Housing adaptions, technology, and control

What this means

Too often, this issue is framed as ‘What we will do for you’, rather than starting from ‘I need…’

Why is it important to think about planning where we can but it's still important for services to be flexible?

David Yeandle explains below why it is important to think about planning and services being flexible:

What are some of the things to consider when thinking about home adaptations and technology?

In this video, Dave Bracher explains things to consider about home adaptations and technology:

It is not a panacea for all. There is a danger with an over-focus on tech, some people will be excluded. There will probably always be the need for other non-tech forms of intervention. For some, tech will go a long way, and others a little way. It’s not a panacea but it is an opportunity. 

The Living In The Place We Call Home group reflected that, often, the way adaptations to home were discussed was limited in scope. These interventions were often framed in terms of ‘greater independence’ – but independence in this definition was about a cheaper or reduced care package, making people ‘independent’ only in the sense of ‘less reliant on state support’. However, adaptations can and should be an enabler, and independence can be defined in many different ways by people. 

Discussions on home adaptations and how technology can help, therefore, need to be much more ambitious. It’s not just about replacing existing care, or a way for people to carry on living as before. How can we use the language of improvement and transformation when thinking about this issue? And how can we make sure we are working with people as individuals? 

The research 

Assistive technology is defined by the World Health Organization as ‘…an umbrella term for assistive products and their related systems and services [promoting] the inclusion, participation and engagement of persons with disabilities, ageing populations and people living with chronic conditions’ (World Health Organization/Unicef, 2022, p. xi). The social model of disability is important to consider when thinking about adaptations and technology – is the intervention designed only to ‘plug a gap’, or is there a more wide-ranging, rights-based philosophy behind its use? Sometimes, the language used is telling. For example, Mackintosh and Frondigoun (2022) found that many housing associations viewed adaptations as only ‘…a minor operational issue’. 

Health and social care organisations in the UK have been slow to adapt to innovations, and tend to view technology as a way of ‘managing’ need – replicating the medical mode of care, rather than the social model of disability (Gilbert, 2022). There can also be poor cooperation between housing and social care services when it comes to adaptations (Zhou et al., 2019). This overlooks technology’s capacity to give people greater agency, choice and control. In addition, technology developers tend to prioritise the requirements of health and social care professionals over the direct experience of people with care and support needs (Gilbert, 2022). 

Assistive technology is not only about physical ability. Technology also has many social, ethical and psychological consequences, both positive and negative (Pols & Willems, 2011). For instance, new technology will need to be integrated into someone’s existing home and the person may not have the space for it, or like the way it looks (Pols & Willems, 2011) – potentially negatively impacting on how ‘home-like’ or personal their space feels to them. 

This means that understanding this impact, often through real-world experience rather than lab testing, is as important as whether an adaptation or piece of technology ‘works’ (Rolfe et al., 2021; Damant et al., 2017). For some people, equipment will include medical equipment; research suggests that while, for some, the presence of medical equipment was upsetting to their sense of self, as time went on – and particularly as control over the equipment increased – people could even feel a sense of pride over how the devices helped them control their own conditions independently of support (Thomson et al., 2013). 

The research is clear that collaboration and relationship-based work empowers people with care and support needs to feel confident in using tech (Rolfe et. al., 2021; Gilbert, 2022). This involves addressing concerns. Stigma and privacy are recurring themes in the research on assistive technology, particularly in the research focused on the experiences of older people (Damant et al., 2017; Rolfe et al., 2021), and fears such as these need to be addressed rather than ignored.  

Skilling up people to feel in control of the technology, including by making links with tech they already use, is very important (Woolham et. al., 2018; County Councils Network, 2021). This may get easier as tech progresses, and more people use smartphone-based systems to assist with their lives, from digital assistants like Alexa to mobile control of heating and lighting in the home. 

There is also a bigger picture. Access to housing adaptations and the use of technology can be very inequitable (see. Also, Poverty, wealth and housing status). 

What you can do 

If you are in direct practice: Take time exploring the options with people. Even if you are not responsible for installing adaptations or technology, your relationship-based work will help support people to feel in control of adaptions or tech. Consider:  

• Focusing on positive outcomes. Needs are important, but they should not be the sole focus of the discussions around adaptations and assistive technology. 
• Exploring someone’s existing use of technology and aids (for example, digital assistants such as Alexa, digital conferencing platforms like Zoom, hearing aids), and support making links between how these technologies improve the quality of life and how other technologies can also do this. 
• Letting people see and try out technology wherever possible – even showing a video can be helpful. If there are opportunities for linking people up with others who are already using the technology, this can be particularly valuable. 
• Recognising that people may have concerns, and that this is OK. Common worries include that it will replace face-to-face contact, that it will be complicated, that it is stigmatising, that it will compromise their privacy, and will be too expensive. Talk through any concerns openly and honestly. 
• Regularly reviewing adaptations and assistive technology, not only to check it is still working, but to inquire as to how it is impacting on someone’s quality of life, being mindful that people’s attitudes may well become more positive over time. 

(Adapted from Rolfe et al., 2021) 

It’s also really important to consider the potential mental health impacts new technology or equipment may have on somebody – both immediately and in the future. (Research in Practice has a number of resources to support working positively with people’s mental health challenges.) 

If you are in policy or senior management: Research suggests that, currently, decision-makers in local government tend not to take a personalised approach to technology and care (Gilbert, 2022). Ask yourself honestly, is this true of your organisation? 

Think of your options locally for people with care and support needs to co-produce the commissioning and governance of adaptations and assistive technology. Currently, how many people with care and support needs are involved in decision-making on an organisational level around this issue, and how can you increase this? How can you bring occupational therapists into senior decision-making around adaptations and technology? (Gilbert, 2022). Amplifying the voices of people with lived experience and occupational therapists will shift the conversation away from ‘managing need’ to ‘transforming lives’. 

It is also really important to keep up with the cutting edge of assistive technology. Don’t only think about now, but where the technology will be in a few years – does your organisation understand developments on the horizon, and think about futureproofing? (A very basic way to keep up is to read the blogs and news from AbilityNet, and sign up to their newsletter.)  

Further information 

Connect: AbilityNet has a network of volunteers who can offer free tech support to older people and disabled people. They also have a free helpline (0800 048 7642).