Abstract
Prior to the industrial revolution, most human endeavor happened at home. Birth, childhood, education, raising crops, making craft items, activities of daily living, chores, entertainment, romance, childrearing, decrepitude, and death all happened in a rather small radius around the home, be it ever so humble or grand. People played out their lives, taught their children, and made their economic way in the home. Children always knew what their parents did during the day as they watched their labor with cottage industry, trades, gardens, fields, and animals. The children learned by emulation to follow the trade of father or mother and a sense of continuity with the family trade as cobbler, miller, or smith over generations. “Hand that hammer and take these apples in to your mother. Here, help me with this load of firewood and help me stoke the fire.” Would it not have been lovely to spend day after day with the whole family working together? “Oh, Jack, look in on grandma and see if she needs anything.” Times lost, indeed!
With diversification of labor, specialization and concentration of technology employment in the industrial age of the 19th century took wage earners away from the home to factory where their labor was measured in productivity and rewarded by hard money, which could be converted into the necessities of life. Even agrarian families by the end of the 19th century were not entirely isolated social and economic entities. In the past century the home became more and more a place of rest and retreat from the business life at jobs, whereas earlier it had been the center of aspects of life and family including the business. In fact, the time at home required rigorous protection from the prosaic demands of career and compartmentalized thinking. The home could not be the retrace that brought in the income. With increases in two-income families, the home became something of a shrine to shrinking personhood where childrearing, housekeeping, cooking, and many maintenance activities could be delegated in order to maximize earning potential outside the home and to allow for sometimes outrageous commute times. Things are changing!
We know in the telemedicine community that the home could well become the point of care for health services, as resources evolve to allow precise monitoring, high-fidelity telecommunications, and the real possibility to embrace the home in electronic continuity with a virtual team of health experts. Noninvasive monitoring of vital signs, monitoring of medication, monitoring of activity, and monitoring of nutrition, safety, and security are all technical realities. Local processing of data for trends, alarms, and alerts is steadily growing in potentiality. Interaction with the patient at home is a rapidly maturing field with reminders, instruction, social interaction, and therapy interventions. Changing a medical regimen does not require a trip to a clinic, and for conditions such as hypertension, it is now clear that the realistic measure of blood pressure does not happen in a clinic but in the familiar and customary situation of home. Home health and telemedicine have been generally seen as urgent health delivery priorities as the population ages beyond the ability of the current care models to provide the service. The aging individual would be left at home alone rather than staying in an extended family with offspring and other family because those individuals were away at work and could not find the time for care giving. This is a noble endeavor and has led to great technological and system research successes especially in Asia, where the sense of responsibility for the elderly is great and pain of being unable to provide directly for the elderly has been so acutely felt. This situation would never have been at issue when the family remained at home for work and play. Things are changing!
The home may be the place of work for an increasing number of telecommuters. Virtual teams of knowledge workers can link between home office in Europe, clients in Asia, and conduct all the critical interactions to effect business, including telepresence with video and voice and a high-definition projection of the client or vendor on a high-quality screen. Knowledge workers can do their research, planning, training, recordkeeping, reporting, and network building from home. A family in Dallas with two girls under 8 years has two incomes. The wife is planning, selling, and managing finance issues for high-tech software purchases. She travels occasionally around the United States for client work but 80% of her work is done at home. There is no overhead for her to have an office suite and she visits the regional office with just enough regularity to reinforce the virtual team of which she is a vital part. Her husband works for a multinational company based in the Middle East and serves as a 4G wireless consultant to U.S. clients. He develops solutions and applications, offers seminars, and develops products and systems for clients while in virtual teams with the parent company. He frequently has videoconferences with the other team members who are 8 h ahead in time and thousands of miles away. He manages accounts with clients in seamless interaction with the other human assets of the company. He travels about 20% of the time. The children have at least one parent and often both in the house almost every day. They eat together and between business requirements they have interaction with parents for play, reading, music, and conversation. The family cooks together, cares for the pets, attends to the garden, and shares the household chores. The children know very well what the parents do for a living and when to be quiet! The assistant to bring the parent some supply or file or paper during a call might well be the child who becomes part of the family endeavor. “Hand me that thumb drive, sweetie. Mommy will be off the telecon to London in a little while.” They hear the language of the parents in work and the parents hear the language of the children in their daily lives at home. They see their home as not just a playhouse in a dream world of leisure but a workplace where everyone including a 4-year-old has responsibilities. Each says she is interested in a career like the parents. The away time is sufficiently brief that they believe the parents are always around for a question or a laugh. “Oh, Jane, answer the videophone on the plasma screen and see what grandma wants. I think she is at the store.” In this setting there is no scramble forever shrinking quality time. There is a lot of time and it is reality time. The children spend time at school but much of their education is with parents using electronic resources.
This new work model is not rare and seems a durable change in the sociology of the developed world. We are going back to the model of home as workplace and household. The home is highly laced with electronics for information, education, and entertainment and could be for health management. What are the implications of a home as point of care for everyone and not just the elderly? What are the implications if the elderly person is not alone but living in a complex family where adults and children are around for whatever needs the elderly may require. Every member of the household understands the needs of every other, no one is more important, all are respected, and all share the work of mutual care. The health of the parents and the children could be under the management of a medical home clinic, with data collection and interactions coming from the home properly equipped. The possibilities of telemedicine enlarging to serve all aspects of electronic households are intriguing. The elderly may not be so lonely after all and the expense of full telemedicine services may come with the cable bill. Give your imagination a free rein and let us see where the new home is going to take us. Perhaps back to the 18th century but residents of that time would not recognize it!