Implementing telecare for

older people: the West

Lothian experience

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Lothian experience

Alison Bowes

University of Stirling, Scotland

a.m.bowes@stir.ac.uk

Thanks to:

� The Health Foundation

� The Nuffield Foundation

� Big Lottery Fund

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� Big Lottery Fund

� Gill McColgan, Sherry MacIntosh, Ghizala Avan, Mike Wilson

� West Lothian Council

� Research participants

Changing policy for

older people

• Recent changes involve

– Focus on independence

– The whole person

– Individual responsibility

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– Individual responsibility

• Service users as active agents

– Empowered

– With rights

The contribution of

telecare/telemedicine

• Can it– Increase independence

– Deliver more effective and efficient services

– Control expenditure?

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– Control expenditure?

• Or does it– Replace human contact

– Increase isolation

– Raise risk levels

– Present insuperable ethical obstacles?

A citizenship approach

• Focusing on older people as active agents (citizens), I aim to explore the impact of a radical telecare innovation

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a radical telecare innovation in West Lothian, Scotland, in terms of older people’s own citizenship goals.

Citizenship goals for

older people (Craig

2004)

• independence

• social participation

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• social participation

• identity

West Lothian, Scotland

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Telecare in West Lothian

• everyone aged 60 and over (10,000 households – 3,200 as at May 2007)

• baseline for support for older people:– a home alert console, linking sensors to a Call Centre

– two passive infrared (PIR) detectors

– two flood detectors

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– two flood detectors

– one heat extreme sensor (hot and cold)

– one smoke detector

and (optional)

– other devices to suit the individual

• augmented if support needs develop• Call Centre has response protocols for each client• challenging stigma through mainstreaming

The research evaluation

• views and experiences of key stakeholders over time– older people in the different settings (at

home and in housing with care developments)

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developments)

– unpaid (informal/family) carers

– staff at all levels

• comparator study in another area

• file study

• study of costs

Independence

• Maintaining one’s own independence

• Avoiding care

• Freedom of routine

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• Freedom of routine

• Supporting capacity

Limits of independence

• Requires appropriate model of care

• Requires limit to risk aversion

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aversion

• Wider issues of safety and security apply

Participation

• Maintained community and social networks

• For unpaid carers, improved interaction and peace of

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interaction and peace of mind

• In housing with care, open doors and new community

Limits to participation

• Less human contact?

• Narrowing networks

• Disabling environments

• Threats to status

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• Threats to status

Identity

• Belonging, supported by independence and participation

• Local connection

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• Local connection

• Mainstreaming strategy reduces ‘spoiled’ identities

Limits on identity

• Negativity about services reflects perceptions of failure

• Exclusion in e.g. public

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• Exclusion in e.g. public spaces

• Stereotyping of older people – ageist attitudes and behaviours

Conclusion

• Support for citizenship goals through telecare

• Limits come from wider social and policy context

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social and policy context

• Other excluded groups? –identify the possibilities and limitations