SHADES OF GREY MODELS OF CAREGIVING FOR

ALZHEIMERS PATIENTS
STEFAN P. CARMIEN1 AND AINARA GARZO
TECNALIA. Health Technologies Unit, Spain

Keywords: Caregiving, institutionalization, Alzheimers, rotation

ABSTRACT
Introduction: The care path for the typical Alzheimer patient follows a trajectory from
aging-in-place to institutionalization. There are local customs that buffer that path and provide
a more compassionate and economical approach. Rotation, a way for many caregivers to
provide support, may be such a technique.
Objective: This paper will discuss Rotation in several cultures and 1) explore the nature and
suitability of rotation in action and its possible introduction to other cultures and 2) the
technological challenges and opportunities inherent in this approach.
Methodology: Rotation has been documented in several cultures: Taiwan (`meal rotation'
(lum hwo tow)) (Kao & Stuifbergen, 1999), Spain (sistema de rotacin familiar) ((Rivera,
Bermejo, Franco, Morales-Gonzlez, & Benito-Len, 2009), the US (rotating caregivers)
(http://www.armedafoundation.org/nursinghomes.asp). There are two forms: internal (rotating
caregivers in and out of the elders home) and external (moving the elder from caregiver to
caregiver house). External rotation is widely seen to be both more common and more difficult
for the elder. In case of patients with dementia external rotation is worse because it causes
disorientation. The length of time for a given rotation shift varies depending on family
schedules and elder needs, but weekly or longer shifts are most common. Where cultural
movement towards family defragmentation makes difficult the introduction and promotion of
rotation as a mid-point between aging-in-place and institutionalization exploratory housing
practices such as co-housing may provide the distributed care that may successfully bridge the
path of dementia.
Results: Rotation, when it works, can be much more economical than institutionalization, and
contributes to both quality of life and longevity for the senior. It can also mitigate problems
with insufficient room in care homes, as the aging bubble moves forward. Internal rotation
contributes also to maintain the patient at home, in her own environment as long as possible.
A review of both medical and sociological literature reveals a need for demographic and
ethnographic research that provides guidelines the development for rotation supporting
technology. Governmental medical policy should be reviewed with an aim to support and
spread the practice of rotation, harmonized with local culture. Assistive technology (as
implemented in AAL2 environments) and CSCW3 communities can contribute much to
support the spread and success of rotation; an example could be using medical record
technology adapted for caregiver use in assisting continuity of care over caregiver shifts.
Thus, ensuring accurate and reliable continuity of communication and care in rotation
preserves independence of the patients, delaying institutionalisation.
1

Corresponding author: Stefan P. Carmien, Parque Tecnolgico de San Sebastin, Paseo Mikeletegi, 1-3, 20009
San Sebastin, Spain, stefan.carmien@tecnalia.com
2
Ambient Assisted Living
3
Computer-Supported Cooperative Work

REFERENCES
Kao, H. F., & Stuifbergen, a. K. (1999). Family experiences related to the decision to institutionalize an elderly member in
Taiwan: an exploratory study. Social science & medicine (1999), 49, 1115-1123.
Rivera, J., Bermejo, F., Franco, M., Morales-Gonzlez, J. M., & Benito-Len, J. (2009). Understanding care of people with
dementia in Spain : Cohabitation arrangements , rotation and rejection to long term care institution. International
Journal of Geriatric Psychiatry, 24(2), 142-148.