Updated: Apr 16
It goes back to the principle:
“If you don't know where you are, a map won't help”, and “If you don't know where you are heading, any map will do.
Same with assistive technology, selecting a Smart Care technology solution is just like picking the map. There are many technologies available that can do a great job, however, the technology is just a tool.
Critical elements of adopting a solution successfully and sustainably are to manage all key influences of non-adoption and abandonment.
If you or your care organisation are considering to start a Care Technology journey to be used by the consumer (eg. older adults, the disabled, or their loved ones), or by your Care organisation for Care Delivery, what to take along in your assessment “where you are” and “where you want to take the assistive technology journey” to guide your solution selection, decision making and implementation?
Technology can help to overcome ageing challenges
Our World is Experiencing an Unprecedented Demographic Change. By 2050, there will be more than 2 billion people over the age of 60 in the world – about 25% of the world’s population. As one ages, this becomes increasingly challenging, for various reasons. Technology can help to overcome these challenges.
Recent studies like eg. this recent AARP study proves that contrary to common belief, older adults are willing to use new Age Tech-based products and services, however, as long as they find them:
1 Useful (also called fit-for-use), and if it is,
2 Affordable, and if it’s useful and affordable
3 Available support in implementing and supporting their tech
Technology helps to fulfill one or more Care needs. You can’t replace the human touch, but you can extend the carer's reach!
However, selecting an Age Tech service or product for mum or dad, or an aged client, is not the same as selecting a solution for an organisation-wide deployment!
Complex Age Tech landscape
There are many companies that developed tech enabled solutions, products and services with and for consumers (or other stakeholders like family members, governments, (health)care and other service providers), that benefit the aging population. This Medium article provides a great overview on some of the stakeholders in aging.
Difficult to choose
In the last few years the ecosystem of companies and products is getting complex, and unifying themes have emerged. Most solutions have overlap and fall in more than 1 category. More choices to pick from doesn't make a solution selection any easier... See the example of Keren Etkin's Agetech market map for the wide variety available in the market:
Low Care Technology Adoption rate
So with these increasingly low cost solutions at the Care organisation disposal to:
improve the quality of care to automate manual tasks,
minimise human error,
maximise productivity and positive impact of scarce human capital, and
increase family and elderly engagement,
it is surprising to see that the care industry is ill equipped to ensure the health & safety of the frail and cognitively impaired. Despite tremendous technological advances, we have not seen corresponding changes in the way care is provided or technology is used (although the COVID pandemic might become the catalyst).
"Why have client-facing care technology introductions not succeeded in doing what it could do well; enabling care providers and consumers to do what humans do best – care and connect?"
Use cases are not simple or complicated
The answer is not simple or complicated (that is knowable, predictable, and controllable), as use cases are complex (hence, inherently not knowable or predictable and dynamic and emergent).
We know that the ageing needs analysis and selecting the right technical solution that is; fit-for-use, affordable and comes with implementation and ongoing support, is far from easy. Selecting a solution or technology service partner requires very different skills than selecting eg. a supplier for a gardening or cleaning services.
There are 6 more challenges in successfully deploying Care Technology solutions:
The end-user population conditions are not well-characterised, well-understood, predictable, and carefully considered with respect to cognitive or health literacy issues
The value proposition of the technology is unclear, in terms of a clear benefit for end-user/patients and an affordable real-world service model.
The intended end-users of the technology have plausible personal or professional reasons to resist or reject it.
The organisation(s) are inadequately set up for innovation, not ready for (or interested in) this particular innovation, unable to negotiate a viable business model with partner organisations, unable to shift to new ways of working, or unable to support the work needed to implement and sustain the change.
Complexity in external (financial, regulatory, legal, policy) issues—of which reimbursement seems to be particularly key—stall the mainstreaming and spread of the program.
Programs are unable to adapt and evolve over time in a way that continues to meet the needs of its intended users and remain clinically, operationally, and financially viable.
Implementation work may be particularly onerous in relation to care technologies because of the complexities and organisational challenges of addressing, eg.; data security and patient privacy, interoperability across multiple systems, resistance from care professionals with a high degree of autonomy, and disruption to the critical granularity of your (clinical) workflow.
First-order problems (such as slow technical performance) typically generate second-order problems, such as dramatically increased workloads (sometimes necessitating safety-critical workarounds), and perhaps third-order ones, such as reputational damage.
The Technology is (only) 1 of the 7 key influences
Imagine a case where your technology selection is made correctly, and it fortunately:
has the correct features,
generates the right data and knowledge,
is future proof (can be sufficiently customised and integrated/interoperable if needed),
doesn’t require complex knowledge to use it, and
has the correct technology supply model (like substitutability)
you still need to manage successfully the other 6 other major key influences on the non-adoption and abandonment of the technology by consumers or limited success in attempts to to spread distantly, scale-up locally, and sustain the use of care technology within and beyond the care organisation.
Key to success
"Plan & manage all 7 domains that influence non-adoption and abandonment, as well as successful spread, scale-up, and sustain of use"
The 7 domains are: 1) the condition, 2) the technology, 3) the value proposition, 4) the adopter system (staff, patient, and lay caregiver[s]), 5) the care organisation(s) (including attention to the work of implementation and adaptation), 6) the wider (institutional and societal) context, and 7) the domain that considers interactions and adaptations over time.
This domain addresses all aspects of the care needs. Potential end-users need to be assessed as “suitable” for the technology aka fit-for-use.
This domain addresses the features, knowledge generated, knowledge/support required to use, and very critical, the technology supply model.
3. VALUE PROPOSITION
This domain addresses the management and measures of the “relative advantage’ (the extent to which potential adopters, both care organisations as well as the end-user’s value, believe that the innovation is better than what has gone before).
This domain addresses the people aspect, probably the most critical and difficult domain to manage. Management and measurement of acceptance by Care staff, end-user, and family carers/loved ones
This domain addresses the Care organisation’s a) capacity to innovate, b) readiness for technology/change, c) adoption & funding decisions, d) extent of change needed to routines, and e) work needed to implement change.
6. WIDER SYSTEM
This domain addresses the wider institutional (eg. privacy and consent aspects) and sociocultural context, key to move from a successful demonstration project (heavily dependent on particular champions and informal workarounds) to a fully mainstreamed service (scale-up) that is widely transferable (spread) and that persists long term (sustainability).
Last but not least, this domain addresses the embedding and adaptation over time. Management and measurement over time of the scope for adapting and co-evolving the technology and the service, as well as the organisational resilience.
So which Assistive Technology approach to pick?
As explained, due to the complexity of the influences, there is not an available checklist to select and implement a care technology.
However, our experience can be used by you to guide your strategic conversations and design & implement care technologies successfully. The technology is just a tool, and there are many solutions out there that can do a great job.
If you plan and manage your care technology adoption holistically to avoid non-adoption and abandonment of the technology by end-users AND successfully spread, scale-up, and sustain the use of care technology within and beyond your care organisation, you will reap measurable benefits sustainably over time. Contact us if you need our advice!
Hubert van Dalen is Managing Director of eHomeCare, who advise and implement technology solutions for the health, aged and disability care sector.