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A WHI White Paper

Opportunities for Technology to Support Independence and Assisted Living in Older People and Other Vulnerable Groups Written by: Dr Kevin Doughty, Consultant and Deputy Director of The Centre for Usable Home Technology (CUHTec) E:

Commissioned by Wellness and Health Innovation, Scotland’s national initiative designed to support Scottish companies developing innovative products or services for the wellness and health sector.

Opportunities for Technology to Support Independence and Assisted Living in Older People and Other Vulnerable Groups A WHI White Paper

The Independent and assistive living market is set to grow exponentially in the next 30 years, this is largely due to the demographic shift which is said to be as big a challenge as Global warming!

1. MARKET OVERVIEW Older people with disabilities used to be considered poor targets for the purchase of products and services to help them live independently because:

• they were perceived as being resistant to change • they struggled to deal with new devices and procedures (e.g. programming the VCR) • they represented a small sector with little voice and lower influence • they were unlikely to live for many years, and • they were considered to be financially badly off with little disposable income. Such an approach is no longer the case; a typical older and disabled person in the 21st century is rather different to the stereotype implied above. The financial muscle that the over 50s can exercise, produces a great commercial opportunity for companies that can satisfy their various needs. Over-50s, in the UK, hold 80% of the nation’s wealth, including 60% of all savings; they are responsible for 40% of all consumer demand. (1)

Dr Kevin Doughty, Consultant and Deputy Director of The Centre for Usable Home Technology (CUHTec) Dr Kevin Doughty is an experienced consultant in telecare and is currently advising CUHTec on this topic as its Deputy Director. Originally a physicist and electrical engineer by origin, Kevin became interested in medical electronics. Via a research and then a lecturing career in sensor technologies and telecommunications, he established his own company Technology in Healthcare to enable direct and practical application of expertise to the running of a residential care home. As former Director of Telehealth for Tunstall Group he now works with them to enable leading edge research to guide the design of telecare products.

The main drivers for change: a. Demographic shift – increasing lifespan and a fall in the birth rate; according to the Office of National Statistics since 1931 the number of people aged 65 and over has more than doubled, and this age group has exceeded the level of under 16s for the first time in 2008 (2). b. Living arrangements – The number of single person households in Scotland will increase from 34% of all households to 42% within a period of 20 years (4). This is consistent with a continuing reduction in Social Capital (which includes involvement with family, neighbours, societies etc.). Therefore fewer people will have someone to rely on to provide care and support.

E: (references on page 15)


c. Cost – the cost of providing care is increasing exponentially not only because of the increasing numbers of people requiring care and support, but also because expectations are increasing, and the cost of new procedures and pharmacological interventions are also accelerating. In the USA, the annual cost has reached $2.2 trillion, consuming 17% of GDP (6). Planned reforms are likely to increase the potential and penetration of new technologies including telehealthcare which already has a global marked of more than $6 billion (7). d. Mature technology – the miniaturisation of electronic circuit boards, the efficiency improvement in electronic actuators, and the use of embedded intelligence within devices has enabled the design of more powerful assistive devices that are adaptable and wanted by a new generation of relatively wealthy healthcare consumers who are keen to exercise choice on the High Street. e. Growth in long term conditions – Older people already consume the lion’s share of NHS and social work budgets. They also are likely to suffer from one or more long term conditions (LTCs) and are responsible for more than 80% of current NHS spend.

2. RELEVANT TECHNOLOGIES The term Assistive Technologies applies to any device or system that promotes independence (8). For assisted living applications, we should look at the two right-most intersecting circles on the right of the spectrum shown in Figure 2 and prepare to move away from the traditional disability focus of AT. These technology elements are a sample only of what is and might become available. However, it may provide a useful context and starting point for the discussions below concerning opportunities for small or medium sized companies. To clarify the meaning of some of the terms employed in this paper, we therefore offer some simplified definitions in the appendix.

Assistive Technologies Telecare

walking aids stair lift pavement scooter

smart homes alarm sensors

Virtual Presence

granny-cams health promotion speaking communicator virtual visits proactive calling hearing aids prediction telehospice holography exoskeletons activity monitors remote consultation bath hoist video conference reminder devices virtual health coach movement analysers spectacles door intercom remote door entry vital signs measurements tap turner


hug suits remote controls gait analysis carer quality management remote cognitive therapies energy consumption monitor internet shopping actuators and valves finder devices



video doorbell

grab rails


security devices


environmental controller

level access shower


Increasing level of telecommunications

40 30

Figure 2: The Intersecting Worlds of AT, Telecare and Virtual Presence 85+*


















10 0-4

Percentage with one or more LTCs

page turners

Age Two LTCs

Three or more LTCs

Following the various initiatives in the UK over the past few years, there are about thirty commercial companies operating in the wider UK electronic AT and telecare market segment.

Sources: General Household Survey 2005 and population census estimates 2004 for England * For those aged 65 or over an adjustment has been made using 2001 census data to account for those living in communal establishments

In summary, PEOPLE ARE LIVING LONGER, and want to STAY INDEPENDENT IN THEIR COMMUNITIES; this will drive an ever-expanding market for care devices and systems.


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and, most significantly, whether they live alone or with an informal (i.e. family or friend) carer. In many situations, individuals or their families will wish to use individual budgets (15) or their own money to purchase AT or telecare devices that will improve their Quality of Life or which will ultimately reduce other care and support costs.

3. NEEDS OF OLDER AND VULNERABLE PEOPLE The model of care in the UK has changed from one of keeping vulnerable people in long term hospitals, into one of Community Care; ranging from family members and formal carers in existing dispersed housing through sheltered housing with wardens (and the equivalent in private retirement sector), to the new housing with care models, and ultimately to residential care homes and nursing homes. Assistive technology and telecare can play a role in each of these areas so it may be necessary to consider market segmentation. In the UK, there are over 700,000 people aged over 50 in sheltered housing schemes (and perhaps a similar number in private retirement apartments) (13). They are generally supported by a basic community alarm and a warden whose duties have changed significantly over the past 20 years so that they do not have to be available and on-site on a 24/7 basis. Floating support is now more likely, so a telecare service will enable rapid responses to be made to problem situations detected by technology. Such changes, though necessary because of the European Working Hours Directive, are not popular with tenants so technology needs to become more user friendly whilst offering cost benefits to the Registered Social Landlord or management service. There are over 250,000 people currently living in residential care homes (14), and a similar number in nursing homes. Only a minority of these homes are today owned by local authorities. Many are operated by small concerns though large groups such as Barchester Healthcare, Bupa Care Homes, Caring Homes, Four Seasons Healthcare, Hallmark Healthcare, Southern Cross and Sunrise Senior Living continue to buy up capacity. Monitoring systems with sensors, and more advanced nurse call systems will enable them to improve the quality of care provision, minimising the effects of and accidents and safeguarding members of staff. Despite a rapidly increasing number of new Housing with Care establishments, funded, in part, with grants from central government, most people will be cared for in their own homes where the equipment that they will need will depend on their particular requirements, the type of property 4

This private market is likely to expand quickly, especially if organisations develop retail models for their Community Equipment Stores. The personalisation of health and social care (16) is likely to result in the consumer being empowered to exercise more control, and this could lead to more examples of users selecting technology. Their requirements can be grouped under 3 main headings: personal well-being, practical concerns, and Quality of Life:


Personal Well-being

Safety – older people are involved in more household accidents than any other group. These include slips, trips, fires, scalds, poisoning, electrocution and problems around the home such as plumbing leaks, floods and spills. The risk of such accidents can be reduced by improving lighting, offering reminders and providing automatic switch-offs to appliances so that they aren’t left on or used inappropriately. Alarm sensors provide reassurance but for those who live alone, they need to be linked into a telecare system and to have a service to provide monitoring and, sometimes, a response. Design tends to be industrial rather than domestic, and they do not blend into the home environment.

Figure 3: Banryu dragon – a smoke and intruder detector, and the Paro therapeutic seal The opportunity is to make these sensors more aesthetically pleasing, perhaps by combining 2 or 3 devices into a single product that fits with the community/home environment. Figure 3 shows two Japanese electronic pets that are used

to support personal well-being. The former (17) protects the home and its resident from fires and from intruders, while the latter (18) allows its owner to be relaxed through stroking it. Comfort – extremes of hot and cold or dry and damp in the home can aggravate many health conditions including arthritis, asthma and diabetes. These can be managed by electronic sensing devices with direct feedback to operate fans and heaters, plus instructions to advise them of any actions that have been taken. Such functionality may be possible within a smart home, but there is a market for smaller more direct components that can offer the user choice, and which will report problems directly to a remote adviser in a monitoring centre.

outside their property. Pavement scooters and modern buses enable more people with mobility problems to get out and about, and free bus passes remove some of the financial obstacles, but many visits are compromised by uneven ground, steps and stairs. Within the home, stair lifts have enabled people with such problems to continue to live in properties where accommodation is on two floors; but such solutions are restricted to the individual’s own property and are an expense resource to leave behind when the individual finally moves on. For example, Exoskeletons and joint enhancement motors are mobility aids that could extend the role of stair lifts into the outside world. Applications for force enhancing devices exist for other joints (such as the wrist, the elbow and the ankle). There are opportunities to develop more aesthetically appealing technologies than the ones shown in Figure 5 (23-25) alongside the use of information technology to integrate transport and mobility options for older people, so that going out into the community becomes a viable and comfortable option.

Figure 4: The smart door camera and time-stamping arrangements Security – Feeling secure is a basic human right. Existing security systems involve door and window sensors and automatic lighting. More intelligent approaches may involve the use of remote monitoring and access control using video surveillance or smart intercom systems. These have yet to be optimised for use by older people who may have different needs to the rest of the population. Capturing visitor information including identity, purpose of call and verifying they are bona fide may be relevant and an opportunity for developers of equipment extending some of the principles employed in products such as those shown in Figure 4 (20, 21).


Practical Concerns

Mobility – many older and disabled people suffer from conditions that limit their ability to move both inside and

Figure 5: Exoskeleton examples Forgetfulness – current estimates suggest that there are already over 65,000 people in Scotland suffering from a cognitive impairment (26). By 2029 this number is likely to have increased to over 108,000. Similar increases will be evident in other countries that have an ageing population. The vast majority will be supported at home but the most advanced cases, including those of people with no close relatives, will be supported in specialist mental health units, care homes or housing with care facilities. In each case, there will be an enormous burden of care giving individuals 5

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reassurance, reminders and warnings of mistakes or dangers. Current telecare systems employ sensors to detect when a mistake has been made, enabling monitoring centre staff to provide advice and to notify telecarers where appropriate. These devices work well with detecting floods, people wandering out of the house at night and leaving gas devices on without being lit. There remains a need and a great opportunity to use technology to prevent problems from occurring and in allowing people more freedom through understanding where they are at any time either inside or outside the home. A Scottish company has already produced an intelligent cooker monitoring device that automatically provides an automatic switch-off facility (27). Many other proposed devices will need to rely on individuals carrying or wearing some form of interface or tag (rfid or active radio transponder) to predict their activity and location within the home or GPS modules to allow them to be tracked and kept safe outside the house. The challenge will be to find an acceptable way of fitting the devices on the person, and of managing the batteries so that they can remain active for extended periods of time without recharging. Intelligent homes may include systems and displays (such as those shown in Figure 6) that are installed in kitchens and are able to predict activity and provide advice on how to perform specific tasks (28, 29).

Access to doctors, nurses and hospitals – older people miss having their GP calling on them when they are unwell. They are the least likely people to use NHS 24 because they are used to being able to see and speak personally to their doctors and nurses. Consequently, they want a way of receiving the personal attention that they are used to but without having to travel, especially when they are ill. These are ideal opportunities to provide remote vital signs monitoring and remote consultations i.e. virtual healthcare. This will require a low-cost infrastructure (based on available digital telephone service) and a simple user-interface with a new range of sensors suited to the monitoring of parameters of relevance to the long term conditions that affect more than half of all older people. Many of the sensors will be body worn and will measure vital signs. They may provide alarms if a parameter lies outside a safe range. Response to alarms may also be virtual and might include teleconsultation with nurse advisers or the use of the TV to play recorded information clips. Continuous monitoring of activities of daily living, and real-time analysis of performance may be useful in detecting response to new medications, therapies or other interventions. Remote vital signs monitoring holds out significant potential for the management of long term conditions (including obstructive pulmonary disease (COPD) and epilepsy). The potential for employing enhanced monitoring technologies to provide early warning of mental health problems and support for the patient will be welcomed. This may include on-line versions of cognitive behavioural therapy for depression. The introduction of BT’s 21st Century Network may offer increased opportunities to employ standard solutions. Checking up on carers – personal care is free in Scotland but other forms of home help are charged as is all forms of domiciliary care (other than nursing care and reablement) throughout the UK. The consequence is that people who have assets over about £20K must pay by the hour. The rates vary considerably between local authorities but are generally in the range £10 to £15 per hour, and are scheduled in care slots as small as 20 minutes. People are concerned that carers may arrive late (or not at all) and leave early, short-changing the service users on the way. Furthermore, they may not perform the required tasks.

Figure 6: Activity reminder interfaces and displays for users with cognitive impairment


Keeping healthy & active – a lifestyle that includes exercise and a balanced diet is a requirement for managing many long term conditions whilst boosting quality of life. Technology can play a role in monitoring levels of activity, calories consumed and cardiopulmonary effort, and also in promoting such exercise regimes through reminders and feedback. New ways of taking exercise and of improving gait and stamina are needed to ensure that people are coaxed back into a better lifestyle. Technology-supported health coaching techniques may also play an important role in supporting smoking cessation efforts and similar initiatives designed to keep people healthy. These may include interactive conversation maps (31) (such as the one for diabetes on the left of Figure 7) or worn devices which give direct feedback (32) as a dashboard (see right of Figure 7 for example).

Figure 7: Interactive Approaches to Help Promote Healthy Lifestyle


Quality of Life

Social isolation/loneliness – the level of social capital (which incorporates the number of close relatives, visits by friends, community support and membership of societies, churches etc) continues to fall across the UK, including Scotland. In a 1999 report for the Scottish Government (33), low levels of social capital are associated with higher mortality, a failure to participate in health promotion activities (such as flu inoculations) and, ultimately, high per capita spending on health and social care. This is particularly the case for those people who are lonely and depressed. There are great opportunities to use technology to help include these people in their communities, and to link them with others with similar interests elsewhere in the country or even abroad. Government support for new initiatives is possible through the campaign to connect people through the digital switchover which begins with the South West Highlands and Islands in October 2010, extending to the rest of the country by June 2011. We should also consider the plight of informal carers (mainly family members) on whom a large number of people depend for support and personal care. There are 660,000 informal carers in Scotland who are often socially excluded. Telecommunications technology can offer them a means of keeping in touch with friends and former work colleagues without giving up their loving and important role. Shopping & accessing services – increasing amounts of retail purchases are performed on-line, in a manner which excludes the face-to-face contact on which many people thrived for their social interaction. Yet, teleshopping services that deliver heavy items including groceries to the front door are a boon to many people who are unable to visit supermarkets. Home shopping websites could be made more attractive and usable through better design and by providing some of the opportunities for meeting and speaking with people as they would in a real shopping aisle. Many services are found most easily and then more details obtained using on-line search facilities. There is a need for easier to use interfaces to allow older people to access the web.


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Receiving information & news – people are excluded from society and community participation perhaps because they aren’t informed about events that may be relevant to them. They need access to information streams that are fed into their homes and presented to them appropriately. This would include generic advice regarding, for example, flooding alerts as well as specific information relevant to their individual concerns such as the impact of the weather on their particular conditions. Younger people have information delivered to them on a plethora of mobile devices, which are upgraded at least every other year. The challenge is to find an equivalent ubiquitous delivery vehicle which will appeal to older people irrespective of their dexterity, eyesight and hearing abilities. It will need to be simple and low-cost, and of a form that it will pass the test of time so that the model purchased in 2010 will still work and be useful 5 years later. Applications for a TV based systems are described in Figure 8.


Smart sensors

4.1.1 Body worn devices Sensors to measure physiological parameters may need to be implanted beneath the skin or worn against the skin in order to optimise sensitivity. They may take the form of a sticking plaster or some form of clothing (see Figure 9). In most cases, the challenges are in providing power for normal use without the need for daily recharging through an external source. Opportunities for scavenging power from the movement of the body or of wireless power transmission need to be considered. There will be a market for both devices that simply transmit data to a receiver and those with embedded intelligence that are capable of making a decision (e.g. raising an alarm) (34, 35).

Figure 9: Smart plasters and clothing 4.1.2 Medical emergencies Many out-of-hours care requirements and A&E admissions are due to dangerous situations that have not been recognised until a crisis is reached. Early detection of these situations could be achieved through sensors to detect problems of the type shown in Figure 10 In addition, devices to detect bowel blockage, urinary tract infections, and food poisoning would have applications beyond the telecare and care of the elderly markets. They would enable timely interventions to be made by paramedics or nurses thus reducing the number of unplanned hospital admissions.

Figure 8: Home Hub for Information and Monitoring


have an important role to play in ensuring that people don’t become disabled. Robotic assistants can help people who have suffered a stroke to exercise particular joint and movements in order to speed up recovery (36). University research examples are shown in Figure 11 (37).

Figure 10: Some medical alarm opportunities for telecare systems 4.1.3 Furniture sensors Many of the sensors necessary to monitor lifestyle and activities have their origins in security systems. They are functional but are more industrial than domestic in appearance. Miniature versions of movement sensors, sound sensors and occupancy sensors may be integrated into the fabric of the home in the form of sensor picture frames, mirrors, chairs and kitchen appliances. Joint working with manufacturers of beds, chairs and other items used by older or vulnerable people may be relevant. 4.1.4 Interoperable devices Devices need to communicate with more than one receiver depending on whether it is transmitting an alarm, a binary piece of data, or a sequence of information with a request for a reply. Different frequencies and different communication protocols are currently employed depending on the appropriate application and the manufacturer of the system. Devices should be system agnostic and offered as modules ready for easy interfacing with any system. This move towards interoperability will be accelerated when existing social alarm requirements are brought up-to-date and when duplex communication overtakes the simplex approach for critical care situations. Transceiver modules may be offered for OEM (Original Equipment Manufacturer) applications.


Figure 11: Telerehabilitation and programmable rehabilitation aids 4.2.2 Stair lifts Local intelligence could monitor use of the stair lift and provide information on performance to social workers or occupational therapists. A dedicated user interface would provide the patient with appropriate reminders and safety information during their ride up or down the stairs. The potential for use of strap-on exoskeletons or motorised joints should increase as replacements for stair lifts should increase. 4.2.3 Toilets Intelligent toilet systems can provide comfort and convenience through flexible support and the use of water jets and hot air to provide cleaning and drying. There is an enormous market for a safe toilet that helps users to get onto and off the toilet seat – especially for use in the confined spaces which are typical of UK bathrooms in sheltered housing. The Japanese have extended the concept into that of a smart measurement device by including sensors to detect sugar or blood in the urine. Figure 12 shows current examples of smart toilet design (38, 39).

Digital assistants

4.2.1 Smart rehab tools After accident or illness, patients often have to relearn simple mobility tasks. Devices that measure parameters such as posture or gait and provide positive feedback will

Figure 12: Electronic toilets designed for older people 9

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4.2.4 Bathing aids Two carers are often required to prepare someone for a bath or to support them in the shower. One of the carers effectively offers physical support only, and obeys direct instructions from the second carer. A suitably flexible support stand could be used to replace the second carer, enabling the actual cost of delivering many personal care services to be halved.


4.2.5 Dressing aids Most people who need domiciliary care are unable to get themselves out of bed and dressed without help. Electronic profiling beds could be adapted to enable an individual to become more independent. Devices to help users put on or take off clothing are in demand.

4.4.2 Low level communications Relatives who live at a distance from their lonely family members can share a sense of belonging using photographs and other reminder devices linked through broadband. A simple photograph touch arrangement is shown in Figure 13.


Virtual communication tools

4.4.1 Linking services Video and telephone conferencing between people matched through their interests, problems or personal circumstances facilitated through telecare monitoring centres can relieve loneliness. It is effectively a matching arrangement that can operate at a distance enabling individuals or groups to be put into contact.

Linked devices for smarter homes

4.3.1 Water control unit Floods can be prevented by the closed loop control of water-flow. Water shut-off valves need to be controlled by flood detectors or by intelligent flow meters. These would prevent the loss of water through links and could also provide automated billing i.e. integrated solutions. 4.3.2 Lighting assistant with messaging Pathways should be illuminated at night to prevent falls. Residents need a spoken interface to inform them of lights that are inside or outside the house. Outside lights could be linked with cameras to enable them to see visitors and to identify them before their arrival at the door. Systems could also reduce wastage of electricity by automatically switching off unnecessary lights. 4.3.3 Cooking assistant Intelligent monitoring of tasks is needed so that advice and/or interventions can be offered when a sequence of tasks has been interrupted. Systems needs to link in with smart cooking appliances of the type that will be available through IP6. Knowledge of current tasks needs to be inferred from image analysis or by using tags built into kitchen appliances.


Figure 13: Continuous distant communication between family members 4.4.3 Virtual tour bus Use of broadband, 3D technologies and surround sound can enable groups of people to overcome physical separation to share the experience of travel and new locations without having to leave their homes. Virtual meetings may be facilitated (40) using optimised camera arrangements and can simulate coach trips, football matches, community meetings and religious services.

5. NEXT STEPS FOR SCOTTISH SMES Scotland provides a natural test bed for many new products in the independent living sector. In particular, by offering free personal care to all older people, it has established principles that necessarily lead to the support of care in the home environment. The use of technology alongside traditional forms of support then becomes a natural progression, enabling new and more innovative opportunities to be explored. A consequence of the home care strategy is that local authorities become powerful commissioners of care and support services. This simplifies the process of explaining the benefits of technology and enables the commissioners to include high levels of technology within their service specifications, thus eliminating any attempt to revert to more traditional approaches. This makes Scotland a more attractive place to introduce innovation than the rest of the UK and provides SMEs based in Scotland with a great advantage over rivals in the rest of the UK. Although the Scottish market may seem relatively small, all products developed may be immediately offered south of the border, and then in other countries (including Northern Europe and North America) where telecare services are being established. The economic benefits are not simply in the manufacture or supply of products, but extend to areas of training, maintenance and technical support. The areas where Scottish companies are most likely to participate in the short term include those where there is already considerable expertise available through government-led centres (such as the Scottish Centre for Telehealth in Aberdeen), professional development centres (such as the Iris Murdoch Centre) and academic research institutes including partners in the MATCH project. These provide cutting-edge research expertise which will be invaluable in identifying gaps in the market and in offering ways of adding value to existing developments. It may be relevant that this level of expertise exists in areas that have been identified previously as being prime targets for development i.e. cognitive impairment, age-related loss of balance (i.e. increased risk of falls), chronic disease and long term conditions. They, and other university departments, can also advise on human factors and interfaces of relevance to exploiting these markets and

of ensuring that new offerings take into account the heterogeneity of older people. It may be appropriate to consider the sharing of this knowledge across Scotland through a Telecare and Telehealth Special Interest Group which could bring together academia, local authorities, the NHS, the voluntary sector, product developers and facilitators. This would allow SMEs to have rapid access to informed opinion whilst also keeping them abreast on progress with interoperability, internet protocols and radio standards. This would ensure that they could plan for a timely introduction of 2nd or 3rd generation telecare products without their route to market being compromised by an inability to fit in with current models of telecare and smart housing. SMEs intending to enter the telecare and assistive technology market need to:

• ensure that they understand the needs of their niche sector of the target market – this means extensive market research (or access to specialist knowledge), • know the limitations of existing products and players in this area, • link with other organisations to tackle problems where specialist knowledge is sparse, • use support agencies to help plan how to introduce the new product into the market by overcoming the potential obstacles to market entry (such as formal approvals from regulatory bodies), and • pilot the concept with focus groups and representative organisations before committing to large scale expenditure on production models.


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APPENDICES APPENDIX 1 - TABLE OF DEFINITIONS Assistive technologies – an umbrella term which is often separated into: ASSISTIVE TECHNOLOGY Fixed systems

DEFINITIONS AND EXAMPLES Stair lifts and level access showers which are adaptations to the property, and which therefore cannot be moved in a simple manner. UK companies dominate the world supply and sale of stair lifts through organisations such as Stannah and Churchill.

Portable systems

Walking sticks and tap turners that are low cost and small enough to be carried on the person. There are hundreds of small companies offering thousands of different products, often marketing only through catalogue and other retail outlets. There are few major brands to consider but moves towards a retail model may encourage growth in this sector.

Electronic devices and systems

Expensive tailored solutions that allow a disabled person to control their environment, or to communicate with others. The two biggest providers in the UK are Possum and RSL Steeper which control 95% of all UK sales.


Electronic devices that help to address the unmet needs of the individual, their carers, or society in promoting or supporting independence.


Telecare – can be further split into 4 parts (or generations) (9) : TELECARE SYSTEM Standalone devices (Generation 0)

DEFINITIONS AND EXAMPLES Any sensor or device that doesn’t need to connect with an external telecommunications network. This is effectively the devices that are described as telecare under the heading of Assistive Technologies above, and are particularly suited to supporting carers and to help people to overcome specific deficits including short-term memory problems.

Linked alarms (1st Generation)

Sensors and intelligent gateway units that detect alarm conditions and send coded messages to a monitoring centre or to an individual telephone where appropriate action can be initiated. The vendors are mainly the companies that produce the social or community alarms that already support about 1.5 million people in the UK through nearly 300 local, regional or national alarm receiving centres (10) . The market has been stimulated over the past few years by telecare grants of £20 million in Scotland, £80 million (PTG) in England and £10 million in Wales. The UK market has been dominated by Yorkshire-based Tunstall which has over 70% of the market in Scotland.

Monitoring systems (2nd Generation)

Sensors and data collection/storage units that forward data to remote servers where trends and exceptions can be displayed and shown to Occupational Therapists, GPs, community nurses and social workers using web technology. The medical versions of these systems (sometimes referred to as telehealth) monitor vital signs and also interact with patients by asking a number of questions relevant to a chronic disease. The Department of Health in England is spending £31 million over 3 years on a Whole System Demonstrator programme (11) in 3 counties to test the monitoring technologies on people at risk of hospital admission for heart failure, diabetes and chronic obstructive pulmonary disease (COPD). Another significant development in the UK telehealth market was the decision by Northern Ireland’s Department of Health and Social Services in spring 2008 to invest £46 million in technology to manage 5000 people with chronic disease by 2011 (12) . There are more than 20 remote vital signs monitoring systems currently on sale in the UK.

Interactive systems (3rd Generation)

Systems that include video and other high-bandwidth communications to enable people to be linked more effectively at a distance. This is a subset of Virtual Presence technologies. The market is immature and in need of some serious technological solutions.


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Telecare – can be further split into 4 parts (or generations) (9) : TELECARE SYSTEM Virtual Presence

DEFINITIONS AND EXAMPLES Systems that aim to reduce the significance of geographic isolation by using high bandwidth telecommunications to bring people and situations together. The main applications use the television and a set-top box with a web-cam as the main components in order to deliver various teleconference possibilities. New systems will utilise the increasing bandwidths available, and the use of switching technologies to introduce 3D or shared experience possibilities. This will include tele-therapies – and the use of robotic assistants to deliver or monitor the delivery of physiotherapy, occupational therapy and psychological interventions for mental health problems.

Mobile Care (m-care)

Cellular phone technologies provide increasing levels of intelligence, memory and interfaces to enable the handsets to be used as a mobile hub in many medical monitoring and alarm situations. The target audience is younger and, obviously, able to move around rather more than those likely to receive telecare.


This is the sharing of electronic records, an essential prerequisite for joined-up care, including ambulance services. The scale is so great that opportunities for SMEs to introduce complete systems are very limited.

Smart Homes

Over the next decade as microcontrollers and processors will be embedded into virtually every item of consumer electronics from the fridge through to the washing machine and from the kettle through to the lights. These will all be provided with unique internet addresses thanks to IP6. This will allow smart systems to control security, energy efficiency, entertainment and assisted living functions provided that the systems are compatible and operate with each other i.e. they must talk to each other using a common language and protocol. Interoperability is a requirement for true integration but may be achieved only through joint working on standards, which tends to be very slow to be accepted. In the meantime, smart homes will focus on individual applications with the assisted living theme being popular for new-build apartments for older people and for people with disabilities.


APPENDIX 2 – SCOTLAND SPECIFIC INFORMATION Scottish Landscape Geography – Large proportion of rural area

The Scottish Centre for Telemedicine in Aberdeen is likely to become a valuable source of expertise for promoting new solutions which may be extended to provide high quality image transfer between secondary and tertiary care facilities.

Informal Care

The replacement value of care provided by informal carers has increased by over 50% in 5 years and is currently estimated to be in the order of £8 billion per annum. There are 660,000 informal carers in Scotland who are often socially excluded because of their caring responsibilities and by a lack of respite options (3).

Long Term Illnesses

WHO data for 1997 (5) shows that Scotland had higher mortality rates due to heart disease, vascular disease, and the majority of common cancers than Japan, the USA, Spain and England and Wales. It is therefore an ideal test-bed to attempt innovative approaches to prevention, treatment and general health promotion.

History of Alarm systems in social care

The early uptake of alarm sensors in West Lothian and in North and South Lanarkshire, helped to make Scotland the focus for trials of new devices.

Living Conditions

Scottish House Condition Surveys show that the proportion of dwellings with condensation or dampness, or failing the Scottish Housing Quality Standard, has fallen, the most recent figures for 2005-06 show that 60% of social housing and 69% of private sector housing falls short of the Scottish Housing Quality Standard with nearly half (47%) of dwellings have some urgent disrepair (19). Despite initiatives such as the Scottish Warm Deal, which offers home insulation grants for those aged 60 or over, many older people who may have reduced peripheral sensitivity and an inability to adjust for extreme conditions, will be at risk.

Security for Vulnerable people

The Scottish Executive is trying to create a feeling of safety by tackling both crime and the fear of crime in communities by building strong, safe, inclusive communities as a foundation for the Social Justice agenda. Reducing the fear of crime among older people is a milestone in this policy and involves support for such strategies including the use of AT and similar devices.

Scottish Housing

In Scotland, a discretionary improvement grant of up to £20,000 is available to provide basic amenities while a 50% of the total approved is available as of right for making a house suitable for the accommodation, welfare or employment of a disabled person who lives there (22). Such grants may not need to be confined to building work; more innovative solutions using AT may become relevant as new systems appear.

NHS Expenditure

The Audit Scotland report shows that the NHS spent at least £98.5m on COPD (Chronic Obstructive Pulmonary Disease) (30). This is an underestimate of the total cost due to a lack of information about social work costs, services provided by the voluntary sector and families, and full prescribing costs. Epilepsy cost a minimum of £38m in the same year. 15

REFERENCES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 The UK Domiciliary Care Market Development © MBD 2009, (pg. 10) World Health Organization, Geneva, Switzerland, World Health Statistics Annual as presented by the United States Census Bureau, Statistical Abstract of the United States 1997, Table 1339 (pg. 17). Doughty K, Cameron K & Garner P; “Three Generations of Telecare of the Elderly”, Journal of Telemedicine and Telecare; Vol. 2, pp. 71-80 (1996) Fisk MJ; “Social Alarms to Telecare”; Policy Press, Bristol (2003) The UK Domiciliary Care Market Development © MBD 2009 Ovum, The emergent UK telehealth market: beyond the hype 05 February 2009 Tola Sargeant toilet Doughty K, The Digital Seventh Age; IET Control & Automation June/July (2007)

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