Attitudes to telecare among older people, professional care workers and informal carers: a preventative strategy or crisis management?

Abstract

This paper reports findings from an attitudinal survey towards telecare that emerged from twenty-two focus groups comprising ninety-two older people, fifty-five professional stakeholders and thirty-nine carers. These were convened in three different regions of England as a precursor to telecare service development. The results from this study suggest that informants' views were shaped by prior knowledge of conventional health and social care delivery in their locality and the implication is that expectations and requirements in respect of telecare services in general are likely to be informed by wider perceptions about the extent to which community care should operate as a preventative strategy or as a mechanism for crisis management. to 'mainstreaming' telecare services in the homes of older people.A major impetus for the formation of the consortium was the inclusion of three project partners where live telecare installations were planned to take place within the lifetime of the project. These provided field sites for action research that constituted three very different physical settings, each representing a major type of housing for older people.Barnsley's patients are living in mainstream housing stock, much of which comprises ageing terraced and semi-detached houses and post-war council flats that were not inclusively designed. The Anchor Trust is developing a technology-enabled retirement village in South Bucks, with houses and bungalows for sale to more affluent older people as well as affordable housing in the form of flats and bungalows for rent, whilst Thomas Pocklington Trust, a leading provider of housing for people with impaired vision, is currently upgrading its extra care housing scheme for older people in Plymouth. Before embarking on any telecare interventions in these varied physical settings, the consortium felt it was important to benchmark the opinions and attitudes to telecare held by older people, care professionals and informal carers in all three areas where the service would subsequently be introduced. What is Telecare?Promoting the independence of older people forms a key part of the government's health and social care agenda, and new care delivery models supported by information and communication technology (ICT) are being developed to assist in realising this goal [2,3].Telecare is one such model that uses ICT to bring health and social care directly to the end user by providing safety and security monitoring, physiological health and activity A typical telecare service involves a system connecting sensors of various kinds that are dispersed in the homes of (or worn by) an older person, to a call centre. The sensors are either activated directly by the user, or raise an alert passively by recognising and responding to a change in the user's status such as a fall. The alert goes to a call centre, which then triggers a response that may involve informal carers, resident or mobile support staff or an emergency service, as required [8]. In some ways, then, telecare is simply an e...

Use of telemedicine-based care for the aging and elderly: promises and pitfalls

“…If the system is given a chance to fit into the everyday lifestyle of the elderly, giving them a sense of security and at the same time allowing them to lead a more independent life, its acceptance will increase significantly. 25,69,89 A study performed by Bujnowska and Pirogowicz 64 showed that approximately 41% of the elderly had a favorable attitude toward e-health services and were willing to use it if/when offered an opportunity to do so. A substantial majority (84%) of supporters expressed a desire to receive simple medical recommendations via mobile phone or a computer, although significant majorities (61% and 60%, respectively) wanted to receive the results of tests by email or SMS reminders for scheduled visits or prescribed medications.…”

“…25,69,93 Until now, telecare solutions have tended to be closed, single-purpose, inflexible, and specialized. The needs of seniors vary widely and can change over time.…”

“…Concerns have been also raised about the ethics of monitoring older people's behavior in the privacy of their own homes and regarding the difficulty of ensuring that consent to be monitored by information and communication technology is genuinely "informed" when the recipient of the technology is frail or confused. 69,88 Privacy and security are central personal fears for older adults. Many attitudes and perceptions of patients are centered on the potential privacy issues that arise with the improved range and resolution of data (such as video streaming and still images) and the improved technology that enables a person's location and activity to be tracked.…”

“…At the same time, patients can receive an appropriate level of care nearest their homes, which in the case of older people with chronic disease/disability is a matter of particular importance and determines their quality of life and care. 63,69 Finally, it should be borne in mind that telecare can support patients with severe mental and/or physical disability and their families/caregivers. 24,70 A disoriented, fearful, suspicious patient with progressive dementia or the person who has had a stroke and is not able to perform even basic activities of daily living (such as dressing, eating, moving, bathing) losses their autonomy and becomes totally dependent on other people.…”

“…It is therefore necessary to personalize and customize telecare systems for a variety of abilities of seniors, addressing their evolving care needs in a flexible and adaptable way, each time taking into account their impaired sensory (eg, sight, hearing), motor, and/or mental function. 69 All elderly persons must be familiar with the operation and aware of the benefits of telecare systems before becoming users. Further, perceived ease of use of home telecare is a significant predictor of compliance with telecare on the part of older people and their caregivers.…”