Abstract

‘Third-generation’ telecare and advanced assistive technologies are widely understood to offer multiple benefits. These are digital devices in the home, that can do things like record how often someone uses their fridge, as well as recognize changes in patterns of behaviour over time. Users can live with the assurance that potential problems requiring medical attention will not go unnoticed. Advanced telecare interfaces can be used to maintain social connections. A key policy goal is that older people who might feel vulnerable living independently can use advanced telecare to live at home for longer than otherwise possible. Numerous local authorities have piloted this kind of technology as part of their adult social care services. Most pilot studies are qualitative in nature, and show promising outcomes in multiple cases.

Given this, it is perhaps surprising that third-generation telecare has not already become a more widespread service across the UK. But the most significant evidence about telecare, drawn from a large randomized controlled trial, launched and funded by the Department of Health in 2007, suggests that the telecare services it studied did not actually deliver better outcomes for older people. This raises several problems. Firstly, this evidence is often disregarded, often by local authorities who see the benefits of these kinds of services and are in favour of expanded telecare provision. Secondly, this creates a false dichotomy, between accepting the evidence that telecare is not beneficial, and rejecting it in favour of continued provision. Both options preclude further in-depth investigation into how telecare technology provision and use actually works, when it doesn’t work, and why. One part of the answer is that moving from first-generation analogue telecare services to digital, advanced telecare services is a social process as much as it is a matter of the technology available. Innovation within the social infrastructure of adult social care services may be important to outcomes as the new technological capabilities of new telecare platforms.