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An International Comparison

EPDF and EPUB available Open Access under CC-BY-NC-ND licence.

Technology is quickly becoming an integral part of care systems across the world and is frequently cited in policy discourse as pivotal for solving the ‘crisis’ in care and delivering positive outcomes.

Exploring the role of technology in Europe, Canada, Australia and Japan, this book examines how technology contributes effectively to the sustainability of these different care systems which are facing similar emergent pressures, including increased longevity, falling fertility and the consequences of the COVID-19 pandemic.

It considers the challenges and opportunities of embedding technologies in care systems and the subsequent outcomes for older and disabled service users, carers and the care workforce.

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This final chapter provides a summary of the main issues identified within each of the selected nations covered in the book. It emphasises key points of convergence across these nations, including the array of care ‘systems’, internal diversity and fragmentation of such systems, prevalence of sustainability discourses, the ‘ageing in place’ agenda, precepts of ‘choice’ and ‘control’, the digital divide, and divergent and variegated responses to the COVID-19 pandemic. The chapter and Policy Press Short conclude with recommended priorities for policymakers and practitioners and identifies areas requiring further research within the field.

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This introductory chapter reviews and positions this edited book’s underpinning concepts of care, technology and sustainability. It defines the editors’ and contributors’ cross-national, comparative analytical approach to characterise the ‘state-of-the-art’ within each nation and evaluate thematic areas of policy and practice divergence and convergence. It concludes by presenting nations included in this volume (England, Australia, Germany, Canada and Japan) and justifying their selection with reference to contemporary research on their orientation to care regime and welfare regime typologies.

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This chapter explores Japan’s demographic changes, the shifting role of the family and related pressures on care provision. The author outlines the country’s approach towards introducing technology into the long-term care (LTC) system, including in residential care settings and for those living in their own homes. The integration between LTC and technology-based services reflects great hopes and possibilities to overcome various challenges related to the ageing of Japan’s population.

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Germany is facing significant challenges in meeting the demand for care against the societal background of advanced population ageing. The use of assistive technologies is considered an important element in solving care worker shortages and in enabling older people to ‘age in place’. Today, 80 per cent of Long-Term Care Insurance (LTCI) beneficiaries are being cared for at home. In this light, the lack of a clear government strategy on Assistive Technologies (AT) for home care is amazing. Various central government departments work with varying, partly conflicting objectives. While social care is strictly regulated by legislation, AT are only beginning to make their way into legal frameworks. Three prerequisites for a successful integration of AT into home care delivery are identified in this chapter: 1. nationwide fast and reliable Internet access; 2. a clear central government strategy for integrating AT into legislation governing social care; and 3. co-creation of AT by scientists/engineers and their intended user groups.

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This chapter begins by setting out the context of the English adult social care system, including funding and policy, key statistics, and the hopes invested by the government and local authorities in the use of technology to cut costs while improving the quality of life of older adults.

The deployment of digital technologies intended to facilitate the delivery of care is then examined, including telecare and telemedicine devices; robotics and information and communications technologies (ICT); consumer electronic devices, apps and websites; and ICT infrastructure and data. The impact of the COVID-19 pandemic on technology uptake and use is also discussed. The next section presents recent research evidence on the use of different technologies in English social care, including studies of telecare as well as other digital technologies.

The chapter concludes by setting out several key challenges facing the effective implementation of technology in the care sector in England.

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This chapter focuses on policy and practice related to care and technology in Canada. The authors highlight that the federated government structure (a central federal government and thirteen semi-autonomous provincial/territorial governments) results in overlapping jurisdiction over continuing care services, and the lack of a legislated mandate to provide these services means that Canada lacks a national social/long-term care (LTC) ‘system’. The chapter then describes how technology is harnessed in the delivery of care in Canada, with a focus on four key areas: 1. care management/coordination; 2. smart homes; 3. outdoor tracking; and 4. communication technologies. Recent empirical evidence related to technology and care in Canada is also explored.

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Australia’s major aged care policy reforms in 2013 introduced a consumer-directed care (CDC) funding model as a core component that sits within the policy framework of ageing in place. CDC is intended to provide older people with choice and control in their living and care arrangements through access to needs-based, means-tested home care packages (HCPs) that specifically allow for the purchase of technology to provide support to remain in one’s own home. Available evidence indicates technology use (assistive/digital) can support older adults’ independent living and improve physical well-being, self-care and social connections. This chapter provides an overview of Australia’s policy framework around aged care and ageing in place, and reports on our research studies identifying issues related to knowledge and use of technology (scoping reviews, interviews), including the role of health professionals. Recommendations are made for advancing research along with strategies enabling professional support for older adults’ use of assistive/digital technologies.

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RAPAR applies our participatory action research methods to amplify the living experience of families seeking asylum in the UK who are in ‘contingency accommodation’, aka ‘hotels’, and claiming human rights abuses on these sites. From all over the world, these people are without status in the UK and are therefore without recourse to the public funds that are, theoretically, available to everyone living in the UK with status. Their complete legal dependence on the Home Office and its subcontractors to ‘look after’ them and deal with any complaints leads to the question: why would anyone choose to challenge any organisation about human rights violations when that same organisation exercises such profound control over their day to day living reality? The data comprises contemporaneously collected evidence from individual correspondence, questionnaires, semi-structured conversations and case studies with hotel residents. Our preliminary analysis demonstrates considerable failures of statutory bodies in implementing their statutory duties. No evidence of meaningful investigation by any implicated statutory authority, or their privatised sub-contractors, into the human rights violation allegations asserted by hotel residents has been produced. The Local Authorities and the NHS insist that the Home Office is responsible for hotel residents within their boundaries. In turn, the Home Office, including Greater Manchester Police and sub-contractors Serco and Migrant Help, have failed to address the allegations in any transparent way.

We call for immediate action that enables hotel residents to safely protect themselves and stimulates inclusive solution-making, with them, to end these human rights violations.

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During the pandemic, governments had to communicate complex scientific and epidemiological concepts in such a way that they could be understood and accepted by the population, and result in behavioural changes that limited or stopped the spread of the virus. The challenge of communicating the risks of COVID-19 was affected by the ways in which it was initially framed. In those countries in which it was framed as a SARS-like disease, there was no need to change and adjust the public health message. From the start, the new virus was presented as a major danger and one that required significant changes in behaviour. In Taiwan, Japan and New Zealand, there was a clear and consistent message engendering public trust. In countries that initially framed COVID-19 as flu-like, such as the UK and US, there were major shifts in messaging, especially in the early stages of the pandemic when it became evident that there was community transmission, that hospital admissions were taking place and deaths were rising rapidly. In some countries, the messaging was further undermined by tensions between populist politicians and public health experts. This tended to undermine trust in public health messaging.

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