1.1 Explain how technology can be used to support users of health and social care services in living independently
1.2 Analyse barriers to the use of technology to support users of health and social care services in living independently
1.3 Explain the benefits of these technologies to health and social care organisations and their users
2.1 Explain health and safety considerations in the use of technologies in health and social care
2.2 Discuss ethical considerations in the use of technologies in health and social care
2.3 Explain the impact of recent and emerging technological developments on health and social services, organisations and care workers
3.1 Identify the specific needs of an individual requiring support to live independently
3.2 Make recommendations for how technologies might support the independent living arrangements
3.3 Evaluate the usefulness of technology for users off health and social care services
Supportive independent living
Independent living implies that people with disabilities enjoy the same freedom, choice, dignity and control as people without disabilities do at home, at work, and in the community. It means living on one’s own or by oneself or fending for oneself while exercising rights as citizens to practical assistance and support from the state to participate in society and live an ordinary or near normal life.
The seven needs of independent living are as follows:
Techno Aid is a company that specialises in technology that can be of help to individuals who need access to health and social care services and live independently. As more people access independent living funds and become employers of their own personal assistances, the balance is shifting from dependency towards independence.
1.1 Assistive Technology is defined in the Technology-Related Assistance Act (Tech Act) as “any item piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” (Tech Act, 1988). Assistive technology can be made at home and custom designed for an individual, purchased at a local store, or ordered out of a catalogue that is targeted toward people with disabilities and their families. The technology relevant to an individual can be high tech or low tech. Examples of low tech technology include ramps, switches, switch-operated toys, communication boards, car door openers, Dyce (non-skid material), preachers, roll-in showers, and Velcro. Some high tech examples are computers, software, extended keyboards, electronic communication devices, power wheelchairs, and van lifts for wheelchairs.
Assistive technology cannot make the disability go away; but it can lessen the impact of the disability. (Moore, 1991). Assistive technology aims to provide independence and improve an individual’s outlook on life. Besides, it can help students access education and enable adults to secure a job. Individuals with disabilities can become an integral part of the community and engage in pursuits like education, leisure activities and work – with the appropriate technology.
However, assistive technology is not without its problems or barriers. Many times the devices that are needed are very expensive and resources are not readily available; or the equipment is purchased and no training or support system is in place to teach individual how to use it effectively; or the device simply breaks down and needs to be repaired (Moore, 1991).
Tele care is used to describe sensors or detectors (for example movement, flood, gas, smoke or fall detectors) that automatically send a signal through a base unit connected to a telephone line to a care facility, community alarm or monitoring service which can call for assistance when it is needed. According to the Royal Commission on long term care, (1999) a person suffering from dementia is not required to press a button or dial a number to raise an alarm. For example, if a sensor detects gas, smoke, water or a fall, it can send a signal to a community alarm service automatically to be able to receive an appropriate response. The response could include providing reassurance, contacting an agreed key holder from the family, friend or caregiver to provide help, or if the need arises contacting the emergency services. A loud speaker on the alarm base unit allows the call center to communicate with the person. Irrespective of whether the affected individual is able to respond verbally or the distance of the individual from the loud speaker the service will send help.
The invention of Louis Braille (1809-1852), who turned blind by accident at the age of three years, changed the world of reading and writing forever for the visually impaired. When Louis was 12 Charles Barbier while giving a talk at the school that Louis attended shared an invention called the ‘night writing’, a code that used 12 dots. The code allowed soldiers to share confidential information on the war field without the need to speak. But the code was not easy for the soldiers to learn, but not so for Louis. Louis reduced Barbier’s 12 dots to 6, perfected the system by the time he was 15, and published the first Braille book ever in 1829. He continued to improvise and by 1837 he was able to add symbols for music and math. Acceptance was slow so blind students had to study Braille on their own. Even at the royal institution, where Louis taught after he graduated, Braille was taught only after his death. Braille began to gain worldwide acceptance in 1868. A group of men from the Royal National Institute for the Blind took to the task of spreading its reach. Today every country uses Braille. Braille books help blind people receive education and Braille signs help to get around when they are outdoors. And most importantly blind people can communicate easily. The development of assistive technology has brought many possibilities for the visually impaired in the areas of education and employment. Through the use of other technology enabled devices, the blind and visually impaired can perform many day to day activities on their own particularly in reading and learning.
An example of a need based innovation is the electronic battery operated wheelchair. The wheelchair is a complex piece of equipment that has been extensively engineered and studied. Most individuals with spinal cord injury become wheelchair experts because doing so increases their chances of getting a wheelchair that truly meets their need.
The major barrier in use of technology by users living independently is the difficulty faced in choosing devices from available technology suitable for their specific needs. The following example illustrates how an elderly couple was helped in making the choice.
The two key priorities for investment in tele care are prevention from falls and mental health services for older people. Other considerations were to use technology as a contributory factor in helping to avoid residential care and avoidable hospital admissions. The following example clarifies the point. Mr and Mrs B, an elderly couple lived within a sheltered housing scheme for years. Mr B has been his wife’s carer for ever since she was diagnosed with Parkinson’s disease. Mrs B’s mobility has steadily deteriorated over years, so has her memory. Mr B has found it difficult to care for his wife and many of his and her social life has been put on hold. Mr B was becoming uncomfortable at the thought of leaving his wife for even small periods of time for fear of her safety. As a result of this he was compelled to feel isolated, and had little opportunity to socialise. Even though living in a sheltered accommodation which was well equipped with emergency pull cords and access to pendant alarms, Mrs B’s memory problems were such that she was not able to use them. In order to measure the risks Mrs B was helped to complete a questionnaire and she was examined by an occupational therapist. It was identified that Mrs B was at a high risk of falling, particularly while trying to rise from her chair on her own. All available options were discussed, and the assistive technology advised was the use of a fall detector. This device is worn on the waist band of a skirt, trousers or in a specially designed pouch depending on the choice of apparel.
The benefits of using assistive technology are evident in the way their use transforms the lives of the users and their families. A general sense of independence and well being is enhanced.
The Fall Detector was particularly beneficial to Mrs B as it did not require any input from the user. If Mrs B fell, the detector would sense the tilt of her body, and this would set off the alarm automatically at the call centre. The call centre personnel would alert Mr B on his mobile telephone. After a trial of few months, Mr B was asked to give his feedback on the Fall Detector and whether it had made any difference to his insecurities about leaving his wife unattended even for short periods. His feedback said it all as he said it as “brilliant”, and added that “I can go out, have a game of cards with friends, or go to the shops without worrying”. If Mrs B does fall Mr B now feels confident and reassured since he can respond quickly in case of a fall. He says, “it has given me real peace of mind”. Mr B can now continue caring for his wife, without feeling socially bereft. Using tele care allows for actual improvements to the quality of support and helps them and their care givers to feel safe, reassured, able to have a better grip over their day-to-day lives and minimise the risks that compromise independence. This strategy will ensure the consideration of Tele care throughout the customer pathway, from the earliest point of contact right through to complex, care-managed cases, with the aim of supporting people to maintain or improve on their level of independence and avoid hospital or residential/nursing care admissions.
Electric powered indoor wheelchair (EPIC) is an electrically powered wheelchair to be used within the client’s home. The client must have difficulty in walking or self-propelling in a manual wheelchair within the home. Adequate space is required for the wheelchair to move, including footplates and a suitable space with a power supply for charging the batteries overnight. The client must practically demonstrate they are able to independently and effectively control the wheelchair within the internal environment, taking into account impediments, hazards and/or risks.
Braille books are available in many libraries (like the Library of Congress) and schools for the blind. The production of Braille books made use of metal plates. Characters were stamped on both sides of the paper where the dots on one side do not interfere with those on the other side. But now, computers have made the process of publishing Braille books easier. The text is typed into the computer and, with the help of a software program; it is translated automatically into Braille. The computer then transfers the output onto printed paper or metal plates as required. Braille reading helps blind people to socialise with people for example, going to restaurant with friends and finding a restaurant that has a braille menu book encourages the service user to select what he/she would like to eat and instills a sense of independence.
In the near future, propelled by the concept of internet of things, new homes, public and private, and all renovated social housing, will be fitted with the devices for care and medical services to be provided in real time via broadband from day one of occupation. A number of studies suggest that disintegrated and inaccessible clinical information raises the cost and lowers the quality of health care and compromises patient safety. Information technology has been proposed as an essential tool in solving these problems and promoting better health care. When used in social context and the area of care giving, technology contributes to supporting a better life, reinstating human dignity, right of self – determination, inclusion, and caring.
Thus the three technology equipment can be used by service users. The use of technology is agreed upon in collaboration with the user while deciding the user plan. For example, an elderly woman living on her own was suggested the use of wheel chair for her independence and the alarm for her safety. Because she is an elderly person, the chosen technology must be easy to use and suit her lifestyle and health condition. The disadvantages and the risk related to its use should be assessed, and information about how to use should be provided in user friendly formats. Within the health and social care sectors, there is huge potential for information technology (IT) to support practice with greater safety. Several things can go wrong if information is incomplete or incorrect or if glitches in the system interfere with critical processes such as prescribing medication. The use of safety standards for IT required in health and social care should ensure that risks are identified in real time and can then be nullified before the product actually used. Organisations that purchase and use IT enabled systems are advised to take measures that understand system risks and take suitable action, such as staff training, to ensure that systems are operated safely while implementing the service..
Equipment may be provided to help the individual at their residence and customized to meet their specific needs. It can be as simple as the basic alarm system base on sensors and able to respond in case of an emergency and provide constant support via telephone (Department of Health, 2005). Tele care can also be used in a preventative manner for keeping track of an individual’s health parameters or general wellbeing (for example, by using sensors on the bed programmed to record the number of times a person leaves the bed during the course of one night).
The technology involved in tele care services has been used for many years to give care to older people, usually in the form of pendant alarms. This technology has great potential to benefit people by boosting their confidence and assisting them to remain independent bur cared for in their own homes. By monitoring people’s safety, technology can also ease the lives of friends and family care givers so they can perform the task of givinging social support. It is important that giving care through assistive technology does not threaten their right to privacy. Deciding on the choice of type of technology used is critical and should suit the needs of the elderly and disabled. One needs to be alert against misuse or unintentional leaks of personal information. Oversight in these aspects could compromise people’s privacy, autonomy and wellbeing. A careful assessment of risks can be balanced by taking care at the time of installation.
Consent of patients with dementia should be taken before installation so that they are included in decision making.
The principal ethical concern during the pre- installation phase is that services should be customized to suit individual needs and that when considering appropriate tele care the risks of the person coming to harm should be balanced against their right to autonomy and participation.
There is evidence that new technologies can improve the quality of care processes by improving communication, applying standard processes, and enhancing workflow, when used in conjunction with existing care rather than as a substitution. For example, a survey of GP practices in countries such as Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the US have found that health systems that promote new technologies and information system based infrastructure are better able to address care coordination and patient safety issues and maintain the satisfaction of GPs. In England, researchers studied how electronic patient records influenced the way staff members interact with each other during critical care ward rounds compared with paper based records. Upon analysis of videos, general observation and interviews, they found that it was difficult for the ward round team to interact with each other using the electronic record as compared to paper records. The physical setup of the technology was an impediment for consultants’ when leading the ward round and prevented other clinical staff from contributing to discussions. There are numerous examples of the benefits of new technologies. A literature review found that information technology supported a systematic approach to diabetes management in general practice. New information technologies have been used to support patients, enhance changes in healthcare delivery and provide clinicians with access to expertise and data about individual patients and populations. Such technologies have been associated with improved diabetes symptoms and enhanced tracing of risk factors. There is sufficient evidence that introducing new technologies can make a significant difference to the quality and safety of care. For instance, proactive tele- care assisted by decision support software has been found to improve clinical outcomes or reduce symptoms in people with depression, heart disease, diabetes, asthma and the frail elderly, amongst others. Similarly, telemedicine based consultations have been available for some years and more recently diagnostic services such as pathology and radiology are beginning to embrace this new technology. Tele radiology and tele- pathology allow medical services to be delivered across vast distances, including across national and international boundaries and facilitate patient recuperation at home. Using technology in this way can be particularly valuable in remote communities where transporting patients and medical practitioners is difficult. Practitioners other than doctors deliver much of the healthcare in rural communities, so it has been suggested that it is essential to ensure that nurses and support staff are IT-enabled and technologically savvy. On the positive side, new technologies have an impact on how staff can be trained and updated. Examples include simulation technology, accessing information via handheld devices, interactive DVDs and online training.
Literature suggests that nurses and allied professionals think that computer skills should be taught as part of the undergraduate curriculum or as basic training and that staff is willing to undertake web based learning for continuing professional development in this area. Other useful training requirements include information literacy, privacy and security of health information, and techniques for identifying and adopting new technologies. In the NHS, assessing and training teams in technical skills may be a priority. Research suggests that cell phone applications can significantly reduce the cost of treating young people with severe asthma due to more frequent communication between patients and their medical teams, and by motivating patients to become more engaged and knowledgeable about their care.
A spinal cord injury (SCI) may cause a loss of movement and feeling below the site of injury. One can suffer from a spinal cord injury due to trauma, such as a car accident or a fall. Spinal cord injuries are either complete or incomplete. It results in no feeling or movement below the site of the injury. Partial injury allows some feeling and movement. People with spinal cord injuries also may have other problems, such as not being able to control urination and bowel movements. When spinal cords are injured in the neck often need devices to help them breathe. Therefore each client must be assessed as an individual, because no two clients are the same. Customised help is usually required to suit the needs of each patient.
Electric wheelchairs are designed for an independent life and can be fitted with a host of drive bases, adjustable seating systems and expandable control systems. With spinal cord injuries (spinal cord injuries), there is a general set of clinical expectations based on where the injuries occurred. But in reality, patients with spinal cord injuries, even those with injuries in the same location, can have significantly different problem sets. And for clients with injuries at the fifth or sixth cervical vertebra — the differences from client to client can be even greater. For these clients, electric wheelchairs custom fit to their required specifications can offer independent mobility indoors and outdoors. In addition the client should also have the ability to pronate his/her wrist as well as extend it and complete a tenodesis pattern — passive thumb adduction on the index finger during active wrist extension — which can also lead to a better, stronger push on the rear wheels. C6 injuries, if complete, “typically result in lack of finger movement, wrist flexion and elbow extension, but good control of elbow flexion and wrist extension.
The mobility requirements determine the many practical activities and tasks that need to be carried out every day. The tasks they will perform at work need to be considered. Whether they have to carry items, and whether they can push and do this at the same time. Everyday tasks, such as grocery shopping, visiting the bank, getting hair done, eating out, should be considered while making equipment choices..
The use of power wheel chair is the best for patient for in and out door mobility besides ability to move around in the environment. How to use it in residential homes can be learnt through staff support. It facilitates lot of changes in care environment and gives the client the autonomy to move about in the environment they are living in. The client gets trained in how to use the technology device through the mass controller. People need a power wheel chair as repositioning device to aid in prevention of pressure sores. Some manufacturers produce 140- 180 degree power seat which is helpful for people with certain medical conditions. When it comes to recommendation a battery powered wheel chair can be the best when discussing options with therapist through assessment of individual needs. Some wheel chairs are equipped with a power leg where you can move your leg and also power seat elevation, this will help client to facilitate in doing things they are used to do for example cooking in the kitchen. A power chair can provide power seating functions that can ensure independence with pressure reliefs. Clinicians and providers may have to consider recommending changes to seating and mobility equipment decisions as a client’s medical condition changes. There are many changes that occur over a lifetime that can result in a change in recommendation. Some of these include changes in the patient’s functional level, either continued recovery or a functional decline; changes in shoulder, elbow or finger range of motion, development of upper-extremity pain, change in daily routine or activities, change in life plan and, therefore, mobility goals, etc. The power chair is a vehicle to get to a destination and maintaining independence across all aspects of life.
The patient’s choices should be considered. It is very important to actively involve the patient in the evaluation process and have an open discussion/interview regarding their expectations about mobility goals. If they have a desire to drive, how would they like to do that? What kind of vehicle are they hoping to obtain? If they would like to travel, where would they like to go? How will they be getting there? During evaluations consideration of what clinically related changes could be anticipated need to be taken into account. Power assist functions require a very careful assessment, as while the wheels add power and distance covered, there is a safety issue of control of the wheels and wheelchair, which requires upper-extremity fine motor coordination and control.
Talking with patients when they are having trouble accepting power mobility and helping them to understand the consequences of their decision can be undeniably difficult and time consuming. But Brown points out that these discussions are crucial to achieving a good outcome. Ultimately, the decision is up to the patient, and it is important that they feel that way. Pressuring them into something is not the answer. It could result in abandonment of the selected technology. It is important to fully understand the patient’s and/or the caregiver’s primary goals for the mobility device, related to all aspects of their life. Perhaps neither style of chair will make them independent with all of their mobility goals, but which type will check off the most items on their list in the safest and most efficient fashion? This decision is made on a completely individual basis.
Although assistive technology increases independence and improves individual’s life. It helps individual from different group such as elderly, young ones and adult. Assistive technology device are expensive and effective equipment. Tele care alarm, Power recliner chair and Braille books are assistive technology used for different individual groups in residential homes for their own independence. The use of (IT) information technology protects information from being leaked out or missing concerning confidentiality in health and social care sector in NHS. The main ethical consideration of tele care in residential homes for older people, protect them from danger. The impact of assistive technology of tele care improves clinical outcomes. The new assistive technology has been impacted that all staff needs to be trained before using any equipment at workplace in health and social care sector. Client with spinal cord injury used power wheel chair because is very effective and easy to move about for day to day activities in terms of independent, but is expensive.
Similarly, for elderly patients depending on alarm systems of different kinds, technology may have to be regularly updated to suit their changing needs. New products that cater to specific requirements may have to be installed. Care givers need to be educated on the availability and suitability of such devices.
According to Han, YY adopting new technology carefully is key to its success after considering all its pros and cons. Samore MH has cautioned against medical device related hazards to the patients.
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