The language of telecare

We should be pleased to be in a field of activity that is changing so rapidly that people struggle to find the right words. Most people accept that Assistive Technologies represent a spectrum of systems, devices and communications that give people more independence. Maybe the debate has moved on to what we mean by independence. To some it is having their own front door; to others it is the ability to offer a visitor some refreshment; and to another group it could be the ability to choose to live alone in the community. Telecare does indeed support all these requirements to some degree - so telecare, when focused on the home, does cover a wide range of Assistive Technologies - but certainly only a small percentage of them.

If an individual with a chronic disease is able to continue to live safely at home (rather than in a hospital or a nursing home) as a result of having his or her vital signs recorded and monitored remotely every day, then this medical telecare system is surely also an Assistive Technology. The problem could be that Assistive Technology isn't as sexy a term as "telecare", and doesn't sound as expensive as "telehealth" - which really is a contrived term that must become redundant when new ways of continuously collecting and analysing physiological data become commonplace, eliminating the need to send all the data to some cloud in the sky for processing and storing.

I predict that Assistive Technologies will again become the dominant term when the first generation of Personal Electronic Assistants (PEAs) makes their appearance. They will help people with impairments (probably physical and cognitive ones first) to perform the domestic and personal care tasks that they may be unable to perform for themselves, typically as a result of having one or more limiting long term conditions. People will then realise that the right combination of Assistive Technologies will make independence a practical concept to countless millions. Telecare (and the version designed for a more mobile lifestyle) will be a part player in such a world - but one that will nevertheless be vital to many people who are anxious, live alone or who are at risk of accident and sudden decline in well-being.

I feel much more closely aligned with what Guy is saying. Vital signs monitoring cannot really be described as AT unless it is informing an individual , or their 'carers', about the appropriateness of their current actions/situation in real-time.

If it is not augmenting a reduced functional ability, or replacing an ability that has been lost, or never existed, then it is not AT. Simple!

Looking across a range of government documents, telecare is seen as sitting within the 'AT spectrum', which is recognised to range from grab rails to smart homes. (Section10, 'Housing, Health and Care', in Lifetime Homes Lifetime Neighbourhoods, April 2009, for example). What function(s) the technology performs and for whom the function is performed are critical questions in determining the correct terminology, from what I can see.

In the brave new world that Kevin envisions these conjectured PEAs will probably be capable of simultaneously straddling many of the terms previously described. It will be the functions that they perform and for whom that will determine which are appropriate to apply. The correct application of terms will be even more critical then than even now, as it will be harder to differentiate which services, service providers, budgets and protocols will be applicable to creating the correct package of support/care (the three Rs; rights, responsibilities and resources). Language is key to all communication AND action. Let's get back to basic and get it right.

Jeremy Linskell

Mike, my feeling is what you say is partially applicable, and this in fact hits at the heart of what Guy was trying to say.

Paracetamol is a headache/cold remedy that the vast majority of people are familiar with and quite happy to buy in the supermarket and self prescribe/administer. But if you need to take the maximum advised dose, over an extended period, then you should probably be seeking advice from a medical practitioner on your condition. Also, no supermarket will refuse to sell you a large enough supply, that you could actually do harm to your self with.

The point of that analogy is that paracetamol is a medicine and everyone understands that and what is meant by that, and who the people are that we should turn to for advice on how much and when, especially when we have taken the enclosed advise to its limit. But it remains our personal responsibility to do so, as we judge appropriate to our circumstances, as it falls well within the remit of expected self-management. Between this and obvious emergencies like sever trauma, there is a grey area where we seek advice from our GPs and others.

Assistive technology assists!! This covers everything from labour-saving kitchen appliances to deep brain stimulators and between these 2 extremes there is a very large grey area where the general public need a lot of information, advice and support.

If we don't remain clear on what we mean by 'assist', 'care', 'monitor' and 'treat', then this process is going to become a lot messier before it ever becomes clearer and my feeling is that we will doing the general public a dis-service.