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  • Author or Editor: Malcolm J. Fisk x
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Older people’s services in transition
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Healthcare, social welfare and housing policy agendas, while emphasising the importance of supporting the independent living of older people at home, have generally failed to take account of the actual or potential role played by social alarms and telecare.

This book draws on research and practice throughout the developed world. It documents the emergence of these important technologies and considers their potential in the contexts of healthcare, social welfare and housing.

The book is of immense importance to policy makers and practitioners in healthcare, social welfare and housing. It signals the potential, the challenges and the threats associated with such technologies. As such it must be compulsory reading for every current or potential service provider.

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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.

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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.

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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).

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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.

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Of the 300 public sector services in Great Britain identified by Fisk in 1990, 280 were managed by English and Welsh local authorities (Fisk, 1990, p 3). These included many of the largest and smallest services, in terms of the number of their service users.

The establishment of the early schemes in Stockport and the London Borough of Hammersmith and Fulham have been described in Chapter Four and some of the debates concerning the technology options and ways of configuring social alarm services have been initiated. Notable, however, is the extent to which the social welfare perspective, exemplified by the Stockport scheme, was set aside as housing authorities developed services that primarily responded to their management requirements for sheltered housing. To put it bluntly, older people with high levels of support needs, whether or not living in sheltered housing, were not their responsibility and they, generally speaking, saw their social welfare objectives in terms of responding in emergencies rather than supporting independent living. But social alarms were attractive to housing authorities because of their perceived ability to improve the efficiency of sheltered housing services, make revenue savings and, in the words of Parry and Thompson (1993, p 16) make a “major contribution towards improving the working conditions of many wardens”.

It is small wonder that social services authorities had to stand on the sidelines while their housing colleagues were almost indecent in their haste to acquire the new technologies and garner the associated kudos. In some instances the social welfare practitioners may have appeared suspicious and/or hostile towards such developments and that, perhaps, was entirely predictable.

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As noted in Chapter Four, many social alarm services managed by Scottish local authorities are distinguished by the extent to which social work departments were instrumental in their establishment. This is despite social alarms in Scotland sharing, with the rest of Great Britain, their provenance in sheltered housing. The fact, however, that resident wardens in sheltered housing schemes were generally paid for or subsidised by the social work authorities meant that those authorities had greater influence.

The earliest social alarm services in Scotland were those of East Lothian and Central Regional Councils, both social work authorities. Both used non-speech radio equipment. They were, therefore, part of that early raft of pioneers that included Stockport and Oldham south of the border.

The interest generated in other Scottish authorities by the establishment of MECS in Central Region was substantial and as a consequence several sought to follow their example. There was, however, no rush. The pace of development was such that just one new Scottish service was established in each of the seven years from 1980 to 1986 (Duncan, 1993). The caution of authorities reflected:

  • a desire to await and consider the outcomes of the Central Region initiative;

  • a recognition of the high capital cost of equipment, this being added to where equipment in sheltered or amenity housing schemes might require replacement because of its incompatibility with that at the monitoring and response centre;

  • concerns regarding likely additional costs of providing for the needs of users in rural areas;

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This chapter details the position of social alarms in Ireland, covering both the Republic of Ireland and Northern Ireland. Social alarm services in each have different characteristics that reflect the respective perspectives on housing, social welfare, healthcare and security matters, and are partly determined by the extent of state subsidies and the agencies through which those subsidies are channelled. Almost all social alarm services, however, operate via nominated contacts, that is without the use of paid response staff such as mobile wardens. Social alarm services in the Republic, furthermore, appear to be unique when considered in relation to services in all other countries in the relatively narrow emphasis placed on security.

The differences in broader policy frameworks reflect, of course, the concerns, priorities and views of the governments of the United Kingdom and the Republic of Ireland. For Northern Ireland, therefore, there is much in common with the three countries of Great Britain, albeit that there are variations in administrative frameworks and the responsibilities of local authorities. In Northern Ireland there are joint health and social services authorities. This, it might be considered, could result in greater attention being given to healthcare agendas when endeavours are made to develop the potential of social alarms, but that it is not notably the case reflects a shared perspective with the rest of the United Kingdom whereby social alarms have tended to be promoted by housing rather than social welfare agencies. In the case of Northern Ireland, however, the main developments of social alarm services resulted from housing association, rather than local authority, initiatives.

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As noted in Chapter Four, the main difference in the evolutionary path for social alarms or personal response systems and services (PRS) in North America arises from the fact that their development was almost entirely a private sector phenomenon, with such services being promoted on the basis of cost savings in healthcare. This contrasts markedly with the position in Great Britain where, as was noted in Chapters Five and Six, development predominantly took place within the public sector and was concerned with housing and social welfare agendas.

This is not to suggest that there was no overlap or common ground between the respective experiences. Both, as with other developed countries, experimented with bell and buzzer systems in the context of different types of accommodation, such simple technologies becoming particularly commonplace in institutions. However, the ensuing paths were divergent.

In Canada, common ground has been evident mostly with the United States and relates to the fact that social alarms (PRS) were seen as relevant, at least in part, to private sector healthcare services. There is also, however, some common ground with Great Britain relating to the recognition that social alarms are also relevant to the needs of older people in public sector housing.

The Canadian context is one where there are relatively high levels of public sector housing provision in some areas. In 1992, for instance, there were 46,000 public sector dwellings for older people in the province of Ontario (Hobbs, 1992, p 24). PRS installations had at this time already been made in the context of healthcare facilities and nursing homes, reflecting the nature of developments in the United States.

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The development and growth of social alarm services within countries of the European Union has been extremely variable. This is unsurprising given the different national contexts; their particular heritage and idiosyncrasies in relation to housing, social welfare and health/medical services; and the mixed array of equipment that has been developed and marketed.

And despite the gradual moves towards the adoption of more shared perspectives among EU countries and some shared trends away from forms of institutional provision for older people, it should not be assumed that a common approach is either appropriate or necessary. Indeed, the contrary is probably the case in view of the varied frameworks of service provision and different built forms to which they relate. Such differences become evident in this chapter.

What is clear is that in all countries the role of social alarms crosses professional boundaries. The effectiveness of the technologies and the services that depend on them is, therefore, frequently compromised as a consequence of poor coordination (King, 1993, p 13). This is, perhaps, an inevitable outcome of the promotion of care in the community in contexts where existing service frameworks had been established with other objectives in mind. The old perspectives associated with more institutional forms of provision are being discarded with difficulty. The discussion (in Chapter Two) of the potential for such technologies to liberate their users seeks to redress such matters and, where endorsed, can help underpin changes in approach.

Some generalisations can be made and become evident from the ensuing descriptions for a selection of countries in the European Union:

  • In almost all of the EU countries examined in this book, as with Great Britain and Ireland, there is emphasis on the development of care in the community (Walker, 1993, p 5).

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