New technologies and care
In coming years, the number of people needing long-term care will increase, given the ageing population and increasing life expectancy across the EU (EIGE, 2020e; Iancu and Iancu, 2017; Stavrotheodoros et al., 2018). In order to contain costs and allow the long-term care system to sustain the pressure of growing patient numbers, countries are promoting independent living in any care setting (residential, home or community-based).
Policy solutions are being developed, together with technological options (Grabowski, 2006). The COVID-19 pandemic has emphasised the key role of the care sector in the good functioning of welfare states, and how a shortage of healthcare and long-term care professionals, as well as insufficient stocks of medical equipment, puts the safety of entire countries at risk. Technology-based solutions were at the forefront of public health strategies to contain the pandemic.
Assistive technology can improve long-term care
Assistive technology (AsT) has been defined as ‘any item, piece of equipment or product system, whether acquired commercially off the shelf, modified, or customised, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities’ (Gamberini et al., 2006, p. 288).
The application of AsT solutions to the specific needs of an ageing population is called ‘gerontechnology’, in addition to which there are a wide range of general technologies that can be converted for use by elderly people, for example Alexa and Siri (Piau et al., 2014; Woyke, 2017).
These solutions are designed or can be used to play a growing role in the provision of residential and formal home-based care while maintaining high quality standards (Koop et al., 2008; Micera et al., 2008).
In practical terms, AsT allows improved service provision by identifying individuals at risk (e.g. of falling or isolation), monitoring health conditions through sensors, monitoring daily life activities (e.g. social and physical activities), helping to manage daily tasks and developing a safer environment (Iancu and Iancu, 2017; Medrano-Gil et al., 2018).
The greatest advantage of these devices is their ability to collect large amounts of data from the environment, thus interacting with patients in a smart way, providing personalised interventions and improving service efficiency (Medrano-Gil et al., 2018). AsT’s benefits thus go beyond the medical sphere, increasing people’s independence, facilitating social interaction and access to information, and reducing loneliness and isolation (Iancu and Iancu, 2017).
Women are the primary beneficiaries of these technological innovations, as they are significantly more likely to be in need of long-term care. In fact, despite their longer life expectancy, they spend fewer years living in good health than men, and are more likely to develop health problems and live with disabilities (EIGE, 2020b).
Longer life expectancy, combined with the fact that women tend to marry older men, means that they often outlive their partners and, unlike men, are unable to count on their spouse’s assistance in later life (Bisdee et al., 2013; Markson and Hollis-Sawyer, 2000). AsT is therefore an incredibly valuable resource for providing long-term care to older women living alone, as it allows medical professionals to improve standards of home-based care without relying on formal care institutions.
Technology can alleviate women’s caregiver burden
Technology presents many advantages for the well-being of care recipients, but even more for caregivers. Caring (paid or unpaid) for an old person takes a considerable toll on the caregiver’s welfare, at physical, psychological and emotional levels. The phenomenon is known as the ‘caregiver burden’ and it encompasses a wide range of symptoms, including physical and mental health problems, financial problems, social isolation, depression, anxiety, fear, task difficulty, stress and burnout (Lopez-Hartmann et al., 2012; Madara Marasinghe, 2016).
Poor caregiver well-being has direct consequences for the careseeker as well, who ends up not receiving the appropriate assistance (Madara Marasinghe, 2016). Several studies have confirmed that the use of ICT-based solutions can significantly alleviate caregiver burden by taking on some care tasks (Lopez-Hartmann et al., 2012; Madara Marasinghe, 2016). For example, digital solutions are a substantial support to people with Alzheimer’s disease, helping caregivers to better understand the disease process and to manage critical situations more effectively (Martínez-Alcalá et al., 2016).
Such technologies can also help caregivers to monitor the status of frail old people. Starting with the data they collect, these devices can conduct physical activity tracking, fall risk assessment, isolation risk assessment, behavioural analysis (to assess cognitive decline), outdoor tracking (using walking patterns to detect erratic navigation as an indication that the user is lost) (Medrano-Gil et al., 2018). Having access to this kind of information can significantly support caregivers in their daily activities and alleviate the burden imposed by such care.
This positive effect is highly relevant to gender equality, as women are the majority of caregivers, across all care settings (ILO, 2018b). It is estimated that, in the EU, only 17 % of social workers who provide home-based professional care to people with disabilities and to older people are men (EIGE, 2020e).
The caregiver burden is especially heavy for those who are not professionals: the mothers, daughters, wives and sisters who are required to interrupt or give up entirely their professional career to reinvent themselves as unpaid caregivers when a member of the family needs assistance (Martínez-Alcalá et al., 2016). Forthcoming EIGE research highlights that the gender care gap is the ‘missing link’ in analysis of the gender pay gap and gender inequalities in the labour market generally (e.g. in relation to labour market participation and quality of employment).
Technology could help to decrease the disproportionate amount of care work for which women are responsible and thereby reduce gender inequalities in the economy overall.
Technology and the healthcare sector during COVID-19
During the COVID-19 pandemic, technology was effectively deployed to track and trace the spread of the virus among the population in order to plan the most suitable medical response. In France, for example, some online platforms were developed for remote monitoring of infected patients isolated at home (e.g. Covidom and COVID AP-HM).
These services were designed by local health precincts to aggregate and analyse data submitted twice a day by patients, and they helped in providing adequate interventions tailored to the needs of the community (Mouterde, 2020). Data collection through devices such as smart thermometers proved to be one of the greatest advantages of technology, as the optimal allocation of scarce resources was a key determinant of success in containing the emergency (Statucki, 2020).
Another crucial application of digital technology was the possibility to monitor and treat patients with mild symptoms remotely, without exposing healthcare professionals directly to the risk of contagion. One of the biggest challenges of COVID-19 was the high infection rate among doctors and nurses, causing a medical staff shortage in several countries (Nugent, 2020). Given the disease’s highly contagious nature, some healthcare facilities placed sensors under patients’ pillows to monitor their status, reducing human contact to a minimum.
COVID-19 played a crucial role in shedding light on the dire working conditions faced by healthcare workers across the EU, most of whom (76 %) are women. They bear heavy workloads, work long shifts (including nights and weekends) and undertake physically demanding tasks, for very low wages. The low economic value assigned to care is a result of cultural norms (care is stereotypically considered women’s natural role within the household, not valued as ‘work’), as well as cutbacks in public spending, which translate into low wages across the whole care industry (ILO, 2018b).
In addition, during the pandemic healthcare workers were disproportionately exposed to the risk of infection and were asked to reduce their time off in order that hospitals might cope with the increased workload. Here, technological solutions were essential in helping them to face these challenging circumstances and secure safe working arrangements insofar as possible
 The topic will be further explored in a forthcoming publication by EIGE. See https://eige.europa.eu/about/projects/gender-inequalities-unpaid-care-work-and-labour-market-eu