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Using technology for self care

March 2008

FAST have been successful in securing a Department of Health Section 64 project grant for 'Supporting people to choose and use technology for self care'. The project will demonstrate that the self care approach can be extended to enable older people to make choices about how to use assistive technology to maximise health, care and well-being. The project will also demonstrate the potential for existing self care models, such as the Expert Patient Programmes that are relevant to people with long-term conditions, to be extended to include technology as one of a range of strategies to maximise care and well-being. The project is due to run to March 2011.

Further news will be posted to this site.

The development of self care in Assistive Technology (AT)

FAST is currently working with a cross sector partnership to promote the case for investing in workforce development strategies in AT. In order to understand how workforce competence can support self care in AT it was necessary to draft a paper setting out the nature of self care within the context of AT service provision.

Key Issues

The key issues in the provision of AT which have implications for the scope of self care strategies are:

Competent initial assessment of the needs and wishes of the individual, the required tasks and activities and the social and environmental context is necessary for effective AT provision.
Many people are unable to access competent assessment, or engage actively in the assessment process due to: poor understanding on the part of practitioners and service users of what constitutes an adequate assessment in AT; service specialisation which precludes comprehensive assessment; lack of voluntary sector and private assessment services as an alternative to AT statutory services, to which access is restricted.
Decision making and choice in AT is poorly supported, particularly in relation to assessing and negotiating the optimal funding route acceptable to the user and the provider organisation.
Sustaining the use of AT over a period of time, in a variety of environments and over transition periods is vital to deliver outcomes of increased independence, value for money and reduced need for related services, which it has the potential to deliver. This element of service is rarely available due to restricted availability of AT practitioners. There are relatively high levels of abandonment of AT, which appear to relate directly to the lack of support in maintenance and adjustment of AT following supply and installation.
AT provision requires risk management. Service provider organisations currently take most responsibility for risk in AT, are consequently risk averse and therefore unable to provide choice. Disabled and older AT users who self-purchase or exercise choice in AT take on risk, particularly if they employ staff who use that AT, but they are not supported to understand those risks or to manage them.

Potential self care models

Potential self care models and related strategies to support self care fall into three categories which are likely to reflect the level of engagement desired by users or carers.

The first model would aim to build greater awareness of the potential of AT and to empower disabled and older people to make a considered decision to include AT as part of their care package. The existing self care model with potential to deliver these outcomes is that of the Expert Patients Programme (EPP). Related strategies to support greater public awareness and to provide relevant information are particularly important in relation to these outcomes and would underpin self care at all levels.
Building the capacity of users and carers to actively engage in the assessment and decision making process is likely to increase the effectiveness of AT provided. The Trusted Assessor training framework could substantially deliver this outcome. Additional approaches to develop users’ capacity to assess and negotiate the optimal funding route would be required in recognition of the high level of self purchase and shortfall in statutory provision of some AT. Related strategies would include standardising the information available in order to empower users to choose the best products and services to meet their needs.
The third model would aim to build the capacity of users and carers through skills training, which may be provided jointly with professionals. This recognises the current shortfall in service provision in relation to sustaining the use of AT post-assessment. Building the capacity of users and carers to carry out simple technical adjustments and maintenance tasks in relation to straightforward as well as complex AT is likely to substantially sustain the use of AT. The High Tech Assistive Technology training delivered by Enable Ireland and peer mentoring programmes in the US indicate the capacity and desire of a significant client group to receive training and provide peer support in complex AT.