While videoconferencing may not make sense for everyday use, I think it has special value for contact with distant relatives, particularly older ones who don’t travel very much. They may not get to see the grandchildren, great-grandchildren or even children very often, and their lives are often marked by a particular loneliness, particular at senior homes.
But today’s videoconferencing tools are getting quite good and will get even better. Skype now offers a 640x480 video call if you have enough bandwidth and CPU, which is not far off broadcast quality if not for the mpeg artifacts they have trying to save bandwidth. It’s also pretty easy, as is Google’s GMail video chat and several other tools. We’re just a couple of years from HDTV level consumer video calling.
Many seniors, however are unfamiliar with or even afraid of many new technologies, and often in places where it’s hard to get them. And this in turn means they can’t readily set up computers, cameras or software. There is also still not internet access in many of the locations you might want ot reach, such as hospital deathbeds and senior homes. (Had they had the access in my stepfather’s hospital room, I could have had a video conversation at the end; he died as I was heading to the plane.)
Video calls also offer extra human bandwidth, which is a big plus with people who are getting infirm, less strong of mind and hard of hearing. Reading lips can help improve how well you are understood, and physical cues can mean a lot.
And so I think it’s crazy that senior homes, hospitals and hospices don’t come standard with a video call station. This is not anything fancy. It’s a computer, a webcam, and a megabit of internet. Ideally wireless to move into rooms for the truly infirm. Yet when I have asked for this I have found myself to be the first person to ask, or found that there are policies against internet use by any but the staff.
I’m going to describe two paths to getting this. The first uses off-the-shelf hardware and freeware, but does require that the staff of these facilities learn how to use the system and be able to set their residents up in front of it when it is time for a call. This is not particularly difficult, and no different then the staff being trained in any of the other things they do for residents and patients. Then I will discuss how you would design a product aimed for the sector, which could be used without staff help.
A senior home will contain both fully able-minded residents and some who are slower. It will have technophobes. While there are several video call tools, and in a perfect system you would be able to talk to whatever the grandkids use, supporting this is probably too complex. If you settle on one system — I would recommend Skype at this time — you can get the more tech-aware parties at the other end to use it. It is available for Windows, Mac and Linux, which is a big plus.
Unfortunately, Skype and most of the other systems are geared mostly to a single user. You can log out and log back in to change users, but technophobe seniors will not be up to doing this, or even remembering userids and passwords. One account, always logged on, is much easier to get going, though it means that this account will have a huge buddy list of all the contacts of each senior. Skype has contact groups which can help here, but it’s not going to be perfect. If Skype, or some other tool, put together a much simpler multi-user interface, like I will describe in the latter section, it would help a lot. A plugin for the Skype API could also help do this. In this case, we’re mostly giving up security — any senior, or anybody else, could log in as anybody, but the risks to that are low.
The full quality video calls require a fairly modern CPU to send the good video, unfortunately. A dual core processor is needed. These are now starting to get cheap, even in used laptops. For mobility, I think a laptop is the best device to use. It’s not hard to find a cheap, 1-2 year old laptop with dual core and an integrated camera. Due to the fading vision of many seniors, a large screen laptop is useful, or even an external monitor when the laptop is not being used in mobile mode.
However, it may be argued that the video grandma sends doesn’t have to be the full HQ level stuff, it’s more important that the view of the grandchildren be sharp. That requires them to have a newer computer (which is far more likely) and good upstream bandwidth. The senior home computer can be an older generation, single-core, 2-3ghz model. Such systems can be had for a song in the used market, and almost certainly could be had from a donation by a relative of a resident.
It is best not to stint on the camera, but good quality cameras can be had for $50-$60. Skype pretends that it insists on Logitech’s latest cameras which cost $70-$100, but in fact it can be told to do HQ video from almost any recent camera.
Because many seniors will be more comfortable with old style telephone, I recommend the addition of a USB phone handset. A wide variety of these are sold for use with Skype and other programs. (I don’t think any have a “Start Video” button, it would be nice if they did.) If the handset has a number pad, it could also be used by almost all seniors to start a call by picking it up and dialing their relatives with Skype-Out. They would not need to know they are using Skype-Out. The relative would get the call, and then go to their computer and log into Skype. They would then hang up the PSTN call and place the video call, knowing grandma is at the video console. This would require a quite small Skype-Out budget for the station, which should be easily afforded by any institution, as long as it’s not abused. (A version of Skype that could only skype-out to a limited set of numbers for calls of just a few minutes could solve such an issue.)
The USB handset must feature a high-volume feature for the hard of hearing. In addition, there should also be a set of headphones. These are better than a handset, but just not as familiar. They can offer better audio, less echo, higher volume and a different balance for those with different hearing in their two ears. While computer control of balance is possible, there is not a good UI for it, so headphones with a balance dial would be better, though such a feature is not easy to find.
Of course, Skype also does speakerphone quite well, though it’s always better if both ends don’t do speakerphone. Since calls to families may have several people on the other end, it makes sense to avoid speakerphone at the senior station.
The computer would be kept on, with Skype running. Calls would probably be set up using the PSTN, though more aware seniors could go to the system, log in to their own account if they know how, and see if their relatives and friends are online to talk to them.
The computer might also live at the nursing station, where families could call in (over Skype even) to ask that the computer be taken to their relative, or that he/she come to the station.
Start with phone call
An interesting interface, that would be quite handy in regular video call software like Skype would be a “start with phone call” interface.
In this interface, the user would dial a phone number on a keypad, ideally on a USB phone handset. The system would look up the number and see what computer user that is. If the computer user is online, it would connect over the internet to that user. If the user is not online, it would place a PSTN call to the phone number. For example, in Skype, using Skype-Out.
When the other party answers and is told it’s a video call, they would go to their computer. Once they logged into the video call software, they could place an internet call to the person who called them on the phone. When the client that made the PSTN call receives this 2nd call, it would seamlessly hang up the PSTN and switch to to internet call, adding video. The senior who dialed the phone would have no idea this took place, they would just see audio quality improve and video start up.
Even better, the target’s client, once it logs in, could be made aware of the PSTN dialog and make it all automatic on their end too, so all they have to do is log in, and immediately voice and video start.
Since the PSTN portion of these calls would be short, the cost would be minimal and could be done on a monthly fee.
This approach requires no buddy lists or identification or security at the senior home end.
Dedicated Senior Video Call Terminal
Things would be better with a bit of custom software. This would start with a PC/Laptop mostly dedicated to this function. The UI must be extremely simple, perhaps even automatic. Note that I recommend the use of a standard PC rather than trying to make a dedicated device, because standard PCs are very cheap and the software available for them is much better. It matters more that the system be compatible with what the families have, and that means the PC based systems — and the ability to change to another system if trends change.
For example, in an ideal system, the senior would come and sit before the screen. The camera, using face recognition, would identify which senior it is — this is not too hard to do when dealing with only a small set of people, and can be done with face geometry. If, for some reason, it can’t distinguish between two people, it could then display their two names and faces on the screen, and let the senior select who they are, perhaps with a touch screen, or by saying their name.
If face recognition seems too hard, speech recognition is certainly good enough off-the-shelf to let the senior say their name to be identified. Or if that’s still too much, they could pick from a list of names on a touch screen. I think a touch-screen is a must if there has to be pointing — many seniors are not familiar with a mouse, or may have disabilities that prohibit the use of a mouse. Another alternative is a keypad on the phone handset that should come with this. As noted, seniors will all be highly comfortable with the phone, and pressing a number on a phone can work as a means of input. Indeed, a simpler to build UI would just have the names of all seniors on the screen with numbers, and the senior picks up the phone and dials their number (or says their name) to start using the system.
(Note that while these systems might provide some security against impersonation, home staff/nurses will need to be able to get into any account to help set up buddies or any special config for them.)
Once the senior is recognized, the screen would show their buddy-list, primarily the family members who are online and ready. Again, each name should have a number after it (which never changes, no matter who is online) and the senior should be able to call one of them by pressing their number on the handset or keyboard. Sure, mouse and arrow keys should work as well, for those able to handle that.
For many seniors there may be just one person they talk to. In that situation, it should take nothing more than identifying to the computer, and confirming by voice or keypad press that you want to call. If the other person is already ready, they can initiate the call.
Since this is a video call terminal, it should send and receive video automatically, unless told not to, at least in calls to the recognized buddies. If there are concerns about the security of this, it could require that there be somebody present at the computer for this to happen, and this person would be able to cancel the video. For example, if there is nobody present, video start would be manual. If somebody is present, the terminal would display “video starting in N seconds, say ‘no’ to cancel” and then automatically start.
(Underneath, the system could be working with multiple video and buddy systems, so that grandchildren can be found on Skype, GMail, MSN, AOL, iChat or what have you. The Senior should not be particularly aware of that. It should be up to the family member to set this up, perhaps working with a nurse or assistant.)
There’s a lot to be said for keeping the interface just like a phone call, with the video added. It may make sense that the seniors can just go to the handset and dial the real world 7 or 10 digit number of their relative and have this number be recognized so that it all works. Indeed, even though the face-recognition system might provide a simple, no-touch interface, some seniors might adapt better to the familiarity of the phone style interface.
If headphones are to be made available, the system should remember what volume level and left-right balance the senior uses, and set this. Initial setup of this can be done with a simple UI, or the assistance of a helper the first time. The system should be able to automatically detect if the user is using the headphones, a handset or the speakerphone with no UI required to switch. It can tell just by what volumes it gets from the microphones, off-hook signals from the handset and echos of signals it sends out the various speakers. This does require that all the audio devices be independent, which is becoming much more common in modern computers and is easy to do with USB audio devices.
Note that this computer could also be a full-function computer for use by the seniors who know how to use it, and do E-mail and web browsing. However, these would be things such users would have to click to get with the mouse, rather than the typical default of a computer that is in full-power mode and lets you run a program to do video calls.
We could get closer to this ideal system with a few tweaks from the video call developers, or perhaps plugins that go on top:
- The tools could all support a shared computer better, with easier identification of who the user is and switching, without requiring them to use the mouse or do login procedures.
- Tools could support an easy, but reasonably secure, semi-automatic start of video, or accept a keypress from the handset for start-video. In general a mouseless interface should be considered.
- In general, a much cleaner UI skin with just a few features presented unless asked for would allow better adoption by the aged.
- Good support for multiple audio devices. Figure out if the user is using the handset, headphones or speaker without them having to specify. Do this by listening to all microphones and the echo coming through them.
The hardware for this is cheap or getting cheaper. I would not at all be surprised that if the software were available, the relatives of seniors would donate older computers, or possibly even newer computers. In addition, if the facility doesn’t have internet, donations could easily be arranged. The system could even be built to require that the families who use it contribute to its cost, if the money can’t be raised any other way.
Further, the system could send calling family members to a URL for donations not just for the video system, but to the senior home itself, making this a money-raiser, rather than a cost.
In a senior’s home
Of course, there is a desire to get a video call facility into private homes of seniors who are not yet in group homes. Usually this is up to the family, though software to make it easier and more phone-like would be a plus. However, many seniors do not have internet access. This can often be solved by connecting to a neighbour’s wireless internet. In most of the world’s cities, there are tons of local wireless nets visible in just about any home, especially if an antenna is put by the window. With a very light usage pattern predicted, what neighbour would not allow access to a dedicated system that lets the old lady see her grandchildren once a month?
Of course, some ISPs forbid any sharing of connections over wireless networks. They should be shamed out of this, at least in the case of a video terminal for seniors. These are people who would not buy a full connection and who put little strain on the system. If any of them tried to block such a usage, I am sure enough negative press could be generated to get them to reverse such a decision.