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Ageing, Technology and Home Care

Maggie Mort
Christine Milligan
Celia Roberts
et al.

General conclusions

Texte intégral


1The four themes raised a series of issues of relevance for policy in relation to the design, development and implementation of new care technologies for older people at both the level of member states and across the EU itself. These are outlined below under three sub-headings: a) policy issues; and b) design issues.

2At a broader level, it is also important to note that policy around new care technologies for older people developed at the European level needs to take cognizance of the following issues:

  • Europe is marked by political and cultural and diversity. This has implications for who cares, where and the role of formal and informal health and social care providers in delivering that care.
  • Diverse healthcare systems across Europe mean varied levels of availability of NCTs will emerge and a range of choices made by citizens about which technologies to adopt or reject.
  • North/South migration of older people brings with it differing normative expectations of care and the technologies to support that care.
  • East/West migration of people taking employment in the caring services is creating a potential ‘care gap’ in their home country that will have implications for the care of older people.
  • Any discourse of aging should be positive and supportive rather than emphasising how frightening and disabling aging might be.

3There are potential tensions between the different goals of new care technologies. EU guidelines for the development of telecare systems would help to reduce these tensions. These should take account of the issues set out below.

Policy issues

4Technologies don’t care – they support care, hence they need to be seen as one element in a wider package of care interventions.

5NCTs need to provide ‘safe systems of care’. To avoid the risk of remotely gathered data falling into the wrong hands, clear policy guidelines need to be developed about where this data is stored, who has access to it and the ethical implications.

6It should not be assumed that NCTs are economically cheaper or a replacement for other care interventions. To understand who benefits (in economic terms), requires a comprehensive cost/benefit analysis.

7It is important to remember that care technologies are only part of the solution – they always need a human environment in which to function. Any development and evaluation of NCTs must be undertaken with this in mind.

8In developing and commissioning NCTs for older people, it is important to take into account the environment within which the technology will be located, including housing, family networks, community support and so forth.

9Policies designed around ‘aging in place’ should recognize that the home is not always a safe, comfortable or desirable place for the older person to receive care. Thus, where appropriate, alternative options must be available.

10While NCTs can be beneficial, they can also disrupt the home, making it a difficult place to live. Policies around aging in place should consider what kind of ‘homeliness’ we are trying to achieve.

11Effective design should assess NCTs in particular contexts and situated interactions and be adjusted accordingly.

12NCTs should be only one element in a range of care options – people should have the freedom to choose which care options they prefer and where that care should take place.

13Replacing face-to-face health care with remote NCTs runs the risk of losing ‘local knowledge’ of individuals and their circumstances. Hence, NCTs should only ever be seen as one element in a package of care to older person.

14NCTs bring new sets of people into the care network – including telephone operators, installation technologists and maintenance people. It is critical that such people have appropriate training in working with older people. Where they will be entering the homes of older people they should also be subject to Criminal Records Bureau (or equivalent) checks.

15NCTs affect who cares – from health professional to family care – and where that care takes place. Care should be taken that these changes do not act to reinforce traditional gendered caring roles.

16There is growing recognition that the design of NCTs has tended to focus too narrowly on medically-oriented clients’ needs. This approach is too limited. When purchasing NCTs, organisations should also address the social and affective needs of their clients.

17Over-regulation focused on risk avoidance can stifle innovative design.

18Evaluation of technology should take as its starting point not just how effectively the NCT works, but how care improves as a result of the technology.

Design issues

19The development of NCTs needs to take as a starting point the needs and desires of older people themselves. However, it is important to recognize that there are huge variations between older people, their needs and the differing forms of frailty/ill-health they may experience. Policy-makers and NCT designers should beware of over-generalization.

20Rather than focusing solely on NCTs based on supervision, monitoring and risk avoidance, commissioners and designers should also focus on directly improving the life situations of older people through flexible NCTs that can also enhance social contact and communication.

21New care technologies cannot replace the human ability to know an individual and respond on the basis of that knowledge, hence NCTs are Ageing, Technology and Home Care an ‘add-on’ not a replacement for human care. This also raises the issue of how much of this pre-supposition goes into the design of NCT systems.

22It is important to consider the norms that NCTs embody, for example what it means to be old and the values attached to old age will vary across Europe.

23Care technologies tend to be developed in a gender, cultural or socio-economic vacuum. This needs to be addressed.

24Effective design needs to bring key groups of people together on a regular basis not just at a singular moment in the design process. This should include designers, care providers, service users, family carers and other relevant actors.

25There is often a significant difference between a comprehensive NCT trialled in a pilot and the ‘pared back’ version purchased by providers following such pilots. This has a significant impact on the effectiveness of an NCT. Designers should consider the economic viability of developments with a range of potential purchasers at the outset and shape NCT developments accordingly.

26It is important to judge care technologies in action rather than in the abstract and to make adjustments according to the needs and situations that older people encounter in their daily lives.


27As a result of the interactions generated around this event, a number of outcomes can be indentified. Two websites/links have been circulated where participants can access the materials and ideas worked on:


29A new research project has now been funded by the EC under its Framework 7 Programme, Science in Society Section. This project which formally began on March 1, 2008, is called EFORTT (Ethical Frameworks for Telecare technologies for older people at home). It involves new indepth research in four countries: UK, Spain, Netherland and Norway and will examine further some of the questions identified in the Utrecht Conference1.

30The network formed around MEDUSE and the Utrecht conference has also given rise to a new Swedish project: Good Care at a Distance? E-Health, Telemedicine and Medical Practice. This is coordinated by Prof Boel Berner at the Department of Technology & Social Change University of Linköping. Funded by the Swedish Council for Working Life and Social Research., the first part concerns how the usage of different forms of e-health and telemedicine affects patients’ illness identities, knowledge and care. In particular the group will study how patients individually and in groups use the Internet to get knowledge and ex-change information about their illness and how their increased knowledge affects their interaction with doctors; if and how the traditional situation of asymmetric knowledge is changed and how doctors and patients handle these changes. The focus is on breast cancer and prostate cancer patients, i e there is a gender component to the project. The second part looks at communication between ambulance personnel and hospital experts in pre-hospital care and how information and decisions are negotiated at a distance. The project aims at a later stage to examine care-giving situations, at home and/or at hospitals.


1 For more information about EFORTT please contact the coordinator, Maggie Mort:

© Presses des Mines, 2008

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