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Contributors
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- By Isabella Aboderin, W. Andrew Achenbaum, Katherine R. Allen, Toni C. Antonucci, Sara Arber, Claudine Attias‐Donfut, Paul B. Baltes, Sandhi Maria Barreto, Vern L. Bengtson, Simon Biggs, Joanna Bornat, Julie B. Boron, Mike Boulton, Clive E. Bowman, Marjolein Broese van Groenou, Edna Brown, Robert N. Butler, Bill Bytheway, Neena L. Chappell, Neil Charness, Kaare Christensen, Peter G. Coleman, Ingrid Arnet Connidis, Neal E. Cutler, Sara J. Czaja, Svein Olav Daatland, Lia Susana Daichman, Adam Davey, Bleddyn Davies, Freya Dittmann‐Kohli, Glen H. Elder, Carroll L. Estes, Mike Featherstone, Amy Fiske, Alexandra Freund, Daphna Gans, Linda K. George, Roseann Giarrusso, Chris Gilleard, Jay Ginn, Edlira Gjonça, Elena L. Grigorenko, Jaber F. Gubrium, Sarah Harper, Jutta Heckhausen, Akiko Hashimoto, Jon Hendricks, Mike Hepworth, Charlotte Ikels, James S. Jackson, Yuri Jang, Bernard Jeune, Malcolm L. Johnson, Randi S. Jones, Alexandre Kalache, Robert L. Kane, Rosalie A. Kane, Ingrid Keller, Rose Anne Kenny, Thomas B. L. Kirkwood, Kees Knipscheer, Martin Kohli, Gisela Labouvie‐Vief, Kristina Larsson, Shu‐Chen Li, Charles F. Longino, Ariela Lowenstein, Erick McCarthy, Gerald E. McClearn, Brendan McCormack, Elizabeth MacKinlay, Alfons Marcoen, Michael Marmot, Tom Margrain, Victor W. Marshall, Elizabeth A. Maylor, Ruud ter Meulen, Harry R. Moody, Robert A. Neimeyer, Demi Patsios, Margaret J. Penning, Stephen A. Petrill, Chris Phillipson, Leonard W. Poon, Norella M. Putney, Jill Quadagno, Pat Rabbitt, Jennifer Reid Keene, Sandra G. Reynolds, Steven R. Sabat, Clive Seale, Merril Silverstein, Hannes B. Staehelin, Ursula M. Staudinger, Robert J. Sternberg, Debra Street, Philip Taylor, Fleur Thomése, Mats Thorslund, Jinzhou Tian, Theo van Tilburg, Fernando M. Torres‐Gil, Josy Ubachs‐Moust, Christina Victor, K. Warner Shaie, Anthony M. Warnes, James L. Werth, Sherry L. Willis, François‐Charles Wolff, Bob Woods
- Edited by Malcolm L. Johnson, University of Bristol
- Edited in association with Vern L. Bengtson, University of Southern California, Peter G. Coleman, University of Southampton, Thomas B. L. Kirkwood, University of Newcastle upon Tyne
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- The Cambridge Handbook of Age and Ageing
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- 05 June 2016
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- 01 December 2005, pp xii-xvi
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fourteen - Conclusions
- Malcolm J. Fisk
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Summary
Introduction
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. The book has also considered technological developments that will lead to social alarms becoming part of broader arrays of technologies that underpin smart homes, telecare and lifestyle monitoring services.
Making the links with social theories
Chapter Two bore testimony to some of the range of social theories to which social alarms could be related. Further ideas were added that were concerned with the potential for communications technologies to liberate their users from what could otherwise be oppressive and inappropriate service frameworks. It was pointed out that there was no single social theory or group of theories that appeared directly to apply to social alarms.
Social Alarms to Telecare
- Older People's Services in Transition
- Malcolm J. Fisk
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Social policy agendas 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 healthcare, social welfare and housing.
five - Social alarms in England and Wales
- Malcolm J. Fisk
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Summary
Introduction
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.
The technology rush among housing practitioners was borne testimony to in articles within the professional housing journals over a considerable period (see, for instance, MacCreath, 1980; Sand, 1986). By contrast and with few exceptions (see Fisk, 1985) social welfare journals were virtually silent on the issue.
As noted in Chapter One, the whole business of developing social alarm services was technology led. The local authority, mainly housing sector purchasers, were wooed and seduced. Articles in housing journals were, in many cases, adulatory and often appeared little more than a means of marketing the wares of a particular manufacturer. Some were written by service providers, others by the manufacturers themselves.
thirteen - Falls, lifestyle monitoring and dementia care
- Malcolm J. Fisk
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Summary
Introduction
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 dangers associated with this relate to that potential being realised in ways that are narrowly focused on clinical objectives and which would be likely to treat older people as patients as opposed to service users. Chapter Twelve was clear about this and about some of the ethical issues that need to be addressed. Closely relating to this are the dilemmas associated with what has become known as lifestyle monitoring.
Lifestyle monitoring is a direct descendant of passive and activity monitoring.
twelve - Social alarms, telemedicine and telecare
- Malcolm J. Fisk
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Summary
Introduction
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. But they recognised that the use of communications systems could offer a means of redressing some of the power imbalances that are normally found with medical services in that they noted the opportunity (p 14) for patients to benefit from on-line information as well as for medical practitioners to remotely check on a patient’s healthcare status. Of note in relation to this book, however, is the fact that Curry and Norris (1997, p 18) saw the “opportunity to develop rapidly the healthcare side of telecare using the existing community alarm infrastructure”.
The first and broadest perspectives on telecare are those that see it as close to, or an integral part of, telemedicine.
List of tables and plates
- Malcolm J. Fisk
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one - Introduction: what are social alarms?
- Malcolm J. Fisk
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Summary
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. The latter most typically portray older women, lying prostrate on the floor having suffered a fall (see Plate 1.1).
Definitions of social alarms and the objectives of this book are set out below. First, however, some of the terms used and which are, in some cases, considered to be a source of confusion, are explained.
Terminology
In all parts of the world, the vast majority of users of social alarm services are older people. The term older people is, therefore, commonplace throughout this book, but such terms as elderly people, the elderly, the aged and seniors do appear when the works of others are quoted.
three - A critical review of the literature
- Malcolm J. Fisk
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Summary
Introduction
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 described the service in North Wales launched by the then Alyn and Deeside Council. It claimed that “local councils are turning to modern technology to overcome the fears of thousands of old people who live alone … many have a real fear of being unable to summon help in the event of a fall or an accident in the home”. The system provided cover when resident wardens were off-duty, with responses to calls being made by mobile wardens. Mrs Phoebe Catherall, aged 81, was quoted as saying, “I’ve never used the alarm but I feel so much happier knowing that I could. I feel safer, I sleep better and I know there is always someone there if I pull the cord”.
Frontmatter
- Malcolm J. Fisk
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Also available from The Policy Press
- Malcolm J. Fisk
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References
- Malcolm J. Fisk
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six - Social alarms in Scotland
- Malcolm J. Fisk
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Summary
Overview
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.
EAST LOTHIAN COUNCIL
The East Lothian service commenced in 1979, served the City of Edinburgh and was supported by funding from the Lothian Health Board (Duncan, 1988, s 7.1). Like that in Stockport, it was not intended to give cover to sheltered housing schemes managed by the council, but rather was to be focused on the needs of others, essentially older people in the wider community.
While it had a remit to serve both older and younger people with support needs, the Lothian service grew only slowly. Just 300 users were linked in 1988. Keys were in most cases held by mobile wardens who, together with a coordinator and clerical assistant, managed the service. Management was later vested in a monitoring and response centre facility operated jointly with Midlothian Council. By 1996 this had grown to serve the needs of 2,150 users with carephones and to provide an out of hours service to 350 sheltered housing tenants (Dick and Pomfret, 1996, Appendix).
(FORMER) CENTRAL REGIONAL COUNCIL
Better documented and evaluated than the East Lothian service is the Mobile Emergency Care Service (MECS), set up by the then Central Regional Council in 1980. This service had been particularly influenced by the English experience at Stockport (McWhirter, 1984, p 11).
From the outset, the challenge facing Central Region in setting up a service was substantial. The authority had responsibility for services to older people over a huge geographical area and experienced difficulties with regard to radio signal reception in some rural areas.
ten - Social alarms: international comparisons
- Malcolm J. Fisk
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Summary
The current position
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.
Themes and issues
Making comparisons between the contrasting countries with social alarms is difficult. The paucity of specific information regarding them has been noted. And even when some information is available it may only be passing mention.
Few central or regional government departments or agencies have specifically addressed the issue of social alarm services and their role. Accolades must go, therefore, to the Victoria State government in Australia in their review of the VICPACS service discussed in Chapter Nine (Department of Human Services, 1998) and, for earlier studies, to Scottish Homes (Duncan and Thwaites, 1987), the Ontario Ministry of Community and Social Services (1987) and the Canada Mortgage and Housing Corporation (MacLaren Plansearch, 1988).
four - The origins of social alarms
- Malcolm J. Fisk
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Summary
Introduction
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.
Bells and buzzers
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. In the earliest period of sheltered housing this responder would have been as likely to be an active older resident as a warden.
Originally the alarms used in Great Britain were simply bells and buzzers activated by switches or push buttons and individually wired to a panel in the responder’s dwelling.
Contents
- Malcolm J. Fisk
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seven - Social alarms in Ireland
- Malcolm J. Fisk
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Summary
Introduction
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. They took place in a context where the provision of social housing has not, since 1971, been a responsibility of local authorities.
Statutory services relating to the needs of older people in the Republic of Ireland are less well developed. Local authorities are providers of social housing at a modest level when compared with Great Britain, with the amount of provision being substantially diminished by virtue of high numbers of sales to tenants. But the heritage of social welfare services has much in common with Great Britain and is characterised by a widespread provision of institutional care. A vital need to extend community services has, however, been recognised (Crosby, 1993, p 136).
Appendix - A note on methodology
- Malcolm J. Fisk
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Summary
Uncharted waters
The role of social alarms has been very poorly researched, despite their increasing provenance and the variety of claims made about their benefits. Indeed, apart from within the communities of service providers and older people in Great Britain, the United States and a handful of other countries, social alarms are generally little known and only occasionally are they considered within broader service or social policy frameworks.
The reason that social alarms are poorly documented is because they have been seen as, at worst, irrelevant and, at best, as tools that are used as a means of helping fulfil objectives that relate to other services. Academics and practitioners who are concerned with housing, social welfare and healthcare have usually viewed social alarms as a kind of adjunct to their work, peripheral to the mainstream and, therefore, not worth much attention.
This book remedies this by bringing social alarms into focus. An approach was taken that, in the very first instance, was concerned to gather basic information from within Great Britain, Ireland and other countries. This information was then built upon through more focused work that was concerned with the operation of social alarm services; establishing user perspectives; exploring the extent to which claims made for social alarms had been, in reality, fulfilled; and considering the implications of recent technological developments.
The ways in which the methodology more specifically responded to the objectives of this book are noted below.
Establishing the position of social alarms in Great Britain, Ireland and Internationally
Gathering information in relation to the first two objectives took place over many years. The objectives were, as noted in Chapter One, concerned with establishing the position of social alarms in Great Britain, Ireland and other parts of the world. In Great Britain, Ireland and to some extent the United States, this involved an exploration of their evolution and of the services provided, and consideration of their place within social policy frameworks. This work, when broadened to include other countries, then explored different themes and enabled the making of international comparisons.
A range of different approaches was taken to gathering information, this in several cases involving case study visits and original survey work with service users in Great Britain, Ireland and beyond.
nine - Social alarms in the rest of the world
- Malcolm J. Fisk
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Summary
European Union (excluding Great Britain and Ireland)
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:
1. 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). The prerogative is, in essence, the same as that in Great Britain and Ireland, that is to respond to agendas associated with enhancing the rights of individual older people and to redress their marginalised position.
2. A call is being made in all countries for the greater effort of families and communities to support their relatives or neighbours. This signals the need, acknowledged to a greater or lesser degree, for new policy frameworks to support informal carers (King, 1993, p 13).
Acknowledgements
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