding p o ided by Technical
Resea ch Cen e o Finland (VTT).
Funding This s udy was unded by Tekes (G an Numbe
3724/31/2014) and S a egic Resea ch Council a he Academy o
Finland (G an Numbe 292980).
Compliance wi h E hical S anda ds
Con lic o in e es The au ho s decla e ha hey ha e no con lic o
in e es .
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i e Commons A ibu ion 4.0 In e na ional License (h p://c ea i eco
mmons .o g/licen ses/by/4.0/), which pe mi s un es ic ed use, dis ibu-
ion, and ep oduc ion in any medium, p o ided you gi e app op ia e
c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he
C ea i e Commons license, and indica e i changes we e made.
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Table 4 Summa izing he esul s as a d a o e hical guidelines o using a mobile elep esence obo in esiden ial ca e o communica ion
be ween esiden s and amily membe s
Le el o accep ance Type o use o a mobile elep esence obo in esiden ial ca e Sou ce in his s udy
Well accep ed use Using a elep esence obo o main ain and ex end he exis ing
(posi i e) social, in o mal ela ionship be ween he esiden and
amily membe s (in a p i a e space)
Elde ly esiden s, amily membe s, ca e wo k-
e s (in e iews)
Family membe s’ pa icipa ion in ca e nego ia ions wi h he esiden
and he ca e wo ke (in a p i a e space)
Ca e wo ke s (in e iews; e hical ques ionnai e)
D i ing a elep esence obo e e ywhe e in he esiden ’s oom,
including ba h oom, in case o eme gency
Elde ly esiden s (in e iews)
Ca e wo ke s (e hical ques ionnai e)
Mode a ely accep ed use Family membe s’ pa icipa ion in in o mal social ga he ings in com-
mon spaces
Ca e wo ke s (e hical ques ionnai e; in e iews)
Less accep ed use Family membe s’ pa icipa ion in common meals o isi ing in com-
mon dining space
Ca e wo ke s (e hical ques ionnai e)
Visi s o o he esiden s’ ooms Ca e wo ke s (e hical ques ionnai e; in e iews)
Family membe s’ pa icipa ing in heal h checks o hygiene ca e o
he esiden
Ca e wo ke s (e hical ques ionnai e; in e iews)