If telecare is the answer, what was the question? Storylines, tensions and the unintended consequences of technology-supported care

Telecare – services employing technology to monitor people’s movement, medication and home environment at a distance – has emerged as a key component of global social care and health policies. The relationship between policies about telecare and the experiences and aspirations of service users has been under-interrogated. This article draws on findings from an organisational case study involving people living with complex conditions using various telecare devices and employs Hajer’s (1995) concept of argumentative discourse analysis to identify two key storylines arguing that telecare improves people’s quality of life and promotes independence. While these storylines point to seemingly logical and incontestable objectives, uncritical policy and practice fails to recognise and prioritise the aspirations of service users, leading to unintended consequences that can deepen people’s isolation and minimise organisational benefits.

[1]  Heather Draper,et al.  Telecare, Surveillance, and the Welfare State , 2012, The American journal of bioethics : AJOB.

[2]  Guy Paré,et al.  Review Paper: Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base , 2007, J. Am. Medical Informatics Assoc..

[3]  Trisha Greenhalgh,et al.  Technology as system innovation: a key informant interview study of the application of the diffusion of innovation model to telecare , 2014, Disability and rehabilitation. Assistive technology.

[4]  P. Bower,et al.  Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial , 2013, BMJ : British Medical Journal.

[5]  Lambert Felix,et al.  Care at a Distance: On the Closeness of Technology , 2013 .

[6]  S Holm,et al.  Assistive technology, telecare and people with intellectual disabilities: ethical considerations , 2009, Journal of Medical Ethics.

[7]  Nelly Oudshoorn,et al.  How places matter: Telecare technologies and the changing spatial dimensions of healthcare , 2012, Social studies of science.

[8]  Joseph P. Wherton,et al.  SCALS: a fourth-generation study of assisted living technologies in their organisational, social, political and policy context , 2016, BMJ Open.

[9]  M. T. Have,et al.  Healthy Aging and Personal Responsibility , 2013 .

[10]  K. Brittain,et al.  The everyday use of assistive technology by people with dementia and their family carers: a qualitative study , 2015, BMC Geriatrics.

[11]  Trisha Greenhalgh,et al.  Co-production in practice: how people with assisted living needs can help design and evolve technologies and services , 2015, Implementation Science.

[12]  F. Buttel The Politics of Environmental Discourse: Ecological Modernization and the Policy Process.By Maarten A. Hajer. Oxford University Press, 1995 , 1997 .

[13]  M. Hajer Doing Discourse Analysis: Coalitions, Practices, Meaning , 2006 .

[14]  M. Fisk,et al.  Social alarms to telecare: Older people's services in transition , 2003 .

[15]  Brandie Nonnecke,et al.  Personalized Telehealth in the Future: A Global Research Agenda , 2016, Journal of medical Internet research.

[16]  Kenneth J. Turner,et al.  Advances in telecare over the past 10 years , 2013 .

[17]  S. Wyke,et al.  Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study , 2012, The Lancet.

[18]  Judith Green,et al.  Qualitative methods for health research , 2004 .

[19]  Å. Brandt,et al.  Activity and participation, quality of life and user satisfaction outcomes of environmental control systems and smart home technology: a systematic review , 2011, Disability and rehabilitation. Assistive technology.

[20]  Jeannette Pols,et al.  Where is grandma? Home telecare, good aging and the domestication of later life , 2015 .

[21]  L. Patterson Narrative Methods for the Human Sciences , 2008 .

[22]  Zach Coble,et al.  Moving from Independence to Interdependence: A Conceptual Model for Better Understanding Community Participation of Centers for Independent Living Consumers , 2010 .

[23]  Stuart G Parker,et al.  Telecare for an ageing population? , 2013, Age and ageing.

[24]  T. Metze,et al.  Words matter in policy and planning: discourse theory and method in the social sciences. , 2006 .

[25]  Jeannette Pols,et al.  Ethical implications of home telecare for older people: a framework derived from a multisited participative study , 2015, Health expectations : an international journal of public participation in health care and health policy.

[26]  M Schermer,et al.  Telecare and self-management: opportunity to change the paradigm? , 2009, Journal of Medical Ethics.

[27]  K. Fenton Our health, our care, our say. , 2006, Nursing management.

[28]  A. Sheikh,et al.  The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview , 2013, PloS one.

[29]  R. Wootton,et al.  A systematic review of successes and failures in home telehealth: preliminary results , 2006 .

[30]  Karen Cimon,et al.  Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis , 2010, Journal of telemedicine and telecare.

[31]  Stuti Dang,et al.  Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[32]  S. Yeandle From Provider to Enabler of Care? Reconfiguring Local Authority Support for Older People and Carers in Leeds, 2008 to 2013 , 2016, Journal of social service research.

[33]  Julienne Hanson,et al.  Big brother or brave new world? Telecare and its implications for older people’s independence and social inclusion , 2006 .

[34]  Paul Abberley The Politics of Disablement , 1992 .

[35]  C. May,et al.  Established users and the making of telecare work in long term condition management: implications for health policy. , 2011, Social science & medicine.

[36]  Jennifer Dixon,et al.  Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial , 2013, Age and ageing.

[37]  John Bond,et al.  Ageing in place and technologies of place: the lived experience of people with dementia in changing social, physical and technological environments. , 2010, Sociology of health & illness.

[38]  M. Mort,et al.  Ageing with telecare: care or coercion in austerity? , 2013, Sociology of health & illness.

[39]  Martin Knapp,et al.  The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial. , 2014, Age and ageing.

[40]  M. Priestley Adults Only: Disability, Social Policy and the Life Course , 2000, Journal of Social Policy.