Active subjects of passive monitoring: responses to a passive monitoring system in low-income independent living

Abstract

Passive monitoring technology is beginning to be reimbursed by third-party payers in the United States of America. Given the low voluntary uptake of these technologies on the market, it is important to understand the concerns and perspectives of users, former users and non-users. In this paper, the range of ways older adults relate to passive monitoring in low-income independentliving residences is presented. This includes experiences of adoption, non-adoption, discontinuation and creative 'misuse'. The analysis of interviews reveals three key insights. First, assumptions built into the technology about how older adults live present a problem for many users who experience unwanted disruptions and threats to their behavioural autonomy. Second, resident response is varied and challenges the dominant image of residents as passive subjects of a passive monitoring system. Third, the priorities of older adults (e.g. safety, autonomy, privacy, control, contact) are more diverse and multi-faceted than those of the housing organisation staff and family members (e.g. safety, efficiency) who drive the passive monitoring intervention. The tension between needs, desires and the daily lives of older adults and the technological solutions offered to them is made visible by their active responses, including resistance to them. This exposes the active and meaningful qualities of older adults' decisions and practices.

‘That's for old so and so's!’: does identity influence older adults’ technology adoption decisions?

“…For many older adults, the desire to remain independent stemmed from their wish to not be perceived as a burden to family, friends or society more generally. As such, technologies that enabled or prolonged independent performance in meaningful activities were met with great enthusiasm (Brownsell et al , 2000; Johnson et al , 2007; Horton, 2008; Hernández-Encuentra et al , 2009; Steggell et al , 2010; Van Hoof et al , 2011; Bowes and McColgan, 2013; Gramstad et al , 2014; Claes et al , 2015; Hill et al , 2015; Pino et al , 2015; McGrath and Astell, 2016; Berridge, 2017). For example: Now what could you ask for more than that and you're independent.…”

“…(Demiris et al ., 2008: 122)Other participants were reluctant to adopt monitoring/surveillance technologies ( e.g. fall detectors) due to privacy-related fears, such as someone ‘always watching’ or ‘spying’ on them (Brownsell et al , 2000; Courtney et al , 2007; Londei et al , 2009; Van Hoof et al , 2011; Berridge, 2017). For example, a participant in Van Hoof et al (2011) promptly removed the newly installed surveillance devices from her apartment because she felt watched, which threatened her feelings of personal privacy (Van Hoof et al , 2011: 320).…”

Building trust in persuasive gerontechnology: User-centric and institution-centric approaches

“…(5) PGTs, as novel technologies might also give rise to various kinds of anxieties, concerns, and feelings of uneasiness in older individuals, especially with regard to being observed or manipulated by technology. Older users of PGTs can, for instance, become concerned about the impact on their self-determination, their privacy, as well as the safety and security of their data and personal information (Sorell 2011;Sorell & Draper 2012;Berridge 2016Berridge , 2017. In this respect, many such anxieties and concerns could be remedied through activities aimed at building and maintaining trusting relations and attitudes toward relevant persuasive technologies.…”

Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis (Preprint)

“…Potential benefits of passive remote monitoring include reduced health service use [26], enhanced emergency response, fall detection, independence and postponement of institutionalization [27], feelings of security and peace of mind [28], whereas potential risks include isolation through reduced human interaction and hands-on care, privacy invasion, loss of control, data inaccuracy [27,[29][30][31][32], and reduced behavioral autonomy and access to services [29,33,34]. Reviews of the passive remote monitoring literature exhibit that ethical issues are treated superficially, and detailed consideration of serious ethical challenges is absent [23,35].…”