ABSTRACT
A significant government effort is underway to make supportive technology services available in the homes of people who might otherwise require institutional care (Department of Health 2002b; King’s Fund 2006), through the provision to all local authorities of preventative technology grants totalling around £80 million (Lyall 2005). This technology and the support staff involved is known generically as telecare, a service that delivers care to a user’s own home through the provision of information and communications technology (ICT) (Audit Commission 2004b). Telecare can provide virtual interaction with health and social care practitioners as well as close monitoring, through the installation of home-based sensors, of an individual’s activities of daily living. These monitoring sensors take two different forms: ‘active’ monitors, including food detectors and blood pressure monitors, which provide real time responses to environmental or biological changes, and ‘passive’ lifestyle monitors, in the form of strategically placed sensors that, over time, gather and analyse an individual’s domestic routines and behaviour, so as to raise alerts when unusual and worrying changes take place. Telecare therefore includes a preventative element of support that improves upon the basic community alarm system (Brownsell 2000), which has over past decades enabled people to activate a radio pendant or cord switch to raise assistance if in difficulties, a system popular in sheltered housing schemes. Ambitious claims are often made for telecare, and supporters of the industry
argue that, as well as equipment and support, telecare offers dignity and independence (TSA 2007). However, there is a lack of good-quality research about telecare’s effectiveness (Hailey et al. 2002; Whitten & Richardson 2002). In particular, few studies present the views or experiences of telecare users or potential users (Sixsmith & Sixsmith 2000; Levy et al. 2003), and there is little empirical evidence on the ways in which older people use assistive technology (Gann et al. 2000). Furthermore, user-focused studies have tended to elicit the views of people living in sheltered housing, where residents already have access to a community alarm system and may therefore be more receptive to telecare. Studies have insufficiently explored telecare’s potential with regard to the
majority of the older population who live in mainstream housing, who may lack support and social inclusion (Fisk 2003). As a result, relatively little is known about the views and preferences of key stakeholders: potential service users living in ordinary housing, family members who have support responsibilities and care staff based in the community. This chapter and the research1
upon which it is based seek to widen the debate by providing information that details the potential benefits as well as the limitations of telecare, from a range of perspectives. Discussion begins with an account of research participants’ attitudes towards the sort of technology encompassed by telecare and their suggestions for further innovation. This is followed by an analysis of topics that emerged throughout our research, which include the importance of tailoring and targeting telecare services, issues of confidentiality and surveillance, the question of virtual care and social inclusion and, lastly, implications for integrating and resourcing telecare. Before the discussion, we present a brief account of our research methods.
