DREAMING brings together a set of services which, packaged together, allow extending the independent life of elderly people while providing them with the same level of safety as in their own home, offering them a way of staying in touch with their loved ones even when the latter are away. In addition, the DREAMING services facilitate the management of chronic conditions in a domestic environment, reducing the costs derived by an extended stay in the hospital.

The package comprises:

• A Monitoring and Alarm Handling service: this is provided through a combination of medical devices and environmental sensors and a powerful Decision Support System able to detect risk situations based on the specific profile of the individual user or of the category to which the user belongs and on any combination of sensor measurements including trends over a certain period of time. Data collected from the sensors can be complemented with information from external systems (Electronic Health Records, weather and pollution forecast, etc.) to prevent as many as possible domestic accidents and health crisises. The Monitoring and Alarm Handling service is active both indoors and outdoors although, of course, with more limited functionality when outdoors.
• Elderly-friendly videoconferencing service (eInclusion): A videoconferencing system which has been specifically designed for elderly people, provides a very familiar user interface consisting of a TV set and an infrared remote control that almost any elderly person can use in his/her daily life.
• Non-technology based services: the ultimate goal of DREAMING is to keep elderly people in their home environment as long as their physical and mental conditions allow it. However, this goal cannot be achieved only with technology, therefore the participating Social and Health Authorities will keep providing and enhancing their offers of non-technology based services which are essential for supporting the autonomy of elderly people (e.g. visits by community nurses and social workers, psychological support, delivery of hot meals and shopping, special transportations for people with limited mobility, house cleaning, etc.)

The case is piloted in several countries Denmark – Region of Southern Denmark, Estonia – Tallin, Germany, Italy – Friuli-Venezia Giulia, Spain – Aragon, Sweden – Uppsala.

Description of target users and groups

The actual users of the services can be broken down into different categories:

• Elderly people: they are the main users and beneficiaries of the services and they will use the medical devices and the videoconferencing service directly;
• Caregivers: they play a major role in looking after elderly people. They will keep such an important role in the context of DREAMING by helping elderly people do measurements when their manual skills and/or intellectual faculties decline. They will also have access to the Decision Support System, limited to information concerning the type of assistance to be provided to the elderly people. They will receive information concerning situations of risk according to the intervention protocols agreed for each type of risk;
• Contact Centre operators: they will have access to the Decision Support System for monitoring and elderly assistance purposes;
• General Practitioners and Community Nurses: they represent the front line of the healthcare system and their primary mission is to look after elderly people in their houses. They will be given specific permissions to access the Decision Support System, according to the category they belong to. They will be automatically notified by the Decision Support System or by the Contact Centre operators when their intervention is required and will  have access to videoconferencing service to keep in touch with their patients.
• Emergency services: this group will be automatically notified by the Decision Support System or by the Contact Centre operators when the situation detected by the Monitoring and Alarm Handling service requires immediate action (fire, gas leak, fall, life threatening health conditions, etc.);
• Medical Specialists: depending on the local healthcare organisation, some chronic diseases can be monitored directly by the Secondary Care Medical Specialist. They will be given access to the Decision Support System for a periodic check of the disease evolution and they can be notified by the Decision Support System of any condition which is considered anomalous.
• Social Workers: This group  will be involved only in case of necessity; they will rely on the videoconferencing service to keep in touch with the elderly people they look after when they cannot assist them in person; they will also have limited access to the Decision Support System;

Description of the way to implement the initiative

The objectives of DREAMING are:

• To enable elderly people to continue living in their home without compromising their level of safety, for as long as they wish or until their physical and mental conditions make a transfer to an elderly or nursing home mandatory;
• Providing elderly people with a simple though effective way of staying in touch with their loved ones even when they are physically away;
• Increasing the efficiency of the health and social care professionals interventions including emergency services. This translates not only into a better use of the limited resources available but also into a reduced intrusion in elderly people’s private life;
• Cost-effective services: ongoing experiences have demonstrated that monitoring technology, even when much more basic than those deployed by DREAMING, can be delayed by up to 18 months in average. At the moment an elderly person has to be transefferd to a specialised centre. This translates into substantial savings for the Social Authorities; this experience is also widely documented. Demonstrating that savings are equally achievable in healthcare is one of the main challenges of DREAMING. To this end, three categories of chronic diseases have been selected: diabetes, Chronic Obstructive Pulmonary Disease (COPD) and heart failure.

Technology solution

Monitoring and Alarm Handling System: the personal alarm system is based on the combination of the following components:

• Local set-up:This component is split into three subsystems; an environmental monitoring subsystem able to detect movements in the house and to build a normal user’s profile for each flat or house. Sudden changes to the normal pattern are detected and reported to the Contact Centre. The Contact Centre is then able to establish voice communication with the flat to check the real occurrence of an accident before the emergency procedure is launched.The environmental alarm system can be extended with a large variety of wireless detectors (smoke, gas, water leak detectors, etc.) which can render the environmental monitoring more comprehensive and more reliable by cross-checking a large number of parameters to detect anomalous situations.
• A health monitoring subsystem composed by a set of self-operating medical devices, the number and the type of which is determined according to the specific health conditions of each person and the main health threats to which he/she is exposed. Environmental sensors and medical devices are linked to a local concentrator (the H.I.S. Central Unit) through wireless communications (Bluetooth or RF). Measurement of the vital parameters of each individual will be taken according to a personalised schedule sent by the H.I.S. Central Unit through fixed (PSTN or ADSL) or mobile (GPRS or UMTS) communication links to a Decision Support System  (CenterSightâ„¢).
• A mobile alarm and localisation system, constituted by a cellular phone, the Butler, specifically designed for elderly people and that has received several international awards for its efficiency. The Butler provides a number of remarkable features such as an integrated fall detector and a positioning system based on a combination of cellular network and radio beacons. It is ruggerised and waterproof. Thanks to the Butler, the elderly person can be monitored and located wherever he/she is and, through the combined use of the fixed H.I.S. Central Unit and the Butler, the residence and the individual can be monitored independently from one another.
• Decision Support System (CenterSightâ„¢): data transmitted to the Contact Centre are received, analysed and stored by a Decision Support System named CenterSightâ„¢, operating on the basis of a set of personalised rules agreed with each pilot site and depending on the specific profile of each elderly person and on the type of problem detected.
• Elderly-friendly videoconferencing: the videoconferencing environment is a software-based solution running on a standard PC-based set-top box under MS-Windows or Linux and allowing point-to-point sessions. To offer an acceptable quality of images the communication link must have a guaranteed bandwidth of at least 128Kbps, using ISDN or ADSL protocols. The videoconferencing equipment has been designed to function on any IP network and uses proprietary audio and video codec. The user interface is TV-like and does not require the use of a keyboard or any other PC-specific input device. Selections are made using a normal infrared remote-control. The videoconferencing system is compatible with the Session Initiation Protocol (SIP) standard.

Main results, benefits and impacts

The expected impacts are the following:

• Substantially prolonging the time that elderly people can live independently at home and manage their everyday activities in a socially integrated manner. DREAMING allows a minimal intrusive monitoring of elderly people inside and outside their apartments and provide them with an adequate level of safety. This, in turn, enables them to continue living independently,. Videoconferencing can be used to keep in touch with elderly people when nobody can visit them in person. Interaction with other persons, even through ICT means, will help the elderly people to keep healthy mental conditions. The positioning system embedded in the Butler will be able to locate anomalous situations, which are relative common in the initial phases of some of the most serious mental diseases such as senile dementia, etc.
• Improving the quality of life of older people and their families, increasing the effectiveness of care systems and facilitating the wide implementation by public authorities in conjunction with industrial players of a sustainable, innovative, chronic disease management service. During its lifecycle, DREAMING will provide its services under real-life conditions. The duration of the pilots guarantees that the benefits of the system can be measured by comparing a number of indicators for the people receiving the DREAMING services with those for another homogenous group of elders (the Control Group). This will ensure that a solid case can be mounted for the sustainable deployment of the DREAMING service on a large scale.
• World leading position for the European industry and in particular of SMEs working for the  ICT market concerning independent living of the ageing population and for chronic disease management. The SMEs participating in the project already have a competitive offering for the home monitoring of elderly people and their social integration. Behind them there is an even larger community of SMEs providing products to build the DREAMING platform. All the SMEs can enhance their competitive positioning by refining their offerings and by developing a convincing business case for the purchase of the DREAMING service.
• Opening up an internal market for ICT based solutions for the elderly (e.g. home and portable systems). It has already been mentioned that assisting an increasing number of elderly people, often living alone, is a general problem throughout the European Union, although with big differences among the Member States; the implementation of the DREAMING solution would have significant importance in the whole Union.

Lessons learnt

As the project is still ongoing, there are not sufficient data to fully describe the lessons learned, It is however possible to provide an estimation of the lessons learned so far:

• The pilot phase of the project has revealed many challenges of incorporating new technologies into an already existing organisational routines. To a great extent, DREAMING has learned from these initial challenges and acknowledges that a pilot project like this should take into account the many possible scenarios the implementation phase can provide.
• Regarding the elderly users’ acceptance, it has been remarkable how open and willing they have been towards the DREAMING services. The project has definitely showed that elderly users are ready to be empowered through social inclusive technologies and eHealth solutions. 
• The project already acknowledges that a pilot project may not continue after the end of the funding period; the local project management in Denmark is currently taking measures towards national continuance after the project end through national, regional and local funding possibilities.

Through these acknowledgements, the DREAMING project’s local management team is convinced that the great potential for added value provided by the DREAMING concept will be widely used.