Mapping of Effective Technology-based Services for Independent Living for Older People at Home Deliverable 1 Author: Dr. Stephanie Carretero V e r s i o n M ay 2 01 4 Report EUR xxxxx EN 1 Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. European Commission Joint Research Centre Institute for Prospective Technological Studies Contact information Address: Edificio Expo. c/ Inca Garcilaso, 3. E-41092 Seville (Spain) E-mail: Acknowledgements This deliverable was funded by Directorate D- Unit 3 on Social Protection and Activation Systems of the Directorate General for Employment, Social Affairs and Inclusion as part of the project entitled “Long-Term Care Strategies for Independent Living of Older People (ICT-AGE)”. I would like to give special thanks to Arnaud Senn, policy officer of ICT-AGE at DG EMPL, for his useful comments and advices for the good development of this ongoing project. I also appreciate the inputs and support of the Working Group on Ageing of the Social Protection Committee in the definition of the mapping of good practices, as well as those from the experts of 1 the Stakeholders Consultation Workshop of the project . I also thank Clara Centeno, leader of the ICT for Employability and Inclusion team of the Information Society Unit of the JRC-IPTS of the European Commission, for her thoughtful revisions of the report, her inputs to match the findings to policy, and her support to deliver quality outputs. 1 A list of experts of the Stakeholders Consultation Workshop is available at the following web page: http://is.jrc.ec.europa.eu/pages/EAP/eInclusion/carers_ICTAGE.html 1 Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. Preface This report identifies and maps good practices in technology-based services which aim to enhance the independent living of older adults at home. This is the first deliverable of the research project "Long-term care strategies for independent living of older people (ICT-AGE)". The Directorate General of Employment, Social Affairs and Inclusion (DG EMPL) commissioned the Joint Research 2 Centre (JRC) to do this study through an Administrative Arrangement (AA). The work is being carried out by the team of ICT for Employability and Inclusion of the Information Society Unit at the 3 Institute for Prospective Technological Studies (IPTS). The project started in May 2013 and will last 19 months. ICT-AGE aims to help DG EMPL to support the Member States (MS) in the development of long- term care strategies promoting independent living of older adults at home through technology- based services. These solutions refer to any kind of technology including Information and Communication Technologies (ICT) that empower older adults to manage despite frailties, and that also improve the organisation of care provision or increase the productivity and quality of long-term care delivery. The project is one of the actions of the Social Investment Package (SIP) of the European Commission (2013a,b), which aims to help the Member States to implement the Country- specific Recommendations of the European Semester for more effective long-term care policies. The research will produce guidelines for the Member States on how to implement technology-based services for independent living, by:  Identifying and mapping good practices in technology-based services for independent living at home for older adults with different needs. These good practices have been successfully implemented in Europe, United States and Japan.  Analyzing a selected number of good practices case by case, focusing on their business case, business model, technology and organizational change, technical standards, quality, scale and scale-up, and the role the individual Member States and the EU could play as regards leadership and transfer.  Elaborating manuals on long-term care strategies to help policy makers design policies which increase the independent living of older adults through the use of technology.  Identifying how the European Union could help the Member States to implement these technology-based services. This deliverable covers the first objective of the ICT-AGE project. We found 14 different, mature and mainstreamed technology-based services for the independent living of older adults at home that effectively address a set of long-term care needs. This is the first study that has managed to obtain a representative number of good practices in technology-based services which have increased the independence of older people living at home, improved the productivity of carers, enabled better quality of care, and generated savings for the care system. More information on the project can be found at: http://is.jrc.ec.europa.eu/pages/EAP/eInclusion/carers_ICTAGE.html This report may be referenced as follows: Carretero, S. (2014). Mapping of effective technology- based services for independent living for older people at home. Sevilla: Joint Research Centre, Institute for Prospective Technological Studies, JRC Scientific and Technical Reports Series. 2 JRC Nº 33156-2013-05 EMPL D.3. 3 IPTS is one of 7 research institutes that form the European Commission's Joint Research Centre. 3 'KNMPR?LRKCQQ?ECRFGQPCNMPRGQQRGJJGL Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. Table of Contents Acknowledgements ............................................................................................................................................................................... 1 Preface ......................................................................................................................................................................................................... 3 Executive Summary .............................................................................................................................................................................. 7 1. INTRODUCTION .......................................................................................................................................................................... 11 2. RESEARCH AND POLICY FRAMEWORK .......................................................................................................................... 13 2.1 The increase of older adults in need of long-term care in Europe ................................................... 13 2.2 Independent living services ..................................................................................................................................... 18 2.3 European Commission policies for technologies for independent living ....................................... 22 3. METHODOLOGY ......................................................................................................................................................................... 25 3.1 Criteria and steps to select and map the good practices ....................................................................... 25 3.2 Information analysed and instrument to collect it ..................................................................................... 28 3.3 Procedure for data collection ................................................................................................................................. 30 3.4 Data analysis ................................................................................................................................................................... 30 4. RESULTS ........................................................................................................................................................................................ 32 4.1 Overview of the good practices identified ...................................................................................................... 34 4.2 Evidence of the effectiveness of the good practices ................................................................................ 42 5. CONCLUSIONS ............................................................................................................................................................................ 49 6. ADVANTADGES AND LIMITATIONS OF THE STUDY ..................................................................................................... 52 REFERENCES .......................................................................................................................................................................................... 54 ANNEX I: LIST OF ARTICLES ........................................................................................................................................................... 61 ANNEX II: TEMPLATE FOR THE COLLECTION OF DATA ................................................................................................... 77 ANNEX III: Individual Analysis of the 14 Good Practices organized per type of Technology-based .... 79 Assistive Technologies ................................................................................................................................................................ 79 INTELLIGENT SYSTEM FOR INDEPENDENT LIVING AND SELF-CARE OF OLDER PEOPLE WITH COGNITIVE PROBLEMS OR MILD DEMENTIA (ISISEMD)................................................................................................................................................................................. 79 HOME AUTOMATION AND ADVANCED TELECARE (ESOPPE PROJECT) ............................................................................................... 87 PARTNER PERSONAL ROBOT (PAPERO) ............................................................................................................................................................... 93 ROBOT SUIT HAL-5 (HYBRID ASSISTIVE LIMB) ................................................................................................................................................ 96 ROBOTIC STRIDE ASSISTANCE SYSTEM (SAS) .............................................................................................................................................. 101 SMART HOME ........................................................................................................................................................................... 104 X10 ACTIVEHOME KIT ................................................................................................................................................................................................ 104 TECHNOLOGY-BASED HEALTH CARE .......................................................................................................................... 108 TAIWAN’S TELEHEALTH PILOT PROJECT (TTPP) ........................................................................................................................................... 108 KAISER PERMANENTE TELE-HOME HEALTH RESEARCH PROJECT ...................................................................................................... 114 TELEHEALTH (WHOLE SYSTEM DEMONSTRATOR PROJECT) ................................................................................................................. 118 CARELINE NATIONAL TELECARE DEVELOPMENT PROGRAMME ................................................................................................................................. 139 TECHNOLOGY-BASED WELLNESS SERVICES.......................................................................................................... 146 BRAIN AGE ........................................................................................................................................................................................................................ 146 6 Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. Executive Summary In the coming years, Member States will find it challenging to deliver quality of life to the growing number of older adults with functional limitations, while being, at the same time, more efficient with the economic and human resources they allocate to their care systems. For example, according 4 to a constant disability scenario , it is expected that around 39 million older people in the EU27 will be in need of some form of long-term care in 2060, compared with 20.7 million in 2007 (Przywara et al., 2010). Public expenditure on long-term care in the EU27 could therefore almost double over the period 2010–60, - a possible increase of +1.7 p.p. of GDP (ECFIN, 2012). This situation will not be improved by the difficult working conditions experienced by formal carers or the finite availability of informal carers. In 2013, the Commission published the Social Investment Package for Growth and Jobs – SIP – (European Commission, 2013a,b) urging the Member States to develop policies to achieve the following four objectives:  to increase the functional capacity and independent living of older adults,  to improve the productivity of care  to improve the quality of long-term care delivery,  to maintain the financial sustainability of care delivery as has also been recommended by the 2013 European Semester (European Commission, 2013c). The use of technologies has been identified as the key to addressing these objectives. The JRC-IPTS was commissioned by DG EMPL to carry out the project "Long-term care strategies for independent living of older people (ICT-AGE)" as an action of the Social Investment Package for Growth and Jobs (SIP) of the European Commission (2013a,b). This targets the development of science-based policies to close the gap between growth in long-term care needs and stagnant and shrinking resources through the use of technologies. The findings of ICT-AGE will also help the Member States to implement the country-specific recommendations of the European Semester for more effective long–term care policies. Concretely, the project ICT-AGE aims to help DG EMPL to support the Member States in elaborating strategies to deliver long-term care for the independent living of older people at home based on the use of technologies. One of the project's first tasks was to identify and map good practices in technology-based services that enhance the independent living of older adults at home. This report presents the findings of this mapping exercise. The identification and mapping of good practices was carried out through a systematic literature review, followed by an analysis of the outputs obtained. We limited the selection of good practices according to certain criteria: i.e. we specified key words related to the definition and typology of technology-based services, we looked for practices that have reported their effectiveness in scientific articles, and that have been implemented at public or private level. The good practices selected were analysed using a template we designed to collect information on their scope, aim, services delivered, and effectiveness. This information was collected using articles from the literature review and any other documents available on internet obtained by desk research. The information was processed and analysed according to the template. We also carried out a cross- 4 In the "constant disability scenario" the total number of years spent with disability during a person’s life time is assumed to remain the same while life expectancy increases. Thus, if between time t and t+1, total life expectancy increases by n years for a cohort of age a, "disability-free" life expectancy for that very same age cohort must also increase by n years in order for the dynamic equilibrium hypothesis to be valid. If "disability free" life expectancy increases by n years, then the disability prevalence of this cohort of age a at time t+1 will be the same as the disability prevalence of cohort of age a-n at time t (European Commission and the Economic Policy Committee, 2011). 7 Important message: this report is still in elaboration. Any mention to this report should be referred as a draft version. analysis in order to find trends and to understand the development and evaluation of the good practices. The literature review revealed a total of 14 good practices in technology-based services for the independent living of the older adults at home. These services have been effective regarding the European policy objectives and are being delivered by private or public organisations to cover the needs of older people at home and their carers. The analysis of these 14 good practices showed us that they represent almost all the types of technology-based services for independent living available as good practices in the literature. These services cover a wide set of long-term care needs of older adults, mostly chronic conditions. Half of these good practices have been implemented in the Member States, and the other half outside the EU (the USA, Japan and Taiwan). It seems that the good practices selected are being mostly delivered in the long–term care system where the provision of long-term care is oriented towards informal care with private financing. Most of the good practices are currently in operation and have been running for many years. The newest good practice has provided services to older adults for 4 years and the oldest for 35 years. Cost information varies for each practice, though usually the service is provided by the implementing organisation in exchange for a fee paid by the end-user. These technology-based services for independent living have been widely implemented on more than one site and in many cases to thousands of users. They generally focus either on providing services that control the environment of the users in order to avoid emergencies, or help the users to follow health prescriptions and carry out the activities of their daily lives. Others focus on monitoring the health of older people at home, avoiding as far as possible their admission to care centre or hospital. Other services include the maintenance of their social lives, and supporting ways of communication from home. A wide range of devices are being used to provide these services: internet/website, cameras, video, sensors, alarms, alerts, screens, computers, GPS, robots, software, remote controls, home automation, microphone, peripheral devices for health monitoring, games and consoles. When we analysed the studies on effectiveness carried out by the good practices, we saw that these have been mainly motivated by the organisations that developed or implemented the service. The methodologies used to study the effectiveness of these 14 good practices are diverse, although we can identify a common tendency to select quite a high number of patients (more than 1,000 individuals) and to apply experimental or observational research designs. As regards the variables evaluated, it has been much more difficult to find a common pattern, as each good practice used different indicators. Regarding the findings of the research on effectiveness of the 14 technology-based services for independent living, 10 of them claimed to improve the independent living of older people at home, 6 claimed to increase the productivity of the carers, 3 the quality of care, and 10 generated savings for the care system. Only one showed benefits for all four policy objectives. To conclude, it is relevant to say that this is the first study that has managed to document a representative number of good practices which have been scientifically demonstrated to deliver an increase in independence for older people living at home, an improvement in the productivity of carers, better quality of care, and the generation of savings for the care system. These technology-based services cover a wide range of different, mature and mainstreamed technology-based services and products that are able to address effectively a set of long-term care needs. 8 JnNpsRboR nCQQbEC RiGQ sCNpsR GQ QRGJJ Go CJbcpsbRGpo oW nCoRGpo Rp RiGQ sCNpsR QipvJe cC sCgCssCe bQ b esbgR TCsQGpo