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these were often based on misunderstandings. Respondents’ views were often explained
in terms of potential threats to identity associated with positive ageing and self-reliance,
and views that interventions could undermine self-care and coping.

It is essential to ensure that telehealth devices are not contrary to cultural practices
and do not affect the way the person is living. This means that if telehealth is deployed in
assisted living it is required to be sensitive to the ecological social infrastructure in which
it is deployed.
This can be a costly and time-consuming venture as messages are required to be per-
sonalised and repetition can cause people to become bored of using the device no matter
how much it can benefit them. Greenhalgh et al. (2012) explored a range of reasons why
telehealth is not utilised to its greatest extent and suggested that different stakeholders
hold different assumptions, values and worldviews, which can lead to the technology
not being fit for purpose. This was earlier identified by Dewsbury and Ballard (2014) who
put forward a range of reasons why technology can fail if it is not person centred.
Personalisation and the ability for technology to grow and evolve with the person, so
that as the person’s needs change the technology can be responsive to that change, are
central to the effective use of technology to support people in assisted living.
One of the issues with telecare and telehealth devices is that they are predominantly
unidirectional in response. The alert is triggered and the device sends code wirelessly to
activate the base unit, which sends the information to external sources. This means that
reprogramming a device to have further or better functionality is very limited or not pos-
sible in many cases. Similarly, one of the weaknesses of traditional telecare and telehealth
is that they are tied to the phone lines or require a modem to upload the information. What
is apparent about modern technology is that it is evolving and becoming mobile, with
the increased use of smartphones and tablets to provide content and information to the
person wherever they are. This mobility has led to the notion of the IoT, which was a phrase
coined by Ashton (2009) that refers to the interconnectivity of mobile devices. This has led
to the Internet of Health.

Telehealth and Telecare in Europe
Europe, excluding the United Kingdom, has taken a different path to its implementation
focusing more on the support and enablement aspects rather than the technological. In
Bulgaria, the municipality of Sofia set up its own social assistance system as a reaction to a
shortage in social assistants available through the national system. This programme imposed
hardly any requirements for the assistants. In contrast, the PreQual project (in Italy, Austria,
the Czech Republic, Germany and Hungary) educated migrant women to qualify them for
work in the care sector. This scheme tried to match the needs of the labour market with those
of migrant women and to provide a future-orientated and innovative solution (Araujo, 2009).
In Slovenia, the Slovenian Federation of Pensioners Organisations developed a pro-
gramme of voluntary work carried out by older people to improve their own quality of
life and that of their peers. Feeling lonely is a common problem among older people, so