Debate: why aren’t we further ahead with assistive technology?

Since demonstration sites appeared locally almost a decade ago, the potential for smart home technologies to support Australia’s growing older population has been evident. Yet the widespread take-up of these technologies remains patchy. Here, leading experts, aged services providers and vendors discuss why this is the case, and what’s needed from a policy and practice perspective to realise the smart home vision. 

Having their say are:

• Professor Jeffrey Soar, University of Southern Queensland
• Tom Sykes, general manager, product management, Hills Limited
• Catherine Daley, CEO, integratedliving Australia
• Lyn Davies, managing director, Tunstall Australasia

The researcher: ‘On the cusp’

There is a renewed determination that we will eventually succeed in having smart home technologies transform the ageing experience, writes Professor Jeffrey Soar.

There is a paradox of high needs for services amongst the frail elderly, availability of smart home technologies, and an evidence base showing that these deliver benefits; and yet there remains a low level of widespread adoption.

There is a widespread perception in Australia, and around much of the world, that smart home projects have rarely moved into sustainable mainstream use. The feedback I had a few years ago from a national grant application I submitted sums it up. The grant reviewer said words to the effect that these telehealth projects go nowhere, and my proposal will only add to the large number of projects around the world that have failed to move into widespread adoption.

There now is increased acceptance that this is a challenge requiring a multidisciplinary approach. The technologists have delivered smart innovations, now it is up to care managers and business experts to develop the required models of care and business models for sustainable adoption and realisation of benefits.

I started research in the field of informatics and ageing just over 12 years ago when I came to academia from an international career in healthcare ICT management. My aim is to assist aged care consumers, families, care providers and technology industries through research. Like other researchers in the field, my colleagues and I have conducted projects to develop and trial technology innovation; we also established the Queensland Smart Home Initiative in 2007 which developed demonstration smart homes. We have used available telecare and telehealth smart home technologies in our research, but are also working on intelligent agents or software robots. There is a need also to develop the technical and semantic interoperability standards to achieve a “plug and play” infrastructure for user convenience.

There is now a reasonable body of international evidence to support the claim massive potential from smart home technologies in terms of consumer comfort and satisfaction, reduction in transport of both consumers and visiting carers, reduction in hospital and clinic attendances, and clinical benefits. These technologies could clearly provide better access to care services for remote and isolated consumers, reduce unnecessary home visits by care staff, help people age safely in their own homes, and allow clinicians to better monitor and care for ever-growing and increasingly complex case loads. Our focus in more recent times has been to research the needs, issues and anxieties of ageing from the perspective of consumers, carers and providers.

There is a need for research into models of care that utilise available technologies and business models for the technologies and technology-based services. This needs to include work practice modification so that care staff can take greater advantage of new technologies. Existing technology can eliminate the need for printed documentation or for completing time-sheets; it can allow immediate point-of-care access to the most-up-to-date information. We still have care staff travelling large distances sometimes to take vital signs or check on a client’s wellbeing which could be more efficiently undertaken through smart home technologies.

On 30 September 2014 a report relevant to the question of what’s needed to bring about the widespread adoption of smart home technologies was released. This was the Assistive Health Technologies for Independent Living report prepared by the Australian Academy of Technological Sciences. This was the third report of ATSE, the first two reported on research, development and projects in Australia and overseas. This most recent report involved consultation with participants in many of the Australian telehealth/telecare projects to try to understand specifically why most had not moved from pilot phase into broad operational usage.

This project identified several barriers and facilitators for enhancing the adoption of assistive health technologies and the development of innovative models of healthcare delivery. A key finding was that an increasing number of interdisciplinary players are moving into the healthcare sector, and that there is a need for an even greater range of disciplines in the future. Many of these players would be considered non-traditional, such as consumer electronics, large and small retailers, software developers, telecommunications companies, mutual/membership organisations and others considered important in bringing new business models to the sector.

My involvement in the research for this report was re-invigorating; there was a determination on the part of participants that we will eventually succeed in having smart home technologies transform the ageing experience as technology has done in other sectors where it provides consumer convenience, greater consumer control, improved safety, productivity and efficiency. I am convinced that we are on the cusp or tipping-point and something could happen very quickly to transform ageing and aged care.

Professor Jeffrey Soar holds a Personal Chair in Human-Centred Technologies in the School of Management and Enterprise at the University of Southern Queensland. He is available to advise on smart home technologies and can be contacted at jeffrey.soar@usq.edu.au

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The vendor: ‘Smart home key to keeping seniors at home’

Governments should consider funding the devices and systems that will keep people out of care and in their own homes, writes Tom Sykes.

While nothing beats the human touch, there is an increasing recognition that technology will soon allow carers to keep tabs on everything from trips to the bathroom to signs of imminent crisis.

This technology has traditionally been largely response orientated – the use of panic buttons and fall detection mats can alert caregivers when something has gone wrong, after the fact.

What we’re seeing increasingly is a shift in focus to prevention, intervention and mobility, particularly in the home as growing numbers opt to age-in-place. Unsurprisingly, the home can serve as an early detection system. Research shows that even small changes in daily routines can hint at serious problems to come.

The significance of the home and a growing number of tech-savvy seniors has seen a number of smart home products released which give older Australians independence and their carers’ peace of mind.

In Geelong, Victoria we are partnering with two of the region’s largest medical practices to bring a sensor system known as Lively to the region’s elderly residents.

Lively’s wireless smart sensors can be placed around the home on commonly used items to monitor a senior’s movements in a non-invasive and discreet way.

The system’s ability to track whether elderly patients are opening their pill boxes, whether they’re getting food out of the fridge, how many times a day they’re going to the bathroom and even when they leave the house is providing invaluable insights and peace of mind.

In November, we also signed an agreement with Ollo Mobile to exclusively distribute their single button, no display, push to talk 3G smartphone. The device has the usual smart phone features but can also map the user’s location and relay important metrics such as physical activity that seniors and their families read on a tablet app. Sensors in the phone detect falls and inactivity and can alert emergency contacts or emergency services.

Smart home technology isn’t going to replace the role of aged care nurses or other health workers but it does have the potential to be provided as part of an overall care package for older Australians. Ageing-in-place supported by smart technologies also offers the potential for substantial savings in residential aged care and in reduced admissions to hospitals.

Despite the benefits this technology represents, the uptake of technology across the broader sector has been relatively slow.

So what’s needed to bring about greater adoption of smart home technology?

First of all, we need to rethink how we deliver aged care services. This relates to models of service delivery and which aspects of smart home technology can be funded through health programs.

The user experience, and the look and feel of the technology, plays a vital role in its adoption and acceptance into the home. Many of the current generation telecare solutions look like they belong in the emergency room at a hospital. Research shows that bulky, clinical looking devices make people ‘feel old’ and generally aren’t embraced in the home.

More needs to be invested in design, development and form factors to help smart home products blend and integrate into the existing home environment. The smart home innovations we have released are non-invasive, operated by small sensors rather than cameras and preserve a user’s privacy.

Many older Australians don’t want to enter an aged care facility and in many regions there simply aren’t sufficient places to begin with. Governments should look at this as an opportunity and consider funding the devices and systems that will keep people out of care and in their own homes.

The continued roll out of the NBN offers a unique opportunity to link older Australians with state-of-the-art technologies that improve health, wellbeing and quality of life. New housing stock should be custom designed to maximise use of the NBN and integrate all of the home systems – from lights to smoke and fire alarms to health monitoring and door locks.

We need to involve older Australians in defining their own needs to ensure we deliver solutions that actually meet their needs. Smart home technology shouldn’t be narrowly seen as monitoring devices – they should be seen as devices that link people and their loved ones together.

Tom Sykes is general manager, product management with Hills Limited.

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The provider: ‘Selling the message’

We need to arrive on the doors of policy makers armed with evidence of the cost effectiveness to be achieved through smart technologies in the aged care sector, writes Catherine Daley.

As the Australian population ages, smart home technology and the broader field of e-healthcare offer viable contributions towards solving a number of sector issues ranging from workforce shortages to regional and rural service delivery.

As an organisation committed to servicing regional and rural communities, integratedliving recognises the significant benefits that can be realised from harnessing innovative technologies. In June 2014, we successfully completed an 18-month, $2.1 million trial funded by the Department of Health, providing telehealth services to older Aboriginal and Torres Strait Islander people with multiple chronic health conditions.

The project had a mixed model comparing in-home delivery of telehealth with telehealth services offered at community-based Aboriginal Medical Centres; and was the first of its size and scale in Australia working specifically with this group of consumers and focussed particularly on supporting people to age at home.

An independent evaluation of the project found that it was significantly more cost effective than a traditional face-to-face model, reduced unplanned hospitalisations amongst participants (with concomitant reductions in public health spending), increased health and wellbeing outcomes for individual participants; and, importantly, quantified some of the key “success factors” that underpin a culturally appropriate and accessible service model.

Indeed, the need to ensure “special needs” groups – such as older Aboriginal and Torres Strait Islander Australians and recent arrivals from non-English speaking backgrounds are not “left behind” and have equitable access to and receive commensurate benefits from the emerging field of e-healthcare will be one of the key challenges for the sector.

A further challenge is overcoming the fallacy that e-healthcare will “do us all out of a job” and that “by wiring people up to technology” we are losing the invaluable “human element” of service delivery.  Telehealth and assistive technologies do not have to be antithetical to the human interaction so prized in our traditional care models. As industry leaders, there is a need to reassure not only consumers, but often our own frontline staff, that technology is a tool that will actually enable us to do our jobs better, more efficiently and more cost effectively; freeing up time for more meaningful human interaction. The two are not mutually exclusive.

To “sell” this message effectively requires both investment and sector leadership. We need to be championing evaluation and innovation – researching and sharing knowledge in the field that enables evidence-based models of best practice to evolve over time. We need to arrive on the doors of policy makers and government funding bodies armed with independent research and evidence of the cost effectiveness and enhanced health outcomes able to be achieved through smart technologies applied in the aged care sector.

For instance, we are investing in a partnership with the eHealth Flagship of CSIRO to trial a reablement model using CSIRO’s unique Smarter-Safer-Homes platform that infers the activities of daily living information from a passive sensor-enabled environment and correlates the information with home-based health monitoring measurements. The project has the potential to revolutionise the way we undertake assessments, create efficiencies through reduced inappropriate servicing and provide truly individually tailored service models.

Whilst the new consumer directed care model provides sufficient flexibility for most large providers to incorporate a suite of assistive technologies in to their standard service offerings; looking forward, the challenge for vendors and providers will be to establish the unique value proposition for consumers (and staff) communicated through the language of tangible individual outcomes that go beyond the simple dollar savings.

The challenge for government and funding bodies will be “loosening the reigns” sufficiently to provide broad based “seed” funding for innovation and pilots without restrictive presumptions on the model that should be implemented; and to bring together the disparate and varied projects that will continue to spring up across the country into a unified, meaningful and accessible central respository where the success of various pilot projects can be collectively learnt from and built from over time as monitoring and assistive technologies increasingly roll out across not only our sector but the human services sector more broadly.

Catherine Daley is the CEO of integratedliving Australia.

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The developer: ‘Greater focus needed’

Government campaigns promoting wellness and independence in the home will also help to drive uptake of assistive technologies, writes Lyn Davies.

Currently in Australia there are about 300,000 people utilising assistive technology via a personal medical alarm service, with over 200,000 of those supported by a 24/7 response service.

These services unobtrusively monitor risks to safety in the home, assisting people to maintain their independence in the home for longer than they otherwise may be able to. The central hub of Tunstall’s telecare offering is the personal medical alarm used to make contact with our 24-hour monitoring centre and interfaced with a range of sensor devices to monitor the home environment. Our telecare sensors cover a range of solutions for falls, dementia, epilepsy, physical and cognitive disabilities, hearing impairments and carers.

By 2028 for the first time in Australia’s history, there will be more people over the age of 60 than under of the age of 20 (Australian Bureau of Statistics).

With an increasing population and decreasing tax base, enhancing care through assistive technology will greatly improve the reach of our community services. To ensure this widespread adoption is possible an increase in the number and flexibility of funding packages is required, including the introduction of co-payment arrangements.

Within the areas of community care, retirement villages and healthcare providers, these services are well-known and used to enhance care services to help people remain independent in their own homes. However, these services are not necessarily well-known within the private sector.

With a shift to consumer directed care, a focus needs to be places on improving awareness and understanding of assistive technology solutions for consumers. Government campaigns promoting wellness and independence in the home will also help to drive uptake. Industry also needs to drive affordable solutions and there needs to be a continued focus on product development that caters for individual needs.

For many years, Tunstall has been working very closely with the community care sector, Government, and not-for-profit organisations to create awareness and understanding of these services. We have developed products and services to meet the needs of the consumer and continue to invest more than 4% of revenue into research and development to meet the needs of an ever growing market place.

In 2010, Tunstall, along with a consortium of organisations set up the Queensland Smart Home Initiative (QSHI) to educate the community and encourage the adoption of assistive technology for older people, people with special or ongoing needs, and people managing chronic conditions.

The aim of the QSHI was to advance the adoption of intelligent assistive technologies and smart homes, to encourage and support independent living, access to care, improved outcomes and reduced costs.

QSHI was funded by LifeTec, Tunstall Healthcare, Queensland Health and the Home and Community Care program in Queensland.

Located in Brisbane and Townsville, visitors can see, touch and trial an extensive range of telehealthcare products.

To bring about mainstream proliferation of assistive technologies, we’re looking to government to add these services to the procurement list of the National Disability Insurance Scheme. We’re also looking for a Medicare item to cover telecare and telehealth services and an e-health record that links information from these services to a centralised system.

Lastly, and more importantly, there needs to be a focus on ensuring standards and guidelines for the delivery of telehealthcare services are developed and implemented to ensure the safety of consumers.

Lyn Davies is managing director of Tunstall Australasia.

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HAVE YOUR SAY: What do you think is needed to realise the smart home vision? Comment below