The Thuiszorg Telephone

Our objective was to make homecare available to the elderly so that they could find a way to live independently in their own homes for as long as possible. That's why we researched Thuiszorg Rotterdam as an organisation and looked closely at the needs of the elderly who were already receiving care at home. Before we could develop a plan for the elderly to receive home care, we needed to know why, up to now, they often refuse help.

Authors: Wessel van den Berge, Bonnie van den Heuvel, Megan McNulty and Simeon Ritman

At the moment Thuiszorg Rotterdam (Homecare Rotterdam) is facing the problem of their clients refusing home care. This leads to situations where people are being moved into nursing homes, even though they are physically and mentally able to live independently.

A brief introduction: we are Kwartetpret Design. A small group of four people who met each other during the gamification minor of the Social Practices at Willem de Kooning Academy. In collaboration with Rotterdam Community Solutions, we took on the challenge of giving Thuiszorg Rotterdam, who specialise in various types of home care, a new and positive identity.

During a visit to the Laurens Antonius Nursing Home, which is located on the Nieuwe Binnenweg in Rotterdam, we met Wilhelmina Valk, one of the elderly residents. She told us that she was recovering from her recent hip surgery, so that her stay would only be temporary. She could not wait to go home and thanks to the hip surgery she would finally be able to do her own grocery shopping again. She enjoys it and takes pride in doing it at her age. But she did have a problem – the door of her apartment is heavy and is a hassle for her to open and close. But it would be an even bigger hassle with her now fragile hip. So she asked Thuiszorg Rotterdam if they could help her with her problem and the solution they offered her was: "Don't worry Ms. Valk, we will do your grocery shopping for you". This was not the solution that Wilhelmina was hoping for. Without her grocery shopping she would skip her daily physical and social needs and would lose her independence. Even though Thuiszorg Rotterdam would like to help, they simply don't have the manpower to fix her problem in any other way.

Sadly Wilhelmina is not the only elderly person with a story like this. A lot of other elderly people who we spoke to were bothered by the fact that they had lost the feeling of being in control of their own situations, lives and decisions. The fact is that things change the older we get. We all become less physically able. This could start out as physical challenges but could also lead to a negative impact on our psychological state. These changes may not only be frightening, but may also be hard to accept. The fear of change and decline only gets bigger when you start needing help from an organisation like Thuiszorg Rotterdam. This leads to a paradox: elderly people want help to stay independent, but when Thuiszorg Rotterdam tries to help by taking over and offering general solutions, it only takes their independence away. So we wanted to find a way to support the independence of the elderly by letting them find solutions themselves.

So we asked ourselves a simple question: what is the first thing we do when we 'younger' people have a problem? Where do we find information in this day and age? Wilhelmina might have thought of a button to automatically open her front door. But where can she get one? She does not own a computer and doesn't know how to use one so the internet isn't an option. And let's be honest, the first thing we would do, is google it. This got us thinking. What if we could offer Wilhelmina and other elderly people in the same situation the functionalities of the internet? What if we could turn Wilhelmina into a google expert, so she could find all the answers to her questions? And why stop there? What if we could also show her how to chat online, and meet all kinds of people! To offer her the functionalities of the internet we had to find a medium which all elderly people can understand and use.

We thought of various media like print and the telephone. These are examples of communication that have been around for quite a while. Everyone understands how to use them. The problem with print (post) is the time it takes to receive an answer to a question, which leads to a lack of direct contact and interaction. We wanted to make sure people could ask a question and receive an answer right away. The telephone provides these requirements perfectly. So how do we use the telephone to help elderly people use the internet? We initially thought of an automated telephone service. After running tests with a simulation of a pre-programmed answering service it became clear the target audience needs more than a robot to answer their questions. Without human interaction the unique needs of Wilhelmina would not be fulfilled. So we came up with a more personal and friendly solution: De Thuiszorgtelefoon!

The Home Care Telephone Clients of Thuiszorg like Wilhelmina receive a package from their carer. The package contains all sorts of goodies and gadgets, a leporello (harmonica book) and a welcome letter with a short introduction to the Thuiszorgtelefoon. It invites them to start using the phone service and join in the fun. In the leporello each category is explained and we designed a different host for each category. Using storytelling, small games and the phone service, we created a pervasive game experience. In a pervasive game the boundaries of the game are unclear. It mixes reality and play which leads to an even better experience where 'players' are either aware or unaware that they are being supported and motivated by the world we created.

The first phone line is run by Toon and Toos, the health care coaches. You could see this as an online profile. The useful aspect of a profile is having an overview of yourself and your situation. Toon and Toos tell you everything you need to know: about what you are entitled to, when you should take your pills, which carer will be taking care of you and when they are coming over. But they also tell you where and how you could get a button to automatically open your heavy front door. Calling Toon and Toos should help find answers to any questions. The line is answered by an employee of Thuiszorg Rotterdam taking on the role of Toon or Toos. By training the employees to answer the phone with: "Hello this is Toon" (if male, if female they use the name Toos) they unknowingly takes the client into the world of the Thuiszorgtelefoon. Thus the pervasive game. Because the clients have already been introduced to Toon and Toos through the welcome letter and leporello, they have a sense of safety and recognition.

The second line provides the functionality of online chatting and is hosted by Babbette. We wanted the options of going on or offline, as you would do when chatting on the internet. That's why there are two options: one to create a message to indicate the times that you are available and await the calls; and two, to listen to available messages (profiles) of people awaiting a phone call. The online players simply select 'yes' or 'no' after they have been asked if they want speak to the person (player) whose message they just heard. If they answer yes, the other person gets a call, if they answer no, they go on to the next message till they find a chat partner. The system needs minimal guidance after the first use. The leporello also contains an easy game to break the ice and start a conversation.

The third and final telephone line came to life as a solution to finding the answer to everyday questions and problems. Providing a search engine system like google would be vital in order to allow the user to gain access to knowledge and information. The character hosting this service is Nico, but he won't be doing this alone. In order for these needs to be met we needed real people on the other side of the phone, volunteers. We found "Het Nieuwe Vrijwilligen" a new kind of volunteering. Instead of expecting a volunteer to be available for eight hours straight, a volunteer can now say "I am available for half an hour, and later in the day I will have another 45 minutes in which I am also available." By designing an app for them and adding the option to turn themselves 'on' or 'off' we cater to this need. The advantage of this kind of volunteering is that people can start helping whenever they themselves want. They don't have to clear their whole schedules but they can help in their breaks or when they are waiting for the bus. In this way we connect people who want to volunteer but have limited time to elderly people who can use their knowledge of the internet. By connecting the caller to a volunteer through Nico we make the volunteers part of the game and world.

The app, which serves as a platform, grows by user generated input. Within the platform, we provide motivation though different game mechanics so we can engage two types of players within the app and thus the game. The first type will be motivated by extrinsic rewards in the app, showing their progress with strong visual rewards, like badges and achievements. This group has a good knowledge of how to use the web and can share this with the elderly calling the service. The second type is triggered by the idea of helping people, so we give them tools to create a log about all the elderly they helped, serving a more intrinsic value. This gives them an epic meaning of being helpful towards others, and also enabling them to read back the stories they wrote. These players also provide the data for the database, filled with the answers to questions that have already been asked. Thus making it easier for other users of the app to answer questions in the future by consulting the user generated database. Combining these two target audiences and making them both part of the same pervasive game enables us to solve the problem of the elderly, and to give volunteers the feeling of being part of something bigger, in an easy way. This group of volunteers can easily grow because of its flexible and approachable platform.

The Thuiszorg Telephone is a practical and social tool for people who receive care at home which introduces them to the functionalities of the internet in a playful way. The hosting characters create a new and positive identity for Thuiszorg Rotterdam, resulting in a better attitude towards the organisation and giving the elderly the feeling of being in control of their situation.

Megan McNulty - Illustration student WdKA with a minor in gamification. Simeon Ritman - Illustration student WdKA with a minor in gamification. Wessel van den Berge - Graphic design student WdKA with a minor in gamification.

Bonnie van den Heuvel - Copywriter, student at WdKA with a minor in gamification.