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Social alarms, as documented in Chapters Five to Nine, are now established in most, if not all, countries of the Western world. They are particularly well established in Northern Europe including the Scandinavian countries, and also in North America, Israel, Japan and Australia. They are also increasingly evident in a number of less developed countries such as those within former Eastern Europe and the former Yugoslavia.

The evidence for this wider distribution of social alarms is limited in the sense that there are, as emphasised in Chapter Three, few published articles and reports emanating from many of the countries in question. The main manufacturers meanwhile have been understandably guarded about where they have marketed their wares lest they signal commercial opportunities to others. Despite such provisos, the information presented in this book makes it possible to list both the countries where social alarms are well established and those where some social alarm services are evident but the markets remain poorly developed. Social alarms are well established in many of the former in the sense that they are underpinned by public sector subsidies and sometimes legislation that encourages or requires such provision. Alternatively there are commercial markets within which services can actively compete for the custom of older people and/or agencies that provide support services for their benefit. A number of smaller countries can also be included where the markets may be limited in size but where social alarms are used by several thousand older people. Table 10.1 provides those listings of countries with established or developing markets.

Smart homes, when appropriately designed and incorporating suitable technologies, may be an ultimate goal by which older people can achieve independent living. Such a vision is beginning to emerge as smart homes are considered alongside developments in telemedicine, telecare, activity and lifestyle monitoring (discussed in Chapters Twelve and Thirteen). Social alarms can be seen as at the core of smart homes.

As noted by Fisk (2001, p 101) there is no single accepted definition of a smart home. At its broadest, a smart home is one where smart technologies are installed and where those technologies facilitate automatic or user-initiated communication involving a range of appliances, sensors, actuators and switches. Such communication takes place in ways that can empower people and, in so doing, improve their quality of life. Implicit in this definition is the notion that the same empowerment and improvement in quality of life would not be achieved in ordinary homes despite the fact that most of these would have a range of devices that operate independently of each other. Some would benefit from the presence of a social alarm. There is, in other words, something to be gained by communication in a way that adds to that offered by social alarms. This chapter explores the importance of that new way of communicating, specifically relates it to the needs of older people, and considers its impact on social alarms. In doing so it attempts to capture the ways in which smart technologies can help to promote engagement and social inclusion as well as support the independent living of their users.

An integral element of smart homes is the transmission and interpretation of data and information about the dwellings and the environment within which they are installed. The act of transmission reflects, of course, the ability to communicate. The act of interpretation, however, means that for systems to be smart they must have intelligence. And as seen in Chapter Eleven, such intelligence can be used in a variety of ways to assist and empower dwelling occupants.

It is the increased capacity for communication and the power of microprocessors that offer the ability for transmission and interpretation of data and information about people as well as the home environment. This ability, building on the experience of social alarms, has brought us telecare – care provided remotely. The link with smart homes is clear; Tang and Venables (2000, p 8) having referred to smart homes and telecare as “natural companions”. The origin of the term telecare is unclear. It was used with increasing frequency during the 1990s to describe medical services provided at a distance, albeit generally within hospital and clinical environments. It has also been used for some telephone mediated counselling and advice services. And with the development of medical services within people’s own homes, as associated with hospital-at-home and early discharge schemes, the word telecare has been encountered with increasing frequency, although the meanings ascribed to care, as noted in Chapter Ten, are varied.

Curry and Norris (1997) reviewed telecare activity in the United Kingdom for the Department of Health, ascribing a somewhat medically oriented position to it.

One powerful reason for the use of social alarms is a concern about the consequences of falls experienced by older people. Indeed, as noted in Chapter One, the image of someone who had fallen and was unable to call for help became, as noted in Chapter Ten, an icon for social alarms and featured frequently in the advertising of both manufacturers and service providers.

The inappropriateness of the iconography was noted. It is undeniable, however, that social alarms have a role to play in enabling older people to call for help after they have fallen or, as noted in Chapter Three and as strongly affirmed in the work of Thornton and Mountain (1992), when they are stuck. More than this, one of the main benefits and possibly the main benefit of social alarms has been repeatedly affirmed as facilitating speedy interventions and thereby avoiding the adverse consequences of lying unaided for sustained periods.

The long-standing focus on the benefits of social alarms in relation to falls was a reflection of the fact that, while most services were located within housing departments, there was considerable relevance to social welfare and healthcare agendas. That such relevance was recognised by some was noted in Chapter Four. But the small scale of such recognition in Great Britain was instrumental in marginalising social alarms and arguably held them back from realising a greater potential.

The technological changes associated with smart homes, telemedicine and telecare, discussed in Chapters Eleven and Twelve, and the gradual awakening of social welfare and healthcare practitioners and policy makers to the potential of social alarms means, however, that a greater potential stands to be realised.

The objectives of this book were stated in Chapter One as:

• To establish the position regarding social alarms in Great Britain and Ireland, to explore their evolution and the services provided, and to consider their place within social policy frameworks.

• To establish in broad terms the position regarding social alarms in other parts of the world, the services provided, and to make comparisons where possible between them and with Great Britain and Ireland.

• To consider the role and effectiveness of social alarms in supporting independent living.

• To explore the implications for social alarm services of current technological developments associated with smart homes, certain aspects of telemedicine, and lifestyle monitoring.

The hypothesis that affirmed that social alarms and the services associated with them help to support independent living was also to be tested.

The intellectual context in which the work has been undertaken was set out in Chapters One to Three This pointed to the fact that there was a paucity of literature on the subject of social alarms and that there had been no prior attempt to position such technologies within any social theoretical framework. The material gathered in this book that is pertinent to social alarms has served to confirm that social alarms are peripheral to the housing, social welfare and health services within which they have been used. That such a position on the periphery is no longer appropriate is, it is considered, borne out by its findings.

However, social alarms have not been considered in isolation. They have been placed in the context that relates to the interface between older people and technologies.

This book explores the topic of social alarms. It does so mainly in relation to services in Great Britain and Ireland. However, it also provides an international overview and comparison of such technologies and related services.

The international perspective includes the United States, the country within which, along with Great Britain, social alarm technologies initially developed. It also includes more than 20 other countries throughout much of Europe, North America and most of the developed world.

A number of key issues regarding social alarms are addressed and social alarm service provision internationally is mapped. No other study has attempted to do this or has brought together such an extensive range of material on the topic.

First of all it is necessary to state what social alarms are. In all countries they can be seen, at their simplest, as devices that can help to support the independent living of their users. This is the oft-quoted primary aim of social alarm services. Indeed, the words independent living and independence feature in much of the literature concerning social alarms and are very prominent in publicity material produced by social alarm manufacturers, suppliers and service providers. The main competing perspectives are those that are concerned with the more specific roles of social alarms in offering security and in providing help in emergencies.

The affirmations concerning supporting independent living, offering security and providing help in emergencies have been and are frequently accompanied by imagery associated with such objectives. This, on the one hand, offers pictures of healthy and happy older people that are suggestive of active and independent lifestyles; and, on the other hand, feature the frailest and most vulnerable.

Social theories relating to older age are changing and developing. The old certainties about older people and their place in the social order are being swept aside as new agendas are followed in Great Britain and other Western countries. The readily adopted perspective that saw older people as neatly fitting within a particular stage of the life-course, defined by retirement at one end and death at the other is being questioned and theorising now increasingly starts from a perspective that sees older age as a meaningful period of life that warrants more considered attention. This means that some questions about older people and their place in wider society are being addressed for the first time.

The questioning and theorising is, in part, being driven by the demographic changes that are resulting in growing numbers of older people. They also result from agendas concerned with social inclusion, individual rights and freedoms and the questioning of traditional, often institutional, frameworks that have been the locus of care and support for older people in the past.

The paucity of social theories relating to older age has been pointed to by such analysts as Phillipson (1998) and Estes et al (1996). With regard to gerontology, that is the study of older age, Estes et al (p 350) referred to its “broad and fragmented theory”. And, as becomes clear in this chapter, such fragmentation remains. But given that gerontology is itself interdisciplinary, the fact that it may draw on social theories that are extant in different disciplines should come as no surprise.

Little of authority has been written about social alarms. This reflects the manner of their evolution and the fact of their perceived marginality to mainstream housing and social policy. In Great Britain it also reflects a widespread and unquestioning acceptance among housing service providers that they were and are a good thing.

Justification for this view of social alarms in Great Britain was readily made, as noted in Chapter One, by reference to the management efficiencies and cost savings that they permitted. In addition, in every service, it was possible to point to real events where the use of a social alarm had enabled help to be obtained in necessitous circumstances with, in many cases, lives being saved and a contribution made, therefore, to supporting independent living at least in its most fundamental of senses.

The glow of satisfaction felt by housing service providers about such benefits militated against any deep sense of enquiry about the technologies. As a consequence, caution before making purchasing decisions was often thrown to the wind, with the benefits that were anticipated being taken for granted. Searching questions about the effects of social alarms, their role and their wider potential were generally not asked and were, as noted in Chapter Two, not prompted by any attention within relevant debates about social theory. Much of what was written, therefore, tended to be descriptive accounts of services that were intended to give, and succeeded in giving, positive publicity to local service providers and equipment manufacturers.

Examples, from many, in Great Britain include one published in a national newspaper in 1983 (Daily Telegraph, 15 January).

This chapter documents the evolution of social alarms and discusses their emerging role within the context of housing and social welfare service provision for older people in Great Britain and, to some extent, Ireland. Evident from this discussion are a number of dilemmas and choices that had to be addressed by service providers as social alarm technologies developed and were marketed. At the same time social policy and, notably, housing policy frameworks relating to older people were changing.

The key to the latter lay in sheltered housing and the then emerging role of the warden. Associated with this were a number of questions about the relationship between wardens and the services they provided to the older people living in sheltered housing schemes. The technologies and their use clearly had an impact on this by providing a means and a medium of communication that was previously unavailable.

That housing policy for older people took this course can be partly explained by long-standing concerns at that time about the inadequacy of residential care. Such concerns were particularly highlighted in the work of Townsend (1962). An irony, however, is that in seeking to develop sheltered housing as an alternative, key features of residential care were reintroduced as the sheltered housing model became more clearly defined. Call systems can be seen as having helped to consolidate such definition.

The broad definition of social alarms adopted in this book, that is including call systems, makes it impossible to point to their origin with any precision. In Great Britain, however, and as noted in Chapter One, the widespread use of such technologies followed the development of sheltered housing and the adoption of what were to become known as social alarms as a standard feature to link individual residents to a responder living elsewhere in the scheme.