How might older people and disabled people be using assisted living services in 2030?
A recent study commissioned by Ofcom examined the long-term requirements of key sectors for communication services in the United Kingdom.  The authors, from Plum Consulting, Sagentia, Aegis and Loughborough University, considered the following:
- how assisted living services (ALSs) might help older people and disabled people to live more independently over the next 20 years
- technology drivers for developing ALSs
- potential barriers to and drivers for ‘digital inclusion’
- potential scenarios for the use of ALSs in 2030
- barriers to realising the most desirable scenario.
The report explored these questions using a combination of secondary research, interviews with stakeholders and a series of service development and validation workshops. In this context, ALSs refer to electronic and/or communication technologies and not to assisted living devices such as stairs or bath lifts.
In a context where people are living longer with single or multiple long-term conditions, the report estimates that the number of people with moderate to severe disabilities will increase from 1.8 million in 2007 to 2.6 million by 2025. At the same time, public spending is becoming more restricted. The authors believe these factors will create a ‘latent demand’ for ALSs that enable people to live independently in their own homes for longer.
The authors propose five main types of ALSs for the future:
- digital participation (providing service users with entertainment, education and social interaction)
- wellness (encouraging service users to maintain their health)
- teleworking (enabling service users to work from home and still contribute to society and the economy)
- telehealth (remotely managing service users’ long-term conditions)
- telecare (remotely managing vulnerable service users’ welfare).
As the recent WSDAN report, Sustaining Innovation in Telehealth and Telecare, explains, telehealth remains in the early stages of development.  It began with a limited number of schemes, and momentum increased following the introduction of preventative technology grants and the WSD pilots. Telecare is more widespread in the UK, as it has been available for a number of years – mostly in the form of fall alarm systems. As the Ofcom report argues, limited ‘interoperability’ between technologies purchased from different suppliers remains a significant challenge. Telehealth and telecare technologies tend to be purchased by individual primary care trusts (PCTs) or local authorities, resulting in fragmented supply chains, high purchase costs and limited production.
What will assisted living look like in 20 years’ time?
The authors of the report consider a range of potential advances in telehealth and telecare in the UK in the next 20 years – for example, online cognitive behavioural therapy (in two years) or real-time video calling with carers (in three years, depending on location). The main drivers for this vision include Moore’s law leading to equipment becoming cheaper, and increased speed and memory and universal broadband access. The implications are lower costs of equipping a home for telehealth or telecare, and a wider range of products available. However, the rate of improvement could be impeded by limited interoperability and by medical regulation processes.
The report also suggests that older people and disabled people may be positive about ALSs in terms of feeling empowered, and feeling less of a burden on informal carers. The research also highlights a number of concerns and reservations people have about using ALSs, such as ease of use, reliability, potential for technology to replace personal contact, or the perception that the technology is unwarranted. The authors identify 10 main challenges and propose potential solutions to ensure that the benefits of ALSs can be fully realised. Solutions include ensuring that people are assessed appropriately, can make an informed choice, and receive good support.
The study goes on to explore barriers to take-up of ALSs by statutory organisations. There is currently a lack of evidence regarding health and cost outcomes, and the results from the WSD pilots are eagerly awaited for this very reason. Furthermore, there are restricted funds, care professionals have a lack of experience of working with ALSs, and care records are not sufficiently integrated across health and social care. This raises the question of whether health and social care need to be more closely integrated to get the best out of ALSs. Also, would a more collaborative approach by the NHS and private companies help to maximise patients’ use of ALSs?
Based on the research and information about the drivers for change, the authors developed four scenarios for take-up of ALSs by 2030. The four scenarios were designed to be equally probable, but one was the most desirable: full-scale complementary provision of ALSs. In this scenario, private suppliers and statutory purchasers ‘devote substantial effort’ to promoting the use of ALSs from 2010. By 2030, there is substantial and varied supply of ALSs from private and statutory sectors, and older people and disabled people use ALSs both at home and away from home. Service users are involved in monitoring their physical health and well-being. This means they can remain in their own homes for longer, and informal carers have greater peace of mind.
Finally, the authors consider the technology and standards requirements, as well as the best approaches to engage older people and disabled people in using ALSs, in order to ensure that the full-scale complementary provision scenario is realised.
Shilpa Ross is a researcher in health policy at The King’s Fund
 Lewin D, Adshead S, Glennon B, Williamson B, Moore T, Damodaran L, Hansell P (2010). Assisted Living Technologies for Older and Disabled People in 2030: A final report to Ofcom. Plum Consulting website. Available at: www.plumconsulting.co.uk/publications-strategic-radio-media-spectrum.asp (accessed on 14 June 2010).
 Clark M, Goodwin N (2010). Sustaining Innovation in Telehealth and Telecare. London: WSD Action Network, The King’s Fund. Available at: wsdactionnetwork.org.uk/network_publications/index.html (accessed on 28 July 2010).