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The Question of Movement in Dwelling : Three Displacements in the Care of Dementia

Francisco Tirado, Blanca Callén and Nizaiá Cassián
Space and Culture 2009 12: 371
DOI: 10.1177/1206331209337081

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 The Question of Movement
in Dwelling

Three Displacements
in the Care of Dementia

Francisco Tirado
Blanca Callén
Nizaiá Cassián
Universitat Autònoma de Barcelona

The authors explore transformations in the surveillance and discipline framework proposed by
Foucault (technologies that “allow to see,” the panoptic as a completely closed space) by analyzing
new Global Positioning System (GPS) care technologies. The authors contrast the antinomadic
characteristics of traditional care practices for people with dementia with the new “in-movement”
GPS care devices. They outline three main displacements: the definition of a new space that erases
the distance between separated social and sanitary spaces; the lifting of the boundary between the
home and the neighborhood; and finally, we point out the importance of movement in this process.
These devices show the emergency of new micropractices of power and control: a new anatomy of
surveillance. Grounded on movement, they transform physical barriers into risk alarms that do not
block users’ way; instead, they generate information that mobilizes others. The authors refer to the
notion of kinevalue to explain how these devices turn living organisms’ motility properties into a

Authors’ Note: This article belongs to the first exploratory stages of an ethnographic research
project that is currently being conducted by the Red Cross in Catalonia, Spain, as part of the
European Union’s Ethical Frameworks for Telecare Technologies project for older people at
home (Project No. 217789FP7-Science-in-Society 2007-1), together with research funded by the
Spanish government called “Science, Technology and Attention to Dependency: The
Transformation of Care in the Knowledge Society” (CSO2008-06308-C02-01/SOCI), a study of
the implications of the introduction of remote care technologies worn, installed, or embedded
in the homes of older citizens and frail older people.

space and culture vol. 12 no. 3, august 2009  371-382

DOI: 10.1177/1206331209337081
© 2009 Sage Publications
371

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372 s p a c e a n d c u l t u r e / a u g u s t 2 0 0 9

value that can be managed, as well as the central feature around which new exercises of patients’
security and caregiving may be deployed. Through the analysis of a pilot project on GPS telecare
devices carried out by the Spanish Red Cross, the authors suggest a new diagram of the control and
management of subjects based on their movement, called “kinepolitics.”

Keywords:  dwelling; telecare; motility; biopolitics; kinepolitics

The trick is not having a home but having many, and being away from and at every
one of them at the same time, combining intimacy with the critical eye of someone
from elsewhere, involvement with distance . . . learning this is the exile’s opportu-
nity: the chance of someone who is technically exiled—someone who is some-
where but is not from there.
—Zygmunt Bauman (2001)

In the past two decades, the development of distance care (the provision of health
care and social assistance from a distance) and domotics (the science of electronic
technologies at home) has experienced a sharp rise all over Europe (Aldrich, 2006).
The promises of this technological transformation are obvious. First, they ensure that the
economic costs of caring for dependent persons are lowered (Fisk, 1997). Likewise,
they improve the care that the community can offer: It becomes an action in real time.
And finally, it is stressed that users’ quality of life improves in a way unknown until
today inasmuch as their potential for autonomy and freedom of movement are
enhanced. Nevertheless, as some European stakeholders who are experts in this matter
(Information Society Technologies Advisory Group, 2004) have pointed out, this
transformation also gives rise to certain questions that cannot be ignored by the social
sciences, including a question about the new models of inhabiting the home and the
community that are implemented.
Our text examines this problem. To do this, we shall focus on one technological
innovation in distance care devices: Global Positioning System (GPS) localization tech-
nologies. In the first part of the text, we shall discuss the antinomadic characteristics of
traditional practices of caring for people with dementia. We shall then explain the trans-
formation involved in incorporating ICTs (Information and Communication
Technologies) , focusing on the pilot tests that are being conducted with localization
systems using GPS. We will consider the pilot studies currently being done by the
Spanish Red Cross in the first stages of implementation of this technology. The GPS
care service for dementia patients was first tested in Catalonia, and now trials are being
carried out throughout all the Spanish territory. We will talk here specifically about
Sistema Inteligente de Monitorización de Alertas Personales (SIMAP), a project that
incorporates a remote mobile device. SIMAP is an initiative undertaken by the Spanish
Red Cross with support from the private institution Fundación Española de Alzheimer
(the Spanish Alzheimer Foundation) and without public collaboration. The service is
aimed only at people in the first stages of dementia (with mild cognitive impairment)
and uses a tracking system via mobile phone and GPS to determine the position of a
subject with a 5-meter margin of error. In the third section, we shall outline the impli-
cations of SIMAP in defining its users’ way of inhabiting. We base these considerations
on interviews we have carried out with managers and coordinators of the SIMAP ser-
vice and the Red Cross in Catalonia, together with the analysis of several brochures and
Web pages from all the companies providing this GPS telecare service in Spain. We shall
focus on three issues: first, on the definition of a new space that erases the distance
between separate social and health care spaces; second, on the lifting of the boundary

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 M o v e m e n t i n D w e l l i n g 373

between the home and the neighborhood; and finally, we shall point out the impor-
tance of movement in this process. We shall refer to the notion of kinevalue to explain
how these devices turn living organisms’ motility properties into a value that can be
managed, as well as the central feature around which new exercises of patients’ security
and caregiving may be deployed. In distance care, surveillance includes movement and
no longer requires either physical barriers or keeping a constant watch over the care
recipients. Now their pathways are recorded, they are permanently locatable, and
physical barriers become risk alarms that do not block the user’s way; instead, they
generate information that mobilizes third persons. We shall call this state of affairs
kinepolitics.

Traditional Care of Dementia

All over Europe, dementia in the elderly represents one of the leading health care
challenges. The cognitive deterioration characteristic of this illness is primarily mani-
fested in memory loss and disorientation problems. Oftentimes, these deficits make
patients with this type of illness get lost when they leave home or walk aimlessly even
when they set out with a specific purpose. It is estimated that at some point, one third
of people with dementia show wandering behavior, a movement defined as “without
any purpose or direction” (Rasquin, Willems, de Vlieger, Geers, & Soede, 2007).
In the majority of cases, the risks associated with wandering and disorientation
require family members and caregivers to curtail patients’ freedom of movement and
reduce their possibility for making decisions by secluding them in the home and con-
stantly keeping watch over their actions. Delimiting their steps and reducing the num-
ber of outings, always in the company of their caregivers, does translate into a
reduction in the possible dangers, yet it also means a decline in their autonomous
movement and social life and, consequently, in their quality of life. To date, the inter-
ventions implemented to prevent patients from getting lost and to prevent wandering
have been characterized by a restrictive, antinomadic type of care aimed inside the
home. Some of these measures involved intervening by closing doors and windows
with lock and key, or putting up visual barriers in the exits to the home, constantly
watching patients or subjecting them to physical exercise programs that tire them
enough to reduce their desire to go outside (Rasquin et al., 2007, p. 114). Rasquin et al.
(2007) also point to more extreme measures, such as behavioral interventions via posi-
tive and negative reinforcement, securing patients (tying them to the bed or some other
element), and monitoring them via motion sensors. These interventions are aimed at
preventing demented wandering by securing patients. All of them resolve the risky situ-
ations associated with wandering by maintaining patients inside their households,
allowing them to stay safely at home, and their effectiveness is proven inasmuch as they
manage to keep them inside.
In these cases, caregiving practices take place inside the home and rely on the pri-
vate relationships that enter it. In the majority of cases, the family, especially partners
and daughters, are in charge of constantly supervising patients, caring for them and
keeping them company both inside and outside the home. The work they perform is
personalized: from caregiver to patient. It is an exercise of keeping a close watch on the
patient’s body and behaviors that requires the presence and permanent availability of
the caregiver. The person with dementia thus becomes the center around which the
time and space in the household and its inhabitants are arranged: entrances to the

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374 s p a c e a n d c u l t u r e / a u g u s t 2 0 0 9

home, furniture and objects, and the everyday life of the caregiver all revolve around
the patient’s errant habits. Regulating risk, freedom of action, and autonomy in deci-
sion making is thus a problem shared by caregivers and patients; it is the subject of
tensions and constant negotiation (Gilmour, Gibson, & Campbell, 2003).
In this sense, responses to the problems associated with dementia have ranged from
total enclosure of patients in institutions (Goffman, 1961) such as hospitals or psychi-
atric wards to individualized enclosure in their own homes. Despite the obvious differ-
ences, both solutions have shared a single goal: to control and organize the movement
of their inhabitants to ensure their safety and inculcate in them a series of habits that
allow them to be the subject of a caregiving plan whose goal, especially in case of deep
and extreme dementia, is immobilization. In both cases, by placing obstacles that hinder
free social interaction with the outside world, patients can end up facing a certain decul-
turizing isolation, especially given that in some neighborhoods or towns in Catalonia,
there are no day centers or organized social groups available. In both cases also, even
when people with mild to moderate dementia can go out and socialize by taking part of
clubs, day centers, or organized social groups, patients lose certain autonomy by being
forced to be kept under watch and to depend constantly on their carers’ presence. Thus,
either confinement or patients and caregivers’ forced dependency would be the basic
equation of traditional care. The disconnection of external ties and practices is gradu-
ally replaced with their identity as an ill person and their socialization within institu-
tions or, later on, inside their home.1 The purpose of both spatial systems, clearly aimed
at the maximal functionality of the caregiving practices, is the same: “to cancel out the
effects of indecisive dispersions, individuals’ uncontrolled disappearances, diffuse circu-
lation, unusable and dangerous coagulation; an anti-desertion, anti-wandering and
anti-agglomeration tactic” (Foucault, 1975, p. 147).
The difference between these two traditional forms of care resides in the fact that
when patients go from institutions to their homes, they have to remain in their own
habitats and keep up the routines and habits they used to follow. The effect is that there
is no longer a homogenized and institutionalized top-down program that they must
heed beyond their daily habits. Nevertheless, these habits and routine movements
remain limited to inside the four walls of a given place and are managed on the basis of
the purpose of ensuring patients’ total safety and protection. That is, by enclosing them
and managing their movement inside institutions and homes, the goal is to deploy a
disciplinary plan over patients’ bodies that turns their erratic tendency into something
controlled and easily managed by whomever is in charge of their care. Therefore, this is
a kinetic domestication whose goal is the health and physical integrity of patients, while
their security and adaptation mean greater comfort and fit of their caregivers’ job.

Localization Systems: SIMAP

With the recent use of GPS technologies and localization devices in the care of
patients with cognitive problems, Alzheimer’s or other types of dementia, which are
associated with a certain risk of disorientation in their everyday comings and goings,
we are ushering in a new type of care. Although with the traditional solutions, wander-
ing was restricted and prevented, devices such as SIMAP aim to ensure the safety
conditions that make it possible for users to leave their homes unaccompanied.
Targeted specifically to people with slight to moderate cognitive deterioration, this
localization system uses mobile telephony and GPS to determine the location of a

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 M o v e m e n t i n D w e l l i n g 375

subject with a 5-meter margin of error. As SIMAP’s managers demonstrated to us, the
service consists of a small mobile device with a GPS receiver and a global system for
mobile modem that, when attached to the trouser belt loops or the skirts of individu-
als affected by dementia, enables authorized persons (family members or caregivers) to
be apprised of the movements and location of the users at all times. These coordinates
are updated every 3 minutes, and should a user be inside a building or area without
coverage, a signal is issued indicating that this is not the position in real time but rather
the last one received. Additionally, a record is available that is saved systematically that
keeps track of every single location detected in each update. Caregivers may access this
information through the Red Cross Contact Centre, upon request via text message, or
by checking it directly on Internet. Therefore, information the location of the indi-
vidual who is wearing the device is available at all times, and thanks to a program of
warnings and alarms that is configured in advance, it can detect potentially dangerous
systems. To do this, family members previously design the cartography of the area
where the user may circulate freely on the basis of the everyday habits and movements
of the individual with dementia. They set up a virtual geographic space near the user’s
house, from 250 to 500 meters, approximately, and are alerted when the user leaves the
safe zone. Should the device detect that the user is going at a speed of over 35 km/h,
which would mean that he or she is using some means of transport, the central alarm
is also activated. In this cartography, which is personalized for each user, the safe zones
are delimited, as are the unsafe zones (such as motorways, underground transport,
busy streets, etc.), and even places that are not officially identified can be specified
(especially useful in rural settings). According to service managers interviewed, the
initial cartography must be updated periodically in response to the degenerative pro-
gression of the illness, reducing the size of the safe zones and including new risk points,
until the area is so reduced that it is practically unusable and the service loses its initial
sense: This is shown by the average length of time that the service is used, which tends
to be about 18 months. Should the alarm sound, the care protocol is activated: The
contact person is notified, ambulances are mobilized, and so on. Therefore, there is no
type of physical contact between the Red Cross, which provides the service, and the
users beyond the design of the initial cartography that the caregivers define at the start.
The role of the Red Cross, which is traditionally oriented toward social assistance and
health care, is basically limited to ensuring that all the technological aspects are work-
ing properly so that the caregivers and family members may properly check on the
locations of users and act in the event of an emergency. The Red Cross therefore oper-
ates as the manager of the technological means in order to provide information on the
comings and goings of the patients and later store this information.
The device, which has been in use since 2007, entails a reconsideration of the forms
of care. The main goal is to encourage or help users recover their autonomy and in
consequence to help their caregivers recover theirs as well. As explained in the adver-
tisements for the service, this is achieved “by fostering their individual and collective
capacities, their participation and social integration.” Plus, “efforts are made to ensure
that they remain in their day-to-day setting and continue on with their lives if possible,
for as long as possible, and avoiding unnecessary internments.” In this way, by hiring
SIMAP, “family members and caregivers are given the tools and support to cope with
this situation [the illness] with peace of mind and confidence.” Autonomy and greater
freedom of movement are then joined by a second value: affective interactions and
well-being. Therefore, when promoting the service, it is argued that both users and
family alike will enjoy greater peace of mind and quality of life inasmuch as the former

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376 s p a c e a n d c u l t u r e / a u g u s t 2 0 0 9

may leave their homes and the latter are not obliged to constantly keep direct watch
over the users. As a result, the curtailment of the disciplinary restrictions applied to the
users and the lack of need for the constant presence of both family members and
patients help reduce the caregivers’ anxiety, the demands placed on them, and the time
needed to perform their caregiving tasks. Although it does not mean that some sup-
port from the family is always necessary, as when they are called on by the Red Cross
if an emergency arises.
These transformations in the ways that care is administered to people with demen-
tia show that the inclusion of new technological devices, in this case SIMAP, cannot be
considered a neutral, aseptic process bereft of importance for the stakeholders involved:
users, caregivers, service suppliers, and even health care systems in general. In fact, we
could claim instead that these changes propel us into a new, eminently distance-based
scenario in which movement is productively managed via mechanisms that have little
to do with discipline and that give rise to different models of inhabiting the home and
the community.

Three Displacements in Care: Dwelling in Movement

Three displacements capture the transformations that devices such as SIMAP are
introducing in caregiving practices.

Social Space Versus Health Care Space

With the implementation and adoption of devices such as SIMAP, caring for a per-
son with dementia translates into knowing his or her location and making this infor-
mation available at a distance. The organic surveillance and exercise over the body that
we found in enclosure and restriction interventions now shift toward technology- and
pixel-based monitoring on a map on which the coordinates of the user’s position
appear in real time. Controlling the comings and goings, considering productive and
unproductive displacements, demarcating the places considered both safe and unsafe,
and an immediate response in the event that these boundaries are overstepped become
the basic jobs of caregiving. Here it is important to emphasize that even though the
company providing the service offers in its advertising (http://www.simapglobal
.com/?pag=partes) an almost automatic security by demarcating safe and risk areas,
the situation is much more complex. People with dementia may experience problems
even in safe zones, because this technology merely tracks movement, not well-being.
The need for close-up monitoring, in person, remains, particularly for people with
degenerative conditions (which is why the service is recommended only for people in
the initial stages of dementia).
The clear personalization of traditional interventions gives way to a singularization
in which the relationships between caregivers and care recipients transcend space and
time, and the latter’s bodies shed weight and are replaced by information on their move-
ments. The cartography designed by family members captures the particularity of the
users and their histories, habits, and everyday life, the places they tend to visit every day
and their interactions, yet it transcends their person. Their bodies recover their auto­
nomy, expands their capacity for movement, and are set free from a restrictive, disci-
plinary type of care, as long as they do not cross the boundaries set by third persons.
Indeed, spatial reference comes to be located beyond the walls, even beyond the
streets; it is located in a cartography that contains information on the past (by the

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 M o v e m e n t i n D w e l l i n g 377

record of coordinates), that updates the present constantly (in real time), and that
generates enough knowledge to forecast patients’ future comings and goings. All of this
is made available to caregivers, who replace the patients as the center around which the
elements of the service revolve: The family members are the ones who design the car-
tography, who set the limits of what is possible and impossible, who can access the
information on the displacements, whom the alarm warns, and, most important, who
have the ability to modify the device and alter its conditions. With SIMAP, the logic of
caregiving responds to the regulations that the caregivers ultimately set. In the strict
sense, it could be claimed that the effective user of the service is the person who pro-
vides the care as opposed to the person wearing the device. In fact, the moment when
patients threaten and challenge the control that the caregivers exert over them, when
they make unexpected incursions or change the preset normality of their habits, is
when the alarm sounds and, in consequence, when the cartography is readjusted. This
gesture empowers the family members in charge of the users to actualize—even when
not being next to the users—their responsibility as caregivers, with the ultimate goal,
it is worth repeating, of ensuring the safety and physical integrity of the users.
The most direct consequence of these caregiving technologies is the reconfiguration
of what has been considered social and health care spaces. In recent years, an interest
has emerged in the possible relationships between the characteristics of neighborhoods
and health care systems. More specifically, special attention has been paid to how
neighbors’ support may protect and attenuate situations of dependency in ageing
(Shaw, 2005). With restrictive measures, the domestic space had closed in upon itself,
it had become secure and hospitalized at the cost of expelling the threatening other-
nesses, yet it also excluded the opportunities for socialization inherent in public space
(Harper, 2006). However, with the appearance of devices such as SIMAP, there is an
intention to open up the home to the public and the social, so that patients can once
again inhabit both in a two-way fashion. The privacy of dementia is opened up to the
public, and caregiver-care recipient relationships are expanded with the presence of
neighbors, acquaintances, or simple strangers. Somehow, safety is still generated, but
outside the protection erected by the walls of the home.
According to Gilmour et al. (2003), while health care professionals have placed
greater stress on the physical aspects of safety (hence the physical restrictions in the
traditional care of dementia), in a variety of studies, both patients and their family
members have stressed the importance of social and affective relationships. In this
sense, the risk is related to concepts of danger, yet simultaneously to the opportunity
to gain benefits precisely in those situations in which harm is also possible. This second
aspect is what SIMAP providers (both the Red Cross and the companies) aim to stress
by offering users the possibility of leaving home and keeping up their ties with the
community, offering risk management on the basis of surveillance of the displace-
ments around the neighborhood. Encounters with other neighbors makes possible the
proliferation of neighborly relationships in which the illness ceases to be the core
around which the user’s life revolves, without this meaning having to give up the par-
ticularities inherent in the illness. To a certain extent, patients’ going out and partici-
pating in public life makes their dementia a public affair in which stakeholders other
than the caregivers and family members are involved. The presence of others’ eyes (the
so-called audience effect), coupled with knowing that they have been acknowledged by
these “others,” facilitates diffuse coresponsibility for users’ safety. The neighborhood
thus becomes the most intimate public space, “the place where a social ‘commitment’
can be expressed; in other words, an art of coexisting with the interlocutors (neigh-
bours, merchants) to which we are tied by the specific yet essential fact of proximity

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and repetition” (De Certeau, Giard, Mayol, 1999, p. 6). This conversion of the social/
health care dichotomy into a single space makes the neighborhood the ideal place for
administering these new forms of technology-based care inasmuch as the neighbor-
hood is “that portion of the public space in general (anonymous for everyone) where
one gradually shapes a particularised private space through practical, everyday use of
this space” (De Certeau, Giard, Mayol, 1999, p.8).

From House to Neighborhood

As mentioned above, SIMAP assumes that autonomy is the possibility that persons
may move around outside their homes without the need to be accompanied, yet this is
not open-ended movement anywhere they want. The SIMAP territory is the neighbor-
hood. The device operates precisely on the basis of its ability to enclose and delimit
open, diffuse territories (outdoors, in the city) while doing away with physical barriers
such as the walls of a home, hospital, or residence. This technology is implemented by
setting clear limits that highlight the meaning of the neighborhood, drawing attention
to its particular features: a space that is not as enclosed and “safe” as the home, yet nor
is it so dangerous as the open city; a portion of public space that has gained particular-
ity and proximity through everyday processes of coexistence and inhabitation.
What are the assumptions of the neighborhood that SIMAP developers and provid-
ers take for granted? For them, the city is disperse and sprawling, and within it the
neighborhood is a bubble in which the user may move about with a supposed degree
of safety. The neighborhood is neither exterior nor interior; rather, it is an intermedi-
ate area. First, it is the zone of circulation that connects and buffers the shift between
house and city, and second, it is also a specific space that is inhabited under the
rhythms of constancy and frequency.
To Mayol (De Certeau, Giard, Mayol, 1999), the neighborhood is a practical device
that ensures continuity between the most intimate (the private space of the home) and
the most unknown (the city as a whole, the world). In line with the way SIMAP works,
the neighborhood is an extension of the home, which for users means the entire set of
routes embarked on from their homes, an appropriation of the space in which the out-
doors gradually becomes the extension of the indoors. “It is what results from a walk,
from a succession of steps on a street, gradually expressed by its organic link to the
home.”
Until now, SIMAP has been promoted as a response to two concerns that affect the
lives of people with dementia, their family members, and their caregivers: first, the
need to preserve the rhythms and activities that make up and give meaning to everyday
life, and second, the importance of helping keep up the social ties that ensure users’
belonging to and participation in the community. Being part of a neighborhood
means inhabiting a space of familiar practices, of activities whose pace is determined
by spaces and relationships (De Certeau, Giard, & Mayol, 1999). “It is the chosen ter-
rain for staging everyday life”, a link that relates private with public space. Referring to
Serres (1999), in his proposition on the use of two nuances that distinguish ways of
being in a place, one does not patrol or haunt the neighborhood (hanter); rather, one
inhabits it (habiter) with well-defined habitats and habits. We are linked to our neigh-
borhoods through proximity and repetition, and these two characteristics are what
allow the routes in SIMAP to be managed and delimited. The device makes a cross-
section of the space on the basis of persons’ use of the neighborhood and the spaces
they dwell within it. The boundaries are established up to where elderly persons have
some reason or need to go (the shop, the local bar, the market, the baker’s, etc.). As

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 M o v e m e n t i n D w e l l i n g 379

soon as they cross these boundaries into the areas where they have “no reason” for
being, this is viewed as “wandering” or as a sign that they are “disoriented.” Whereas
the routes shaped by everyday habits, frequency, and custom are assumed to be rea-
sonable and safe enough to be permissible, the ones with “no reason” are unneces-
sary and potentially dangerous. The displacements “with a reason” are taken as the
norm, assumed as a necessary part of patients’ health and well-being, and even fur-
ther, they are fostered by a device that charges this movement with the value of
tranquility (no alarm sounds). Placid.
On the basis of the modern conceptions of the house and the city, the home has
been the refuge of the familiar, the feminine, childhood, old age—the place of what is
seen as vulnerable, as Baydar (2002) claimed. It is a refuge from the chaos, pollution,
intensity, and risk of the city. In this conception, which dichotomously opposes the
public and the private domains, leaving home means facing death, leaving the safety of
the walls to get lost in the streets of risk. This device to control movement suggests a
demarcation of the wandering that solves the dangers of leaving the domestic realm by
surveillance tactics, by domesticity. The cartography of the neighborhood, necessary
for SIMAP, is designed (first by the developers of the device, and later by the Red Cross
for its use) as an effort to create an open space that has been fenced in and domesti-
cated without the need for walls and locks.
SIMAP posits a particular construction of the order of space, of register, of the
distribution of bodies; it provides technological elements that make movement pos-
sible for people who used to be confined. Going from deprivation to privilege, this
device proves what Bauman (2001) has pointed to as a new form of emerging stratifi-
cation, in which access to mobility becomes the highest value and one of the main
factors in this order.

Kinevalue: Schemes of Motility

From all the above we can infer that devices such as SIMAP support the mobility of
these people in the city. As mentioned before, this device enables us to establish the
monitoring and safety conditions that allows users to leave their homes and walk
calmly around the neighborhood. In fact, the advertising to promote this service liter-
ally states, “Want to go out to play? SIMAP gives them back their freedom and you your
peace of mind.”
SIMAP brings back mobility as a mainstay of its users’ quality of life. And this
means the condition of the possibility of freedom and peace of mind. But the freedom
and peace of mind of whom? we might ask. Of both the users and their caregivers or
the people who care for them on a regular basis? If users can go out and their caregiv-
ers are not required to constantly keep direct watch over them, the physical restrictions
in the household are loosened, the caregivers’ anxiety and stress are lowered, and the
quality of life of everyone involved in the caregiving situation is enhanced. Therefore,
the device is far more than a mere technical solution and instead offers a second dimen-
sion of reality that is related to the realm of affective relationships and well-being.
Indeed, SIMAP deploys a set of practices that involve affection, ethical claims, and
political formulations over its users. In them, for example, capital and movement
merge into a single value. The use of the device means enjoying mobility as a type of
well-being capital for both users and caregivers. The service makes this very clear by
stating that it fosters “the peace of mind that comes with knowing that your family
member enjoys their freedom safely.”

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We have called this mobility, formulated as a type of capital that can be purchased,
compared, or exchanged, kinevalue. With this term, we wish to stress the superimposi-
tion of a dimension that refers to movement as a physical property, that is, as a capacity
of living organisms due to the mere fact of being alive, coupled with an economic
dimension. SIMAP transforms movement into goods, and conversely, it operates with
a mercantile object, which is pure motility. Nonetheless, as seen above, GPS localiza-
tion systems do not make claims on behalf of any kind of movement, even in the
abstract sense. On the contrary, not any movement is valid, and in fact, not any move-
ment is actually defined as such. In the case of people with some type of dementia or
cognitive deterioration, only movement that allows them to be permanently locatable
and enables potentially dangerous situations to be detected in relation to their geo-
graphic position is considered movement, good movement. Without the device that
offers this safety, mobility is pure risk and an undesired consequence of a disorder that
must be reined in. Therefore, SIMAP does not open up a question on movement per se.
The goal is not to seek the natural movement of the ill person nor the circulation hab-
its that this person practiced before. The device installs its own mobility, with its map
of geographic circulation, risk zones, boundaries, and so on. SIMAP offers a value that
has to do with the new codification of the lost power of a body and with control of the
illness or handicap from which the person suffers. That is, it establishes its own circu-
latory reality, its own scheme of motility. And in this, biology and economics merge
seamlessly.

Conclusions: Schemes of Motility and Kinepolitics

On the previous pages, we have pointed out several transformations that traditional
caregiving practices in the first stages of dementia have undergone with the introduc-
tion of the GPS care service that the Spanish Red Cross is currently testing. This has
enabled us to note how large enclosed areas where many people in the same situation
were arranged in uniform series of pathologies and dispossessed of any personal items,
have been (partially) dismantled and replaced by the ill individuals’ remaining in their
own homes. Once there, the introduction of devices such as SIMAP seems to put an
end to the restrictive nature of this type of care, as it enables the doors of their homes
to be opened up to the external life of neighborhoods and cities.
Remote care enables users to keep their habits and everyday routines through the
possibility of action and displacement outside their homes as well. Thus, the scenario
of privacy and familiarity that was inherent in the ill person’s return home from insti-
tutions has experienced a shift and extended to include broader networks and social
spaces. With enclosure in one’s own home, the clear separation between social and
family life (outside the institution) and health care and caregiving life (inside the insti-
tution) was blurred into the same social/health care space. However, with the advent
of technologies such as SIMAP, this space of social/health care convergence is extended
even further toward the community, eliminating, for example, the boundary between
the home and the neighborhood. And this is achieved because the cornerstone of the
new caregiving practices for dementia aims to gain movement for the individual.
This restructures both social and symbolic space and power relations. Nevertheless, as
Sheller and Urry (2006) point out, discussions on mobility are based on several assump-
tions that are bandied about in a thoroughly acritical fashion. Specifically, it is assumed
that movement per se generates change, which is self-evident, and that the main char-
acteristic of our present is the enormous capacity for mobility we have within our reach.

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 M o v e m e n t i n D w e l l i n g 381

In view of this state of affairs, it is crucial to ask ourselves what counts as movement
today and what counts as capital. While the movement of thousands of tourists via inter-
national circuits prepared just for this purpose is fully legitimate, the circulation of the
last nomadic Tuareg families through the Saharan countries is regarded as illegitimate;
it is banned and persecuted. Compared with the image of clear, evident, and ethereal
movement that modern discourses of mobility offer, we should assume that there is a
host of practices that set the conditions of what is considered movement or not,
legitimate or illegitimate movement (Sheller & Urry, 2006, p. 36). In short, mobility is
not an obvious, self-evident notion. It constitutes a precarious achievement that
requires both effort and the establishment of a series of practices and definitions that
allow or deny it. SIMAP does precisely this job in the case of individuals suffering from
dementia: It sets up a scheme of motility for them. And the consequence of this, albeit
one that is not very visible, is extremely important, as it means the transformation of
an entire political order, specifically the shift from a biopolitical caregiving system to a
kinepolitical system.
Some authors (such as Parker, 2005) have shown that in the case of dementia and
other serious cognitive disorders, caregiving and control practices are connected in
such a way that it is difficult to extricate one from the other. As we have seen in the first
section, we tend to assume that the potential for surveillance ensures good care and
that, in this sense, the very definition of the function of caregiving involves a total or
quasi-total controlling action. These statements show that traditional caregiving prac-
tices used with dependent persons were an exercise in biopolitics. As Michel Foucault
argued (2007), biopolitics is a governing action that strives to manage life. It works by
acting on the body and the species. Biopolitics marks a historical period, one in which
life and the living become the playground of political struggles and economic strategies.
More precisely, the entry of life into history is an event that corresponds to liberalism.
Nevertheless, remote care, and specifically SIMAP, delimits a series of practices and
transformations that might be indicating that the diagram of action delimited by bio-
politics has changed (Tirado & Doménech, 2006). The activities of institutions, rules
and real games that had a direct impact on our bodies as machines and as a species are
gradually giving way to an intense management of movement. Biopolitics is not disap-
pearing, of course, but its action is now subsumed in the apparently simpler process of
setting up schemes of motility, of coupling biology and movement and creating a new
law of exchange and transaction: kinevalue. Drawing from an expression by Tirado
(2001), we call this new device whose center of action is this law kinepolitics. Describing
and analyzing it constitute a major challenge for the future of the social sciences.

Note

1. This identity effect of the totalization and institutional isolation that operates on the every-
day and affective order of their inhabitants has come to be called “hospitalism” (Goffman, 1961).

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Francisco Tirado (DrPh, social psychology) is a lecturer in the Social Psychology Department
at Universitat Autònoma de Barcelona and a full member of the Group for Social Studies of
Science and Technology. His main research interests are power relations and political action in
sociotechnical contexts and biopolitics and care technologies.

Blanca Callén is a PhD student and researcher in the Social Psychology Department at
Universitat Autònoma de Barcelona. She is member of the Group for Social Studies of Science
and Technology and coordinates the Spanish part of the Ethical Frameworks for Telecare
Technologies project. Her main research interests are technoactivism and political action and
government, control, and power relations.

Nizaiá Cassián is a PhD student and researcher in the Social Psychology Department at
Universitat Autònoma de Barcelona. She is member of the Group for Social Studies of Science
and Technology and a grant holder from the National Council of Science and Technology of
Mexico. Her main research interests are urban studies, public space, urban activism, art, and
urban planning.

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