Studies in Co-Creating Assisted Living Solutions
The SCALS team has won a prestigious award from the University of Oxford for its work using co-design principles to inform the design of assisted living technologies for older people. The Vice Chancellor’s Awards are new for 2016 and have been set up to reward excellence in public engagement. SCALS Programme Lead, Trish Greenhalgh, said ‘We are delighted to receive this award. Our work has benefitted enormously from the insights that we’ve gained from working with ‘housebound’ elderly. These are people who are usually hidden from society, and from researchers, and so the award is a very welcome recognition of their contributions’.
Christine A’Court, Sara Shaw and Joe Wherton attended a ceremony at Merton College in July to collect the award on behalf of the team.
PURPOSETo explore and address organisational barriers to the creative and adaptive use of assisted living technologies by older people with chronic illness and the people who support them (health and social care staff, technology designers, technical support staff, lay carers).
- To inform local, national and international policy on assisted living.
- To inform the design, distribution, installation and support of assisted living technologies by service organisations, care professionals, industry and lay networks.
RATIONALEHealth and social care in the UK is often depicted as being at crisis point. The population is ageing; chronic illness is increasing; and financial pressures in the public sector make efficiency savings essential. There are no easy fixes for this problem, but it is widely agreed that we need to work on four kinds of solution:
- New models of care that are better matched to delivering care across sectors for people with complex needs (including accountable care organisations, devolution, pooled budgets and ‘integrated care’ of various kinds)
- A shifted focus of care from treating episodes of illness to preventing chronic illness and its serious complications
- New roles and responsibilities, including the promotion and support of self-care by empowered patients and citizens
- New technologies that will support the integration of care, the delivery of remote care and self-care, thereby allowing people to ‘age in place’ (that is, continue to live independently and safely in their own homes).
In recent years, there has been significant investment in technological innovations intended to create the ‘smart home’ (e.g. alarms, sensors, medical devices, ‘social presence’ robots). But uptake of these technologies remains substantially lower than predicted. If installed at all, they are often abandoned (and sometimes deliberately disabled) by the people they are intended to help. With rare exceptions, anticipated efficiency savings have not materialised, nor have the intended users of assistive technologies been ‘empowered’. In particular, installation of assistive technologies does not always (or even usually) reduce use of conventional health services, and the evidence on whether it reduces acute hospital admissions is conflicting.
The main reason why technological solutions have disappointed is poor innovation-system fit. Ethnographic research has demonstrated that the lives of older people with multiple medical and social needs are invariably unique, complex and evolving. Technologies often fit awkwardly into people’s lives and may oppress rather than empower. The standardised solutions typically offered in care packages often clash with the material, socio-cultural and (changing) clinical detail of a particular individual care situation. ‘Bricolage’ – that is, needs-focused customisation – by patient, carers and front-line staff is key to generating a workable solution that adapts to the person’s changing needs.
But personalisation of technologies and care packages is difficult, not least because of the increasing tendency to standardise and formalise organisational work and professional practice via contracts, service level agreements, guidelines, protocols and algorithms. It is this tension – between the need for adaptive and ongoing personalisation and the pressure to standardise – that the SCALS study seeks to explore.
The SCALS team are based in the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Our focus is on exploring academic questions around the tensions and paradoxes (such as the trade-off between personalisation and standardisation) inherent in assisted living policies and services. But as pragmatists and optimists, we are also interested in supporting organisations to develop workable service solutions that deliver better care, with and through technologies, for the ageing population – and in doing so, generate wider lessons about how this can be done.