It’s good to see someone else fretting at the terminology issues once again. This time Guy Dewsbury in his Telecare Blog focuses on people who play fast and loose with the phrase ‘assistive technology’ in particular. “If we fail to [understand what we mean by the words] then a conversation can be futile or even dangerous depending on what the other party takes away with them.”
Who will – or can – take up the challenge in Guy’s final paragraph? 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.
Language of telecare – response
Thanks for the speedy and excellent response. I suspect we are talking at cross purposes to a great extent. I am most concerned about the here and now and the current use of words. I can see where you are coming from and I really take on board many of your points.
I do, however, think that you have exemplified a fundamental difference in the way we think and our experiences in the field of telecare and assistive technology. You appear to be concerned with the future; a robotic future with Personal Electronic Assistants (PEAs) which might or might not come to pass but the issue I am trying to address is that we need a common parlance agreed now!
I like the assertion that “Assistive Technology isn’t as sexy a term as ‘telecare’, and doesn’t sound as expensive as ‘telehealth'” but I do not agree. Telecare and telehealth, to me, sound cheap and nasty; anything but sexy; whereas assistive technology says exactly what it is, technology designed specifically to assist people. No more… No less!
I am in favour of thinking about the future and spend much of my time doing just this but when you work as a practitioner in the field it is very difficult to understand the basic concepts if everyone is talking about the same thing using different words. Bear in mind, most practitioners are very, very busy people. They have limited access to journals or have the time in their working day to read. They rely on experts to guide them. It is difficult for anyone to be guided though this if in a conversation about a fall detector the words telecare, telehealth, telemedicine and assistive technology are used interchangeably to mean the same thing. Hence, it is hardly surprising that many people listening will be baffled.
Is it really accepted that most people agree on what assistive technology means? I suspect many people outside of academia would not have an easy job defining assistive technology. Certainly, I would suggest that few people would be able to compare and contrast the two. It is precisely because of this ambiguity in meanings that we need to all sit down and take responsibility for agreeing a definition.
I think that the world of technology is baffling to most, bewildering to many and utterly incomprehensible to some. From a personal perspective, if I were talking to someone from a call centre about Telecare and then I phoned back and talked to someone else who talked about assistive technology I am sure I would be little confused. In fact I might feel less inclined to take up the potential of using this technology.
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The Language of Telecare
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.
If professionals workng in this field get confused about the terminology how about the end user and their family/carers who this technology is supposed to support. How are they to understand what we mean? Does it put them off adopting this type of technology because they do not understand it or are a little wary of it? We could try using simple plain english. Perhaps Assistive Technology is too broad a term and maybe we should revisit this terminology.
AT itself is becoming mainstreamed or normalised as I like to refer to it. This is evidenced by High Street chainstores beginning to retail a wide range of AT including basic Telecare.
Innovation and rapid development of technology to support independence first within the home and increasingly on a mobile platform, is likely to have tremendous implications in enabling users to take their independence and security around with them. The Television together with broadband is also beginning to take on a multi-function role within the home.
Why not really normalise the use of all this technology as something that can be taken for granted and available as and when required – in other words demystify it. That includes the language.
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.