ENABLING ENVIRONMENTS: A STEPPING STONE TOWARDS INDEPENDENT LIVING

Patricia Regan says the use of assistive technology is proving to be an exciting and productive method for facilitating more independent-living situations.

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We are living in a world where technology is integral to our day living—from waking up to the clock-radio alarm, using a smart phone reminder to attend an appointment, the use of sensor lights to make our way safely from the car to the front door at night time.

Assistive technology is a term that has come to be generally used to refer to practical tools that can support functional needs of people who experience difficulties linked to disability or ageing. The most widely used definition of assistive technology is probably the definition of ‘assistive products’ used by the International Standards Organisation (ISO): ‘Any product (including devices, equipment, instruments and software), especially produced or generally available, used by or for persons with disability: for participation; to protect, support, train, measure or substitute for body functions/structures and activities; or to prevent impairments, activity limitations or participation restrictions.’

Many people think of complicated computer software programmes, when they think of assistive technologies. However, there are many characteristics of technology, low to high technologies, commercial to custom technology. We often describe inexpensive devices that are simple and easy to make and maintain as ‘low’ technology, and harder to obtain as ‘high’ technology. Examples of low technology could be communication boards, modified eating utensils, or bath aids. Powered wheelchairs and electronic communication devices, and eye-scanning equipment are examples of high technology.

When we speak of assistive technology, we often think of technologies that help people with disabilities to be more independent in activities of daily living, for example, the use of infrared motion sensors that can facilitate the opening of a door, turning on a lamp, making a phone call, all from pushing a button. Assistive technology is often discussed in the realm of educational technology, where products are provided to people with disabilities to access educational materials and instruction in school and in other learning environments. The use of assistive technology by people with intellectual disabilities to enable individuals to live more autonomous and independent lives is not usually highlighted when assistive technology is being discussed in the media. There is a presumption that such technologies would be ‘too difficult’ for the person with an intellectual disability to manage, and that the concept of ‘wrap-around care’ is the ‘safest’ way to support the person with a disability.

However, in Ireland, and in other countries around the world, the use of assistive technology is proving to be an exciting and productive method for facilitating more independent-living situations, and in supported living. These technologies can lay a crucial role in facilitating independent living and accessing education.

The increased sophistication of communications hardware, coupled with technological developments in devices such as sensors, has created the potential for vulnerable people to be monitored remotely and supported as needs arise, rather than having to be supported by staff directly and irrespective of immediate need. Telecare can be described as ‘the delivery of health and social care to individuals within the home and wider community outside formal institutional settings, with the support of devices enabled by information and communication technologies’ (Tang et al. 2000).

Assistive technology and telecare devices that are commonly in use include:
■ Gas, flood, smoke, carbon monoxide and temperature extreme sensors, sometimes linked to voice announcers, staff pagers and mobile telephone contact systems, gas and water shut-off valves, automatic window openers,

■ Bed and chair occupancy, door opening, falls and infra-red sensors,

■ Environmental control systems that ensure easy to use controls for TVs, DVDs, lights, etc.,

■ Fingerprint-operated door and room locks,

■ Easy-to-use mobile telephones that include alarm prompts, task scheduling, GPS tracking,

■ Door closing and key reminders, medication reminders,

■ Low-tech solutions such as picture phones and plugs to prevent sink/bath overflows.

Figure 1: Motion Activated Memo Reminder
figure-1User friendliness is a key feature in the area of assistive technology, as it works best when a good match is reached between the user and the technology. ‘One size fits all’ does not work in the area of assistive technology; a comprehensive needs assessment is crucial to identify a tool that is well-matched to the individual, and the environment in which they live. Critical transition points in a person’s life—from school to work, or moving from a congregated setting to community living—are times where the use of assistive technology may be of benefit to facilitate independence.

The following areas should be taken into account when conducting a needs assessment:
■ The individual’s cognitive/learning level,
■ Their physical abilities related to device usage,
■ The individual’s awareness/motivation, and
■ The individual’s self-determination/expectation.

Figure 2: Big Button Phone with 4 Picture Press Dialling

figure-2Before an individual with a disability and their parent/carer/significant other begins to look at assistive technology as a means to facilitate increased independence, the abilities of the individual concerned are taken into account. A keyworker, and the greater multidisciplinary team, may be consulted, along with parents/carers and perhaps new skills may need to be learned to use the technological device. As in any situation, if the person who is to use the device isn’t interested, often this device will be abandoned quickly, or ‘left on the shelf’.

We all know situations where complex mobile phones were purchased for relatives/friends with good intentions, but were too difficult to use by the recipient, and therefore abandoned. Unfortunately, the purchaser of the phone may come to the conclusion that the person ‘can’t use a mobile phone’, instead of looking at the skills and abilities of the person involved, enabling the person to buy a mobile phone that best suits his/her needs. It also takes time to learn a new skill, and the appropriate amount of time should be dedicated to skill learning commensurate with the person’s abilities.

According to the National Housing Strategy for People with a Disability 2011-2016, extensive international research, spanning over thirty years, consistently points predominantly towards a better quality of life for people with disabilities in community settings compared to institutional care. All those now living in congregated settings should have the opportunity and right to move to a home of their choice in the community (Time to move on, HSE, June 2011). However, while a person’s home offers safety, warmth and a good environment to live in, it cannot be and should not be the person’s complete world. Independence and inclusion in our own community is a measure of a fully-engaged life for people with a disability, as it is for everyone. The new model of support should enable people with disabilities to live in dispersed housing, with supports tailored to their individual need (Report of the working group on congregated settings, HSE, 2011). Assistive technology can play a vital role in enabling this new model of support, such as in-home supports.

In-home supports are the forms of support that enable the person to live independently and safely in their own home. As well as support provided by paid staff, smart technology (technology to enable people to live independently) should form part of the new model of in-home support, to facilitate independence and community inclusion. There is a fear that the introduction of assistive technology is due to ‘financial cutbacks’ and ‘cost saving’, rather than trying to facilitate increased independence and autonomy. This is a valid fear, due to the current financial crisis that the country finds itself in, and daily discussions in the media with regard to staff being ‘let go’ and words like ‘redeployment’ being bandied about on the airwaves. Parents/relatives/friends of people with disabilities have every right to be concerned about the safety and well-being of the person that they love. However, if a person with a disability has the potential to achieve even a small amount of independence due to a piece of assistive technology, wouldn’t it be a shame not to give that person the gift of some autonomy in their activities of daily living? There is no magic wand; there is no way of knowing whether assistive technology will facilitate independence without trying it out, where appropriate, and it goes without saying that assistive technology should go hand-in-hand with the appropriate level of direct support from a carer/staff/friend of the individual with a disability. It is not envisaged that assistive technology will ‘take over’ the role of direct, paid support; rather, it is to empower and facilitate independence. It is not an either/or situation, but there are situations globally where, over time, the amount of direct support has been reduced considerably through the use of assistive technology. You might wonder who will fund this assistive technology—a valid point. But such technology has become very cost-effective and it can supplement paid support very well, as research on the provision of assistive technology in Ireland (conducted by the National Disability Authority in 2012) and in other countries has shown.

Figure 3: Big Button Phone with SOS Button and GPS Location

big-buttonWe are at a vital time in our history, with the closure of congregated settings and the move towards community living for people with intellectual disabilities,. It would be a shame to substitute large institutional settings with smaller institutional settings, based in the community. Now is the time to look at the wider picture on how people with disabilities of varying abilities can be supported to live in a variety of home settings, with a variety of supports, with assistive technology, where appropriate.

Of course, there are cases where full-time paid support is necessary and essential for the safety and well-being of the individual living in the community—that is not disputed. We are at a turning point in how the type of support, individualised to the needs of the person with a disability, can facilitate the best possible quality of life and tap into the potential of the person involved. This is not to say that everyone wants to live alone; many people with disabilities enjoy the company of their friends (as per the rest of the population). However, how often is this model employed to facilitate budgets, staff ratios and vacancies in community houses, rather than true individualisation and the wishes of the person with a disability? Some people, particularly those on the autistic spectrum, may not like sharing with others, and if appropriate, they should be facilitated through the use of assistive technology, and with the correct and individualised level direct support, to enjoy the best quality of life for their individual situation.

To conclude, they say that ‘no man is an island’—every person in the community relies on others, in varying degrees, to achieve their potential. Assistive technology should not replace support; rather it should be considered, where appropriate, to supplement the correct and individualised direct support to facilitate the person with a disability to achieve his/her potential and to experience the simple pleasures in life that many of us take for granted.

headshotPatricia Regan is employed as a Senior Occupational Therapist by the HSE and has worked for the Longford/Westmeath Occupational Therapy Service since 1994, previously having worked in Beaumont and St Vincent’s Hospitals and the former North Eastern Health Board. She qualified as an Occupational Therapist from Trinity College Dublin in 1991 and completed a MSc in Rehabilitation Studies in University College Dublin in 2005. Patricia worked as a Project Lead in Assistive Technology on the Alvernia Transfer Programme, and as a Person Centred Planning Facilitator for the HSE Intellectual Disability Service, Westmeath Area, in 2012 to 2013. She is currently the Irish Delegate for the World Federation of Occupational Therapists.

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