The potential implications and inequalities in the care of older people in a post-COVID world: An autoethnographic account


  • Rachel Creaney University of St Andrews; James Hutton Institute


COVID-19, ageing, healthcare smart homes, autonomy, healthcare


Healthcare smart homes have been positioned as a potential innovative solution to the current global ageing crisis and an alternative for the care of older people within a post-COVID-19 world. However, such innovations have emerged within a dominant discourse in which older people are framed and pathologized as societal burdens. This autoethnographic paper, based on my reflections and recent (but pre-pandemic) ethnographic fieldwork with older residents of healthcare smart homes, explores the potential changing landscapes of care and home that older people may experience in a post-COVID-19 world. Previously, these homes were associated with wellbeing, choice and autonomy, however, with the negative impacts of COVID-19 on care homes and the care sector, healthcare smart homes and digital-by-default care may become the prominent means for the future care of older people. I argue this may cause increases in the social, economic and geographical inequalities around access to smart healthcare technologies. Many of these inequalities are experienced more strongly by individuals from different intersectionalities including age, disabilities and class. Furthermore, potential feelings of autonomy experienced by older people using smart healthcare technologies may be reduced when a post-COVID-19 move to digital-by-default health and social care becomes a necessity rather than a choice.



Aceros, J. C., Pols, J. and Domènech, M. (2015) ‘Where is grandma? Home telecare, good aging and the domestication of later life’, Technological Forecasting and Social Change, 93, pp. 102–111. doi: 10.1016/j.techfore.2014.01.016.

Adams, S. and Niezen, M. (2016) ‘Digital “solutions” to unhealthy lifestyle “problems”: the construction of social and personal risks in the development of eCoaches’, Health, Risk and Society, 17(7–8), pp. 530–546. doi: 10.1080/13698575.2015.1136409.

AGE UK (2017) Older carers left to fill the gap as our social care system crumbles | News | Age UK. Available at: (Accessed: 29 July 2020).

Ahmad, A. et al. (2020) ‘What does it mean to be made vulnerable in the era of COVID-19?’, The Lancet, pp. 1481–1482. doi: 10.1016/S0140-6736(20)30979-X.

Balta-Ozkan, N., Davidson, R., Bicket, M, Whitmarash, L. (2013) ‘Social barriers to the adoption of smart homes’, Energy Policy, 63, pp. 363–374. doi: 10.1016/j.enpol.2013.08.043.

Balta-Ozkan, N., Boteler, B. and Amerighi, O. (2014) ‘European smart home market development: Public views on technical and economic aspects across the United Kingdom, Germany and Italy’, Energy Research & Social Science, 3, pp. 65–77. doi: 10.1016/j.erss.2014.07.007.

BBC (2020a) Coronavirus: Spanish army finds care home residents ‘dead and abandoned’ - BBC News. Available at: (Accessed: 29 April 2020).

BBC (2020b) Coronavirus: Tenth resident dies at Skye care home - BBC News. Available at: (Accessed: 28 July 2020).

BBC NEWS (2020) ‘Coronavirus: Why disabled people are calling for a Covid-19 inquiry - BBC News’. Available at: (Accessed: 29 July 2020).

Bennett, J., Rokas, O. and Chen, L. (2017) ‘Healthcare in the Smart Home: A Study of Past, Present and Future’, Sustainability, 9(5), p. 840. doi: 10.3390/su9050840.

Bevir, M. (2016) Governmentality After Neoliberalism, Governmentality After Neoliberalism. Routledge. Available at: (Accessed: 16 May 2019).

Buckingham, H. (2020) ‘Coronavirus: how will the NHS cope? | The Nuffield Trust’. Available at: (Accessed: 29 April 2020).

Bülow, M. H. and Söderqvist, T. (2014) ‘Successful ageing: A historical overview and critical analysis of a successful concept’, Journal of Aging Studies. JAI, 31, pp. 139–149. doi: 10.1016/J.JAGING.2014.08.009.

Burrows, A., Coyle, D. and Gooberman-Hill, R. (2018) ‘Privacy, boundaries and smart homes for health: An ethnographic study’, Health & Place, 50, pp. 112–118. doi: 10.1016/J.HEALTHPLACE.2018.01.006.

Bytheway, B. (2005) ‘Age-identities and the celebration of birthdays’, Ageing and Society, 25(4), pp. 463–477. doi: 10.1017/S0144686X05003831.

Chapman, T. and Hockey, J. L. (1999) Ideal homes?: social change

and domestic life. Routledge.

Colic-Peisker, V., Ong, R. and Wood, G. (2015) ‘Asset poverty, precarious housing and ontological security in older age: an Australian case study’, International Journal of Housing Policy, 15(2), pp. 167–186. doi: 10.1080/14616718.2014.984827.

Cristoforetti, A., Gennai, F. and Rodeschini, G. (2011) ‘Home sweet home: The emotional construction of places’, Journal of Aging Studies. JAI, 25(3), pp. 225–232. doi: 10.1016/j.jaging.2011.03.006.

Currie, M., Philip, L. J. and Roberts, A. (2015) ‘Attitudes towards the use and acceptance of eHealth technologies: a case study of older adults living with chronic pain and implications for rural healthcare’,

BMC Health Services Research 15. doi: 10.1186/s12913-015-0825-0.

Darby, S. J. (2018) ‘Smart technology in the home: time for more clarity’, Building Research & Information, 46(1), pp. 140–147. doi: 10.1080/09613218.2017.1301707.

Dowds, G., Philip, L, Currie, M., Masthoff, J. (2018) ‘A Window to the Outside World. Digital Technology to Stimulate Imaginative Mobility for Housebound Older Adults in Rural Areas’, in Curl, A. and Musselwhite, C. (eds) Geographies of Transport and Ageing. Cham: Springer International Publishing, pp. 101–130. doi: 10.1007/978-3-319-76360-6_5.

Eaves, L. and Al-Hindi, K. F. (2020) ‘Intersectional geographies and COVID-19’, Dialogues in Human Geography, 10(2), pp. 132–136. doi: 10.1177/2043820620935247.

Ekerdt, D. J., Koss, C. S., Li, A., Munch, A., Lessenich, S., Fung, H. (2017) ‘Is longevity a value for older adults?’, Journal of Aging Studies. JAI, 43, pp. 46–52. doi: 10.1016/J.JAGING.2017.10.002.

Ellis, C., Adams, T. E. and Bochner, A. P. (2011) ‘Autoethnography: an overview’, Historical Social Research, 36(4), pp. 273–290. doi: 10.12759/hsr.36.2011.4.273-290.

Fealy, G., McNamara, M., Treacy, M.P., Lyones, I. (2012) ‘Constructing ageing and age identities: A case study of newspaper discourses’, Ageing and Society, 32(1), pp. 85–102. doi: 10.1017/S0144686X11000092.

Golant, S. M. (2017) ‘A theoretical model to explain the smart technology adoption behaviors of elder consumers (Elderadopt)’, Journal of Aging Studies. JAI, 42, pp. 56–73. doi: 10.1016/J.JAGING.2017.07.003.

Guardian (2020a) ‘Black Americans dying of Covid-19 at three times the rate of white people | Coronavirus outbreak | The Guardian’. Available at: (Accessed: 29 July 2020).

Guardian (2020b) ‘Low-paid workers more likely to die from Covid-19 than higher earners | Society | The Guardian’. Available at: (Accessed: 29 July 2020).

Gurney, C. (2020) Out of harm’s way? Critical remarks on harm and the meaning of home during the 2020 COVID-19 social distnacing measures. UK Collaborative Centre for Housing Evidence. Available at: (Accessed 15th July 2020).

Hargreaves, T., Wilson, C. and Hauxwell-Baldwin, R. (2018) ‘Learning to live in a smart home’, Building Research and Information, 46(1). doi: 10.1080/09613218.2017.1286882.

Hillcoat-Nallétamby, S. and Ogg, J. (2014) ‘Moving beyond “ageing in place”: Older people’s dislikes about their home and neighbourhood environments as a motive for wishing to move’, Ageing and Society., 34(10), pp. 1771–1796. doi: 10.1017/S0144686X13000482.

Hine, C. (2019) ‘Strategies for reflexive ethnography in the smart home: Autoethnography of silence and emotion’. Sociology, 54(1), pp.22-36. doi: 10.1177/0038038519855325

van Hoof, J., Demiris, G. and Wouters, E. J. M. (2016) Handbook of smart homes, health care and well-being, Handbook of Smart Homes, Health Care and Well-Being. Springer International Publishing. doi: 10.1007/978-3-319-01583-5.

Hooyman, N. R. and Kiyak, H. A. (2011) Social gerontology : a multidisciplinary perspective. Pearson Education: Los Angeles.

Horsfall, D. et al. (2017) ‘Home as a place of caring and wellbeing? A qualitative study of informal carers and caring networks lived experiences of providing in-home end-of-life care’, Health and Place, 46, pp. 58–64. doi: 10.1016/j.healthplace.2017.04.003.

Iacovone, C. et al. (2020) ‘Breaking the distance: Dialogues of care in a time of limited geographies’, Dialogues in Human Geography, 10(2), pp. 124–127. doi: 10.1177/2043820620934940.

Imrie, R. (2004) ‘Disability, embodiment and the meaning of the home’, Housing Studies, 19(5), pp. 745–763. doi: 10.1080/0267303042000249189.

Katz, S. (2000) ‘Busy Bodies: Activity, aging, and the management of everyday life’, Journal of Aging Studies, 14(2), pp. 135–152. doi: 10.1016/S0890-4065(00)80008-0.

Katz, S. and Marshall, B. L. (2018) ‘Tracked and fit: FitBits, brain games, and the quantified aging body’, Journal of Aging Studies, 45, pp. 63–68. doi: 10.1016/j.jaging.2018.01.009.

Kim, K., Gollamudi, S. S. and Steinhubl, S. (2017) ‘Digital technology to enable aging in place’, Experimental Gerontology, 88, pp. 25–31. doi: 10.1016/J.EXGER.2016.11.013.

Lake, J. (2015) ‘Autoethnography and reflective practice: reconstructing the doctoral thesis experience’, Reflective Practice, 16(5), pp. 677–687. doi: 10.1080/14623943.2015.1071247.

Layzell, B., Manning, B. and Benton, S. (2009) ‘The elderly demographic time bomb - Sharing the load with the active ageing: Can eHealth technologies help defuse it?’, Studies in Health Technology and Informatics, 146, pp. 166–170. doi: 10.3233/978-1-60750-024-7-166.

Lê, Q., Nguyen, H. B. and Barnett, T. (2012) ‘Smart Homes for Older People: Positive Aging in a Digital World’, Future Internet, 4(4), pp. 607–617. doi: 10.3390/fi4020607.

Lee, B., Kwon, O., Lee, I., Kim, J. (2017) ‘Companionship with smart home devices: The impact of social connectedness and interaction types on perceived social support and companionship in smart homes’, Computers in Human Behavior, 75, pp. 922–934. doi: 10.1016/j.chb.2017.06.031.

Leibing, A., Guberman, N. and Wiles, J. (2016) ‘Liminal homes: Older people, loss of capacities, and the present future of living spaces’, Journal of Aging Studies. JAI, 37, pp. 10–19. doi: 10.1016/J.JAGING.2015.12.002.

Liu, L., Stroulia, E., Nikolaidas, I., Miguel-Cruz, A., Rios Rincon, A. (2016) ‘Smart homes and home health monitoring technologies for older adults: A systematic review.’, International Journal of Medical Informatics, 91, pp. 44–59. doi: 10.1016/j.ijmedinf.2016.04.007.

Maalsen, S. and Dowling, R. (2020) ‘Covid-19 and the accelerating smart home’, Big Data and Society, July -September, pp. 1-5. doi: 10.1177/2053951720938073.

Majumder, S., Aghayi, E., Noferesti, M, Memarzadeh-Tehran, H., Modal, T., Pang, Z., Jamal Deen, M. (2017) ‘Smart homes for elderly healthcare—Recent advances and research challenges’, Sensors (Switzerland). MDPI AG. doi: 10.3390/s17112496.

Manzo, L. K. C. and Minello, A. (2020) ‘Mothers, childcare duties, and remote working under COVID-19 lockdown in Italy: Cultivating communities of care’, Dialogues in Human Geography, 10(2), pp. 120–123. doi: 10.1177/2043820620934268.

Marikyan, D., Papagiannidis, S. and Alamanos, E. (2019) ‘A systematic review of the smart home literature: A user perspective’, Technological Forecasting and Social Change, 138, pp. 139–154. doi: 10.1016/J.TECHFORE.2018.08.015.

Mason, R. (2020) ‘NHS and care workers may be asked to reuse PPE, No 10 confirms | Coronavirus outbreak | The Guardian’. Available at: (Accessed: 29 April 2020).

Mitchell, S. E., Weigel, G.M., Stewart, S.K.A., Mako, M., Loughnane, J.F. 2017) ‘Experiences and Perspectives on Advance Care Planning among Individuals Living with Serious Physical Disabilities’, Journal of Palliative Medicine, 20(2), pp. 127–133. doi: 10.1089/jpm.2016.0168.

Neven, L. and Peine, A. (2017) ‘From Triple Win to Triple Sin: How a Problematic Future Discourse is Shaping the Way People Age with Technology’, Societies, 7(3), p. 26. doi: 10.3390/soc7030026.

Park, S. (2017) ‘Digital inequalities in rural Australia: A double jeopardy of remoteness and social exclusion’, Journal of Rural Studies, 54, pp. 399–407. doi: 10.1016/j.jrurstud.2015.12.018.

Peine, A. and Neven, L. (2020) ‘The co-constitution of ageing and

technology-a model and agenda’, Ageing and Society, pp. 1–22. doi: 10.1017/S0144686X20000641.

Philip, L., Cottrill, C., Farrington, J., Williams, F., Ashmore, F. (2017) ‘The digital divide: Patterns, policy and scenarios for connecting the “final few” in rural communities across Great Britain’, Journal of Rural Studies, 54, pp. 386–398. doi: 10.1016/J.JRURSTUD.2016.12.002.

Philip, L. and Williams, F. (2019) Healthy Ageing in Smart Villages? Observations from the Field in: European Countryside Volume 11 Issue 4 (2019). Available at: (Accessed: 29 April 2020).

Powell, J., Newhouse, N., Boylan, A-M., Williams, V. (2016) ‘Digital health citizens and the future of the NHS’, Digital Health, 2, p. 205520761667203. doi: 10.1177/2055207616672033.

Power, A. and Hall, E. (2018) ‘Placing care in times of austerity’, Social & Cultural Geography, 19(3), pp. 303–313. doi: 10.1080/14649365.2017.1327612.

Rogers, D. and Power, E. (2020) ‘Housing policy and the COVID-19 pandemic: the importance of housing research during this health emergency’, International Journal of Housing Policy, 20(2), pp. 177-183. doi: 10.1080/19491247.2020.1756599.

Rose-Redwood, R., Kitchin, r., Apostolopoulou, E., Rickards, L., Blackman, T., Crampton, J., Rossi, U., Buckley, M. (2020) ‘Geographies of the COVID-19 pandemic’, Dialogues in Human Geography, 10(2), pp. 97–106. doi: 10.1177/2043820620936050.

Sakellariou, D. and Rotarou, E. S. (2017) ‘The effects of neoliberal policies on access to healthcare for people with disabilities.’, International journal for equity in health, 16(1), p. 199. doi: 10.1186/s12939-017-0699-3.

Scally, G. (2020) ‘England’s ravaged public health system just can’t cope with the coronavirus | Gabriel Scally | Opinion | The Guardian’. Available at: (Accessed: 29 April 2020).

Sixsmith, A. and Sixsmith, J. (2008) ‘Ageing in Place in the United Kingdom’, Ageing International, 32(3), pp. 219–235. doi: 10.1007/s12126-008-9019-y.

Sparks, C. (2013) ‘What is the “digital divide” and why is it important?’, Javnost, 20(2), pp. 27–46. doi: 10.1080/13183222.2013.11009113.

Standring, A. and Davies, J. (2020) ‘From crisis to catastrophe: The death and viral legacies of austere neoliberalism in Europe?’, Dialogues in Human Geography, 10(2), pp. 146–149. doi: 10.1177/2043820620934270.

Visser, R. C. (2019) ‘Going Beyond the Dwelling Challenging the Meaning of Home at the End of Life’, Visser | Anthropology & Aging, 40(1), pp. 5–10. doi: 10.5195/aa.2019.215.

Weicht, B. (2013) ‘The making of “the elderly”: Constructing the subject of care’, Journal of Aging Studies. JAI, 27(2), pp. 188–197. doi: 10.1016/j.jaging.2013.03.001.

Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., Allen, R.E.S. (2012) ‘The meaning of “aging in place” to older people’, Gerontologist, 52(3), pp. 357–366. doi: 10.1093/geront/gnr098.

Williams, F., Philip, L., Farrington, J., Fairhurst, G. (2016) ‘“Digital by Default” and the “hard to reach”: Exploring solutions to digital exclusion in remote rural areas’, Local Economy: The Journal of the Local Economy Policy Unit., 31(7), pp. 757–777. doi: 10.1177/0269094216670938.

Wilson, C., Hargreaves, T. and Hauxwell-Baldwin, R. (2015) ‘Smart homes and their users: a systematic analysis and key challenges’, Personal and Ubiquitous Computing, 19(2), pp. 463–476. doi: 10.1007/s00779-014-0813-0.

Wilson, C., Hargreaves, T. and Hauxwell-Baldwin, R. (2017) ‘Benefits and risks of smart home technologies’, Energy Policy, 103, pp. 72–83. doi: 10.1016/j.enpol.2016.12.047.

World Health Organisation (2020) Coronavirus (COVID-19) events as they happen. Available at: (Accessed: 29 April 2020).