Will the sensors look after us?

This guest blog was contributed by Dr Maggie Mort, Reader, and Dr Celia Roberts, Senior Lecturer, of Lancaster University.

There seems to be an assumption everywhere that ‘doing more for less’ is in itself a virtue. Take telecare (the provision of home care at a distance by means of devices linked to a central call centre). It is said that this will enable economies of scale because large numbers of people (who may be chronically ill or frail) can be monitored in their own homes at the same time, making services more efficient.

There will be less need, it is argued, for home visits by paid carers and healthcare workers. Sensors placed around the home will detect problems such as gas leaks, falls or restlessness. It is claimed that these systems will give peace of mind and crucially enable older people to stay in their own homes for longer, rather than have to move into residential care.

Does this mean we need to have devices placed all over our homes and linked via a central hub to a monitoring centre? Crucially, if efficiency is the goal, will it mean reductions in face to face care? Our booklet, developed for those thinking of having telecare installed, aims to help users, carers and families clarify whether it will meet their needs.

Maybe this is not an either/or situation. For our research on telecare issues, we interviewed older people. Many told us that they valued their pendant alarms, but were less sure about sensors. Others had suggestions about designing devices to suit their own requirements such as a mobile alarm that would work outside as well as inside the home. While respondents were adamant that telecare should not be seen as a substitute for ‘hands on’, face to face care, we also learned that older people wanted to be involved in how systems were designed and who received information about their movements around the house.

And what of the other ways that we already create, or could create, peace of mind? One of the older respondents in our study came to a discussion group and afterwards gave us a handwritten note describing all the ways she and her neighbours and friends managed this:

Arrange things to give peace of mind: telephone in every room; key holders; my friend and I ring each other every morning; neighbours know I am around when my curtains are opened.

In our work we explored the social and ethical issues arising from installing home telecare systems which we felt were too long neglected by manufacturers and even care providers. This allowed us to develop a framework which can be used by older people and their families to help then decide how and when to engage with telecare at home.

Just because it’s technology doesn’t mean we can’t be critical of it, engage with it and shape it for our own needs.

Age UK aims to be a centre of expertise on ageing issues and a knowledge hub for all information relating to older people. Find out more about Age UK’s Knowledge Hub

Read another blog about telecare

12 responses to “Will the sensors look after us?

  1. It would be a comforting thing to think our elderly could be left safely in the care of big brother! Ultimately what makes the real difference to our loved ones is regular contact with relations and friends. Even if short memories cant recall who has actually visited, the visitors are greatly appreciated. Good care in home surroundings should be achievable for many with a combination of human beings and electronic systems. It is often the case that these devices are outwitted by the elderly who don’t understand or remember why there are strange bits of gear around the house.

  2. It takes some time to get used to these new technologies – particularly as we get older. My mother had an alarm button and I was very glad to know it. But it was not without teething troubles. People use them differently. I think my mother would have been very very reluctant to call for help, but in other cases I heard tales of them being used to contact the call centre for very trivial matters.

  3. I think the most important thing is that something like this should be used as part of an integrated care package. Used in this way it could prove very useful. A friend recently came home from a trip out to find her elderly husband had left the gas on. Towards the end of her time in her own home my mother in law took to sleeping downstairs but denied this to her family. If the sensors could pick up on this type of issue it would be helpful. Also if the sensors could detect that a person had not been in the kitchen for some time and therefore maybe not had a meal. Or the fact that a person had not left their bedroom. Such a system would not be suitable for everyone but could prove useful in certain situations but as I said at the beginning it can only work in co-ordination with other services.

    • Just as you say Janet, such devices work best when they are connected to other people, services and networks. They don’t work on thier own. Devices such as gas detectors and movement detectors are often part of telecare packages and do just the sorts of things you mention. But while they detect that something may be wrong, it’s the quality of response to that detection that then matters. Thanks for raising this vital point..

  4. Josie Ramsay oct. 24th at 5.pm
    Any aids to helping an elderly person stay in their home if this is their wish must be welcome.Human contact is vital of course. I suppose us younger folk should be able to adapt more easily to new tech devices than some of the present elderly folk who have not grown up with so much of this.

  5. I think many elderly people would welcome tecnhnology that assists them but they need to be given good explanations and practice in using anything new. One quick run through and being handed a brochure may not be enough, but a couple of practice sessions may make something new quite acceptable and valuable.

  6. There is much discussion around whether the use of Telecare devices are suitable for older people. Is it going to replace the much cherished already limited face to face contact these people have with their social workers or carers?
    The facts are clear, current social and health system will not be able to sustain the same quality of care with less money for more people unless changes in the system happen. Nobody argues about this. However, the discussion starts when offering solutions to this issue. Although there are various initiatives coming up with creative service solution largely to the issues of social isolation, purely by re-designing services it is not likely to reach the desired quality of life.
    What options do older people, who are at risk of harm in their own home environment, have? One option is not to do anything and keep being admitted to a hospital on a regular basis. Another option is to change their own home environment so that it is safer for them to live in. Last option is to move to a residential care setting where the environment is suitably adjusted to their needs. Which one would you likely go for?
    Would they prefer to go to a nursing or residential home instead of having sensors implemented in their house which would allow them to stay there for longer? Asking this question shifts away the focus from criticism to problem solving.
    Bringing technology to one’s home environment is going to likely result in less contact with social and healthcare professionals but without the technology the system would not be able to bear the amount of face to face visits anyway.
    If loss of social contact is what the users are worried about, show them the alternatives to social contact with professionals. The community has the ability to take care of their residents; support the community to do so.
    If the feeling of being monitored makes people uncomfortable then not only assure them that their data is only going to be used in case of an event or emergency, Telecare centres cannot monitor each resident non-stop, but also remind them what the alternatives are.
    If improper usage of Telecare devices is the problem , try different ones, re-design these devices, re-design the services accompanying those devices, offer training and advice.
    I agree that people should be involved in the design of products and services which are to support them. Absolutely. But people need to experience what is already out there first and built on that. Improve gradually.

    • A lot of these comments, interestingly, focus on the need for training and support when it comes to using new technologies. This came up a lot in our research too – telecare tended to be installed in a one-off visit with a follow-up visit only after 12 months. Not only does this assume that people can remember what they were told about how they should use the technology (let alone how it works!) but it also seems to miss the dynamic nature of ageing. People’s situations and capacities can change quite rapidly and technological systems need to be dyamic and flexible too. Personally, I also think its a bit of a myth that younger generations will be better at managing these things – as someone in my early 40s (does that qualify me as young still?) I often feel rather overwhelmed by the demand to understand and/or master new technological systems with very little training or ongoing support.

      • Radka Bartosova

        It will be interesting to also see the results from the AKTIVE project (www.aktive.org.uk) since the core of the research is to conduct an everyday life analysis of older people using Telecare and the impact it has on their everyday lives.

        I agree that training and support are very important, the question is how to do that cost effectively.

  7. Harris Kaloudis

    Since the findings of the Royal Commission on the Long-Term Care of the Elderly were published in 1999 and through to the more recent publication of the findings of the Dilnot Commission on Funding of Care and Support (2010), the technocratic and policy consensus outside government has been that the social care system in England is severely underfunded. A silent crisis, with humanitarian implications far larger than the financial and fiscal sustainability crises that have dominated the news, is raging in social care in England. This is a crisis lived by a number of older people but more harshly and poignantly by people who live with dementia and by their carers. Our society has chosen to trade off reduced rates in social care spending as part of the national economic product (i.e. allegedly a ‘fiscal sustainability’ measure) with an inhumane gradual lowering in the quality, quantity and availability of services provided to those with the weakest voice and the weakest capacity for representation of their interests in the political system i.e. the people categorised by social services departments as the frail and infirm elderly. The fervour of the government’s promotion of telecare, as a productivity-enhancing innovation, is part of the macro-economic strategy of suppressing the rise of state expenditure and therefore reducing the pressure of state financing through taxation and borrowing. However, this is not an economic necessity. It is a political choice which other countries have chosen not to make: e.g. Germany, in the 1990s, increased the rate of national insurance contribution specifically to meet social care costs in the interests of meeting identified public needs. I don’t think many would argue that German competiteveness was harmed as a result. Given the unfolding crises in: 1) care workforce recruitment – anybody with a degree of involvement in the elderly care sector attributes part of the current problems of under-staffing partly to recruitment, itself the expression of a number of important problems, i.e. the low, social status of care work, the very low wages, the difficult, casualised hours, the lack of appropriate support and supervision, the responsibility placed on individual workers over vulnerable people, the very poor terms and conditions of employment ; 2) care workforce human capital investment deficit – training, development, personnel care, career structures are almost virtually non-existent particularly in the for-profit care sector; 3) the care workforce wage discrimination – for the same level of qualifications and experience you are more likely to be paid less if you work in care relative to other sectors; 4) the number of instances of extremely poor quality care and of the governance and regulation of care providers, to suggest that telecare is the answer to raising the quality of life of people in need of social care services seems a very weak proposal indeed. Of course, telecare is not just an instrument in a political, macro-economic strategy. It can also through appropriate mechanisms and institutions be an extension of our capacity to contribute something to those who trust us by allowing us to care for them. However, this potential of telecare cannot be realised in the current context of governmental, public, media and institutional neglect of the people in need of care services and of the care workforce. Academic work on telecare clarifies in my view exactly why the potential of telecare will remain unfulfilled in the way the government is introducing and expanding its application in care services disregarding the context of people’s lives and of those who provide care professionally.

  8. Response from an Oldie.
    I can understand the reasoning behind electronic surveillance but if it is to be used as a means for cutting costs it is really sad and will create more problems than it solves. There are already similar schemes up and running for elderly people with chronic health problems who live in remote rural areas with few or no public bus services; these schemes link them with surgeries and other services. What has been the feedback from these schemes? The lack of human contact in all such schemes really worries me.
    I wonder if this research is going hand-in-hand with voluntary organisations working in this field apart from Age UK? What is the response to this idea from the many state and private care schemes that are allocated just a few minutes to provide ‘care’ with no time for dialogue with their clients, let alone time to prepare them a proper meal!
    I trained to be a social worker because I was interested in working with people. Times were very different then (it was pre-Welfare State). Whilst I fully appreciate the pressures that abound today, it does seem as though the elderly always get put on the waiting list.

  9. The multiple considerations for independent living can be quite bewildering. I’m not aware of provision in GP services specifically for the problems of  older people and independent living. Drs and nurses deal with clinical problems that become commoner or more serious as people age and they refer patients to occupational health and community nurses, but it seems to be social workers who do the recommendations for telecare and people are often quite frail by the time they are referred to a social worker. Telecare often goes in to a person’s home after a crisis such as an accident or a spell in hospital, it’s not easy to adjust to new technology when you are also dealing with recovery from illness or the loss of confidence that often follows a fall. Nobody seems to be pasting together the full picture of older patients and  giving them information to think about as they go along, so that they can be informed about telecare before they actually need it. Perhaps this is seen as a holistic approach too far.
    I think it is also essential that all new telecare devices should be developed with frequent and in-depth consultation and practice with older people. It is hard for people under retirement age to imagine the difficulties and frustrations experienced by those who struggle with diminishing sight, hearing and dexterity. It is not enough to make things simply bigger or louder. Good design and an in-depth understanding of the challenges of life over 70, 80 or (increasingly) 90 could solve a lot of problems.

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