I have just been to the AKTIVE conference
in Leeds. It was very insightful since it refreshed my knowledge about
Telecare. I have always been careful not to have my research (Teletalker) placed into Telecare
since I didn’t want to come directly from the health related angle. When I went
to the ISG conference in 2012 in Eindhoven – the message was very clear: the
acceptance rate of Telecare was very low, making pilot projects costly and -
with a few exception - unsuccessful.
Now 2014 this is still the case, but at
least researchers and other (steering parties) involved are coming around to
understand that the components to achieve success with Telecare are complex,
context dependent, nuanced and subtle. They realized that a truly
multidisciplinary approach involving “end users” (patients, health personnel, carers
and technicians) is needed to achieve the potential of Telecare.
A bit of back ground to Telecare or Telehealth as it’s also frequently referred to (based on this Eurohealth paper and other sources):
Since 1998 UK and other European country
governments – and later also the EU - have been pushing for ways to introduce
technology to assist with the delivery of care. Europe is faced with the first
time phenomenon of lots more older people than younger people because of
longevity due to healthier living conditions and no wars, combined with a
reduction in birth rates. By 2030 about a quarter of the European population
will be over 65 years old, leaving Europe with a 'person to care for ratio' (or potential support ratio PSR, Clarkson & Coleman 2013)
of 1:4, which has not existed before. Therefore the drive to use technology to
assist and manage health care seems to be a logical step, so fewer people can
look after more people. Numerous pilot projects have been taking place in the
UK and in the EU, all with moderate success. The range of Telecare technologies
range from “low tech” such as pill dispensers, to “more service related” such
as pendants for fall alarms (if triggered a carer will contact you), to “high
tech” devices and integrated systems such as smart houses equipped with sensors
and video connectivity.
The largest technology (and response) provider
in the UK and Europe appears to be Tunstall. Difficulties in delivery Telecare successfully
lies with several layers such as interoperability of the systems, technological
failures, low awareness with professionals and patients, low acceptance rate
(stigma), cost and disjointedness of services (Telecare is seen as an ‘bolt-on’
service).
The Technology
Strategy Board has commissioned several projects (SALT, MALT, AKTIVE, ATHENE,
COMODAL, COBALT), which are due to disseminate their findings in early summer
2014.
For example, COMODAL looked at reaching consumers in the electronic assisted living
technology market. Dr Gillian Ward presented a talk about their work at AKTIVE event. They
were interested in the 50-70s age group, either as consumer for themselves or
for someone for someone they care for. They employed as methods: literature
review, market analysis, product reviews, street surveys, industry telephone
interview, focus groups and co-creation workshop. From the interviews with
consumer and industry they found that there was a large mismatch between
expectations on each side. Industry underestimated the concerns consumers have
around perceptions of the use of technology. Cost is important but not the most
crucial influence in the purchasing decision. People (consumers) were looking
for managed solutions, not products. The design of Telecare should address
aspirations, not disability.
Other themes of
the conference addressed issues around measuring the performance of Telecare and insight into the patient & carer relationship
and the role of Telecare technology in there. The topic of loneliness and the
multifold aspects around caring arrangements were brought out in the open. For
example a neighbour would not mind being the first point of contact during day
time, but not necessarily during night time. Rob Procter and Joe Wherton
reviewed people’s adaptions to Telecare devices, which they termed “bricolage”.
They called for more “co-production” in the shape of telecare devices i.e.
where users can adapt / make the device to their needs. Paul Clitheroe from the
MI-Health, Dallas project in Liverpool, suggested not to “talk” about telecare,
but to reach people through activities they enjoy and to communicate the
message of self-care. In his view, once people took on responsibility for their
own health, people will look for solutions offered on the market in order to
manage their health.
I thoroughly
enjoyed the conference and the people I met. This little summary does not do
justice to the full range of great projects and the wealth of knowledge that
has been generated through the critical review of Telecare options and impact.
Themes that I
felt were missing:
- The delicate and problematic relationships between (informal) carers and older people in regards to abuse – can Telecare play a role in reducing abuse?
- The issue of managing unpredictability in the caring circle, it may be that the carer (the spouse) falls ill too … how quickly can the new carer get introduced to the telecare set-up?
- There was frequently a call to offer more choice to the patient or carer, but I can also see a danger in the “terror of choice”. Particularly when your mind is already occupied with other realizations that you have to come to terms with e.g. cancer, diabetes. In my view it’s not enough to talk about choice, but to consider where it is helpful to offer choice (e.g. it might be useful to offer a fall alarm either as pendant or wrist band) and when to intervene with a set plan based on professional experience.
