Abstract
Assisted living technologies may help people live independently while also—potentially—reducing health and care costs. But they are notoriously difficult to implement at scale and many devices are abandoned following initial adoption. We report findings from a study of global positioning system (GPS) tracking devices intended to support the independent living of people with cognitive impairment. Our aims were threefold: to understand (through ethnography) such individuals’ lived experience of GPS tracking; to facilitate (through action research) the customization and adaptation of technologies and care services to provide effective, ongoing support; and to explore the possibilities for a co-production methodology that would enable people with cognitive impairment and their families to work with professionals and technical designers to shape these devices and services to meet their particular needs in a sustainable way. We found that the articulation work needed for maintaining the GPS technology in “working order” was extensive and ongoing. This articulation work does not merely supplement formal procedures, a lot of it is needed to get round them, but it is also often invisible and thus its importance goes largely unrecognized. If GPS technologies are to be implemented at scale and sustainably, methods must be found to capitalize on the skills and tacit knowledge held within the care network (professional and lay) to resolve problems, improve device design, devise new service solutions, and foster organizational learning.
Highlights
IntroductionAssisted living solutions, which include telecare (remote delivery of support services via devices such as alarms or fall detectors to enable vulnerable people to live independently at home) and telehealth (remote clinical monitoring, consultation, and treatment of people in their homes), are increasingly seen by health and social care policy makers as a solution to the inter-related trends of an ageing population; rising rates of chronic illness and disability; cutbacks in health system capacity and budgets; and shifting social roles and expectations
Assisted living solutions, which include telecare and telehealth, are increasingly seen by health and social care policy makers as a solution to the inter-related trends of an ageing population; rising rates of chronic illness and disability; cutbacks in health system capacity and budgets; and shifting social roles and expectations
Our previous research showed that one important reason for this gap between vision and practice is that many people are assessed for, and fitted with, an assisted living service solution that interferes with rather than facilitates daily living (Greenhalgh et al 2013, 2015)
Summary
Assisted living solutions, which include telecare (remote delivery of support services via devices such as alarms or fall detectors to enable vulnerable people to live independently at home) and telehealth (remote clinical monitoring, consultation, and treatment of people in their homes), are increasingly seen by health and social care policy makers as a solution to the inter-related trends of an ageing population; rising rates of chronic illness and disability; cutbacks in health system capacity and budgets; and shifting social roles and expectations While such policy interventions may be well-motivated, in practice there is a substantial gap between the vision and the realities of assisted living technologies and services adoption (Greenhalgh et al 2012). Successful assisted living solutions are socially and collaboratively accomplished—“co-produced”—on a day-to-day basis by the efforts of clients, and their professional and lay networks of carers (Procter et al 2014)
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