1. Introduction

Nursing care is facing (is going through) an unprecedented crisis in terms of lack of skilled (health) care workforces. Like all high-income countries (HIC), Germany is going through the said crisis, which is continuously accentuating year after year.

The workforce's needs for long-term care in German nursing houses have been estimated in [1] for the period from 2009 to 2030, expecting an increase:

The recommended solutions are intended for neurology, though some of them

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient…

Using telemedicine to overcome workforce shortage implies to keep a patient at his residence or at the care unit with only primary care services. A further research question rising here is what is the quality of life (QoL) of patients treated at home? Is it worth treating dementia patients at home instead of a nursing care home? Rebecca Palm et al. investigated in [8] the environment as a factor impacting the health-related QoL regarding nursing care for dementia patients. The study reveals that the structural and organizational characteristics of care units may impact the QoL though the study does clearly prove through empirical evidence that the care unit's structure and organization influence the QoL. However, to our best knowledge, no study has investigated the impact of homecare on the health-related QoL based on the QoL measurement metrics pointed out in [8] such as temperature, noise, lightning, familiarity, adequate space, and opportunities to participate in domestic activities; it could be subsequently deduced that if the patient's residence place also provides the same environmental criteria as temperature, familiarity, sufficient food, and water, etc., the patient treated at home will undergo the same healthrelated QoL. In [9], the authors investigated the impact small-scaled nursing care homes have on health outcome-related QoL. They found out that moving from large-scaled to a small-scaled nursing house can improve the aspect of the QoL by reducing the anxiety. This study allows us to conclude that a patient treated at home in his family circle and habituated residence place has less anxiety and better QoL. It is obvious that patients requesting nursing care can receive nursing care at their residence places with a better health-related QoL. The factors impacting the QoL are well known though caring for dementia, Parkinson's disease, and elderly patients suffering from possible cognitive impairments is a challenging task. The research question raised here is how to assess the factors impacting the QoL for

The literature review on technologies in nursing care or commonly in healthcare reveals that nursing care at home for dementia and elderly patients can take benefit

Homecare is increasingly getting attention among the population for multiple reasons such as the nursing care crisis. This research mainly aims at proposing smart home automation enabled personalized homecare solution for a better quality of life (QoL) for the patient and for assisting the patient's family members to cost-

effectively and efficiently care for their patients at home without any impairment of QoL. Furthermore, this study pursues the objectives to assess the impacts of being assisted by home automation system on the QoL of all involving family members.

This study contributes to the multidimensionality of the concept of the smart home

Additionally, the study creates an environment for well-being for people limited

where many dimensions of home automation have been considered. The study focuses on many aspects of home automation such as energy saving [10, 11], temperature management, and regulation, security, and safety by managing the

of the technology (cf. section methodology/literature review).

can suite other medical fields.

DOI: http://dx.doi.org/10.5772/intechopen.86247

better health outcome?

1.1 Study objectives

1.2 Study contribution

in the movement.

71

entrance, control doors, and windows.

1. from 94.000 to 331.000 professional nursing and

2. from 157.000 to 298.000 care staff.

Elke Peters et al. have estimated in [2] the number of people living in Germany requesting nursing care to 3 million and to 5 million by 2050. The authors present a recent assessment of the nursing care services at nursing homes and at patient's home and point out the needs for patients to live at home despite the benefit of all care services.

In November 2016, in Mondorf-les-Bains (Germany), a workshop [3] on nursing care had taken place. The topic of the workshop was: Nursing Care at the (German) border Regions? (Ger. Pflege an der Grenze?). The workshop's main objectives were to strengthen the social aspect of nursing care and to more consider the nursing care to be taken place at the place of residence of the patient because of the demographic change and economic as well as employment market policy change. The said workshop pointed out that the share of family nursing care (also called care at home) is very small in comparison with ambulant nursing care. This means, family members do not care for their member requesting for nursing care. One of the main reasons leading to this situation is that the person requesting nursing care at home is living alone. Furthermore, direct family members are requested to participate in care costs. In order to participate, they must work to gain the necessary financial means to face the costs. This situation drives sometimes the family members to employ care staff without or with beginner's care skills to care their parents at home or they send their parents aboard to East-European countries since the nursing care costs are cheaper there though caring at home for a person is not as easy as one can think. Prof. Dr. Eckart Hammer points out in [4] that many dementia patients are subjected to violence by family members who are caring for them at home. By analyzing this book section, one can understand why the German government put effort to solve the care workforce issues faced in order to admit enough nursing care requesting people to the care or nursing homes. Thus, family members who are not able to care for their patients can send them to a nursing/care home. They obviously also want to help the family to decently and lovingly care for their patients and protect the patient against as well as prevent violence. Violence can result from stress faced by the caring person. And the causes of stress are multiple. Violence also occurs in nursing care houses.

People with advanced dementia have complex needs [5]. Schmidt et al. have investigated the needs in a recent study. The study shows the evidence that people with advanced dementia are requesting monitoring round the clock even for a simple activity like "food intake." At nursing care house, monitoring is guaranteed. But what happens if those people are living at their regular residence? This research question is justified by the results carried out by [6], which point out the causes of nursing care workforce shortage and provide recommendations to overcome the issues faced. In [7], the author recommends a series of solutions to fix the workforce shortage. One of these solutions is to use telemedicine to overcome the shortage of issues faced. He writes

Other solutions proposed to reduce the effects of shortages include the use of telemedicine to reach far-away neurologists (though this is unlikely to reduce workloads), the development of artificial intelligence to help in making diagnoses, and expanding neurological care to include non-neurologist physicians and advanced practitioners (specially trained nurses and physicians' assistants)…

IoT-Enabled Health Monitoring and Assistive Systems for in Place Aging Dementia Patient… DOI: http://dx.doi.org/10.5772/intechopen.86247

The recommended solutions are intended for neurology, though some of them can suite other medical fields.

Using telemedicine to overcome workforce shortage implies to keep a patient at his residence or at the care unit with only primary care services. A further research question rising here is what is the quality of life (QoL) of patients treated at home? Is it worth treating dementia patients at home instead of a nursing care home? Rebecca Palm et al. investigated in [8] the environment as a factor impacting the health-related QoL regarding nursing care for dementia patients. The study reveals that the structural and organizational characteristics of care units may impact the QoL though the study does clearly prove through empirical evidence that the care unit's structure and organization influence the QoL. However, to our best knowledge, no study has investigated the impact of homecare on the health-related QoL based on the QoL measurement metrics pointed out in [8] such as temperature, noise, lightning, familiarity, adequate space, and opportunities to participate in domestic activities; it could be subsequently deduced that if the patient's residence place also provides the same environmental criteria as temperature, familiarity, sufficient food, and water, etc., the patient treated at home will undergo the same healthrelated QoL. In [9], the authors investigated the impact small-scaled nursing care homes have on health outcome-related QoL. They found out that moving from large-scaled to a small-scaled nursing house can improve the aspect of the QoL by reducing the anxiety. This study allows us to conclude that a patient treated at home in his family circle and habituated residence place has less anxiety and better QoL.

It is obvious that patients requesting nursing care can receive nursing care at their residence places with a better health-related QoL. The factors impacting the QoL are well known though caring for dementia, Parkinson's disease, and elderly patients suffering from possible cognitive impairments is a challenging task. The research question raised here is how to assess the factors impacting the QoL for better health outcome?

The literature review on technologies in nursing care or commonly in healthcare reveals that nursing care at home for dementia and elderly patients can take benefit of the technology (cf. section methodology/literature review).

#### 1.1 Study objectives

The workforce's needs for long-term care in German nursing houses have been estimated in [1] for the period from 2009 to 2030, expecting an increase:

Elke Peters et al. have estimated in [2] the number of people living in Germany requesting nursing care to 3 million and to 5 million by 2050. The authors present a recent assessment of the nursing care services at nursing homes and at patient's home and point out the needs for patients to live at home despite the benefit of all care services. In November 2016, in Mondorf-les-Bains (Germany), a workshop [3] on nursing care had taken place. The topic of the workshop was: Nursing Care at the (German) border Regions? (Ger. Pflege an der Grenze?). The workshop's main objectives were to strengthen the social aspect of nursing care and to more consider the nursing care to be taken place at the place of residence of the patient because of the demographic change and economic as well as employment market policy change. The said workshop pointed out that the share of family nursing care (also called care at home) is very small in comparison with ambulant nursing care. This means, family members do not care for their member requesting for nursing care. One of the main reasons leading to this situation is that the person requesting nursing care at home is living alone. Furthermore, direct family members are requested to participate in care costs. In order to participate, they must work to gain the necessary financial means to face the costs. This situation drives sometimes the family members to employ care staff without or with beginner's care skills to care their parents at home or they send their parents aboard to East-European countries since the nursing care costs are cheaper there though caring at home for a person is not as easy as one can think. Prof. Dr. Eckart Hammer points out in [4] that many dementia patients are subjected to violence by family members who are caring for them at home. By analyzing this book section, one can understand why the German government put effort to solve the care workforce issues faced in order to admit enough nursing care requesting people to the care or nursing homes. Thus, family members who are not able to care for their patients can send them to a nursing/care home. They obviously also want to help the family to decently and lovingly care for their patients and protect the patient against as well as prevent violence. Violence can result from stress faced by the caring person. And the causes of stress are

1. from 94.000 to 331.000 professional nursing and

Internet of Things (IoT) for Automated and Smart Applications

multiple. Violence also occurs in nursing care houses.

issues faced. He writes

70

trained nurses and physicians' assistants)…

People with advanced dementia have complex needs [5]. Schmidt et al. have investigated the needs in a recent study. The study shows the evidence that people with advanced dementia are requesting monitoring round the clock even for a simple activity like "food intake." At nursing care house, monitoring is guaranteed. But what happens if those people are living at their regular residence? This research question is justified by the results carried out by [6], which point out the causes of nursing care workforce shortage and provide recommendations to overcome the issues faced. In [7], the author recommends a series of solutions to fix the workforce shortage. One of these solutions is to use telemedicine to overcome the shortage of

Other solutions proposed to reduce the effects of shortages include the use of telemedicine to reach far-away neurologists (though this is unlikely to reduce workloads), the development of artificial intelligence to help in making diagnoses, and expanding neurological care to include non-neurologist physicians and advanced practitioners (specially

2. from 157.000 to 298.000 care staff.

Homecare is increasingly getting attention among the population for multiple reasons such as the nursing care crisis. This research mainly aims at proposing smart home automation enabled personalized homecare solution for a better quality of life (QoL) for the patient and for assisting the patient's family members to costeffectively and efficiently care for their patients at home without any impairment of QoL. Furthermore, this study pursues the objectives to assess the impacts of being assisted by home automation system on the QoL of all involving family members.

#### 1.2 Study contribution

This study contributes to the multidimensionality of the concept of the smart home where many dimensions of home automation have been considered. The study focuses on many aspects of home automation such as energy saving [10, 11], temperature management, and regulation, security, and safety by managing the entrance, control doors, and windows.

Additionally, the study creates an environment for well-being for people limited in the movement.
