We’re all familiar with the idea of the smart house of the future fitted with labour-saving gadgets and providing services to its occupants at the touch of a button. Some of the ideas are a bit fanciful, even James Bond-like, but developments in technology are taking us in that direction and none more so than in healthcare.
Because of improvements in medicine, people are living longer and as a result there is a growing need for appropriate social housing. At the same time, individuals are increasingly suffering with chronic conditions such as heart disease, diabetes and hypertension. Rather than keeping people in hospital or care homes, there is a growing realisation that it is better for individuals to remain in their own homes.
Research has shown that it is more cost-effective and desirable to treat people of all ages in their homes rather than them constantly traipsing to a hospital, unnecessarily using their time and that of medics. For example, diabetics can take their blood-sugar levels at home and have them checked remotely by a nurse. Heart disease patients can take their blood pressure and have their pulse-rate checked without leaving their home. These, among many other examples, are known as ‘assisted living’.
Assisted living is the use of sensors and information and communications technologies to facilitate the remote delivery of care and support to people to allow them to live as independently as possible in the lowest intensity care setting consistent with their needs and wishes.
Technology does not operate in isolation, but in conjunction with an integrated and flexible care management service, delivered by care providers who can act on information provided and also provide proactive support. Such technology works remotely, allowing the individual and the care provider to be separated in distance or time (or both) but still able to communicate. This all means that individuals living in social care should be able to enjoy unrestricted choice over their care setting.
Remote technology offers a multitude of applications and purposes to housing providers and their tenants. For example, the provision of telephone-based care management can provide proactive support such as the use of video-conferencing to deliver personalised rehabilitation programmes, an alarm to a carer in the next room which alerts them to make an intervention (for instance, to prevent accidents due to night wandering), and the transmission of physiological data by a patient to a monitoring centre for weekly reporting to another care professional.
Such monitoring services have been shown to lower anxiety in patients and their carers, reduce unnecessary admissions to hospitals and allow doctors to discharge patients earlier because they know the patient has good access to follow-up care services should they be needed.
Assisted living technology can be assigned to one household or two or three, but ideally a housing provider should be aware of the collective needs of its residents so that a larger and more detailed strategy is in place to support them with an appropriate communications infrastructure.
It is important to note that assisted living is not only for the elderly. Other groups living in social housing, such as the disabled, younger people with long-term conditions, and those recovering at home from a period in hospital can also benefit.
It’s also possible to imagine that such services to the home would be useful to those people simply wishing to maintain their health. Making such services readily available is half the battle; if people were more aware of their health and were able to proactively do something about it, for example by becoming ‘self-carers’, in the longer term this would reduce demands on statutory services. Beyond an individual level, there is the possibility of creating communities and cities whose residents are maintaining their health and routinely reporting their wellbeing, creating a massive public health database and early warning system.
Houses of the future will have a network of sensors that provide residents with the services they require. In other words, assisted living is integral to smart homes and part of the fabric of life.
An emerging area of assisted living is through the smart metering programme. The smart meter is a hub that collects information on utility usage, displaying it locally and transmitting the data to utility companies. It has already been shown that this hub can collect data and transmit messages from others such as the health services. An important feature of the smart metering programme is that it deals with existing housing stock, not just new builds. Nevertheless there are technological and organisational issues yet to be overcome.
The major technological issue is ensuring that the network both inside the home and outside is robust. Devices connected to the network must be interoperable so that the network can be expanded as needed. The organisational issues are around the complexity of the supply chain for assisted living, especially where it involves the statutory sector supplying a service. This will involve a public/private sector partnership but such things have been done before with, for instance, community alarm services. Assisted living must be easy to buy and install, along the lines of DIY. If it required an installation engineer, people would be put off and add an extra cost.
There is sufficient technology available to do this now; what is needed is a way of linking it all together.
Dr Richard Curry is the e-health development director for the South East Health Technologies Alliance (SEHTA) and an independent consultant in telemedicine and assisted living.