This report considers the likely impact of e-government on community care and housing-related support. It explores whether and how internet-based delivery of social healthcare related information and services presents any benefits to older people who use care support. The author reviews emerging patterns of internet access, attitudes, skill availability, and levels of e-literacy in the sheltered housing and community care sector. She considers the viewpoints of older people in sheltered homes, care support staff, and management.
The research highlights a number of issues, including: the gap between older people's current skill level and the level needed for internet access; perceptions of the internet as an entertainment medium; the online delivery of services as a substitute for human contact; and the perspectives of internet-literate senior staff and those of frontline staff. The study suggests that implementation of e-government in the field of community care will depend upon staff and customer learning, provision of appropriate services, hardware and software, and assistance by community care workers.
Government policy initiatives aim to encourage online delivery of government information and social services, and to promote take-up of Internet access by all UK residents. Online delivery of aspects of social care and health services will make it possible to access these services via the Internet. This small-scale study, by Maria Sourbati, explored how older people living in sheltered homes use the Internet, and how they and their carers feel about online service access.
- A minority of older tenants were interested in trying the Internet. Some were doing so with assistance from community support workers or family members. Others would like to join training courses and learn how to navigate the Internet.
- For many older tenants who were unfamiliar with computers, Internet access depended on assistance from experienced users.
- Most of the interested tenants considered Internet access as an entertainment/leisure activity.
- Some tenants were worried that, far from offering an extra option in accessing services, online service delivery would replace traditional forms of provision.
- Tenants were at best ambivalent towards the idea of online access to services. Most saw it as a substitute for physical activity and human contact, and a threat of further isolation. Some felt that services enabling the continuation of everyday routines (such as shopping for food) or providing support (for example, transferring prescriptions) could be useful to homebound people.
- Internet-literate staff saw online service delivery as a useful complement to established practices in care provision, but questioned its value for older tenants. Online access could improve the administration of social and healthcare services, enable more co-ordinated use of health and medical advice by care workers and, ultimately, economise on staff time. This could contribute to improving the quality of service delivered to tenants by making it possible to allocate 'saved' care hours to those needing extra care.
- The research identified skill and time shortages and cultural attitudes as major barriers to Internet usage by frontline care workers.
Government policy is aiming for universal Internet access through a range of platforms at home and in the community, and enabling online delivery of all information-based government and welfare services by 2005. Platforms include PCs, street kiosks and digital interactive TV.
This small-scale study sought to understand whether access to the Internet presents any benefits to older people living in sheltered homes. These citizens are traditionally heavy users of welfare provision such as social housing, health services and care support.
The study explored emerging usage of online interactive media (networked computers and the Internet) among older service users and care staff in sheltered accommodation. The research examined Internet access via shared computer facilities, whether tenants and staff use the Internet, what they use it for, and how well they manage their Internet usage. It also looked at underlying perceptions of, and attitudes towards, electronic service delivery.
Older people and the new media
It was evident from interviews with tenants that older people are becoming increasingly aware of Internet access points and training schemes in the community. Encouragement by family, social networks and care staff can generate interest among older people in trying the Internet.
Some of the tenants had tried the Internet, mainly through attending free introductory courses or during visits to relatives. The method of access and perceptions and attitudes towards the Internet varied considerably among the sample of tenants. In general terms, reduced social contact, lack of familiarity with computers and deteriorating health status indicated a low level of both interest in the Internet and of the ability to use it.
The research indicated three patterns of computer contact, and three corresponding types of Internet access:
(i) Assisted computer contact - by frail older people who had no keyboard skills. They had tried the Internet with assistance from staff or family.
(ii) Basic self-service computer contact - by younger, recently retired tenants who were able to sustain fully independent living. They had acquired basic keyboard skills, but had no experience in Internet access.
(iii) Competent self-service networked computer contact - by one user who had a home Internet connection. This was an exceptional case in the sample.
Tenants' perceptions and attitudes
As expected, tenants' perceptions of the Internet reflected their levels of familiarity with it. Tenants' attitudes drew on already acquired competences, daily routines, understanding of current needs, and their inclinations and abilities to acquire skills in the new media.
One accustomed user, who owned a networked computer, appreciated the Internet as a means for social communication and to obtain information quickly. To a lesser extent, this tenant also saw it as a convenient way to access information-based services. Occasional or aspiring users mostly saw the Internet as enhancing their leisure choices.
A minority of the very old and frail tenants who were receiving care support services had had an occasional try on a networked computer, assisted by relatives or care staff. At the time of the interviews, they were learning how to type a password to log on to the Internet and how to use the mouse. They saw the Internet as potentially useful, especially for pursuing hobbies and recreational activities, albeit irrelevant to their lives. They found the computer difficult to use.
"I'd rather use it as, interested in it as a gimmick ... It could be useful, but not for me at the moment ... I don't understand it and I'll - I'll back out of it."
"I find the letters are small. I need my reading glasses to read the screen."
"The only thing I find hard now which I've only ever used once is the what do you call it ... the mouse, you know, it was a bit, it kept going here, there and everywhere."
Some younger, recently retired tenants were quite enthusiastic about the prospect of joining the online community. To them, Internet access represented an opportunity to engage in constructive leisure, find companionship, communicate with other users, and stay in contact with modern society.
"I would love to be able to use the Internet. Because that's tomorrow, I mean if I had a few bob and I wanted to buy something I'd buy the Internet ... I'd use it as an entertainment, I could tap into information, companionship."
Online service delivery
Tenants were at best ambivalent towards the idea of online service delivery, which they tended to think of in terms of threats. Online advice, information and service requests were seen as alienating. These types of application were regarded as a substitute for physical activity and social contact, which would further isolate older people.
"Despite the fact that one knows it's a good idea and it's efficient and all that ... it's sort of cutting off something social that you go out."
Some were worried that in the near future online service delivery, including transactions, would replace traditional forms of service provision.
"I thought there may come a time in a few years when one will have to bank on the Net and it might become compulsory."
On the other hand, some tenants could see benefits in services that would prolong people's ability to carry out their everyday routines independently of care support. Tele-shopping for food, online transfer of prescriptions and remote access to healthcare advice were appreciated as useful - especially for homebound users, provided they were familiar with the Internet.
"Well for people who are handicapped ... it would be useful, yes."
"I think it would be an excellent service to be used. The only thing that I would say is that whilst myself and other elderly people can get out and actually go to get things, go to the pharmacist, make a visit to the doctor, they should be encouraged to do so."
"The new elderly if you like, the people that have had some even small amounts of knowledge of the Internet service are far more ready, able to use it ... But there is a certain age group that I think you'd probably never convince that it's a good idea."
Barriers to access
From the interview discussions with both staff and older people, the researcher identified the following barriers to Internet access:
- lack of equipment and software suitable for users with arthritis-related dexterity problems or declining movement and vision;
- lack of training tailored to the needs and abilities of particular users who are unfamiliar with computers;
- lack of technical support for new users who do not have the expertise to deal with even the most common software-related problems;
- system capacity problems and the need to update technology (seen as a barrier by those who owned computers);
- the price of access - currently a problem encountered by home users, but the price charged by Internet service providers will become a widespread issue once communal access points are taken up by more users;
- cultural-linguistic obstacles deriving from computer terminology;
- lack of assistance for users who are not able to develop competences in the new media.
Care professionals' views and attitudes
Online service delivery
As with the tenants, variations in care staff's perceptions reflected their levels of familiarity with computer and Internet technologies. Senior, office-based staff who used computers at work and a few of the Internet-literate care workers were more appreciative of the potential of Internet access in care settings.
Mixed attitudes towards online service delivery were also evident among the sample of care staff. Some questioned the rationale behind integrating Internet access into care provision. However, staff who were accustomed Internet users appreciated that the take-up of online services by frontline workers would enable more co-ordinated use of health and medical advice and faster access to social care services.
"Internet access is really useful, but it's not a priority by itself. As a whole we lack resources to improve people's quality of life ... We need more support care hours allocated to very frail older people to do more than the basic personal care and providing a meal."
Remote access to aspects of home help (online shopping for food, for example) and health support (such as online ordering of repeat prescriptions) could economise on staff time and reduce the rate of errors in service administration. This would improve efficiency and effectiveness in service delivery.
"That would save a lot of time and effort. If we could get prescriptions on the Internet, it would be fantastic. We could organise ourselves so much better."
Time-saving gains could contribute to improvements in the quality of service delivered to customers, if the care hours released (currently in short supply) were allocated back to frail tenants: "It would save time to do other things".
Access by tenants
Respondents in the staff sample all shared considerable reservations about the Internet's potential for empowering frail older users who are unfamiliar with new technologies. Care managers and senior officers anticipated enhanced customer choice in entertainment, communications and care-related services as a possible long-term outcome.
Frontline staff felt that self-service Internet access through mass-market devices such as standard computers was unlikely to be an option for the majority of older people currently in sheltered accommodation. But care workers who had been helping tenants to access the Internet felt that guided access could be a stimulating recreational activity in itself.
"Tenants are so happy if they can just manage to turn a computer on and type in the password ... Finding out the information is a complete second to that."
Barriers to Internet usage in care settings
The evidence from this study is that the realisation of any benefits from Internet access in care settings is at least partly conditional on frontline care staff using online resources. However, such usage is presently inhibited by:
- skill shortages - most community support officers lack basic Internet skills;
- time shortages, which impede the acquisition of online competences through routine practice at work or via specialist training. Time taken for training is time allocated for providing professional care support to older customers;
- the unavailability of relevant training;
- lack of awareness of the relevance of online information services to the provision of care support. A work culture of using online facilities does not currently exist in the care sector.
The research indicated that tenants who were interested in Internet access faced many obstacles. Of these barriers, only technological problems of usability were connected with physiological changes related to the ageing process (such as declining vision and slowing movement).
Barriers arising from lack of skills in the new media, lack of awareness of the relevance of Internet access to the lives of users, and a failure to link the new media to everyday routines were common to both tenants and care staff.
The above suggests a problem in how to define users in this group. It is impossible to profile the diversity of tenants' circumstances and, more generally, the range of needs, aspirations, degrees of fitness or levels of income in the cohort of 'older people' (commonly defined as those over 60) without building complex socio-demographic definitions.
But bearing this in mind, all respondents were ambivalent towards the idea of online access to services. Tenants and staff recognised that remote access to health and care services could be useful to homebound users. However, they felt strongly that online access cannot substitute for human contact in care provision.
About the project
Researcher Maria Sourbati undertook this work whilst at Goldsmith's College. She conducted one focus group and one-to-one semi-structured qualitative interview discussions with 18 older tenants and six members of staff in two sheltered accommodation schemes in North London. The fieldwork was conducted in autumn 2002.
Both schemes had resident wardens and communal dining and media facilities such as television and telephones. One of the schemes employed care staff on a 24-hour basis and made available to its customers a communal Internet facility and free Internet lessons.