​​Barbara Barbosa Neves, Alan Petersen, Mor Vered, Adrian Carter, and Maho Omori

​​Monash University​

​​‘The aged care system is well behind other sectors in the use and application of technology’ noted the Royal Commission into Aged Care Quality and Safety in 2021. [1 p77] Yet, the Commission also warned that new technological systems and initiatives must ‘identify older people’s needs and preferences.’ [1 p147] 
 
Since the onset of the COVID-19 pandemic, we have seen a renewed drive to introduce emerging technologies, such as Artificial Intelligence (AI), into residential aged care. [2] This drive is fuelled by the promise that AI can help solve the systemic issues affecting the sector, being the ‘future of elder care’. [3] For example, robots and smart voice assistants can help stave off loneliness and social isolation; smart medical systems can improve clinical diagnoses; smart sensors can predict falls and health decline. And while AI can assist with some of these matters, we must examine its limitations and potential harms.   
 
Our new study, published in the Journal of Applied Gerontology, [4] aimed to understand how AI for aged care is imagined, designed, and implemented. For this, we conducted interviews with a range of stakeholders: AI developers, aged care staff, and aged care advocates in Australia. We explored their views about AI for later life, whether as developers of technologies for the sector or as those who have the power to implement or support their use in aged care settings.  
 
We found that, despite good intentions, developers made many promises about what AI could fix in aged care, from loneliness to staff shortages. But these promises were often made without considering the complexity of such environments and its residents. For instance, developers described stereotypical ideas about older residents. They were seen as a homogenous group and as technologically incompetent or disinterested. These ageist ideas illustrate how easily age-related bias can make its way into how we create AI technologies. But aged care staff and advocates held similar views about the technological incapacity or interest of older people. AI can be ageist by design but also by implementation.  
  
Our study shows that, alongside other prejudices pervading AI technologies like gender and racial biases, age is a serious but overlooked factor in research and policy. Understanding how ageism is embedded in both AI systems and in aged care settings is essential to combat it. This requires more institutional and public efforts to challenge simplistic narratives about older people. These narratives can lead to the development and application of technologies that exacerbate existing stereotypes and inequities, as they neglect the diversity of later life and the various needs and aspirations of older people. Indeed, their autonomy and dignity were rarely discussed across the stakeholders in our research. This was clear even when we were talking about AI for surveilling their everyday movements. Older residents were sometimes reduced to sick bodies to be constantly monitored.  
 
As stressed by the Royal Commission, ‘Ageism is a systemic problem in the Australian community that must be addressed’. [1 p75] We cannot forget to address it at all levels, including in relation to how we develop and use technologies for care. 

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Kate Dobie

​​Head of Health and Wellness, ACH Group

When we can all see where our Uber is and more often than not get our problems solved by a chatbot, many people ask, ‘why is aged care not there yet?’ This blog was requested and is intended to provide insight to those not within the industry of the key challenges we face and explain why adding on new technology or testing a new product isn’t as quick or as easy as you might think. 

While there are many aged care providers who have aspects of great tech incorporated into service delivery, many of them are relatively new to the sector and do not have the plethora of non-integrated legacy systems many providers started with and added to over the years to keep up with demand. I know there will be established providers out there who can prove me wrong, but these are the few and the rest of the field are open to opportunity. However, there a few things you might consider before you knock on the door. 

Funding will be the number one constraint to introducing new tech for most aged care providers. ‘Not for profits’ are just that, supporting growth and investing with margins made. ‘For profits’ also have growth strategies and shareholders to maintain. Predominantly government funded, most aged care services do not make large margins (66% of aged care homes operated at a loss for the period July to September 2022 [1]) and large IT infrastructure, whilst required for customer service, does not always add to the bottom line. It’s also not just the cost of the product; impact on service delivery, time and resources to test, train and incorporate the change are key considerations. Ease of implementation and tangible return on investment will be key initial questions.  

Change management is a commonly used phrase and an even more commonly experienced process in aged care. With some of the largest reforms in history occurring in the last few and next few years, maintaining quality services and regulatory compliance are top of every provider’s ‘to-do list’. When faced with introducing new tech or changing to meet funding requirements, the latter will be prioritised. A win/win would be tech that would support the changes, but this requires deep understanding and knowledge of the sector, knowing what is changing, when and the impact. Many providers are keen to partner, but the time and effort bringing the offer or concept up to meet the need can be resource intense and not the major focus for the provider. Vendors that can provide real-life examples of how the tech can meet their needs and will support or flex with changes will have a much greater chance of success.   

The most significant consideration is the consumer. We know demand and behaviour will drive change; however, the current reality is most of the current government-funded aged care customers do not engage with technology as regularly as many developers (and providers) would wish. Indeed, some still pay for services in cash as they do not wish to hold credit or debit cards. Providers can support people to access and learn how to use tech, but the customer needs a compelling reason or desire to engage. Anything new will need robust, comprehensive, and responsive support from a partner, to ensure customers are supported and staff feel confident in recommending something new.    

Providers all know the next generation of customers is on the horizon and these customers will expect ‘Uber’ level tech in all aspects of service delivery. Those providers who can are currently investing in transformational tech projects to support the business of the future. While these customers are on the horizon, there are many competing priorities in the current line of sight, but real solutions to real problems that can provide a quick win or clear return on investment will always be welcome.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

​​Dr Kate Barnett OAM​

​​Standout Ageing (SAGE)​ 

​​When we think of reform in the Australian aged care system, we think of the many formal inquiries, reviews and most recently, the Royal Commission into Aged Care Quality and Safety. This is the formal face of reform, originating within the aged care system, and with multiple stakeholders (in particular, governments, consumers, carers, service providers and peak bodies) as its audience. 

​Rarely is technology seen as a part of this ongoing reform process, probably because it has not been central to the traditional design and delivery of care. It is also likely to reflect a lack of research evidence about Return on Investment in technology in aged care. Analysis of the major reviews of the past decade or so finds them lacking a technology lens. The first Technology roadmap for aged care [1] was designed to complement the 2016 Aged Care Sector Committee’s Aged care roadmap [2], which had not identified a role for technology. The Royal Commission into Aged Care Quality and Safety, however, did make a number of recommendations regarding technology-enhanced care. [3] 

​However, in recent years, the boundaries between the care and technology sectors have been softening. [1] The COVID-19 pandemic played a part in pushing health and aged care providers to make use of technology supporting virtual care, as have the many partnerships between ‘Big Tech’ (e.g., Apple, Google) and health and aged care organisations. In addition, there is now significant cross-over between the aged care sector and technology designed to make lifestyles easier (especially Smart Homes and voice-activated technologies). There is also cross-over with technology that is health-promoting and places the consumer as a collaborator with care providers in managing their health (e.g., Smart Watches, Fitbits, and a plethora of health-supporting Apps). Voice Activation technology overcomes the need for digital literacy and for manual dexterity – a significant advantage for many very old people – and can be integrated into home care delivery to support independent living, as has been ably demonstrated by Feros Care. [4]  

​Smartphone ownership now involves more than 90% of Australians, with older people continuously increasing their engagement with this technology. Importantly, Smartphone technologies include sensors (accelerometer, gyroscope, GPS) that can generate data obtained in ‘real time’, and if linked to appropriately designed Apps, can provide feedback to the individual about their health-related status, and be utilised by care providers. [5, 6]  

​Consumer expectations are changing with increased demands for immediacy and for personalisation of services (e.g., Uber). Portals are becoming increasingly widespread, drawing on software and online platforms that can connect an individual to a specific service, and are now part of the aged care ecosystem. A well-known example is Mable which enables a potential consumer to search for an independent support provider and connect directly with them, negotiating how their service will be delivered and tailored to individual need. 

​It is important to recognise that many technologies are invented without the purpose of providing care or support to older people, but have that outcome and are, therefore, highly relevant to the aged care sector, especially the home care system. They also normalise health promotion and support technologies, avoiding the stigma associated with many Assistive Technologies. These technologies are slowly and surely disrupting the care system as we know it, particularly the home care service sector, and should be recognised as part of the reform process.​

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.