Reframing unpleasurable toilet experience design for nursing homes

Abstract

Safety first or does dignity matter more? This research initially examines how nursing home residents can retain autonomy and dignity in self-managed toileting and bathing, particularly outside staffed hours, while maintaining safety from falls. Conventional monitoring systems often compromise privacy and impose a sense of surveillance. The project explores how assistive technology can enable real-time, non-invasive fall detection that supports both resident independence and ethical care practices. Positioned at the intersection of gerontechnology, inclusive design, and design for ethics, the HKPolyU (UGC)-funded programme (HK$800K) adopts a privacy-by-design approach and emphasizes co-creation among residents, caregivers, families, and professionals with differing values. An interdisciplinary team of academic, NGO, and industry collaborators conducted ethnographic research in twelve nursing homes, followed by iterative prototyping in two facilities. The developed prototype—a non-invasive, AI-augmented skeletal-tracking system—records only joint movements, eliminating bodily or facial imaging and wearable devices. Two pilot studies (2022–2023; 2024–2025) validated its ability to detect falls in real time through posture analysis while preserving residents’ anonymity. Feedback from staff and residents informed design refinement and workflow integration, demonstrating that privacy-preserving safety systems are feasible in practice. Beyond technology, the study exposed structural tensions between safety protocols, autonomy, and dignity, contributing new frameworks and insights for ethical eldercare design and fall-prevention innovation. Does design matter to both care recipients and care providers? Reflecting on the carer’s investigation, the team conducted a second study to reveal the conflicting interactions between care receivers and carers. This study focused on incorporating the care providers’ perspective into the design process, which is usually ignored. This resulted in a paradigm shift in the development of inclusive design principles. The discussions were disseminated at peer-reviewed international conferences and local seminars. The team recommends that a holistic understanding of ethically sensitive eldercare products and environmental design will be needed in the future.