Drivers & Barriers
For social alarms, key drivers have been the inclusion of social alarms as an explicit element of social care policy, and their public provision and financing. More generally, demographic change is affecting the country along with many other EU Member States, and this, in combination with changes in family size and structure, is leading to increased demand for services and supports to provide care that once would have been provided by family carers. This situation is compounded by increasing numbers of women joining the labour force. Another driver is the policy focus on reducing unnecessary admission to long-stay care. Finally, migration of the population from urban to rural areas has also driven demand.
Geographical barriers play a significant role in Spain. In some cases, geographical barriers are linked to technological barriers and, although it is relatively uncommon, there are some municipalities in mountainous areas that cannot yet access tele-alarm or tele-assistance services. In smaller, more isolated communities, awareness of tele-alarm services is low, and this is compounded by wariness of technology, per se. The traditional family structure, now rare in urban centres, is still in existence in rural areas. This means that the infrastructure of informal caring is still intact, reducing demand for assistive services. Finally, one of the main obstacles to the development of services is the IP telephone whose new landline providers offer cheaper services than the traditional phone.
As regards telecare, there seems to have been only very low levels of provision/take-up of more advanced telecare to date, so no strong drivers as such seem yet to have been operating. More generally, it is suggested that the future development of tele-assistance in Spain is closely linked to the launch of the digital household. In this regard two main factors have been identified as affecting the take up of these technologies: factors linked to the market and factors linked to technological development.
Factors linked to the market are mainly related to aspects of cost, quality, security requirements, public policy, expectations and acceptability. Although the market penetration of tele-assistance in Spain has not yet reached significant levels, public policy and use expectations are seen as very relevant for market development. They can be listed in order of importance as follows:
- Increase in demand for home security and social care
- Increasing focus in public policy on home care, cost reduction and service quality improvement
- Increasing awareness of consumers and providers regarding the right to accessible tele-assistance services through the use of public financing and/or out-sourcing of private providers
- Conclusive clinical and social studies regarding the advantages of tele-assistance for citizens and professionals
- Motivation and training of the professionals and institutions responsible for the care of citizens at home.
- Technological factors include those linked to cost and access to technology (devices, networks and applications) and those linked to inter-operability. These include:
- Reducing the cost of tele-assistance devices, services and applications
- Increase in user friendliness and accessibility of tele-assistance equipment and services, particularly for older people
- Convergence between tele-assistance terminals and networks and the information and communication technologies (land-line telephones, mobile devices, TV and Internet in particular)
- Advances regarding the interoperability, standardisation and maintenance of equipment.
The main reported barriers are:
- The resistance of large organisations to change work practices to incorporate new routines and management models
- The capacity to personalise, maintain and update the systems based on the different and changing needs.
- From an economic perspective, the issue is more to do with the organisation of business models than with the actual cost. It is difficult to ascertain who pays and the payment mechanism, while determining the cost is relatively straightforward.
- Social and professional acceptance is a barrier in the sense that some groups may see these services as a step backwards rather than an opportunity for social inclusion.
There has been only very limited implementation and take-up of home telehealth to date in Spain. Support for hospital-in-the-home has been one key objective in the initiatives taken to date. In the main, the efforts to date have been driven by local initiatives by hospitals and others.
The lack of policy focus and lack of financing have been reported to be barriers. More generally, the absence of a clear â€˜business caseâ€™ seems to be a factor limiting implementation to date.