Tele (at a distance) Care.
Any attempt to define Telecare is fraught with contradictions. Here I try to demonstrate the wealth and diversity of the various definitions of Telecare. Let's start with a definition on TelecareAware which comes from an unknown source but is a good lead in:
“Telecare is the continuous, automatic and remote monitoring of real time emergencies and lifestyle changes over time in order to manage the risks associated with independent living.”
Steve Hards (http://www.telecareaware.com/index.php/what-is-telecare.html (accessed Dec 2008).
Defining Telecare is not simple. The definition above contrasts with the following definition by NHS Purchasing and Supply (PASA):
"Telecare describes any service that brings health and social care directly to a user, generally in their homes, supported by information and communication technology. It covers social alarms, lifestyle monitoring and telehealth (remote monitoring of vital signs for diagnosis, assessment and prevention).
“Telecare covers a wide range of equipment (detectors, monitors, alarms, pendants etc) and services (monitoring, call centres and response).
“Telecare equipment is provided to support an individual in their home and tailored to meet their needs. Telecare services range from a basic community alarm service that is able to respond to an emergency and provide regular contact by telephone to an integrated system that includes detectors or monitors (i.e. motion, falls, fire and gas) that trigger a warning to a response centre. More complex systems include telemedicine, which is designed to complement healthcare via monitoring vital signs such as blood pressure. Data is transmitted to a response centre or clinician’s computer where it is monitored against parameters set by the individual’s clinician."
http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Telecare/LandingPage.htm (accessed Dec 2008)
Telecare utilises information and communication technologies to transfer medical information for the diagnosis and therapy of patients in their place of domicile.
(Norris A C, 2002, 4)
A distinct problem with Telecare is its lack of a clear definition. Moreover, the definition of Telecare is constantly modifying depending on who is writing or what the current “in word” is. The first definition above situates Telecare within the social framework whereas the second situates it clearly as medically allied, whilst the third definition sees Telecare as solely a medical intervention transferring medical information. To add to the discussion the Department of Health’s Care Service Improvement Partnership (CSIP) emphasises the remote monitoring aspects of it as well as its use in reducing admissions in their definition:
"Telecare is a broad term which encompasses a wide range of technologies with remote monitoring that can support people to remain independent and potentially reduce the frequency of hospital and care home admissions as well as give peace of mind and reassurance to users, carers and their families."
http://networks.csip.org.uk/IndependentLivingChoices/Telecare/AboutTelecare/ (accessed Dec 2008)
Whereas for David Bradley et al (2002) Telecare is a purely medical allied intervention, when the define Telecare as:
“An holistic approach to the remote provision of healthcare, assistance and monitoring in a community setting, via the use of appropriate technologies, in order to assure client well being.” (Bradley, Williams, Brownsell and Levy (2002) 'Community alarms to telecare – The need for
a systems strategy for integrated telehealth provision' Technology and Disability 14, 64.)
This can be contrasted with Kevin Doughty's recent definition of Telecare as an umbrella term for Domestic AT systems.
"Telecare has become the umbrella term for all assistive and medical technologies that depend on modular, relatively inexpensive and quickly deployed, electronic devices and/or telecommunication systems that help people to maximise their independence within the home environment." (Doughty K, 2007, “Telecare Practice and Potential”).
What is clear is Telecare means different things to different people. Moreover the term Telecare is a euphemism for whatever the new policy of the day is.
The author describes Telecare as the ability to harness simple technology to enable and empower people such that they can live independently in the community. Telehealth and Telemedicine are technological applications which centre on the health aspects of the person and supporting them in the home or hospital. This though is very close to the first definition offered by Steve Hards.
Without a clear strong fixed and universally accepted definition of Telecare, how can Telecare services develop plans and ensure that the people who require Telecare receive the correct information and services?