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					 Assistive Technology




        Help the Aged
Policy Statement 2007
Summary                                                    These benefits are exemplified by quotes from
                                                           older people:
Assistive technology (AT) is any product or service
designed to enable independence for disabled and           ‘Now if it weren’t for those bed levers I wouldn’t be able
older people (King’s Fund consultation, 2001).             to turn over on my own.’
Among other things, AT can include wheelchairs,            ‘I couldn’t use the taps before.’
scooters, walking sticks, ramps, curtain openers,
intercoms, amplifiers, stairlift, hoists, grab rails,      ‘You see how wonderful the window opener is.’
alarms, lighting, height-adapted kitchen, other aids
                                                           ‘I wouldn’t be without the shower.’
for daily living and environmental control systems.
                                                           ‘The door entry is a very good thing.’
Older people are a diverse group among whom
many factors affect expectations and demand for            ‘The community alarm is a godsend – it really is.’
AT: the potential user’s perceived need for it; the
desire to be independent; the working efficiency of
the technology; personal motivations and individual        Background
preferences; availability and cost.
                                                           There are currently approximately 1.4 million users
Increasing the use of AT has the potential to bring        of community alarms in the UK, and 138 community
many benefits. It can:                                     equipment services in England.
1   help unlock resources and redirect them                The Government has been increasingly supportive
    elsewhere in the system;                               of assistive technology in various policy documents,
2   increase choice and independence for services          acknowledging its ability to reduce waiting times,
    users;                                                 prevent avoidable admission to acute services and
                                                           support hospital discharge.
3   reduce the burden placed on carers and provide
    them with more personal freedom;                       In July 2002, it was specifically endorsed by the
                                                           Health Select Committee:
4   contribute to care and support for people with
    long-term health conditions;                              ‘The report recommends that the Department of
                                                              Health establish “a national strategy to promote the
5   reduce acute hospital admissions;                         systematic development of telecare solutions as part
                                                              of a spectrum of care at home”. It also calls for the
6   reduce accidents and falls in the home (and
                                                              Government to examine ways of facilitating greater
    reduce associated depression);
                                                              uptake of Telehealth solutions within both health and
7   support hospital discharge and intermediate               social care.’
    care;
                                                           Since then, interest has continued to grow and a
8   contribute to the development of a range of            wide range of government reports, statements and
    preventative services;                                 initiatives has been published on this issue.

9   help those who wish to die at home to do so            Opportunity Age (2005), the Government strategy
    with dignity;                                          for an ageing population, highlighted the importance
                                                           of the telecare policy collaborative within the DH.
10 reduce the need for residential/nursing care;
                                                           The Use of New Medical Technologies within
11 help people to remain living in their own homes         the NHS (2005) called for greater collaboration
   for longer.1                                            within NHS on implementing new technologies
                                                           that could benefit patient care. It recommended
                                                           caution in the use of telecare within domiciliary
                                                           environments to ensure that telecare systems
1 These benefits are set out extensively in government     actually meet a person’s needs. The Government’s
  and other research studies and publications including    response to the report set out the Government’s
  Department of Health guidance on the Preventative        strategy for technology within health care.
  Technology Grant (2005) and Improving Life Chances for
  Disabled People (2005).
                                                                                                                    2
The Department of Health Vision for Adult                  Helping people to remain independent in their own
Social Care (2005) noted that ‘telecare has huge           homes can prevent or delay unnecessary admission
potential to support individuals to live at home, and to   to residential care; a delay by one year saves
complement traditional care. It can give carers more       £26,000 per person compared to the average cost
personal freedom and more time to concentrate on           of an adaptation of £6,000. Adaptations that could
the human aspects of care and support and will make        enable an older person to move out of residential
a contribution to meeting potential shortfalls in the      care into their own home could save £10 million in
workforce.’                                                England.
Our Health, Our Care, Our Say (2006) refers                In 2000, the cost of hip fractures resulting from
to the Preventative Technology Grant, and to               falls was £726 million. The cost to society of a
the role of technology as supporting health and            fractured hip is approximately £28,000 (treatment
independence.                                              and support post-discharge), which is 4.5 times the
                                                           cost of an average housing adaptation and 100 times
The Department of Health Guidance on the                   the cost of grab rails that can prevent falls. Older
Preventative Technology Grant (2005) set                   women suffering from depression are at increased
out expectations for the new £80 million grant             risk of hip fracture: improvement in mental health
programme                                                  is one of the biggest benefits of housing adaptations.
Improving Life Chances for Disabled People                 Visual impairment leads to 90,000 falls a year
(2005), the government strategy for improving the          costing £130 million in England and Wales alone,
quality of life for people with disabilities, includes     and the chance of a hip fracture is six times higher
an analysis of the potential benefits of telecare in       for those with poor depth perception. Adapting the
delivering the agenda.                                     home and lighting can help reduce the triggers for
                                                           falls resulting from visual impairment.
Telecare Implementation Guide (2005) provided
a comprehensive resource for local authorities and         Delays in providing crucial housing adaptations can
other partners in delivering on the telecare agenda.       lead to pressure sores, ulcers, infections, burns and
It highlights how the telecare agenda fits with the        pain which could otherwise be prevented. Delays
wider health, housing and social care agenda.              are often due to a lack of funding and can result in
                                                           inadequate solutions.
Hi-tech Home Healthcare (2007) In May 2007
the Government announced a series of pilots of             Assistive technology through housing
hi-tech home healthcare. These aim to help older           adaptations
people and those with long-term conditions and
leading more independent lives by using remote             Although there is a great need for housing
monitoring devices to help them manage their               adaptations to aid independence, structural
condition. The telehealth element involves people          alterations cost far more initially than the
monitoring their own vital signs, such as blood            installation of low-level or novel hi-tech equipment,
pressure or blood sugar, with results monitored            although they can pay for themselves and create
remotely. The telecare elements use sensors in the         substantial savings in the long term.
home to carry out tasks such as switching on lights
and activating an alarm.                                   ‘Smart homes’ can provide assistive technology in an
                                                           integrated way, with systems working automatically
                                                           or in accordance with programmed criteria.
Issues
                                                           As JRF explains:
Cost-effectiveness                                         ‘Where the smart house really differs from other houses
                                                           is that a communications infrastructure is installed that
Most assistive technology and housing adaptations
                                                           allows the various systems and devices in the home
are much less expensive in the long term than
                                                           to communicate with each other.The modern home
conventional homecare, providing cost savings
                                                           contains a variety of systems, such as central heating,
through reducing or removing existing spending on
                                                           fire and security alarms, and devices, such as televisions
homecare.
                                                           and lights, that usually exist in total isolation from each
                                                           other. In the smart house, these systems and devices are

                                                                                                                     3
able to pass information and commands between them       •	 information for older people about where they
so that, for example, the security alarm can turn the       could obtain funding for new technologies and
lights on or off.’2                                         what state support is available.
‘I don’t want to live in a smart home – I’d rather be    One of the challenges is that the technology
dead.’ (older person’s comment)                          changes rapidly (as does the cost of it). Information
                                                         is readily available on the internet, but this may be
Many older people who could benefit from                 of limited direct use to the 80 per cent of older
housing adaptations do not receive homecare,             people who have never accessed the internet.
and many who do could not benefit from housing
adaptations because of the character of their needs      Funding for telecare and AT
or the appropriateness of their home. At the same
time, there is currently no legislation to require       At first glance it would appear that there are a wide
housing to meet ‘Lifetime Home’ standards, which         range of sources of funding for assistive technology
ensure that housing can meet the needs of all ages       and telecare.
(including facilitating easy adaptations). Inadaptable
houses may prevent some assistive technology from        Funding to undertake and initiate telecare projects
being introduced.                                        is available from a large variety of sources, including:
                                                         •	 Access and Systems Capacity Grant;
Information about assistive technology                   •	 bids for improvements to ‘extra care’ housing;
Many people do not know what assistive technology        •	 charitable sources;
is, what is available, where information can be
found or where to access AT. Accessing AT is often       •	 Disabled Facilities Grant;
through a ‘disability’ route, relying on the older       •	 Social Fund;
person identifying themselves as disabled, which can     •	 equity release;
mean that many who do not regard themselves as
such never access the information or services.           •	 housing associations;

Two aspects of information provision are inadequate      •	 individual purchase/hire, rents, service charge
in relation to assistive technology:                        or support costs/fees (e.g. social services
                                                            departments);
•	 information about what technologies are               •	 local councils and the NHS, which can use
   available and how they could help older people           Section 31 of the Health Act 1999 partnership
   with their day-to-day lives                              arrangements;

2   http://www.jrf.org.uk/housingandcare/smarthomes/                                                             4
•	 locally across health and social services in            intended to help. The technology can also prove
   relation to delayed discharge protocols and             unreliable.
   intermediate care initiatives.
                                                           Many products have been designed by young people
However, the fact that there is diversity of funding       for young people and many technologies require a
does not mean there is adequate funding.                   degree of media literacy. With only one in five older
The Government’s Preventative Technologies Grant           people having ever accessed the internet and levels
(£80 million) funded a series of projects to explore       of media literacy among older people considerably
the role of telecare across England. The projects          lower than those of younger people, more needs to
sought ‘to initiate a profound transformation in the       be done to educate and inform older people about
design and delivery of health and social care services     how to use the new technology. Government must
and prevention strategies to enhance and maintain the      invest in adult and continuing education to ensure
well-being, self-esteem, independence and autonomy of      older people have opportunities to learn.
individuals by using electronic technologies to support
them to live safely and securely at home’.                 Lack of co-ordination/joined-up services

Government invested the funding over two years             While many government departments and local
to contribute to the delivery of the NSF, the NHS          authorities have shown great enthusiasm for
reform agenda and the Vision for Adult Social              assistive technology, the lack of sustainable joined-
Care: £30 million was available for 2006/7, and            up government initiatives can only slow down the
£50 million for 2007/8. However, the funding was           progress. Despite the wide range of funders and
not ring-fenced, which meant that the resources            ‘prescribers’ of assistive technology, co-ordination is
expended often failed to deliver the intended              lacking.
outcomes.                                                  The transition to digital TV could offer a delivery
However, while there are a large number of                 mechanism for some assistive technology. However,
different funding options, given that people are often     the lack of joined-up thinking within government
expected to wait many months for an assessment             means that we are unlikely to make the most of the
for a relatively cheap aid such as a bath rail, it seems   opportunity.
unlikely that Government will ever find it possible
to invest in hi-tech solutions for the many rather         Moral and ethical considerations
than the few, despite the cost/benefit argument.
                                                           There is a great appetite among AT providers to
                                                           use AT to deliver care or ‘solve the problem’ of
The limits of assistive technology                         increasing numbers of older people with dementia
While the potential of assistive technology is             living in their own homes, rather than in care homes
undisputed, it cannot be a panacea for all problems        or other institutional settings. This, however, creates
relating to housing and care. It is important to           a challenge in terms of society’s desire to protect as
acknowledge that assistive technology will not             opposed to the individual’s right to independence,
be able to completely replace the sort of care             most starkly illustrated by the question of
traditionally provided by nurses and other social          whether people with dementia should be tagged
care professionals.                                        electronically to monitor their movements. There is
                                                           a very fine line between technology that promotes
It could be argued that while there is a role for          independence and technology that threatens
AT, technology is much more successful if services         individual liberty. The question of risk, as well as
are already efficient. As Bill Gates has noted: ‘The       the need to respect human rights, must be a key
first rule of any technology used in a business is that    consideration.
automation applied to an efficient operation will
magnify the efficiency.The second is that automation       As the technology develops, we need a debate
applied to an inefficient operation will magnify the       about the moral and ethical issues concerning the
inefficiency.’                                             use of technology, including how to ensure that
                                                           basic human rights are not compromised by the
Many older people report a negative experience of          introduction of new technology.
some forms of AT, with usability, accessibility and
poor design frequently failing the people it is most
                                                                                                                 5
Using professionals                                     For assistive technology to provide optimal
                                                        benefit, it needs be made available in a timely
Occupational therapists and other health                and appropriate way, regularly reviewed, and with
professionals are in a unique position in terms of      adequate support and training for staff, carers and
assessing the potential and introducing assistive       the older person.
technology. There is a need to ensure health
professionals have continued access to information      A holistic approach to funding is needed, together
and training on the types of AT and where they can      with much better government co-ordination. Also
most effectively be introduced.                         needed is a commitment to review the Social Fund
                                                        and extend the ability of the Disabled Facilities
                                                        Grant to help individuals invest in technology.
Help the Aged recommendations
Older people must be party to decisions about AT.       Help the Aged activities
They can influence the way it is designed as well as
how it is provided.                                     Help the Aged is a provider of telecare services
                                                        through its SeniorLink service. (SeniorLink is a home
Government should consider setting up a cross-          telephone service that connects the older person
departmental working group to consider how to           to a response centre for emergency assistance or
make the most of assistive technology in an ageing      assurance. The service is provided either free of
society.                                                charge for those who meet the charitable criteria,
The private sector should better market assistive       or on a paid-for basis.) We also market a variety of
technology to older people.                             assistive technology items on a commercial basis,
                                                        through our Home Shopping service.
Many forms of assistive technology are introduced
too late (e.g. after someone has had a fall). A major                                                September 2007
campaign from the private, public and voluntary
sectors is needed to encourage people to take up        Help the Aged publications
the technology where it has the potential to be
genuinely preventative.                                 Housing Choice for Older People: a discussion paper,
                                                        2006
Technology should be better designed to meet the
needs of older people (more accessible, usable and      Older People, Decent Homes and Fuel Poverty: an
reliable). Case law should test the provisions of       analysis based on the English House Condition Survey,
the Disability Discrimination Act in relation to this   2006
issue. Older people should be better consulted by       Housing Priorities of Older People, 1997
industry in relation to the design of new technology.   Technology for Living Forum UK – conference report,
Government should invest in media literacy to           1998
raise awareness of the potential of new hi-tech
opportunities.



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