assistive technology report

8/21/2019 Assistive Technology Report

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Research on the provision of AssistiveTechnology in Ireland and other countriesto support independent living across the

life cycle

Kevin Cullen, Donal McAnaney, Ciaran Dolphin,

Sarah Delaney and Philomena Stapleton

Work Research Centre

Dublin

February, 2!2


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Ackno"ledge#ents

The authors are grateful for the contributions of the experts from the othercountries covered in the study: Gert Jan Gelderblom, Zuyd University,Netherlands; abrina !incenti and "en#o $ndrich, %onda#ione &on 'arloGnocchi (nlus, )taly; Ter*e und and +ise %*eldvi, Nor-egian +abour and.elfare ervice; /ary 0etersen, 1ri $rendal and 2se 3randt from theNational "esource 'entre on &isability, $ssistive Technology and ocial0sychiatry of the National 3oard of ocial ervices in &enmar; and4arsten Gareis, empirica, Germany5

)n addition, -e extend our thans to the many people from the assistivetechnology 6eld in )reland 7both public and voluntary sector8 -hogenerously made time and provided much useful information for theresearch5

.e also than %rances 9annon and Ger 'raddoc, National &isability$uthority, for their help and guidance throughout the -or5

&)'+$)/1"

The National &isability $uthority contracted ."' to conduct this research5

The vie-s expressed in the report are those of the authors and do notnecessarily reect the vie-s of the National &isability $uthority5


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Contents

$%$C&TI'$ (&))AR*+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++i

! ITR-D&CTI-++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++!

1.1 THE SCOPE OF THE AT DOMAIN................................................................................................1

1.2 ABOUT THE STUDY...................................................................................................................4

2 R$.$'AC$ AD I)/-RTAC$ -F AT I T0$ IRI(0 C-T$%T++++++++++++++++++++++++++++++++++1

2.1 DATA FROM THE NPSDD AND NATIONAL DISABILITY SURVEY..............................................9

2.2 POLICY RELEVANCE AND IMPORTANCE...................................................................................18

T0$ AT /R-'I(I- (*(T$) I IR$.AD+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++22

3.1 HOME/COMMUNITY/EVERYDAY LIFE.......................................................................................22

3.2 EMPLOYMENT.........................................................................................................................33

3.3 EDUCATION.............................................................................................................................393.4 CROSS-CUTTING PROVISIONS..................................................................................................54

3.5 EDUCATION AND TRAINING IN AT SILLS...............................................................................5!

3 AT /R-'I(I- (*(T$)( I -T0$R C-&TRI$(++++++++++++++++++++++++++++++++++++++++++++++++++++++++41

4.1 U..........................................................................................................................................59

4.2 NETHERLANDS........................................................................................................................!1

4.3 DENMAR ...............................................................................................................................!!

4.4 NOR"AY..................................................................................................................................84

4.5 ITALY.......................................................................................................................................9#

4.$ GERMANY...............................................................................................................................95

4 5$* I((&$( AD T0$)$(++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++!2

5.1 POLICY IMPORTANCE GIVEN TO AT.......................................................................................1#25.2 COVERAGE ACROSS SETTINGS AND THE LIFECYCLE.............................................................1#4

5.3 R OLE OF NGOS.....................................................................................................................11!

5.4 %UALITY ASPECTS OF AT SYSTEMS AND SERVICES...............................................................119

5.5 MARET FUNCTIONING AND COSTS......................................................................................13!

5.$ DEVELOPMENTS IN TELECARE& TELEHEALTH AND OTHER RELATED FIELDS........................14#

6 (*T0$(I( AD R$C-))$DATI-(+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++!36

$.1 MORE ATTENTION AND STRONGER STRATEGIC POSITION FOR AT IN POLICY........................14$

$.2 STRENGTHENING THE AT PROVISION SYSTEMS IN THE THREE SETTINGS.............................148

$.3 COORDINATION AND CONTINUITY ACROSS SETTINGS& TRANSITIONS AND LIFECYCLE..........153

$.4 SOME SPECIFIC %UALITY IMPROVEMENT AND OTHER MEASURES........................................155

$.5 SYNERGIES "ITH RELATED AREAS AND BUSINESS DEVELOPMENT OPPORTUNITIES..............1$1

.I(T -F ACR-*)( AD A77R$'IATI-(++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ !6


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$8ecutive su##ary

The 6eld of $ssistive Technology 7$T8 concerns the practical tools that cansupport functional needs of people -ho experience diculties lined to

disability or ageing5 )t encompasses a broad spectrum of lo- tech andhigh tech technologies, for example, -aling frames, -heelchairs, hearingaids, vision aids and computer everyday life, employment and education5 The maincountries covered -ere )reland, &enmar, Nor-ay, Netherlands, )taly andthe U4, as -ell as a more limited coverage of Germany 7employmentsetting only85 These -ere selected to reect a number of di?erent -elfaresystems and -ays of funding and organising $T provision5 The overall

ob*ective -as to provide guidance for the future development of the )rishsystem in -ays that -ould reect established or emerging good practice inthe 6eld5

The report is organised into six main 'hapters5 'hapter @ provides an)ntroduction, outlining the scope of the $T domain and describing themethodology used in the study5 'hapter A discusses the relevance andimportance of $T in the )rish context, including ne- analyses of existingdata from the National 0hysical and ensory &isability &atabase and from

the National &isability urvey of ABBC5 'hapter D presents a descriptionand appraisal of the current )rish $T provision system7s8 as they apply to

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the three core settings < home>community>everyday life, employment andeducation5 'hapter E presents a description of core aspects of the $Tprovision systems in each of the other countries, covering thelegislative>policy context and the mechanisms and procedures for $T

service delivery5 'hapter F identi6es and discusses some ey themes andissues arising from the system descriptions in 'hapters D and E as -ell asin relation to a number of speci6c themes that -ere also examined in thedi?erent countries5 'hapter C presents a synthesis and recommendations,-ith the main conclusions and recommendations organised in accordance-ith the follo-ing schema5

The main points are summarised belo-5

Need for greater recognition of the importance of AT and the

value for money it represents

The importance of $T and the value for money that it can provide seemsgenerally not as -ell recognised in )reland as it is in some of the othercountries covered5 )t is concluded that:

• $ssistive technology could be given more attention and importance inpolicy on older people and people -ith disabilities, per se, as -ell as in

policy on -ider issues facing the health social care system; it needsto be speci6cally identi6ed as an important dimension in all relevantpolicies and programmes and this needs to be follo-ed


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9ealth and social care system

• The )rish system of $T provision -ithin health and social care is under<developed in comparison to the 6ve other main countries covered inthe study; there is a need to develop a modern and e?ective approach,

-ith assistive technology services clearly de6ned and made visibleamongst the range of services that are provided5

• The modern Kassistive technologyK terminology>conceptualisation mightbe more appropriate than the narro-er Kaids and appliancesK one that iscurrently employed in the 91 and -ould be more in line -ith theapproach in other countries -ith -ell


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1ducation

• There is a need for guidelines to be easily available to primary andsecondary schools and professionals, providing clear information oneligibility criteria and school responsibilities, and describing the service

path-ay for accessing $T, supported by case studies for clari6cation;there is currently no such guidance for primary schools or speci6callyfor assessing professionals5

• 'onsideration should be given to putting in place a more formalapproach to follo- up and monitoring of $T usage and impact includingan analysis of the -ay in -hich $T, -hich has been accumulated byschools, is being utilised to provide support for other learners -ithdisabilities5

• $n important issue to be addressed is the most e?ective -ay to ensurethat learners, -ho reHuire it, are given the training necessary to ensurethat they get the best out of the $T they are provided -ith5

• $ revie- is needed of eligibility criteria for learners -ith high incidencedisabilities, that is, those disabilities that occur more freHuently in thestudent population, such as mild general learning disability, -ho reHuireinformation technology support in primary and secondary education-ith reference to the approach being implemented in higher education5

• %ormal support for net-oring and no-ledge sharing bet-eeneducators and professionals -ith a speci6c responsibility or interest in$T could assist in raising a-areness of ne- developments and support

higher standards of assessment and applications for $T5• $n important concern is ho- best to mae expertise available at a local

or regional level to support schools and parents in understanding thepotential of appropriate $T and to contribute to continuing teachereducation5

• There is a need for a more consistent approach in the further educationsector particularly across !ocational 1ducation 'ommittees 7!1's8, the)nstitutes of Technology and post


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is to replace %oras Liseanna aothair 7%L8, National 'ouncil pecial1ducation 7N'18, &epartment of 1ducation and ills, 'iti#ens)nformation 3oard 7')38, the ey disability NG(s providing $T services,&epartment of 9ealth, National &isability $uthority 7N&$8, 9ealth)nformation and Iuality $uthority 79)I$8, 9ealth "esearch 3oard 79"38

and any other relevant players; N&$ might be an appropriate party totae the 6rst initiative to-ards the establishment of such a forum5

• (ne issue that needs to be examined concerns -ays of creating moree?ective and streamlined access to $T for individuals -ho have beendeemed eligible for $T in one part of the system as they transitionbet-een settings; ey transitions to be addressed include thosebet-een di?erent levels of education as -ell as bet-een education andemployment; an extended version of the Muser pass approach fromNor-ay might be one option to consider in this regard5

• There are many other areas -here coordination and synergies acrossplayers and settings -ould be useful; some examples of these arementioned in the context of the themes raised belo-5

Specic quality improvements and other measures

)n order to develop an )rish approach that is in line -ith existing andemerging good practice in other countries there are a number of speci6careas that need to be addressed5

tandards

• ervice Huality standards need to be developed and applied in the $Tservices 6eld in )reland5 This can be informed by the variousapproaches in this area from other countries, including standards forservices as a -hole as -ell as for speci6c aspects of services5 The-oring group on standards in $T comprised of sta? from N&$s '1U&and N$) and chaired by '1U& might have a contribution to mae inthis context; this group has revie-ed a number of 1uropean and)nternational $T tandards including -heelchairs, mobility devices,voice recognition soft-are etc5

• %or Huality standards in $T provision by the health and social careservices, speci6c issues that need priority attention include:

o $cceptable standards for -aiting times for $T assessment and fordelivery after assessment need to be established andimplemented consistently across the country

o !ariations across the country in ho- 91 Kaids and appliancesKservices are organi#ed need to be addressed; a consistent,nation


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educational and employment settings also needs to be considered5

• 9)I$ -ould have a ey role in this in relation to standards for $Tservices -ithin the health and social care 6eld; a cross


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• $ttention needs to be given both to the inclusion of $T in initialprofessional education and to $T training as part of continuingprofessional development, -ith appropriate accreditation and utilisationof e?ective means of reaching frontline sta? including the use ofe+earning5

• The cross


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innovative and vibrant supply side5

• 0ossible -ays to inuence price and Huality of $T that is purchasedprivately also need to be considered; the impacts of the Mretail model inthe U4 on this aspect -arrant monitoring -ith a vie- to its possiblesuitability in the )rish context5

Synergies with related areas and business development

opportunities

• There is increasing convergence of standalone, special


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! Introduction

This study addressed the provision of $ssistive Technology 7$T8 to support

independent living across the life cycle5 )ts scope covered delivery of $T ineducational, -orplace and home settings, addressing the needs ofstudents and -orers -ith disabilities as -ell as people -ith disabilitiesand older people living at home5 The main focus -as to examine thesystems of provision of $T in )reland and in a number of other *urisdictions-ith relatively -ell


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headings in the )( classi6cation system:

• $ssistive products for personal medical treatment

• $ssistive products for training in sills

• (rthoses and prostheses

• $ssistive products for personal care and protection

• $ssistive products for personal mobility

• $ssistive products for houseeeping

• %urnishings and adaptations to homes and other premises

• $ssistive products for communication and information

• $ssistive products for handling ob*ects and devices

• $ssistive products for environmental improvement and assessment

• $ssistive products for employment and vocational training

• $ssistive products for recreation5

The )( standard provides detailed subdevice types5

)n recent years there has been interest -ithin the $T domain, especiallyamongst service providers>practitioners, to develop more operationallyuseful classi6catory systems5 $ focus has been on organising informationon $T in -ays that are practically useful for users and for professionals-oring -ith users to identify the $T that -ould best meet their needs5 )naddition, there has been a focus on ho- classi6catory systems lined tothe )nternational 'lassi6cation of %unctioning, &isability and 9ealth 7)'%8can be developed5A

)n the )rish context, the term assistive technology is increasingly usedalthough the older Kaids and appliancesK terminology also continues to beused in the health and social services5 $ good indication of the scope ofthe $T domain can be gained from the National 0hysical and ensory&isability &atabase 7N0&&85 The main categories and speci6c

2 for e-&p"e. the %"i/ s#ste& in the ether"nds

2


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technologies covered in the latest 7ABBP8 report from the database arepresented in 3ox @ and this sho-s the very broad range of items>productsconcerned5 %or purposes of the current study -e have maintained a broadscope approach to $T and have not focused speci6cally on particular

categories5 Nevertheless, -e have put the emphasis on $T that is moreto-ards the independent living domain than to-ards medical treatment5

)n addition, consideration has been given to ho- best to conceptualise the$T domain and its lins>overlaps -ith other domains5 The schema in%igure @ presents the conceptualisation that has been adopted for thepurposes of this study5

Figure 1. onceptualising the AT domain

!o" 1. Technical aids and appliances #N$S%%& '(()*

Aids to mobility+ 0o-ered -heelchair; scooter; manual specialised -heelchair; manualregular -heelchair; special pushchair or buggy; special bicycle or tricycle; portableramps; 6xed ramp; rollator; specialised -alers; frame>#immer; -alingstics>canes>crutches; guidance canes; support -hite stic; grab rails and bars; adaptedvehicles 7-heelchair rac for car, gears>lifts8; propulsion unit,rthotics - prosthetics+ 'ervical>lumbar supports; upper limb orthoses; upper limbprostheses; lo-er limb orthoses; lo-er limb prostheses; orthopaedic foot-ear 7e5g5 builtup shoe8; other prosthetic devices; other orthotic devices

ision aids+ !nformation technology for people with visual impairment: pecial computereHuipment; print>display magni6cation; screen reader and voice synthesiser; scanner;3raille printer; notetaer 7e5g5 3raille Mn pea8; character reading machines 7e5g5 4ur#-eil

9ome$daptations

9ome telehealth

mart homes

#elfare $echnology%

Assistive Technology

duction

&p"o#&ent

3


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reading machine8; &ow vision aids: /agni6ers; close circuit television; telescopes;overhead pro*ector; 'raille equipment: 3raille 0erins machine; 3raille paper; &ymogun;other braille eHuipment; audible>tactile devices 7e5g5 taling scales, clocs8; -riting aids7e5g5 -riting frame8; light 6ltersAids to hearing+ 0ersonal listening devices 7e5g5 loop system8; fax>telephone devices;teletext eHuipment>caption readers; hearing aid 7incl5 cochlear implant device>digital

hearing aid8; alerting devices; videophoneommunication aids+ 9igh technology communication devices; lo- technologycommunication devices; tal tools; accessories for telephoning/ncontinence aids+ Neurostimulator; catheters; bags>pads; aids for continence training;urinary prosthesisSpecial furniture and other aids to personal care+ 9oists; po-ered hoists 7includinghydraulic car hoist8; manual hoists; overhead hoists0ifts+ %loor through ceiling lifts; stair lifts; external liftsSpecial bed or bedding+ 0o-ered beds; manual beds; pressure relieving beds; pressurerelieving mattresses; bed accessories 7e5g5 boards, poles and ladders8; mattress raiser;beddingAids to lying+ !arious -edges>rolls; sleep systems 7e5g5 //1T")leep8Aids to toileting+ 'ommode; potty chair; adapted toilet seats; toilet surrounds; bidet;urine bottle; specialised toilets 7inc raised toilets8Aids to bathing+ pecialised bath; po-ered bath aids 7e5g5 bathlift8; manual bath aids7e5g5 bath seat8; sho-er aids 7e5g5 chairs > trolley>shield etc58; bathroom grab rails andbars; adapted -ash basin 7including height ad*ustment, lever taps and special shape8;adapted sho-erAids to sitting+ pecialised chairs 7perch stool>chair8; car seats; high chairs for children;pressure relieving cushions; -edges; chair raiser; custom specialised seating insert;devices for supporting the legs and>or feetAids to standing+ 0arallel bars; standing frame; po-ered standing frame; sit


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domain of home adaptations overlaps to a certain extent -ith this and -illbe addressed to a certain degree in 'hapter D but is not the main focus ofour study5 +ie-ise, the domain of Ksmart homesK 7-hich includes homeautomation as -ell as a -ider range of multimedia applications for

entertainment purposes, energy control applications, and so on8 alsooverlaps -ith the assistive technology domain5 )n particular,Kenvironmental controlsK are a category of assistive technology5

Telecare and home telehealth di?er from these other areas in that they are7remote8 care services5 The core logic is to monitor and transmitinformation from the home>person to some form of care service that -illrespond to needs as they arise5 $ssistive technology, in the sense that theterm is generally used, can be considered to focus more on

products>eHuipment that are oriented to-ards providing immediatefunctionality to support an older person or person -ith disabilities and>ortheir local carer5 )n most countries, in fact, the $T domain has so far beenmore or less separate in terms of having its o-n place in the logic of thehealth>social care system and its o-n provision system, -ithtelecare>telehealth developments evolving as a separate domain5

(ther related concepts are also indicated in %igure @, namely, Kambientassisted living 7$$+8K and K-elfare technologiesK5 K$mbient assisted livingKhas begun to be used as an umbrella term to refer to applications of ne-technologies to support independent living for older people and the termK-elfare technologyK is used in some countries, especially the Nordic ones,to refer to the broad range of applications of technology in the health,-ellbeing and public services domains5

The focus of the current study is on $T as conceptualised above5Nevertheless, some relevant developments in telecare>telehealth and inthe emerging themes of Kambient assisted livingK and K-elfare technologyKare presented and discussed in section F5C5

!+2 About the study

This section outlines the focus and scope of the study and the researchapproach adopted5 The ey ob*ective of the study -as to identify goodpractice from other countries that could provide guidance for thedevelopment of the )rish $T provision system5 Therefore, the research andreporting -as intended to provide a thematic analysis and identi6cation ofuseful insights rather than a comparative analysis of the )rish and other

systems5

5


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Specic themes of interest

$ number of speci6c themes -ere addressed in the research:

• +egislation and policy context

• ystems and structures in place to deliver $T

• %unding of $T

• 0romotion of availability and no-ledge about $T

• Telecare and telehealth programmes

• 0ublic and private expenditure on $T

• /aret situation = competition, regulation, pricing arrangements

-ith suppliers

• &escription and assessment of the di?erent elements of the $T

delivery system

%actors that play an important role in terms of 6nal outcomes for

clients5

esearch approach

The main research methods -ere literature>des research andintervie-s>consultation -ith relevant experts and other staeholdersD54ey elements of the approach and process included:

• 0reparatory -or to support the selection of the *urisdictions to be

covered in the -or

• )nformation gathering and documentation of the $T provision

systems in the selected *urisdictions

• )nformation gathering on the $T provision system7s8 in )reland

• 'ollation and analysis of data on $T usage and needs from ey )rish

3 he e-perts fro& the other countries re &entioned in the cnow"ed'e&ents theinterviews(consu"ttions in Ire"nd covered the spectru& of re"evnt p"#ers crossthe he"th(soci" cre. e&p"o#&ent nd eduction" sectors. inc"udin' pu!"ic'encies nd Os)

6


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sources

• %ocused examination of available literature>evidence on ey themes

• ynthesis and reporting5

election of the other urisdictions to be covered

The study brief reHuired the research to cover 6ve other *urisdictions,these to be selected to reect relatively -ell


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countries aimed to cover a number of di?erent -elfare regimes5

The other ey selection consideration -as that the countries should reectrelatively M-ellcoordination of provisionsacross all settings5 )n addition, there are other more speci6c aspects ofpotential interest and relevance, such as universality of coverage, Hualityassurance approaches and so on5

To address these selection criteria, the research team conducted anextensive preliminary collation and examination of available informationon the systems in other countries5 )nformation sources most useful forsuch purposes are those that describe a number of countries in acomparable -ay, including those directly addressing $T servicesF andthose that include $T services -ithin a -ider scope exercise5C 9o-ever,because such sources generally provide Huite limited and often unevendocumentation on the di?erent country systems, the preparatory scanningexercise -as extended through -eb search and collation of relevantmaterial from other relevant sources5Q )n addition, it -as necessary to loo

5 e"oitte 2003 Access to Assistive echno"o'# in the uropen nion) eport forthe uropen %o&&ission e"oitte ; A!i"it#net 2010 he Intern"


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to other sources for information about developments in telecare>telehealthas this tends to be a separate literature to the $T literature5R

3ased on this, 6ve main countries -ere selected for the core focus of the-or < &enmar, Nor-ay, Netherlands, )taly and the U45 )n addition,Germany -as included as an example of a country -ith a strong focus on$T in the employment setting5 Table @ presents an overvie- of theselected countries in terms of ey features of their K-elfare regimesK ofrelevance for the study5 The Nordic countries 7Nor-ay and &enmar8 haveparticularly -ell


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U4 Tax


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extraction and analysis of Huantitative data on $T usage and needs fromey )rish data sources5 There are t-o main resources in this regard < theNational 0hysical and ensory &isability &atabase 7N0&&8 managed bythe 9ealth "esearch 3oard 79"38 and the data from the National &isability

urvey conducted by the 'entral tatistics (ce 7'(8 in ABBC5 $considerable e?ort -as spent on preparing the 6rst ever focused analysisand e?ort to leverage the data that these provide in relation to $T5

-ocused e.amination of available literature/evidence on ey themes

The main focus of the literature -or in this study -as on literaturerelating to the $T provision systems in )reland and in the other countriesselected5 This tends to be more in the practitioner and>or grey literature

domains rather than in the peeror $T areas as-ell as a very heterogeneous mix in terms of types of research andmethodological robustness5 )n general, this is not a coherent body ofevidence that can be easily dra-n


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of speci6c issues that arise for the particular domain, but this -as beyondthe scope of the current study5 The approach adopted in the study -as togive some attention to relevant aspects of the di?erent sub


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-ere also examined in the di?erent countries5 'hapter C presents asynthesis and recommendations5

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2 Relevance and i#portance of AT in the Irish conte8t

This 'hapter aims to set the scene for the system descriptions and

analyses in later chapters5 ection A5@ loos at the importance of the $Tissue in terms of -hat can be gleaned from existing data sources,especially the data on $T usage and needs contained in the National0hysical and ensory &isability &atabase 7N0&&8 and the National&isability urvey of ABBC5 ection A5A then loos at the strategic policyimportance of $T in terms of its role in delivering on eHuality, independentliving and value for money in )rish policy5

2+! Data fro# the /(DD and ational Disability (urvey

)n recent years some data on overall levels of usage of $T in )reland andsome indication of the extent to -hich needs are being met has becomeavailable, including data from the National 0hysical and ensory &isability&atabase 7N0&&8 and the ABBC National &isability urvey5 These datasources thro- light on the importance of $T from a number ofperspectives5 They sho- that -hilst there are relatively large numbers ofpeople using $T, there is also substantial unmet need in this area5P )naddition, some preliminary analyses conducted for this study suggest that

these data sources could be further mined to provide insight into thecontribution that $T may mae to reduce the experience of participationrestriction amongst people -ith disabilities5

urrent levels of usage and unmet need

Tables A and D present data on current levels of usage and needs inrelation to $T, based on the N0&& and National &isability urvey,respectively5

9 As wi"" !e seen fro& the dt presented in this section. the >S is picin' upre"tive"# s&"" nu&!ers in co&prison to the wider popu"tion esti&tes co&in' forthe tion" is!i"it# Surve#. !oth in ter&s of users of A nd those with un&etneeds for A) One fctor in this is tht the >S on"# covers the under 65 'e'roup. "thou'h even for this 'e 'roup the nu&!ers re often sti"" consider!"#"ower thn those fro& the popu"tion esti&tes co&in' fro& the tion" is!i"it#Surve#

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Table A presents data for a selection of types of $T from the many di?erentcategories of $T that are included in the N0&&5 The focus is on those -iththe highest levels of usage and>or reHuirements -ithin each category5%rom this dataset the numbers -ith reHuirements 7de6ned in the N0& as

those -ho have already assessed needs and>or -ho reHuire assessment of needs8 for the di?erent types of $T are generally in the hundreds5 Thenumerically highest levels of such reHuirements are for grab rails and bars,alerting devices for people -ith hearing impairments, standard computersfor educational>social purposes, po-ered -heelchairs, and specialisedchairs 7perch stool>chair85

There are a number of important limitations to this database5 Theseinclude the voluntary nature of inclusion and the fact that it does not cover

the CFS age group5 9o-ever, it does serve to provide some indication ofregistered need amongst the age group targeted by the database5

The National &isability urvey of ABBC provides a more representativepicture of the population of people -ith disabilities, also including thoseaged CFS5 Given the nature of the survey, it covered a more restrictedand prelifts8

PRD EC D@F DC@

(rthotics prosthetics

+o-er limb orthoses @QEF @BA AQC DQR

(rthopaedic foot-ear 7e5g5 built upshoe8

@@BD RE ACP DFD

Upper limb orthoses CRD DF @BE @DP

!ision pecial computer eHuipment QRQ @AE D@P EED

$udible tactile devices 7e5g5 talingscales, clocs8 FAP CE @E@ ABF

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0rint>display magni6cation EBE EF @F@ @PC

/agni6ers CRP DQ @DB @CQ

9earing $lerting devices CCF @EP CFF RBE

9earing aid 7incl5 cochlear

implant>digital hearing aid8

@PRP @DP DQQ F@C

%ax>telephone devices ERF CC AFD D@P

0ersonal listening devices 7e5g5 loopsystem8

ACD FF A@Q AQA

'ommunication

9igh tech communication devices @EA DF @DD @CR

+o- tech communication devices PP @@ DP FB

9ome>$&+ pecialised chairs 7perch stool>chair8 @ACQ @@Q EDE FF@

0o-ered beds @DPP FR DDF DPD

4itchen aids DQP AP DAE DFD

$ids for grasping, holding, reaching7e5g5 picreaching aid, ey>doorhandle opener, non


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s-itchK9earing aid7s8 -ith KT<s-itchK

@R5A @B,ECE @C5D P,E@C

'ochlear implants A5P @,CCF Q5@ E,@@A0hone related devices @B5@ F,RAQ @D5B Q,FBC

/obile phone for texting A@5C @A,EFR D5R A,ABA%ax machine E5A A,EAR A5P @,CCRpeedtext D5A @,RCR @5P @,@@Q'omputer tocommunicate e5g5 ealarms

P5P F,CRA @D5A Q,CB@

$ loop A5D @,DEP A5R @,CDD

Speech DF,DDF!oice ampli6er @5@ DRA D5@ @,@BB'omputer or eyboard R5@ A,RFQ R5B A,RDA'ommunications board F5E @,PBP Q5R A,QFP

:obilityandde"terity @RE,BBC

.aling aids EF5D RD,D@P F5R @B,QAD/anual or electric-heelchair or scooter

@Q5@ D@,E@A E5R R,PAD

0ortable ramps R5E @F,EQA Q5C @D,PEQ$ssistive devices forsupport or grasping

@F5E AR,EBQ R5Q @C,BRD

Grab bars or bathroomaids

DF5@ CE,FBB @Q5E DA,BFD

+ift, stair lift F5Q @B,EDD @B5E @P,BCC9oist or similar device R5E @F,F@A E5R R,P@R

/ntellectual andlearning

Q@,FRP

creen reading soft-are,learning support soft-are

@F5P @@,EBR @F5D @B,PEB

General products andtechnology for education

@R5B @A,RQR @F5A @B,P@Q

emembering andconcentrating

@@A,PRC

0roducts or technology forpersonal use in dailyliving 7such as automatedreminders or calendars8

@Q5@ @P,AQC P5Q @B,P@R

%rom the National &isability urvey data, %igure A sho-s the numbers ofpeople -ith unmet needs5 $s can be seen, numerically the highest levelsof need are indicated for grab bars 7more than DA,BBB8, hearing aids, -ithor -ithout Tdexterity 7more than @C,BBB8,portable ramps 7almost @E,BBB8, products or technology such asautomated reminders or calendars 7almost @@,BBB8, general products andtechnology for education and -aling aids 7almost @@,BBB85

Figure '. Types of AT with high levels of unmet need #absolute

17


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numbers* 6

National %isability Survey #'((8*

(verall, both the National &isability urvey and N0&& data suggest thatthere are high levels of unmet needs for $T across the spectrum, from lo-cost and relatively lo- tech items 7e5g5 grab bars, -aling aids andportable ramps8 to higher cost and relatively high tech items 7e5g5 lifts,electric -heelchairs8, as -ell as for computereducational purposes and personal listening devices5 %rom theNational &isability urvey 7%igure E8, types of $T for -hich less that FB of

need is met include voice ampli6ers for people -ith speech disability,cochlear implants, lifts or stair lifts, communications boards, loops, screen

18


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readers for visual disability, visual>vibrating alerts for hearing disability,and phone related devices for hearing disability5

19


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Figure 7. Types of AT with high relative unmet need #NS$%%*

Figure ;. Types of AT with high relative unmet need #National

%isability Survey*

20


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)t is also of interest to examine age patterns5 %igures F and C present theage pro6les of those currently using and those reporting a need for the

di?erent types of $T, respectively5

%igure F sho-s the age composition of those using technical aids 7National&isability urvey85 $s sho-n, the current user base is predominantly agedover CF 7and amongst this age group, predominantly aged QF and over8for some types of $T 7lifts or stair lifts, hoists or similar, hearing aids-ithout T


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case covering a fairly broad spectrum from lo- tech mobility aids to highertech computer


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%igure Q sho-s the percentages in each age group in the relevant disabilitygroupings 7seeing, hearing, speech, mobility and dexterity, intellectualetc8 that report using and needing the di?erent types of $T for thatdisability grouping 7National &isability urvey85 $s regards current usage,it can be seen that for most types of $T there is some level of usage across

all age groups5 %or some $T, the lielihood of usage increases signi6cantly-ith age 7e5g5 many mobility aids, more traditional visual aids such asmagni6ers and more traditional hearing aids -ithout Tlearningdisability, and mobile phones or computers for communication for hearingdisability5 $s regards unmet needs, the patterns sometimes mirror thosefor usage but not al-ays5 )n general, it seems that older people do nottend to commonly report needs for the computer


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appropriate for them5

24


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Figure =. $ercentages of each age group #in the relevant disability grouping* using the di>erent types of

technical aids #National %isability Survey '((8*


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Association between unmet need for AT and greater levels of

participation restriction

%inally, %igure R presents some preliminary and illustrative results of thetype of data and insight that could be generated from the available datasources in the future5 The 6gure sho-s levels of participation restrictionreported amongst those -ho use and those -ho reHuire technical aids,focusing on those aids for -hich the data sho-s a statistically signi6cant

di?erence on this dimension5 )t can be seen that those -ho need thevarious types of aid report substantially higher levels of restriction thanthose -ho have the aid5 $lthough further and multivariate analysis -ouldbe needed to properly explore the data, these results give an indication ofthe importance of $T for participation5

Figure ?. $articipation restrictions for those who use and who

need particular aids #N$S%%& '(()*


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2+2 /olicy relevance and i#portance

$T has important relevance for a number of areas of policy, includingdisability policy and policy on older persons as -ell as health and socialcare, employment and education policies more generally5

%isability policy

$T is centrally important for disability policy as it is one of the moreconcrete -ays that the barriers to participation in society can be overcomefor people -ith disabilities5

$ccess to $T is a right under the UN 'onvention on the "ights of 0ersons


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-ith &isabilities 7UN'"0&85 Under $rticle E of the 'onvention, /embertates have a general obligation to undertae or promote research anddevelopment of, and to promote the availability and use of new

technologies, including information and communications technologies,

mobility aids, devices and assistive technologies, suitable for persons withdisabilities, giving priority to technologies at an a1ordable cost 5 $rticle ABof the UN'"0& 70ersonal /obility8 reHuires /ember tates to facilitateaccess to Huality mobility aids, devices, assistive technologies ata?ordable cost and encouraging those -ho produce mobility aids, devicesand assistive technologies to tae into account all aspects of mobility forpersons -ith disabilities5 %rom the perspective of progressive realisation7i5e5 that a /ember tate can demonstrate it is maing progress to-ardsful6lling its obligations8, this reHuires that at the very least there is a

coherent overall plan for the development and dissemination of $T and astrategy for achieving its goals5

$T is also recognised as a ey environmental facilitator in the .orld 9ealth(rganisations )nternational 'lassi6cation of %unctioning, 9ealth and&isability 7)'%, ABB@85 $ complete chapter is devoted to products andtechnology in the environmental domain, and there are other relevantsections on $T 7e5g5 in education85

$olicy on older persons

$s the data from the National &isability urvey sho-s, older people arema*or users of many types of $T as -ell as maing up a substantialproportion of those -ith unmet needs for a variety of types of $T5 )t has avery important role to play in maintaining independent living in oneKs o-nhome, a ey aspiration of the ma*ority of older people5 /ore generally, $Thas ma*or importance as one of the solutions that can help to address thechallenges for the health and social care system posed by an ageing

population5

/nformal carer policy

$T also has importance for policy on informal carers5 )t can enable peopleto do more things for themselves and thus reduce the pressures oninformal carers5 There are also many types of $T available to help carers-ith caring tass5

9mployment policy


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$ctive employment policies are central to approaches to support people-ith disabilities and older -orers today5 $rticle AQ of the UN'0"&reHuires /ember tates to ensure that reasonable accommodation isprovided to persons -ith disabilities in the -orplace5 The )'% lists a range

of $T devices and specially designed eHuipment, products andtechnologies to facilitate employment such as ad*ustable tables, ocefurniture and eHuipment; computer hard-are, soft-are, accessories; andenvironmental control units5 $T is commonly included -ithin the scope ofemployment services for people -ith disabilities and is beginning to begiven increased attention also in relation to extension of -oring age andretention of older -orers5@B

9ducation policy

$T is acno-ledged as an important element in achieving inclusiveeducation environments5 )t has the potential to reduce the isolation oflearners -ith communication diculties5 )t can allo- pupils -ithsubstantial physical or sensory impairments to participate in themainstream classroom5 $rticle AE of the UN'"0& 7on 1ducation8 places areHuirement on /ember tates to mae reasonable accommodation sothat pupils can participate freely in mainstream general education atprimary, post


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5ealth and social care policy

The importance of $T in health and social care policy derives, in part, fromthe role that health and social care services play in delivering on disabilityand older persons policy5 )n addition, there is an increasing recognition ofthe contribution that $T can mae to -ider health and social care policygoals, including:

• prevention 7e5g5 falls amongst older people8

• delay or avoidance of need to move to long


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alue for money

)t could be considered that some aspects of the value case for $T are self<evident in that relatively lo- cost items can enable people -ith disabilitiesand older people to do things that -ould other-ise be dicult or evenimpossible5 /ore speci6cally, in 1ngland the $udit 'ommission hasillustrated the value


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et of personal care > living aids @FB


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contribution to reduction in days spent in hospital 7e5g5 through support forearly discharge or prevention in the 6rst place8 and days spent in nursinghome care 7through delay or even avoidance of need for admission in the6rst place8 -ould provide impressive value for money returns5 (ther

calculations could be prepared, for example, contributions to-ardsreducing the total annual cost of falls and fractures amongst older peoplein )reland 7estimated at up to EBB million euro in total -hen all costs arecalculated, including those of carers>Huality of life85@Q

(ne of the reasons -hy $T has not al-ays received the policy attention itdeserves may be due to the lac of visibility of the value case for $T5 Thisis probably, at least in part, lined to the limitations of outcomes researchin the $T 6eld -here, although there have been numerous studies, these

typically have involved small numbers of cases and have not al-ays beenmethodologically robust5

$lthough this can be a dicult 6eld for research as it is often hard toisolate outcomes solely lined to $T, there have been some randomisedcontrolled trials 7"'Ts8 in the area5 This includes the much cited study by/ann et al in @PPP -hich found that the 7non


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(ne useful metric that has been applied in various 6elds, including someaspects of $T, is the I$+ 7Iuality $d*usted +ife ear85 %or example, therecent 91 revie- of audiology services in )reland cited U4 costI$+ ratios for fouru!"ictions(corporte(Audio"o'#eview)pdf

21 >ersson. ) 2008 %ost$effectiveness nd po"ic# &in': the cse of four$whee"ed w"ers) ordic Assistive echno"o'# Se&inr: Outco&es of Assistiveechno"o'# B Supportin' >rctice nd eve"op&ent) SA?S. De"sini. =in"nd 25B26 ove&!er. 2008


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The AT provision syste# in Ireland

This 'hapter outlines the main features of the $T provision system in

)reland5 $ schematic overvie- of the main elements of the system ispresented in %igure P5

Figure ). :ain elements of the AT provision system in /reland

)n practice the $T provision systems for the three settings <home>community>everyday life, education and employment = operate, to alarge extent, separately and in parallel, although in some aspects there

are legislative reHuirements relating to cooperation, for example bet-eenthe 91 and N'15 ections D5@, D5A and D5D outline the main features ofthe three Ksub


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+! 0o#e9co##unity9everyday life

+!+! .egislation 9policy

&egislation

The 9ealth $ct 7@PQB8 is the main piece of legislation of direct relevancefor $T provision as part of the health and social care services, although the$ct does not explicitly refer to assistive technology as such5 )t maesprovisions for the 7then8 9ealth 3oards 7no- the 918 to supply Vmedicalor surgical appliancesV to eligible persons, as -ell as provisions forophthalmic and aural appliances and for VeHuipment, materials or similararticles for a disabled adult person -here neither the person nor the

personKs spouse 7if any8 is able to provide for his maintenanceV5

The provisions under the 9ealth $ct placed certain responsibilities on the7then8 9ealth 3oards in relation to aids and appliances that have sincebeen passed on to the 9ealth ervice 1xecutive 7918 through the 9ealth$ct 7ABBE85 $s has often been commented before, the $ct is generallyvague regarding -hat $T is expected to be made available and to -hom5AA This has been seen as a signi6cant limitation in the )rish context, -ithapparently di?ering interpretations and -ide variations in levels of service

across the country5$part from transferring to the 91 the obligations of the 9ealth 3oardsunder the @PQB $ct, the 9ealth $ct of ABBE is also relevant in its provisionsin relation to KoutsourcingK of health and social care services by the 915 This $ct established the ne- 9ealth ervices 1xecutive as the publicagency -ith responsibility to V555manage and55555deliver, or arrange to bedelivered on its behalf, health and personal social servicesV, including aresponsibility to Vintegrate the delivery of health and personal socialservicesV5 )t also states that, in performing its functions, the 1xecutiveshall have regard to Vservices provided by voluntary and other bodies thatare similar or ancillary to the services the 1xecutive is authorised toprovideV5 ections DR and DP of the $ct provide the basic frame-or for

22 for e-&p"e. in the e-tensive co&&entr# nd n"#sis in the eport of theorin' roup on echno"o'# nd e"eco&&unictions to the %o&&ission on theSttus of >eop"e with is!i"ities in 1996 unpu!"ished


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the 91 to fund external provision of services5 )mplementation of actualarrangements -ith a given external provider is through servicearrangements or grant agreements, as -ell as more recent use of publicprocurement for some services5

)n practice, ection DR relates to agencies > groups providing services onbehalf of the 915 This refers to services -hich the 91 is legally andstatutorily reHuired to provide and enters into an arrangement -ith anoutside agency to do so on its behalf5 ection DP relates to agencies >groups undertaing services -hich are similar or ancillary to those of the91 and to -hom the 91 is providing grant aid to do so5 9o-ever the91 is not legally or statutorily obligated to provide such services5!oluntary and non


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capacity building for aids and appliances -ithin community services forolder people and in physical and sensory disability services5AE Theincreased allocation of resources to this area appears to have continuedfor a number of years after this5

.ith the economic do-neop"e with is!i"ities in 1996 unpu!"ished


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+!+2 (ervices

$ssistive technology provision in )reland involves a combination of 91and NG( services5 The 91 provides Maids and appliances services as -ell

as -oring closely -ith, and funding, NG(s that provide assistivetechnology services5 )n general, 91 Moutsourcing to NG(s is funded atregional level and service arrangements are in place -ith the main NG(sat regional level5 %unding is generally allocated as a bloc grant andfunding for $T is not ring


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and appliances services the 91 ocially covers all client groups, althoughthe ma*ority of its -or concerns infants>children and older people5

'ommunity aids and appliances services

91 community aids and appliances services are organised mainly at locallevel, either through +ocal 9ealth (ces 7+9(s8 or ervice $reas, and aredelivered through (ccupational Therapy, 0hysiotherapy, 0ublic 9ealthNursing, and peech and +anguage therapy services5

The local services mainly provide aids and appliances necessary for

• $ctivities of daily living 7itchen and food preparation aids, ramps andhandles, bathing and toileting aids, pressure care and manual handling8

• eating and mobility 7seating aids and -heelchairs85

)n some cases, a limited range of higher


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rare5 (nce referrals are received by a particular service, an assessment iscarried out and a Mprescription or recommendation for aids and appliancesis made5 $pplications for aids and appliances are prioritised based onlevel of need and urgency5 $llocations are made 7by heads of services or

by the "esource $llocation Group -here one is in place8 based on thebudget available5

There does not appear to be a systematic approach to medium and long<term follo-


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&isease $ssociation and the '"'5

(verall, it is dicult to get a clear picture of the 91 allocation processesfor aids and appliances at the local level5 0rovision criteria in the 6rst

instance are based mainly on possession of a medical or longautumn ofAB@@8 have meant that in most 7but not all8 areas, priority A applicationsare not being covered5 )n some areas -here demand is high, not allpriority @ applications can be catered for5 (verall, the ability of aids andappliances services to meet current need appears to vary from area toarea5 ome areas struggle to meet all priority @ applications, -hile otherscan provide for priority @ and A applications5

)t also seems that -aiting lists for aids and appliances services can varyconsiderably across 91 areas5 This is probably lined to funding andother variations in aspects of service provision mentioned above5 $lthoughthere is no systematic information published on -aiting times, indicationsfrom discussions -ith sta? from a number of areas suggest that there canbe -ide variation for both assessment and provision of eHuipment, from afe- -ees up to a year 7depending on priority and available resources85

3ottlenecs exist both in terms of available funding and stang5

(verall, the 91 aids and appliances service can be described as beingreactive rather than proactive and it seems that many areas may be


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struggling to meet identi6ed need5 There -as also a concern expressed bysome 91 sta? that there may be a cohort of people -ho reHuire aids andappliances services but -ho are on long -aiting lists for assessment andare therefore are not currently visible to service providers5

$dults aged bet-een @R and CF -ith an acHuired disability or other reasonfor needing $T may also be particularly vulnerable5 .hile children andpeople aged CF and older have relatively clear care path-ays, eligibilitycriteria and path-ays for adults -ith acHuired disability or illness are oftenless clear5

9earing aids

'ommunity audiology services provide assessment and rehabilitation for

medical card holders and for children5 This includes hearing aid 6tting andmanagement advice, and advice on usage of assisted listening devices5

'hildren and young people aged up to @R years are entitled to freeservices5 9earing aid services are provided free of charge also to adults-ith medical cards5 )n addition, the entire population is in principleentitled to access public, hospitalu!"ictions(corporte(Audio"o'#eview)pdf


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N@, services

The NG( sector plays a central role -ithin the mixed economy of -elfarethat characterises )relands health and social care systems5 NG(s -or inpartnership -ith formal structures and service providers to provide $T, butthey also complement these structures in terms of their o-n activities5 Thesector consists of many di?erent organisations, each -ith varying rolesand a varying degree of involvement in $T provision5 $s part of the study,many of these -ere contacted for further information about their $Tservices and issues that arise for them in this area5 The focus -as on theNG(s -ith formalised roles -ithin the $T provision system as -ell asothers that -ere identi6ed as conducting at least some relevant activityrelating to $T provision5 DB

NG(s -ith formal roles

There are a number of ey organisations that have particular expertise andplay a substantial role in the provision of $T5 These are: the 'entral"emedial 'linic 7'"'8, 1nable )reland, the National 'ouncil for the 3lind of)reland 7N'3)8, and &eaf9ear5 These organisations have formal roles in theprovision of $T on behalf of or in cooperation -ith the 915 They are alsothe NG(s most freHuently used for $T


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vary across the NG(s and in di?erent parts of the country5

+entral 5emedial +linic (+5+)

The $ssistive Technology and pecialised eating 7$T8 department at

the 'entral "emedial 'linic provides assessment and recommendations inall areas of assistive technology and specialist seating to children andadults -ith physical disabilities throughout )reland5 This includes thedesign and manufacture of customised seating and mobility eHuipment as-ell as providing o?


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$ssistive Technology 7$T8 provision is an integral part of many of theservices provided by 1nable )reland to people -ith physical and multipledisabilities5 These services are provided to children and adults across)reland through centres in fourteen counties5 1nable )reland also provides

specialist support $T services through its eatTech and National $ssistive Technology Training services5 The eatTech service provides posturemanagement and seated mobility solutions to clients referred from -ithin1nable )reland or from the 915 This includes custom manufacturedseating for people -ith complex needs5 eatTech also provides informationand training on posture and mobility to other service providers5 Theservice accommodates 1nable )reland clients from -ithin the 1asternregion 7&ublin, 4ildare and .iclo-8 and also provides a service to 1nable)reland and t John of God services in 4erry5 eatTech has also formed a

partnership -ith the 91 7The .heelchair and eat ervice 0artnership8-hich incorporates the 91 areas of &un +aoghaire, &ublin outh 1ast and.iclo-5

The National $ssistive Technology Training ervice provides customisedtraining on a range of electronic assistive technologies includingaugmentative and alternative communication devices, smart hometechnologies, and computer access to a -ide range of staeholders5 Theseinclude 1nable )reland sta?, expert and emerging $T service users, and

professional and adult users of $T across the public and private sectors,encompassing education, employment and independent living5 Training isdelivered either on


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carried out by the eatTech team5 3ecause some of the $T eHuipmentprovided is manufactured or adapted to speci6cation, clients may have anumber of appointments in the assessment process5 )n terms of choosinga solution, -herever possible, eatTech try to give clients a trial -ith

eHuipment to see if it is suitable for their needs5 .here a piece ofeHuipment is customised and cannot be tried out, clients -ill have anumber of 6ttings5 This helps to ensure that the eHuipment is appropriateto their needs5 'lients receive training on the use of their eHuipment -henit is issued to them5 .here possible, additional -heelchair mobility trainingis provided by the clients primary therapist or other relevant personnel-hen reHuired5

6+'! 7 #oring for 4eople with ight &oss ($he 6ational +ouncil for the

'lind of !reland)

The N'3) < .oring for 0eople -ith ight +oss, N'3) provides a range ofservices to people experiencing diculties -ith their vision5 The servicesare funded by the 91 7about QF8 and by a combination of fund raising,donations, charity shops and beHuests 7about AF85

.ith respect to $ssistive Technology, N'3) o?ers a full range of $T forpeople -ith vision loss in )reland and serves the needs of people of allages and at all levels of usage, -ho use technology for all sorts of

activities5 N'3) provide an $T retail service to the public, selling eHuipmentto assist -ith daily living, education and -riting, communication andmagni6cation5 N'3) also provides high tech eHuipment such as Global0ositioning ystems 7G085 peech or magni6cation soft-are is availablefor computers5 (ther options include ''T!, reading machines, mobiletelephony etc5 The level of )T experience that the individual has is taeninto account, as -ell as other supports available5 )n addition to the directprovision of assistive technology, N'3) advocates for greater a-arenessaround accessibility in the virtual and built environments and for thee?ective use of $T by other organisations5 N'3) trainers also support thesharing of information and sills among people using the services throughcomputer clubs, online discussion forums etc5

N'3) o?er the $ssistive Technology $cHuisition Grant 7$T$G8, -hich is aninitiative to help the visually impaired -ith the cost of assistive technology5 The scheme is designed to meet up to AF of the cost of $T -hich is notcovered by any other grant and -hich -ould have to be borne by theindividual5 The scheme is funded through N'3) charity shops and

fundraising activities5


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0eople using the $T service either mae contact directly or are referred bytheir ophthalmologist, family member, healthcare or educationprofessionals5 N'3)s )T trainers carry out assessments -ith people toidentify their need for $T and try to meet their needs and -ishes5 'hoices

are made based on a persons level of vision and on -hat tass they -ishto carry out5


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*eaf8ear

&eaf9ear provide direct services and supports to people -ho are deaf orhard of hearing to enable them to lead full, independent lives5 The

organisation also advocates for other services to become accessible todeaf and hard of hearing people and it -ors -ith other organisations topromote this5 &eaf9ears services are RB to PB 91 funded5 Theremaining funding comes from a variety of sources, including a 'iti#ens)nformation 3oard grant, %L grants and its o-n fundraising activities5&eafTech is &eaf9ears specialist $ssistive Technology service5 $ssistive Technology is seen as one of the ey solutions -ithin &eaf9ear in terms ofenabling people -ith hearing loss to lead independent lives5 Theorganisation has a good no-ledge of the solutions that are available to

people5 (n the corporate side, companies -ill often see advice and ordereHuipment through &eaf9ear 7e5g5 loop systems85

&eaf9ear clients fall into t-o groups; those -ho are congenitally deaf andthose -ho acHuire a hearing loss as they get older5 Those -ho havecongenital deafness tend to be familiar -ith using assistive technologyfrom a young age but $T can also eliminate barriers for those -ith anacHuired hearing loss5 'lients are often referred to &eaf9ear by local 91therapists, although approximately FB to CB of adult clients are self<

referred and DB to EB of child clients are self


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mentioned belo-5

&yslexia $ssociation of )reland 7&$)8 o?ers a Technology $dvice ervice forstudents at second and third level, and adults -ith dyslexia, as -ell asteachers, tutors, trainers and 9" personnel -ho -ish to learn more abouttechnological aids for people -ith dyslexia5DA The intended purpose of theservice is to help people to mae informed choices about technologicalaids -hich suit their individual needs5 The focus is on the range ofassistive technology -hich can be bene6cial to people -ith dyslexia insecond and third level education and the -orplace5 There is a charge foradvice sessions, -ith reduced rates available for people on social -elfare5/ore generally, $T is used -ithin &$)Ks 'areer 0ath 'entre service5 Thecentre runs training courses for adults -ith dyslexia and participants on

the courses must be registered -ith %L5/uscular &ystrophy )reland 7/&)8 provides an eHuipment loan service7hoists, sho-er chairs, commodes, electric -heelchairs, manual-heelchairs, air mattresses, slings, electric beds, ramps, and computers8for members or aliate members 7i5e5 members of %riedreichs $taxiaociety )reland85 $ limited Huantity of such eHuipment is held in variousparts of the country and can be transported -here reHuired5DD +oans aremade to clients -ho either may be -aiting for their prescribed eHuipmentto come from the 91 or -ho need an $T item for a speci6c purpose 7e5g5for going on holidays85 1Huipment is also loaned to 91 occupationaltherapists -ho may -ant to try it out -ith their clients before maing aprescription5 /&) also provides information on -here members canpurchase these types of eHuipment if they -ish to do so5 'lients using $Tprovided by /&) are referred by family support or youth -orers -oring-ithin the organisation -ho identify a need5 /embers also self


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of delay5

)rish .heelchair $ssociation 7).$8 has a .heelchair ales, "ental "epairservice located at headHuarters in 'lontarf5 They o?er a selection of ne-and second


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organisations typically do not directly provide $T they are involved ininformation provision and in promoting $T for enabling older people to liveindependent lives5

$s part of its aim to promote positive aging, $ge $ction delivers training

on the use of computers, the internet and mobile phones to people overthe age of FF years through its MGetting tarted programme5 They alsorun free monthly tals on various aspects of )T 7e5g5 internet security, on<line shopping8 and a voluntary )T technician is available t-ice a month at adrop


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NG(s emphasised the importance of $T for the people that they serve andthat $T should be available to everyone -ho needs it5

)ssues around lac of funding and resourcing, both to provide $T and toraise a-areness around $T, along -ith -aiting lists for assessment andprovision, -ere identi6ed as ey issues by most respondents5 1ven -ithinNG(s, the issue of funding for $T can be problematic, particularly -hen itis not ring fenced and $T services are competing -ith other internalservices for resources5 )t -as reported that limited resources are resultingin more and more people, particularly adults, purchasing $T privately5 $lac of certainty around funding means that NG(s cannot give clarity toclients on the $T that they can provide to them and they may not be ableto ensure that clientsK needs are met in a timely fashion5 .here there is a

stable funding route for speci6c types of $T>services 7examples mentionedincluded specialised seating and communication devices8, priority mayhave to be given to assessments for these -ithin an NG(5

(verall, there -as a vie- that, in addition to providing important parts ofthe publicly


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recommended a number of changes including clarity around entitlementand eligibility criteria, consistency in application of the grant across alllocal authority areas and an increase in the amount of the grant5

$pplications for the 9ousing $daptation Grant are made to the housingdepartment of the relevant local authority5 The grant is means tested andapplications are prioriti#ed on medical need5 The highest priority 70riority 38 relates to those -ho are terminally ill or fully>mainly dependent onsomeone else for care or those for -hom adaptation to the home -ouldfacilitate hospital discharge or reduce the need for future hospitali#ation50riority 9 relates to someone -ho is mobile but needs help -ith daily tasssuch as -ashing and toileting, or to someone -hose ability to functionindependently -ould be hindered -ithout the adaptation to the home5

0riority level relates to someone -ho is independent but needs certainfacilities to improve their Huality of life5 .hen an application is made, thelocal authority may reHuire that an (T assessment be carried out5 Thegrant aid a-arded -ill range bet-een PF and DB of the total cost,depending on the persons income5 The maximum grant that can bea-arded is WDB,BBB5 $ person may apply for a local authority loan if theyare unable to borro- the portion of the cost not covered by the grant59o-ever, local authorities meet the entire cost of the adaptations -henthe person is a local authority tenant5 DQ

)f a person only reHuires minor -or they can apply for the /obility $idsGrant cheme rather than the 9ousing $daptation Grant5 The /obility $idsGrant cheme is means


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+2 $#ploy#ent

+2+! .egislation9policy

&iscrimination on grounds of disability in relation to employment andaccess to goods and services -as prohibited on the enactment of the1mployment 1Huality $ctDP in @PPR and the 1Hual tatus $ct in ABBB5EB These pieces of legislation represent ey elements in the strategicdevelopment of protections and supports to enhance employment andtraining opportunities for people -ith disabilities5

The 1mployment 1Huality $ct, @PPR came into e?ect on @R (ctober @PPPand, for the 6rst time, disability discrimination became illegal in the )rish-orplace5 The $ct -as amended 7but not replaced by8 the 1Huality $ctABBE on July @P ABBE5 E@ $mongst the amendments to the 1mployment1Huality $ct @PPR, of relevance for current purposes, -as to change thereHuirement on employers to provide reasonable accommodation forpersons -ith disabilities so that , in future, this -ould be sub*ect to it not

http:((www)citiLensinfor&tion)ie(en(housin'(housin'*'rnts*nd*sche&es(&o!i"it#* ids*'rnt*sche&e)ht&"

39 http:((www)irishsttute!oo)ie(pdf(1998(en)ct)1998)0021)pdf

40 http:((www)oirechts)ie(docu&ents(!i""s28(cts(2000(800)pdf

41 http:((www)oirechts)ie(docu&ents(!i""s28(cts(2004(A2404)pdf


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imposing a disproportionate burden 7rather than Knominal costK, asreHuired in the @PPR legislation85 $ssessment of this is to be based on the6nancial and other costs entailed, the scale and 6nancial resources of theemployers business and the possibility of obtaining public funding or

other assistance 7ection P85

Under the 1mployment 1Huality $cts @PPR ABBE, employers are obligedto tae appropriate measures = Mreasonable accommodation = 7unless thecost of doing so are disproportionate8 to enable people -ith disabilities tohave access to employment, to participate or advance in employment andto undergo training5 uch measures may include training resources oradaptations to -or premises, -or eHuipment, patterns of -or time anddistribution of tass5

$n employer is not obliged to provide any facility or treatment thatemployees can reasonably be expected to provide for themselves5 0rivatesector employees may Hualify for a .orplace 1Huipment $daptationGrant 7.1$G8 from %oras Liseanna aothair 7%L85 EA

The &isability $ct ABBF is also relevant in that it establishes a statutorybasis for, inter alia, obligations on public bodies to be proactive inemploying people -ith disabilities and the monitoring of compliance -iththose obligations5 ED Under the $ct, all public bodies, in so far as is

practicable, should tae all reasonable measures to promote and supportthe employment of persons -ith disabilities5 This includes the maing ofreasonable alterations to -or premises and Xthe provision of suitabletechnical or organisational supports so as to reasonably facilitate theemployment of persons -ith disabilities and to support existing employees-ho are persons -ith disabilities in the performance of their dutiesY5

42http:((www)fs)ie(en(A""owncesMndMrnts(orp"ceM/uip&entMAdpttionMr ntMF28AF29)ht&

43 http:((www)oirechts)ie(docu&ents(!i""s28(cts(2005(1405)pdf


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The afety, 9ealth .elfare at .or $ct ABBF is also relevant5 )t statesthat employers must Xensure, as far as is reasonably practicable, thesafety, health and -elfare at -or of all employeesY5EE "egulation AF of theGeneral $pplication "egulations = 1mployees -ith &isabilities = states that

X$n employer shall ensure that places of -or, -here necessary, areorganised to tae account of persons at -or -ith disabilities, in particularas regards doors, passage-ays, staircases, sho-ers, -ashbasins,lavatories and -orstations used or occupied directly by those personsY5

+2+2 (ervices

)n the private employment sector, the provision system for assistivetechnologies for persons -ith disabilities has mainly been through %L, the

training and employment authority -hose employment functions havebeen transferred to &ept of ocial 0rotection5 Training functions, no-under &ept 1ducation and ills, -ill transfer to a ne- agency olas -hichmerges %L training function -ith further education role of !1's5 The roleof %L has been to enhance the sills and competencies of individuals andenterprises in order to further develop )reland as a competitive, inclusive,no-ledge


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provide path-ays to the provision of assistive technologies as and -henthe need arises for their use5 chemes fall under t-o main headings <schemes under the &edicated &isability 3udget, and schemes under the"easonable $ccommodation %und5

The &edicated &isability 3udget in AB@B -as WQQ5F millionEF, and includedschemes such as:

• pecialist Training 0roviders 7WFF million8 -here %L contracted ABspecialist organisations in FF centres to provide vocational training todisabled people

• .age ubsidy cheme 7W@@5C million8 -hich provided 6nancialincentives to private sector employers to employ people -ithdisabilities

• upported 1mployment 0rogramme 7WP million8 aimed at providingpeople -ith disabilities -ith supports to access the open labour maret,-here Job 'oaches -ere contracted to provide supports tailored to theneeds of the disabled *obseeer5

$s part of its activity, the upported 1mployment 0rogramme allo-sfunding for assistive technology5 $vailable data suggests that for users ofthis scheme 7about A,BBB persons8 about one in eight 7@A8 reHuired useof $T supports5 EC The main forms of $T reHuired -ere adapted-orstations 7including dess, seating, eyboards and screens8, hearing

and visual aids, communication soft-are, and -aling aids and-heelchairs5

The "easonable $ccommodation %und in AB@B -as WACP,BBB and includesfour schemes: .orplace 1Huipment $daptation Grant 7.1$G8, availableto employers and employees in the private sector -ho need to adapteHuipment or the -orplace using assistive technology to accommodate a

45 fi'ures here re rounded

46 http:((www)fs)ie((rdon"#res(826760%$J02$49=1$838J$70A2111706(384(%=IA@>OS>280509)pdf


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disabled employee; Job )ntervie->)nduction )nterpreter Grant, available tocover the costs of an interpreter for intervie- and induction purposes-here an intervie-ee or ne- sta? member is deaf, hard of hearing or hasa speech impediment; 0ersonal "eader Grant, available to blind or visually<

impaired persons -ho are in employment and -ho need assistance -ith *ob


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synthesi#ers for computers, ampli6ers for telephones, etc5 The scheme isoperated via the QB local 1mployment ervices (ces, dispersed -idelythroughout the country5

The procedure for getting $ssistive Technology starts -ith the employee orthe employer contacting a local oce5 The process is thus essentiallydemand


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under the grant scheme5 3ut if a laptop is reHuired so that a particularassistive technology can be used, then the inclusion of a laptop isaccepted5

The 1mployment ervices (cer noti6es the applicant of the outcome ofthe application in -riting and of the grant that has been approved to-ardsthe cost of the eHuipment or adaptation5 7The amount does not include!$T -hich must the claimed separately58 $ maximum grant of C,DER eurois available to-ards the cost of adaptations to premises or eHuipment5 Thisgrant can also be used to adapt eHuipment funded previously5 $t anestimate, the current funding per application is probably around @,ABBeuro5 ince budget is in excess of demand, applications are not turneddo-n due to lac of budget5 The budget for the scheme in AB@B -as

W@PR,BBB of -hich WER,BBB -as actually spent5 The current budget isW@DF,BBB5

)n all cases, the person -ith a disability retains o-nership of theeHuipment or adaptation unless it has been incorporated into the premisesor standard eHuipment of the employer5 .here the person is self<employed, the eHuipment>adaptation remains in their o-nership5 %L isnot responsible for the insurance, repair or maintenance of theeHuipment>adaptation5 )t is anticipated that -hile the person is inemployment, the insurance, repair or maintenance is covered by theemployer5

4ublic sector employment

"esponsibility for the implementation of eHuality of opportunity forpersons -ith disabilities -ithin the public sector is -ith the 9ead of each&epartment and (ce or a person designated by the 9ead5 !ariousfunctions have speci6c responsibilities in relation to employment ofpersons -ith disabilities in their &epartment or (ce: 0ersonnel (cers; Training (cers; $ccommodation (cer; &isability +iaison (cer; 9ealthand afety (cer; )T (cer; +ine /anager5 $reas covered by the aboveroles as reHuired are: recruitment and selection; initial appointment;induction; probation; training and career development; performance;retention5 ER

48 http:((finnce)'ov)ie(docu&ents(pu!"ictions(e/u"it#(codeprctdis!i"it#2007)pdf


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.hen applying for a public service position, people -ith disabilities maycomplete the MNeeds )denti6cation Iuestionnaire to ensure a faircompetition5 This includes Huestions about supports and accommodationsreHuired5 uccessful candidates or employees -ith disabilities -ho reHuire

reasonable accommodations in their -orplace complete or have input tothe .orplace $ccommodation %orm and submit it to their &isability+iaison (cer5 )t should be noted that &isability +iaison (cers are inGovernment &epartments only and so -or on behalf of civil servants5 They are not in all public bodies5 0ublic bodies di?er and so the XNeeds)denti6cation IuestionnaireY does not apply to public servants5[

)n relation to the identi6cation and provision of appropriate $T, thepersonnel ocers consult appointees -ith disabilities in order to arrange a

visit to the proposed ne- -orplace and document accommodationsreHuired on the .orplace $ccommodation %orm5 &isability +iaison (cersmae contact and -elcome ne- employees -ith disabilities to the&epartment or (ce and provide reasonable accommodations -ithin four-ees of receiving a reHuest, -here practicable5 $ccommodation (cersensure that all reasonable measures are taen to minimise the physical ortechnical environmental barriers and organise for an accessibility audit ofbuildings occupied by employees -ith disabilities every 6ve years5 +inemanagers ensure employees -ith disabilities have the reasonable

accommodations reHuested and that they are operational5

&isability +iaison (cers 7&+(s8, -hile not professionals in the 6eld, areappointed -ithin each &epartment to facilitate the sharing of no-ledge,experience and good practice in relation to the employment of peoples-ith disabilities5 The &+(s attend conferences and seminars on a regularbasis to further their education and training5 EP

The range of upports or $ccommodations in the )rish 'ivil ervice variesbut may include: $ccessible $ccommodation; $ccommodation for Guide&og; $lternative 0rint %ormat; $ssistive Technology; (rientation; 'ar0aring; 'ounselling; &yslexia upport; 1xamination upport; Job 'oach;+earning upport; Note


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)nterpreter; peed text; .heelchair $ccess5

!o" 7. ase Study+ The %epartment of Social $rotection>ro'resseport0609)pdf


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designated solely for the procurement of, and research into appropriate$T5

The $T provided is mainly in relation to visual impairments but also some

people -ith speech impairment5 1xpenditure cost is not an issue sincedemand is small5 /ore costly eHuipment, such as lifts and hoists fortoilets, are dealt -ith by the 9ealth afety and the $ccommodationocers in con*unction -ith the (0.5

)n each &epartment the situation in relation to reasonable accommodationis to be monitored on a regular basis and reports on progress made5 uchreports highlight good practice and identify remaining issues of concern5 The process is governed by a set of ob*ectives, actions and performance

indicators speci6ed in the &isability ectoral 0lan of the &epartment ofocial 0rotection5

+ $ducation

++! .egislation9policy

The 1ducation $ct @PPR, the Universities $ct @PPQ, the 1ducation 0ersons-ith pecial 1ducational Needs $ct ABBE 7101N ABBE8, the 1Hual tatus

$ct ABBB


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eHuality of access to, participation in and bene6t from, education 7ectionEA7A87f88,

$ccording to the $ct, support services include Mtechnical aid andequipment, including means of access to schools, adaptations to buildings

to facilitate access and transport, for students with special needs and their

families% 7ection A85

The 1Hual tatus $ct ABBB and the 1Huality $ct ABBE, referred to as the1Hual tatus $cts ABBB to ABBE, have relevance to services provided bythe &epartment of 1ducation and ills and to educational establishments,including primary and post


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inconsistent -ith the best interests of the child or the e?ective provision of other children 7ection A85

(ne of the central elements of the 101N $ct 7ection @P8 -as theestablishment of the National 'ouncil for pecial 1ducation 7N'185$mong the functions of the N'1 7ection AB8 are

• The dissemination of best practice,

• 0lanning and coordinating provision of support services

• /onitoring the progress of students -ith educational needs

• "evie-ing resources in relation to educational provision

• 1nsuring a continuum of educational provision

• "evie-ing and maing recommendations in relation to adults -ith

disabilities including higher education, continuing education foradults, rehabilitation and training,

• $dvising on best practice concerning the education of adults and

conducting and commissioning research

The 101N $ct and the &isability $ct ABBF are strongly interrelated -hen itcomes to assessing needs of children and youth5 .hile there is no speci6creference to $T in either of the $cts there are many references to supportand services -hich are clearly taen to include technical aid andeHuipment under the 1ducation $ct @PPR5 )t is important to note that-hile the legal basis for $T provision is clearly evident, a recent statementfrom the (ce of the (mbudsman for 'hildren raised concerns regardingthe fairness and adequacy of the -ay in -hich this is currently beingimplemented5 )t particularly focuses on the use of narro- diagnosticcategories in determining eligibility, the clarity of guidance on eligibility,responsibility for determining eligibility and the lac of a transparentappeals procedure5FA

52 Office of the O&!uds&n for %hi"dren 2011 A stte&ent !sed on n investi'tion re'rdin' the refus" to provide nssistive techno"o'# 'rnt to chi"d !# the eprt&ent of duction nd Si""s)http:((www)oco)ie(ssets(fi"es(pu!"ictions(co&p"ints*nd*investi'tions(O%OInvesti'tionofrefus"!#StoprovideA'rnt)pdf

http://www.oco.ie/assets/files/publications/complaints_and_investigations/OCOInvestigationofrefusalbyDEStoprovideATgrant.pdfhttp://www.oco.ie/assets/files/publications/complaints_and_investigations/OCOInvestigationofrefusalbyDEStoprovideATgrant.pdfhttp://www.oco.ie/assets/files/publications/complaints_and_investigations/OCOInvestigationofrefusalbyDEStoprovideATgrant.pdfhttp://www.oco.ie/assets/files/publications/complaints_and_investigations/OCOInvestigationofrefusalbyDEStoprovideATgrant.pdf


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Under 0art A of the &isability $ct, children under school


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orders5 FD ection Q of the 1Hual tatus $ct ABBB prohibits educationalinstitutions from discriminating on the grounds of disability in terms ofadmission, access to a course, facility or bene6t, any other term orcondition of participation and expulsion5 The 1Huality $ct ABBE amendedection Q mainly -ith regard to access to grants5 The only ground upon

-hich an educational institution can refuse to comply is on the basis thatthis -ould mae it impossible, or seriously disrupt provision to otherstudents5FE 0art time and private courses are covered under the 1Hualitytatus $cts5 They are legally reHuired to provide accommodations as longas the accommodation does not impose a disproportionate burden5 0rivatecolleges are liable under the acts unless the cost of a device represents adisproportionate burden in relation to the 6nancial resources of thecollege5 $lthough $T is generally not costly and can often be provided asan integrated solution, some private colleges expect students to pay fortheir o-n supports in addition to their fees5

%rom a legislative perspective it -ould seem that the lins bet-een the1ducation $ct @PPR in terms of de6ning support services to includetechnical aids and eHuipment, and the integrated approach to health andeducational needs and service planning contained in the 101N and&isability $cts, provide a sucient basis for an e?ective national system of provision of $T in )reland5 The main dra-bac is that ey sections of both$cts have yet to be activated5 )n relation to the 101N $ct, the relevantsections covering needs assessment, providing statements and developingindividual plans for learners -ith 1N have not been commenced i5e5

implemented by the relevant /inister5 0art A of the &isability $ct ABBF -ascommenced for children aged less than F years on the @st June ABBQ butthe full implementation of the $ct has been deferred pending an upturn ineconomic conditions5FF Given that the 101N act is unliely to be

53 niversities Act . 1997)http:((www)irishsttute!oo)ie(1997(en(ct(pu!(0024(inde-)ht&"

54 overn&ent of Ire"nd 2000 /u" Sttus Act. he Sttioner# Office. Avi"!"et: http:((www)irishsttute!oo)ie(2000(en(ct(pu!(0008(inde-)ht&"

55 http:((de!tes)oirechts)ie(di"(2010(12(15(00056)sp


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commenced in the near future, and that 0art A of the &isability $ct has notbeen extended to F


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strong enough recommendations8, that the eHuipment is needed for theentire day 7occasional use should be met out of existing school resources8and that it is evident that the eHuipment currently in the scho

assistive technology report

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