Page 228 - Handbook of Electronic Assistive Technology

Chapter 8 • Assisted Living 217

There are other widely used meanings of assisted living, which require attention.
Assisted living has been used in the United States for a number of years: ‘most definitions
include 24-hour supervision, housekeeping, meal preparation, and assistance with activi-
ties of daily living’ (Wright, 2004). This concept has evolved slightly differently in the United
Kingdom as independent living in special complexes with some level of support, with the
expectation that it will include an alarm system (Garwood, 2015). The related terms hous-
ing with care and extra care housing, which can be used interchangeably, extend those
concepts to include 24-hour support and the provision of meaningful social activities, and
now place a much larger emphasis on the provision of services to adults with disabilities. A
key aspect is that it is a housing model with social care treated as a separate legal entity and
this separation plays an important role in the personalisation agenda, allowing people to
make decisions about how they wish to live. Assistive technology (AT) is expected to play a
‘tailored role’ but no guidance is offered as to what this might comprise (Garwood, 2015).
Clarification of these and other definitions is important, as a lack of common under-
standing has dogged this field from the outset. This general problem was highlighted
recently by Greenhalgh et al. (2017) who examined different stakeholders’ understand-
ing of telehealth and telecare technologies. It concluded that there were four conflicting
discourses in operation, differing assumptions and a lack of a coherent organising vision,
which, they argued, have hampered successful implementation.

Smart Homes

The descriptions of the early work on smart homes as AT are specifically from an EU-funded
perspective, because it was in Europe that the first work on applying advanced technolo-
gies to support complex disability in the community was investigated. Much of this work
was highly empirical on short-term funding, so sometimes lacked scientific rigour, which
also led to limited publication. Hence much of the information is anecdotal, but is still
worthy of reporting, as it provides the backdrop and context to later developments.
Synthesising a definition of a smart home from a few of the vast number of publica-
tions on the subject (Demiris and Hensel, 2008; Chan et al., 2008; Lui et al., 2016), it can be
confidently surmised that a smart home is a living space with infrastructure that includes
a network of devices, which communicate with each other and potentially with the exter-
nal world. The emphasis here is on the continuous communication between the devices
and their ability to be programmed to interact with each other, either with or without user
interaction. This contrasts with current telecare and telehealth systems, which, from a
communication standpoint, are simple devices. They are in general terms standalone and
act in a stimulus-response manner, requiring a response from an external actor.
This chapter contends that only technologies that provide flexible, two-way commu-
nication, facilitate the use of key status information to inform care providers and simul-
taneously provide local, interactive support for the user can provide truly personalised
care. Such personalised approaches reasonably fall within the potential remit of profes-
sionals working in the field of electronic assistive technology (EAT). However, the authors