1. Implementing telecare for
older people: the West
Lothian experience
Alison Bowes
University of Stirling, Scotland
a.m.bowes@stir.ac.uk
Slide 1

2. Thanks to:
The Health Foundation
The Nuffield Foundation
Big Lottery Fund
Gill McColgan, Sherry
MacIntosh, Ghizala Avan,
Mike Wilson
West Lothian Council
Research participants
Slide 2

3. Changing policy for
older people
• Recent changes involve
– Focus on independence
– The whole person
– Individual responsibility
• Service users as active
agents
– Empowered
– With rights
Slide 3

4. The contribution of
telecare/telemedicine
• Can it
– Increase independence
– Deliver more effective and efficient
services
– Control expenditure?
• Or does it
– Replace human contact
– Increase isolation
– Raise risk levels
– Present insuperable ethical
obstacles?
Slide 4

5. A citizenship approach
• Focusing on older people as
active agents (citizens), I
aim to explore the impact of
a radical telecare innovation
in West Lothian, Scotland,
in terms of older people’s
own citizenship goals.
Slide 5

6. Citizenship goals for
older people (Craig
2004)
• independence
• social participation
• identity
Slide 6

7. West Lothian, Scotland
Slide 7

8. Telecare in West Lothian
• everyone aged 60 and over (10,000 households – 3,200
as at May 2007)
• baseline for support for older people:
– a home alert console, linking sensors to a Call Centre
– two passive infrared (PIR) detectors
– two flood detectors
– one heat extreme sensor (hot and cold)
– one smoke detector
and (optional)
– other devices to suit the individual
• augmented if support needs develop
• Call Centre has response protocols for each client
• challenging stigma through mainstreaming
Slide 8

9. The research evaluation
• views and experiences of key
stakeholders over time
– older people in the different settings (at
home and in housing with care
developments)
– unpaid (informal/family) carers
– staff at all levels
• comparator study in another area
• file study
• study of costs
Slide 9

10. Independence
• Maintaining one’s own
independence
• Avoiding care
• Freedom of routine
• Supporting capacity
Slide 10

11. Limits of independence
• Requires appropriate model
of care
• Requires limit to risk
aversion
• Wider issues of safety and
security apply
Slide 11

12. Participation
• Maintained community and
social networks
• For unpaid carers, improved
interaction and peace of
mind
• In housing with care, open
doors and new community
Slide 12

13. Limits to participation
• Less human contact?
• Narrowing networks
• Disabling environments
• Threats to status
Slide 13

14. Identity
• Belonging, supported by
independence and
participation
• Local connection
• Mainstreaming strategy
reduces ‘spoiled’ identities
Slide 14

15. Limits on identity
• Negativity about services
reflects perceptions of
failure
• Exclusion in e.g. public
spaces
• Stereotyping of older people
– ageist attitudes and
behaviours
Slide 15

16. Conclusion
• Support for citizenship goals
through telecare
• Limits come from wider
social and policy context
• Other excluded groups? –
identify the possibilities and
limitations
Slide 16