Keywords

1 Introduction

The rapid aging of the Korean population has led to an increasing demand for care services, while the younger generation’s population structure is decreasing at an unprecedented rate. As the number of older individuals with disabilities continues to increase, there is an urgent need to address the care burden and determine effective solutions. This is particularly important since many severely disabled older adults and those with reduced mobility spend most of their time at home with caregivers, greatly impacting their quality of life.

Previous studies investigating the living environments of people with disabilities [1,2,3] revealed that their living conditions play a significant role in determining their quality of life. In response, the Korean local governments have been implementing housing improvement projects for the disabled, such as installing residential convenience facilities for low-income registered persons with disabilities [4]. However, the creation of barrier-free spaces that allow for active and personalized care, accommodating both people with disabilities and their caregivers, is urgently needed.

As part of the 4th industrial revolution [5], the development of care robots [1, 6,7,8] has the potential to assist caregivers and reduce their care burden. However, the environmental factors need to be considered for the successful integration and utilization of care robots. Moreover, as Korea is projected to become a super-aged society by 2026, the number of households requiring elderly care is expected to increase, further increasing the demand for home care solutions.

To explore how care robots and services can be effectively implemented in various settings, we conducted a comprehensive analysis of the literature, field cases, and stakeholder interviews through a care robot translational research and service model development project (2019–2022). Based on our findings, we constructed a smart care space (SCS) on the second floor of Nuri Hall in the National Rehabilitation Center, Korea. This paper aims to discuss the design, implementation, and implications of this innovative SCS, which integrates technology and universal design for people with significant severe disabilities, to address the care challenges in the care of the aging population with and into disabilities.

2 Materials and Methods

From January to December 2020, in order to develop the appropriate SCS for severely disabled older adults, results of the literature review of similar cases in Japan and Korea were analyzed, and various cases were collected by visiting the target sites that had a barrier-free design at home and abroad. A total of 11 institutions were visited to collect case studies. Next, 7 domestic cases such as that in Shinnae Medical Safety House and 3 foreign cases such as that in Denmark were visited and benchmarked based on the collected data. Then the results were used to determine the SCS design.

In this study, the British Design Council in 2005 adopted the double diamond process, which involves problem solving carried out through a four-step process (discovery, definition, development, delivery), as a service design developed and analyzed the effective user experiences.

  • Discover: An in-depth interview was conducted to discover the opportunities provided by SCS and to analyze the users’ needs. On-site interviews were conducted in 3 pairs (45-year-old quadriplegic, 40-year-old spinal cord injury, and 45-year-old spinal cord injury, and 61-year-old, 60-year-old, and 58-year-old female caregivers, respectively). The needs for improving the user experience (UX) were determined.

  • Define: Through the creation of a persona that includes specific needs and pain points, the need for a point of contact between specific scenario-based service provision and individual goals was identified.

  • Develop: Based on the ideas derived from the goals of the customer journey map and interviews with experts, the technical feasibility was reviewed, and the composition of the service environment for this study was established.

  • Deliver: The service process reflecting the user’s life cycle was created as a situational scenario based on the research goals and user experience.

In order to establish the SCS for the severely disabled, the areas that need improvements were determined through stakeholder meetings with the severely disabled and caregivers. Interviews were conducted with experts, persons with severe disabilities, and caregivers.

3 Results

3.1 Survey of Current Status and Stakeholder Interviews for Smart Care Space Design

Between 2019 and 2020, the appropriated SCS model was designed by determining the current situation and gathering expert opinions, related to the residential environments of domestic wheelchair users. We collected case studies carried out in various facilities based on a comprehensive literature review.

Through stakeholder interviews surrounding Smart Care Spaces (SCS), the prospective opportunities and users’ needs of care receivers and caregivers were analyzed. These needs are critical to be accommodated within their communal living space. Given that care receivers frequently spend the bulk of their day either in a supine position or require assistance, it's imperative for them to be able to independently operate key devices or equipment. Simultaneously, caregivers showcased significant apprehension towards unfamiliar technology or devices, especially when utilized for the first time, underscoring the necessity for straightforward and intuitive user experiences.

As such, the SCS should be envisioned as an interactive environment in which care receivers and caregivers cohabit and partake in daily life activities together. The focus should be on providing services that cater to individual needs and alleviate common inconveniences.

Furthermore, it was found that the majority of Korean caregivers are older women with a generally low level of technological proficiency and a pronounced fear of new technologies. This demographic tends to react sensitively when interacting with technological devices, thereby necessitating an approach that is user-friendly and non-intimidating.

In expert interviews, it was proposed that the incorporation of Internet of Things (IoT) technologies is crucial to enhancing user satisfaction and the overall quality of life in smart care spaces. These technologies could encompass voice recognition for simple on/off functionalities, sensor-driven alarm systems, behavior detection technology, and services that respond to user-intent. The main implication from this recommendation is the need for these technologies to be effortlessly usable and conveniently manageable by the end users.

The different notable domestic cases that showcased our SCS designs were as follows: Shinnae Medical Safety House, which features safety devices and space designs tailored to individuals with disabilities; Hanssem Smart Home Model House, which utilizes a Wi-Fi-based smart home system; Seongnam Senior-friendly Comprehensive Experience Center, Seongnam Senior Smart Home, and the Home Adaptation Training Center of the National Transportation Rehabilitation Hospital, which emphasize the senior living spaces that incorporate advanced technology from the 4th industrial revolution era, with a focus on the Internet of Things (IoT) technology; and the Korea Institute of Science and Technology (KIST), Gachon University Ambient Assisted Living (AAL), and Bundang Seoul National University Hospital, which offer separated spaces for experiments, exhibitions, and monitoring, as well as for usability evaluations.

Additionally, we benchmarked several international cases that showcased innovative solutions not yet implemented in Korea. These included the installation of folding furniture attached to the wall and wall mounted-type lifts that provided assistance during spatial movement at Musholm (Denmark, a residential facility for people with muscular disorders); the application of universal design principles to enhance usability at the Life and Living Center (Helsinki, Finland); and SilviaBo (Sweden, a residential facility for - older adults with dementia), which had simplified spatial structures and improved indoor circulation for wheelchair users.

3.2 Smart Care Space Design

Main Entrance and Room Door.

Wheelchair users find it easier to operate sliding doors rather than pull-style doors. Although the main entrance door features a set of double pull-style doors for ease of installation, all room doors have been designed with sliding door systems. When designing entrances and corridors, the required effective width and front effective distance should be considered. For bedroom access, the effective passage width, activity space, bed structure, and flooring should be taken into account. Installing semi-automatic or automatic sliding doors at the entrance is recommended, along with securing activity space in front of and behind the entrance to avoid collisions with hallway pedestrians. To accommodate wheelchair users, a toilet door should have an effective width of at least 0.8 m, a step of 2 cm or less, and a sliding door rather than a hinged one, as this provides more activity space in front of the door and added convenience.

Living Room and Hallway.

Architectural considerations should be made to ensure a clear and obstruction-free pathway for wheelchair users. Since it can be challenging for wheelchair users to move in a straight line when their left and right manipulation power is not equal, a wider walking width is necessary. Power wheelchairs require a width of 800 to 900 mm, and the rotation widths should be 2,000 mm for power wheelchairs and 1,800 mm for manual wheelchairs. By securing an aisle width of more than 1,200 mm for emergency beds, placing safety handles in corridors, and installing unit households with emergency alarm lights at entrance tops, emergency contact devices inside households, and motion detectors, safety can be ensured.

Restroom.

To prevent head injuries, a sufficient distance should be maintained between the toilet and the wall, and wheelchair users should have access to either side of the toilet depending on their dominant hand. The effective toilet size should measure at least 1.4 m in width and 1.8 m in depth, with a 0.75 m or wider activity space secured on one side of the toilet for side wheelchair access. The toilet seat height should be between 0.4 m and 0.45 m from the floor, and an adjustable wall-mounted toilet should be installed to accommodate wheelchair users, older adults, and children. A user-friendly flushing mechanism, such as a light-sensing push-button or lever type, should be installed.

Others.

The height of wall hangings, electrical outlets, switches, storage shelves, and hangers should be between 0.8 m and 1.2 m from the floor; if a bed is not used, the installation location of electrical outlets and switches should be within 0.35 m. The doorbells for hearing-impaired disabled individuals must be installed in rooms, bedrooms, and bathrooms. The floor surface of all spaces should be level, be finished with non-slip material even when wet, and have an effective floor area of more than 1.4 m in width and 1.8 m in depth.

3.3 Design and Construction of SCS

Design of SCS.

Based on the literature review and current status survey, an initial SCS design draft was developed and refined using the input from architectural experts (Fig. 1A). Design drawings were then used to gather and apply the following field case characteristics (Fig. 1B): 1) incorporating double doors (final width of 1,600 mm) of at least 1,100 mm at the main entrance for easy movement of emergency beds and wheelchairs; 2) designing steps within 20 mm at the entrance to facilitate wheelchair movement; 3) removing steps at the bathroom entrance and installing a water drainage trench to prevent water from flowing back into the main room; 4) using wheeled furniture or beds for easy mobility; 5) maximizing space utilization with wall-mounted, foldable furniture; 6) positioning ceiling-mounted lifts, height-adjustable washbasins, and foldable shower beds for improved bathroom usability; 7) creating a multipurpose room near the entrance for lift storage; 8) arranging a straight-line wall-mounted lift for convenient bathroom access by connecting the toilet to the main room; 9) designing a barrier-free entrance and toilet considering the turning radius of electric wheelchairs (more than 1,500 mm); and 10) installing sliding bathroom doors instead of hinged doors for optimal space usage.

Fig. 1.
figure 1

Smart care space construction design (draft). (A) Space size and design draft, (B) Smart care space final design draft

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Establishment of Smart Care Space (Nuri Hall, National Rehabilitation Center).

The National Rehabilitation Center’s Smart Care Space was established as part of the Ministry of Health and Welfare's care robot translational research and service model development project, which started in 2019. The space, built for demonstrations like usability evaluations of care robots or care devices, is the first in Korea to address the needs of both severely disabled individuals and their caregivers. The initial SCS was constructed in the National Rehabilitation Center’s Nuri Hall (December 2019) and opened in 2020 (Fig. 2). It integrates care robots and various sensor-based IoT facilities and devices into six spaces to create a convenient and safe care environment that accommodates various care scenarios and physical conditions, emphasizing IoT technology and universal design features.

The SCS was designed to harmonize with the needs of severely disabled individuals and their caregivers, thus enabling care robots to assist with daily tasks seamlessly. It also serves as a demonstration space for caregiver burden analysis and care robot usability evaluations. The service environment for severely disabled individuals includes a Google speaker and application, functioning as the central controller in the bedroom, which connects to other devices in the house and provides personalized services. Voice commands such as “Come out” and “I’ll go out” can sequentially control various devices, while natural language voice commands enable users to manage air-conditioning, lighting, and weather information on-demand. The UI and UX were designed to facilitate device control.

Fig. 2.
figure 2

SCS built in the National Rehabilitation Center, Korea (Photos of 6 spaces of SCS). SCS: smart care space.

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4 Discussion

The SCS offers a revolutionary approach to create tailored, efficient, and accessible care environments for people with significant severe disabilities. First, it integrates cutting-edge technology, universal design principles, and valuable stakeholder feedback to address the unique needs of and challenges faced by both disabled individuals and their caregivers. The incorporation of the barrier-free concept in the SCS, enables the efficient use of care robots, thus enhancing the effectiveness of this innovative space. Second, as a model for future development, the SCS aims to improve the quality of life for those with disabilities and reduce caregiver burden through the incorporation of care robots and other assistive devices. By continuously evolving based on user experiences and feedback, the SCS can potential transform the care landscape, fostering more inclusive and supportive environments for disabled individuals and their caregivers.

The Nuri Hall of National Rehabilitation Center’s SCS allows the utilization of care robots that provide technical assistance in caregiving and enhancing care quality, while also serves as a demonstration space for care robot prototypes. Considering the various stakeholders’ input, the SCS integrated technologies related to daily living convenience, such as barrier-free design, smart controllable IoT devices, voice control applications, and wall-mounted transfer devices tailored for wheelchair users. Opened in 2020, the space caters to the needs of severely disabled individuals, primarily wheelchair users, by designing and organizing spaces based on daily life scenarios illustrated through journey maps. It also features pressure ulcer prevention and posture-changing beds, excretion care robots, and meal assistance devices.

The SCS have been designed and built to enhance the provision of beneficial services in a care environment by integrating networked care robots that can interact with individuals. In light of this, there is a pressing need to explore methodologies for the joint expansion and provision of care robots and care environments, particularly for those most vulnerable, including people with severe disabilities, older adults with notably limited mobility, and caregivers in Korea.

5 Conclusions

The SCS’s most distinguishing feature is its capacity to serve as a genuine residential environment, unlike many living labs or experience centers in Korea. The active participation and choice of users in the design process play crucial roles in the discovery and innovation of new ideas [9, 10]. In the future, patients at the National Rehabilitation Hospital, caregivers, and their families can directly use the space, enabling them to implement similar scenarios and features within their communities. This study does have some limitations. First, the SCS was designed in alignment with Korea’s barrier-free housing blueprint, with specific reference to the living spaces of severely disabled individuals. Moving forward, there is a clear need for research that gathers data from the actual residences of a diverse range of users. Second, it is essential to assess the usability of the SCS across users with various disabilities to ensure inclusivity and accessibility in its truest sense. The SCS model will provide knowledge and guidance while continuously improving the space through the user’s feedback on areas for enhancement after actual residency or usability evaluations, ultimately demonstrating a reduction in caregiver burden.